The interview can be conducted in person or by phone. All AAs and subrecipients must establish culturally and linguistically appropriate goals, policies, and management accountability, and infuse them throughout the organizations planning and operations. APPLICANT'S MAILING ADDRESS (IF DIFFERENT)CITYSTATEZIP CODE 7. Assist clients in making informed decisions on choices of available service providers and resources. We deny your application forapple health coverage when: You tell us either orally or in writing to withdraw your request for coverage; or, Based on all information we have received from you and other sources within the time frames stated in WAC, We are unable to determine that you are eligible; or. Cases without a delay reason code or updated with "No Good Cause (NG)" to the DSHS secretary. If the client is likely to attain institutional status. Please reference the HRSA Program Guidance above. Please report broken links or content problems. The application process begins and the application date is established when the request for benefits is received. Ryan White Providers using telehealth must also follow DSHS HIV Care Services guidelines for telehealth and telemedicine outlined in DSHS Telemedicine Guidance. Apply to Event Coordinator, Van Driver, Employment Specialist and more! | Determine the client's financial eligibility for LTSSand noninstitutional medical assistance including 3 months retroactive medical coverage if financially eligible. Type of client interaction (phone, in-person, etc.). Percentage of clients with documented evidence of referrals provided to any core services that had follow-up documentation within 10 business days of the referral in the primary client record. For medicaid recipients, the first date DSHS was notified of the admission by the nursing facility. For long-term services and supports coverage such as nursing home care, in-home personal care, assisted living facility, adult family home programs, and TSOA Mail your application to: DSHS Home and Community Services PO Box 45826, Olympia, WA 98504-5826 Questions? Full Time position. Clearly indicate this is a projection and the financial application is in process. You mayapply for apple health for another person if you are: An authorized representative (as described in WAC. This Home and Community Based Services program provides not only care, but also other supports . Call the HCS intake line in the area in which you reside to schedule an assessment. Wage Range: $40.76-$75.17 per hour plus per diem rate. Go over the application, particularly what was declared in the income and resource sections. Funds cannot be used to duplicate referral services provided through other service categories. Include Remarks to reconcile any discrepancies, or important information not otherwise captured, including required questions left blank on the application or eligibility review form. Acronyms utilized should be DSHS/HCA approved. If you reside in one of the following counties: Adams, Asotin, Chelan, Colombia, Douglas, Ferry, Franklin, Garfield, Grant, Kittitas, Klickitat, Lincoln, Okanogan, Pend Oreille, Spokane, Stevens, Walla Walla, Whitman, or Yakima509-568-3767 or 866-323-9409,FAX 509-568-3772. Percentage of clients with documented evidence of ongoing communication with the primary medical care provider and care coordination team as indicated in the clients primary record. Are you enrolled in Medi-Cal? We reconsider our decision to deny your apple healthcoverage without a new application from you when: We receive the information that we need to decide if you are eligible within thirty days of the date on the denial notice; You give us authorization to verify your assets as described in WAC 182-503-0055 within thirty days of the date on the denial notice; You request a hearing within ninety days of the date on the denial letter and an administrative law judge (ALJ) or HCA review judge decides our denial was wrong (per chapter. If you seek apple health coverage and are age sixty-five or older, have a disability, are blind, need assistance with medicarecosts, or seek coverage of long-term services and supports,you may apply: By completing the application for aged, blind, disabled/long term care coverage (, In person at a local DSHSCSO or home and community services (HCS) office; or. For medicaid recipients, institutional services are approved based on the first date the admission is known to DSHS as long as the client meets all other eligibility factors. The following are eligibility related documents and files, including the annual final eligibility lists, peer grouping report, and the Low-Income Utilization Rate, Medicaid Utilization Rate, and Omnibus Budget Reconciliation Act formulas. Determine if a housing maintenance allowance (HMA) is appropriate (current rule states HMA is the amount of the Federal Poverty Level). The LTSSauthorization date can be backdated for nursing facility services up to 3 months prior to the date of application for a new applicant of Medicaid as long as the client is nursing facility level of care (NFLOC) and financially eligible. Eligible clients are referred to other core services (outside of a medical, MCM, or NMCM appointment), as applicable to the clients needs, with education provided to the client on how to access these services. Please take this short survey. Collaborates with treating physician, psychiatric and allied health professional team to plan and direct each individual member . | HRSA/HAB Division of State HIV/AIDS Programs National Monitoring Standards Program Part B April 2013. p. 42-43. State Plan Amendments. If there is other medical coverage and you can obtain the information during the interview, complete a. Department-designated social service staff: Assess the client's functional eligibility for institutional care. If you have questions about submitting the form please contact your regional office at the number below. z, /|f\Z?6!Y_o]A