NC DEPARTMENT OF HEALTH AND HUMAN SERVICES EIS MANUAL

ELIGIBILITY INFORMATION SYSTEM EIS 2259

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APPROVING H-SF (NON TITLE IV-E FOSTER CARE) NEW APPLICATIONS OR REAPPLICATIONS

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EIS 2259 – APPROVING H-SF (NON TITLE IV-E FOSTER CARE) NEW APPLICATIONS OR REAPPLICATIONS


I. GENERAL INFORMATION

II. COMPLETING THE DSS-8125

III. KEY THE DSS-8125.

IV. OUTPUTS

V. AUTOMATED NOTICES


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EIS 2259 – APPROVING H-SF (NON TITLE IV-E FOSTER CARE) NEW APPLICATIONS OR REAPPLICATIONS

REVISED 08/01/04 - CHANGE NO. 01-05

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I. GENERAL INFORMATION

REISSUED 08/01/04 - CHANGE NO. 01-05

I. (CONT’D)

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II. COMPLETING THE DSS-8125

REVISED 09/01/03 - CHANGE NO. 02-04

II. A. (CONT’D)

REISSUED 09/01/03 - CHANGE NO. 02-04

II. A. (CONT’D)

REISSUED 10/01/96 - CHANGE NO. 2-96

II. (CONT'D)

REISSUED 10/01/96 - CHANGE NO. 2-96

II. E. 2. b. (CONT'D)

REVISED 10/01/07 - CHANGE NO. 02-08

II. E. 4. a. (CONT'D)

REISSUED 10/01/07 - CHANGE NO. 02-08

II. F. 1. b. (CONT'D)

REISSUED 07/01/10 - CHANGE NO. 01-11

II. F. 2. (CONT'D)

REVISED 07/01/10 - CHANGE NO. 01-11

II. (CONT'D)

REISSUED 07/01/10 - CHANGE NO. 01-11

    K. NEEDS

      1. Enter the MAINTENANCE AMOUNT. The amount must be dollars and cents.
      2. Do not enter AMBULATION CAPACITY.
      3. Do not enter DOMICILIARY RATE.
      4. Enter the TOTAL COUNTABLE MONTHLY INCOME. The amount must be in dollars and cents. If entered, TOTAL NET UNEARNED INCOME must be entered.

    L. SPECIAL DATA

      1. Do not enter FOOD STAMP NUMBER.
      2. Do not mark STEPPARENT INDICATOR.
      3. Do not enter GRANDFATHER STATUS CODE and DATE.
      4. Mark “YES” or “NO” for VA PAYMENT.
      5. Enter SPECIAL REVIEW TYPE and DATE if applicable. If entered, the date must be before the ongoing month. Do not enter if CASE TERMINATION REASON and DATE are entered.
      6. Do not enter JOBS/WORK REQUIREMENT SAVINGS REASON and AMOUNT.
      7. Enter SPECIAL USE CODE and DATA if applicable.

    M. SPECIAL COVERAGE GROUP DATA

      1. Enter SPECIAL COVERAGE CODE, BEGIN DATE, or END DATE, if case is a CAP case. Do not enter end date unless CAP coverage ends. (Refer to EIS 3101. CHANGES TO MEDICAID CASES-SPECIAL COVERAGE GROUPS.)
      2. Do not enter SPECIAL NEEDS INDIVIDUAL ID, SPECIAL NEEDS CODE, SPECIAL NEEDS FROM DATE, OR SPECIAL NEEDS THRU DATE.

    N. SUPPLEMENTAL NOTICE INFORMATION

      The following three data elements have been added to the DSS-8125 Data Entry screen. A recommended form in which to enter the information can be found at the end of this section. This form should be attached to your DSS-8125 when submitting to Data Entry for keying.

      1. AUTHORIZED REPRESENTATIVE NAME AND ADDRESS FIELDS

        If an applicant had an authorized representative acting in his behalf, the authorized representative's name and address may be entered for the purpose of mailing an automated a notice to the authorized representative in addition to the applicant.

REISSUED 07/01/10 - CHANGE NO. 01-11

II. N. (CONT'D)

        If an applicant is a CAP recipient, the CAP Case Manager’s name and address must be entered for the purpose of mailing an automated notice to the CAP Case Manager in addition to the applicant.

      2. SECONDARY NOTICE CODE

        This code may be used in addition to the disposition code at approval time only. You may use it in situations when additional information is needed. Refer to Secondary Notice Codes in the Codes Appendix.

      3. NOTICE TEXT

        This section may be used to provide additional information to the applicant, when a Secondary Notice code is not applicable. This includes information about CAP services for automated notices.

        NOTE: If you are approving both parts of a two-part application at the same time, and you use two different disposition codes, you cannot enter the Secondary Notice Code or Notice Text.

    O. INDIVIDUAL DATA

      The casehead name and individual data for the individual included on the case will be brought forward from the case or the application and cannot be changed. When a DSS-8125 is keyed, EIS reads the common name database to retrieve the individual assigned to the case id with a casehead/payee status of “P”. If any of the individual data is incorrect, use the NAME CHANGE screen to make the appropriate correction(s).

