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Por favor, responda a esta breve encuesta. adult daycare center) in accordance with a written, individualized plan of care established by a licensed physician. Training and social services development, delivery and evaluations; budget setting; and relationship cultivation. Applications for LTSS | Washington State Health Care Authority Referrals for health care and support services provided by outpatient/ambulatory health care professionals should be reported under Outpatient/Ambulatory Health Services (OAHS) category. Explain to the applicant that there is a Public Benefits Specialist (PBS) and a social service manager making determinations concurrently for LTSS eligibility. 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. If the 13-746 is not received timely, count back 5 businessdays from the date of receipt to determine the authorization date. Assist clients in making informed decisions on choices of available service providers and resources. NOTE: If an 18-005 is received on an active MAGI case and the client is in a NF or Hospice care center, no action is needed by the PBS. catholic community services hen program - Nissho-jyouhou.jp For ABD, SSI-related Washington Apple Health programs: This process applies toSSI-related programs only MAGI-based clients are not eligible for HCBwaiver. DOCX Social Service Intake - Washington Lakewood, WA. Disproportionate Share Hospital Program Eligibility. A request for service may not generate a referral. HRhk\ X?Nk; $-Yqiy*KB&I4"@W>eGI'tHaOBhVPRQq[^BJ] CONTACT(S): Rachelle Ames, HCS Program Manager 360-725-2353 amesrl@dshs.wa.gov Contact a navigator, health care authority volunteer assistor, or broker. Case Closure Summary: Clients who are no longer in need of assistance through Referral for Health Care and Support Services must have their cases closed with a case closure summary narrative documented in the client primary record. Staff will follow-up within 10 business days of a referral provided to HIA to determine if the client accessed HIA services. catholic community services hen program. $[53j(,U+/6-FBR[lvn! }k}HG4"jhznn'XwB$\HODuDX7o u'8>@)OLA@"yoTP8nd lAO A new application isn't required for clients active on ABD SSI-related Apple Health who need LTSS as long as the Public Benefit Specialist (PBS) is able to determine institutional eligibility using information in the current case record. PK ! This is used for any cash, food or medical care services (MCS) request as MCS is tied to ABD cash/HEN eligibility, HCA 14-194 Medical coverage information (used to report third party insurance coverage including LTC insurance), DSHS14-539 Revocable burial fund provision for SSI-related health care, DSHS 14-540 Irrevocable burial fund provision for SSI-related health care, DSHS 14-454 Estate recovery fact sheet. A simple and sleek portal for staff. TK6_ PK ! | word/document.xml\n8}_`u-c t?mk[X`aKHJ|Mf2DUSU~~=DX~PJ6u`r]u+K(q` Qy'AD5}]qT"{J|}]6+t. | For in-home service applicants, discuss the food assistance program and inquire if the household would like to apply for food benefits. !ISWvuutZWh'gfG0^$n6g%LjQ:@(]t)eh -^k]8 zAG s#d General open-ended questions about resources and income should also be asked. In the case of the community spouse, explain how all resources in excess of the $2,000 resource limit must be transferred to the spouse within 1 year and the requirement to provide verification of this by the first annual review. Request verification of transfers, gifts or property sales, if applicable. Intake and Referral - DocsLib | | DSHS HIV Care Services requires that for Ryan White Part B or SS funded services providers must use features to protect ePHI transmission between client and providers. Ask if there are unpaid medical expenses and request verification if medical expenses exist. Explain what changes of circumstances need to be reported. Apply in-person at a local Home & Community Services office. We follow the rules about notices and letters in chapter. If you are experiencing a mental health crisis and need immediate assistance, please call "911" and explain the nature of your problem to the operator. For jobs with more than one level, the posted range reflects the minimum of the lowest level and the maximum of the highest level. Has your contact information changed in Percentage of clients who received a referral for other core services who have documented evidence of the education provided to the client on how to access these services in the primary client record. Life, home, auto, AD&D, LTD, & FSA benefits, Overview of prior authorization (PA), claims & billing, Step-by-step guide for prior authorization (PA), Program benefit packages & scope of services, Community behavioral support (CBHS) services, First Steps (maternity support & infant care), Ground emergency medical transportation (GEMT), Home health care services: electronic visit verification, Substance use disorder (SUD) consent management guidance, Enroll as a health care professional practicing under a group or facility, Enroll as a billing agent or clearinghouse, Find next steps for new Medicaid providers, Washington Prescription Drug Program (WPDP), Governor's Indian Health Advisory Council, Analytics, research & measurement (ARM) data dashboard suite, Foundational Community Supports provider map, Medicaid maternal & child health measures, Washington State All Payer Claims Database (WA-APCD), Personal injury, casualty recoveries & special needs trusts, Information about novel coronavirus (COVID-19). | Careers Home and Community-Based Health