CHANGE No. 06-10, Special Review Codes
NC Division of Aging and Adult Services
DATE: November 19, 2010
MANUAL: State/County Special Assistance In-Home (SA/IH)
Subject: Special Review Codes
TO: County Directors of Social Services
EFFECTIVE: November 22, 2010
Special Assistance (SA) and Special Assistance In-Home (SA/IH) cases are required at a minimum, to have income that is at the federal benefit rate (FBR). Changes in the Eligibility Information System (EIS) effective November 22, 2010 require that cases have income at or above the FBR or the system requires an SA Case Special Review Code. Using specific Case Special Review Codes allows certain exceptions to cases having income below the FBR, or allows a window of time for the a/r to obtain the FBR. The edit provides a case management tool that must be used by the worker and the supervisor, and allows enhanced State oversight and assistance.
Effective November 22, 2010 the EIS Spouse Indicator must be completed for all SA/IH cases.
EIS now accommodates the entry of authorized representative information enabling the system to send automatic notices to the authorized representative in addition to the a/r. This was addressed in DAAS Administrative Letter 10-14, and DAAS Change Notice 04-10.
II. CASE SPECIAL REVIEW CODES FOR SAA AND SAD
A. All applications and case changes when keyed in EIS require a Case Special Review Code if the case has income less than the FBR. If a Case Special Review Code is not entered, the error message ‘TOT COUNTABLE MONTHLY INCOME LESS THAN SSI FBR CASE SPECIAL REVIEW CODE REQUIRED’ is displayed.
Case Special Review Codes have been added to policy in each relevant section with instructions provided on when each code must be used. Sections have been renumbered and reformatted as needed.
Six new Case Special Review Codes were created for cases with ambulation capacity codes B, C, H or M and TCMI below the FBR. Full instructions are provided in SA-3210, Income regarding the situations for which these codes must be used. The codes are:
1. Case Special Review Code, “N” ‘SSI Couple Deeming’. This code is valid for SA In-Home cases only; “H” ambulation code. This code has been added to SA-5200, since it is for SA/IH a/r’s only.
2. Case Special Review Code ‘E’: ‘SSI 1/3 Reduced Ending’
3. Case Special Review Code ‘I’: ‘SSI In Kind Support/Maint Ending
4. Case Special Review Code ‘LI’: ‘Life Insurance (with) Cash Accruing Face Value Greater Than $1500
5. Case Special Review Code ‘RS’: ‘SSI/SS Recoupment’
6. Case Special Review Code ‘VA’: ‘VA only OR VA/other income only”. The edit was created for ongoing cases erroneously approved for SA without an SSI referral.
Cases with SSI only income require a Case Special Review Code if the TCMI is less than $654 (this amount, based on the FBR of $674 minus the Special Assistance $20 general income exclusion, is for 2009 and 2010 and will change when new federal poverty guidelines are issued.)
Cases with income from any source without SSI or in addition to SSI require a Case Special Review Code if the TCMI is less than $674 (this amount, the FBR for 2009 and 2010 will change when new federal poverty guidelines are issued.)
B. Spousal Indicator Required in EIS For SA/IH Cases
Effective November 22, 2010 all SA/IH cases are required to complete the SPOUSE INDICATOR field. The spouse indicator must be ‘Y‘ (Has Spouse) or ‘N’ (No Spouse).
This field must be completed upon approval of an application or at the next change in situation if the field is blank. The field may be changed from ‘Y’ to ‘N’ and ‘N’ to ‘Y’ as needed.
III. implementation of changes
A. SA-5200 Eligibility Requirements
1. SA-5200: Changed “SA/ACH” to “SA” throughout the section.
2. SA-5200: Changed “ACH” to “SA facility” or “assisted living facility” throughout the section.
4. SA-5200 V. A. 3 - 4: Added information on the new SA/IH Case Special Review Code ‘N’, “Couple deeming”. Added a link to SA-3210 for the other Case Special Review codes.
5. SA-5200 V. B. 2 – 3: Added an explanation of SSI couple deeming of income. The section has been renumbered and reformatted.
C. SA-5500 EIS Instructions
1. SA-5500 IV: has been added with instructions on the requirement to complete the Spouse Indicator field for all SA/IH cases.
2. SA-5500 V. Case Special Review Codes: This section has been added. It lists and defines the new Case Special Review Codes and provides links to SA-3210, Income for more detailed instructions.
3. SA-5500 VI: Added the new Authorized Representative hierarchy and codes and instructions for completing the field.
IV. Maintenance of Manual
The following manual sections are reissued to reflect the mandated requirements:
If you have any questions regarding this information, please contact your Adult Programs Representative or Brenda Porter, Special Assistance program coordinator at 919-733-3818.
Suzanne P. Merrill, Chief
Adult Services Section
For questions or clarification on any of the policy contained in these manuals, please contact your local county office.