      1. Do not enter INDIVIDUAL TERMINATION DATE.
      2. Do not enter CASE STATUS. EIS generates CASE STATUS CODE “R”.
      3. Enter the RSDI CLAIM NUMBER if the individual receives Social Security benefits or Medicare coverage.
        a. A “Z” suffix is not allowed for an individual under age 65.
        b. The RSDI CLAIM NUMBER must be the individual’s Social Security Number if the suffix is A, M, or T.
      4. Enter a “Y” or “N” in MEDICARE A to indicate whether or not the individual has Medicaid A. If yes, you must enter an RSDI claim number.

REISSUED 07/01/10 - CHANGE NO. 01-11

II. O. (CONT'D)

      5. Enter a “Y” or “N” in MEDICARE B to indicate whether or not the individual has Medicaid B. If yes, you must enter an RSDI claim number.
      6. Enter “A” or “C” in FAMILY STATUS CODE as defined by policy.
      7. Enter a LIVING ARRANGEMENT CODE. See the Codes Appendix to determine the appropriate living arrangement code.
      8. Enter a SPECIAL REPORT CODE if applicable. See the Codes Appendix to determine the appropriate special report code.
      9. Do not enter JOBS/WORK REGISTRATION/EXEMPTION.
      10. Enter SPECIAL USE DATA CODE and DATE(s) if applicable. See the Codes Appendix to determine the appropriate special use data code and date(s).
      11. Enter the REFUGEE STATUS CODE and U.S. ENTRY DATE (in MMCCYY format), if applicable. See the Codes Appendix to determine the appropriate Refugee Status Code.
      12. Enter DATE OF DEATH if applicable.
        a. If entered, CASE TERMINATION REASON and DATE are required.
        b. The DATE of DEATH must be before or the same as the CASE TERMINATION DATE.
        c. DATE OF DEATH must be before or the same as the current date.
        d. Date of Death cannot be more than three (3) months before the month of application.
      13. HSF is exempt from documentation of Citizenship/Identity Code in EIS. Enter Citizenship Identity Code if policy requires a CITIZEN/ID Code. See the Codes Appendix to determine the appropriate Citizen/ID code and date.
      14. Enter Alien ID number, if applicable. Key only the numeric parts of the Alien ID number. Do not enter the alpha “A”.
      15. Enter the RELATIONSHIP TO PAYEE code. See Codes Appendix to determine the appropriate code.

REISSUED 07/01/10 - CHANGE NO. 01-11

II. O. (CONT'D)

      16. Do not enter JOBS/WORK REQUIREMENT SAVINGS REASON and AMOUNT.
      17. Do not enter WORK EXPERIENCE.
      18. Do not enter GROSS EARNED INCOME.
      19. Do not enter WORK EXPENSES.
      20. Do not enter CHILD/ADULT CARE.
      21. Do not enter NET EARNED INCOME.
      22. Do not enter EDUCATIONAL LEVEL.
      23. Enter type and date of EDUCATION. Refer to EIS 4100, Community Care of North Carolina, for more information.
      24. Enter “Y” or “N” for ISSUE CARD. If the individual has an annual Medicaid card from a prior time, enter “N”. A new card will not be issued. If the individual states they do not have an annual Medicaid card enter “Y”. A new card will be produced the night the approval processes and mailed the following workday.
      25. Enter COMMUNITY CARE OF NORTH CAROLINA (CCNC) provider or exempt number. Refer to EIS 4100, Community Care of North Carolina, for more information.

    P. SIGNATURES and DATE

      1. Enter the DATE COMPLETED.
      2. Sign the DSS-8125 in the WORKER'S SIGNATURE field.
      3. The county director or his designee must sign the form in the DIRECTOR'S SIGNATURE field.

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III. KEY THE DSS-8125.

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IV. OUTPUTS

    When the DSS-8125 has processed successfully, the following are received.

    A. CASE PROFILE

      A Case Profile is produced the night the approval processes and is mailed to the county the following workday.

    B. APPLICATION TURNAROUND DOCUMENT

      If one part of a two part application is approved, an Application Turnaround Document is received for the second part of the application still pending.

REISSUED 07/01/10 - CHANGE NO. 01-11

    C. DMA-5016 (Patient Liability Information)

      The automated DMA-5016 is created after the action processes in EIS and is mailed the next workday for the current and retro periods, if applicable, to the appropriate facility indicated by the code(s) or address entered.

    D. CASEWORKER SUPERVISOR REPORT

      The application approval is reported on the Caseworker Supervisor Report. The number of approvals completed is determined from the WORKER NUMBER.

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V. AUTOMATED NOTICES

    A. An automated notice (DSS-8108A) is produced for each HSF approval the night the DSS-8125 processes in the system unless “Y” is entered for “NOTICE OVERRIDE”.

    B. The DISPOSITION REASON CODE, the SECONDARY NOTICE CODE, and the NOTICE TEXT entered on the DSS-8125 determines the text of the notice.

    C. The system calculates the 60th calendar day for the notice.

    D. The date of the automated notice is the next county workday after the DSS-8125 processes. This is the date the notice is mailed to the recipient. A copy of the notice is not mailed to the county.

    E. A Notice Register Report is produced each night and is mailed to the county the following workday. This report lists vital information related to all automated notices produced for that day. See EIS 2304 for more information regarding the Notice Register Report.

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