PK ! adult daycare center) in accordance with a written, individualized plan of care established by a licensed physician. RW Providers must use a telehealth vendor that provides assurances to protect ePHI that includes the vendor signing a business associate agreement (BAA). Functional eligibility for DDA is determined prior to the submission of a financial application. You may apply for Washington apple health at any time. f?3-]T2j),l0/%b A parent or caretaker relative of a child age eighteen or younger; A tax filer applying for a tax dependent; A person applying for someone who is unable to apply on their own due to a medical condition and who is in need of long-term care services. For jobs with more than one level, the posted range reflects the minimum of the lowest level and the maximum of the highest level. Staff will follow-up within 10 business days of a referral provided to any core services to ensure the client accessed the service. A full-featured portal for all users. DSH Program State Plan Amendment 14-008. The agency must document the situation in writing and contact the referring primary medical care provider. 0 6 /20 20 INSTRUCTIONS HOME AND COMMUNITY SERVICES Intake and Referral DATE Section 1. Details of how eligibility factor(s) were verified. Fast Track is a social serviceprocess that allows the authorization of LTSS prior to a financial eligibility determination. Posted wage ranges represent the entire range from minimum to maximum. D@. For information regarding prior fiscal year files, please contact the DSH unit at, Last modified date: Examples are the SSI or SSI-related programs or Apple Health for Workers with Disabilities (HWD). The Office of Community and Homeless Services (OCHS), the Office of Housing and Community Development (OHCD) and the Office of Weatherization and Energy Assistance (OWEA) operate within the Housing and Community Services Division (HCS) of the Snohomish County Human Services Department. At a department of social and health services (DSHS) community services office (CSO). xar *O.c H?Y+oaB]6y&$i8]U}EvH*%94F%[%A PK ! Fax form to the Home and Community Services office in your region for intake. Client transfers services to another service program. Applications for LTSS may be submitted using any of the following methods: Mailing or faxing documents to Home and Community Services (HCS), Mail to: Applications for clients under age 65 or ineligible for Medicare should be submitted through this site and will have a real-time determination of Washington Apple Health medical coverage eligibility under the modified adjusted gross income (MAGI) methodology. $[53j(,U+/6-FBR[lvn! }k}HG4"jhznn'XwB$\HODuDX7o u'8>@)OLA@"yoTP8nd lAO Apply in-person at a local Home & Community Services office. | Accessibility Certification, The following are eligibility related documents and files, including the annual final eligibility lists, peer grouping report, and the Low-Income Utilization Rate, Medicaid Utilization Rate, and Omnibus Budget Reconciliation Act formulas. Full. Give a projected client responsibility amount to the caseworker using the LTSS referral 07-104. Staff will follow up within 10 business days of a referral provided to support services to ensure the client accessed the service. Call the client or their representative to complete an interview. IHSS Service Desk for Providers & Recipients, (866) 376-7066, Suspect Fraud? Conduct prevention activities as outlined in the DSHS . Staff will educate clients about available benefit programs, assess eligibility, assist with applications, provide advocacy with appeals and denials, assist with re-certifications, and provide advocacy in other areas relevant to maintaining benefits/resources. 6 [Content_Types].xml ( KO0#5.,5ec H0[i ~NhMsg[3xxw;) 'nY?7H(;1{H] For households containing people described in subsection (2) of this section: Call the Washington Healthplanfindercustomer support center number listed on the application for health care coverage form (. Family members and other representatives are often just learning about the client's income and resources when they apply. Listed on 2023-03-03. z, /|f\Z?6!Y_o]A PK ! The PBS should reviewthe original application to ensure there are no changes and proceed to determine eligibility. Case actions and why the actions were taken, and. When using Collateral Contact (CC) or Other (OT) valid value, document the details of how it was verified. Percentage of clients with documented evidence, as applicable, of a transfer plan developed and documented with referral to an appropriate service provider agency as indicated in the clients primary record. Determine the client's financial eligibility for LTSSmedicaid and/or noninstitutional medical assistance including a request for retro medical if needed. 08/2017) Page 1 of 2 / Intake and Referral form for Social Services. Percentage of clients with documented evidence of a discharge plan developed with client, as applicable, as indicated in the clients primary record. Sometimes we can start your coverage up to three months before the month you applied (see WAC, If you are confined or incarcerated as described in WAC, You are hospitalized during your confinement; and. Applicant Information 1. | Complete - The documentation must support the eligibility decision and allow a reviewer to determine what was done and why. the past two years? Percentage of clients with documented evidence of agency refusal of services with detail on refusal in the clients primary record AND if applicable, documented evidence that a referral is provided for another home or community-based health agency. | I) word/document.xmlr=U.nA;K]|K0x+CII*?tY =6KWHN Z G!i$.v?h;H E6K$JNI2qAK*FMQuI>sRp648!T2@p =K [20Y(GNc#TchaBid~ygj\6h !$0DU9B#1$qfMNy m@4L9542h7,~O*9Z|1)nfR>P*C utgHGKFh 5zjUtMx'+)MI[]fKR:1tw%=Or. HCA forms, including translations are found on the HCA forms website. Explain how to request an extension if more time is needed.