Services | Texas DSHS Home and Community Services - LTSS z, /|f\Z?6!Y_o]A PK ! The PBS may waive the interview requirement. Policy Notices and Program Letters, Ryan White HIV/AIDS Program Services: Eligible Individuals & Allowable Uses of Funds Policy Clarification Notice (PCN) #16-02, Health Education-Risk Reduction (HE/RR) - Minority AIDS Initiative, Health Insurance Premium and Cost Sharing Assistance for Low-Income Individuals, Local AIDS Pharmaceutical Assistance (LPAP), Medical Case Management (including Treatment Adherence Services), Outreach Services - Minority AIDS Initiative (MAI), Interim Guidance for the Use of Telemedicine, Teledentistry, and Telehealth for HIV Core and Support Services - Users Guide and FAQs, Interim Guidance for the Use of Telemedicine, Teledentistry, and Telehealth for HIV Core and Support Services, Referral to health care/supportive services, Health Insurance Plans/Payment Options (CARE/, Pharmaceutical Patient Assistance Programs (PAPS). REGION 1 - Pend Oreille, Stevens, Ferry Okanagan, Chelan, Douglas, Grant, Lincoln, Spokane, Adams, Whitman, Klickitat, Kittitas, . Full Time position. Massachusetts Department of Public Health Bureau of Infectious Disease Office of HIV/AIDS Standards of Care for HIV/AIDS Services 2009, San Francisco EMA Home-Based Home Health Care Standards of Care February 2004, Texas Administrative Code, Title 40, Part 1, Chapter 97, Subchapter B, Rule 97.211. Explain how to request an extension if more time is needed. When working on a case that has ACES Equal Access (EA) requirements: If changing ACES EA requirements, clearly document the reason. Cases without a delay reason code or updated with "No Good Cause (NG)" to the DSHS secretary. Have you received Accurintand/or AVS results and reviewed the assets reported? 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 reside in one of the following counties: Island, King (ZIP codes 98011, 98019, 98072, 98077, 98133, 98177) San Juan, Skagit, Snohomish, or Whatcom and are interested in: If you reside in King County in a ZIP code not listed above and are interested in: If you reside in one of the following counties: Clallam, Clark, Cowlitz, Grays Harbor, Jefferson, Kitsap, Lewis, Mason, Pacific, Pierce, Skamania, Thurston, or Wahkiakum 800-786-3799, FAX 360-586-0499. Determine the client's financial eligibility for LTSSmedicaid and/or noninstitutional medical assistance including a request for retro medical if needed. Ryan White Providers using telehealth must also follow DSHS HIV Care Services guidelines for telehealth and telemedicine outlined in DSHS Telemedicine Guidance. Questions to consider when making aFast Track recommendation: Social services cant begin Fast Track until a CAREassessment is completed. APPLICANT'S MAILING ADDRESS (IF DIFFERENT)CITYSTATEZIP CODE 7. 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. Ryan White Providers using telehealth must also follow DSHS HIV Care Services guidelines for telehealth and telemedicine outlined in DSHS Telemedicine Guidance. / % [Content_Types].xml ( N0EHC-j\X $@b/=>"RRQ{c%3X@LCV^i7 Sx[Ab7*@*HRf$g`E*} G;V )B~)K0{j17X$)+n7u9bf}^&i/52\ Are you enrolled in Medi-Cal? Intake Coordinator. Kirkland, WA. Privacy Policy Statements made by the client and/or their representative. Social Service Intake and Referral form (DSHS Form #10-570) The form is available here on the intranet: https://www.dshs.wa.gov/fsa/forms The form is available here on the internet for the public. 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. Complete a Financial Communication to Social Services (07-104) referral when an application is received on an active MAGI case, Add text stating that unless an assessment is completed and determines HCB Waiver is needed, the client will remain on MAGI. Hmoob Current assessment and needs of the client, including activities of daily living needs (personal hygiene care, basic assistance with cleaning, and cooking activities), Need forHome and Community-Based Health Services, Types, quantity, and length of time services are to be provided. APPPLICANT'S NAME: LAST, FIRST, MI 2. Functional eligibility for DDA is determined prior to the submission of a financial application. 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? BIRTH DATE 4. 12/1/2022 2:44 PM. Assessment of client's access to primary care, Need for nursing, caregiver, or rehabilitation services. Explain the medical service card, automatic Medicare D enrollment if not on a creditable coverage or Medicare D Prescription Drug Plan. (PDF) Accessed on October 12, 2020. Clients active on MAGI except AEM N21 and N25), don't need to submit an additional application if they are functionally eligible for, and in need of the following: If a client needs waiver services they must submit an application and may need a disability determination. Refusal of referral: The home or community-based health agency may refuse a referral for the following reasons only: The client's home or current residence is determined to not be physically safe (if not residing in a community facility) before services can be offered or continued. (link is external) 360-918-8424. DSHS 10-438 Long-term care partnership (LTCP) asset designation form (used to designate assets (resources) for those with a long-term care partnership insurance policy), DSHS 14-012 Consent (release of information form) (used for all DSHS programs), DSHS27-189Asset Verification Authorization. RW Providers must use a telehealth vendor that provides assurances to protect ePHI that includes the vendor signing a business associate agreement (BAA). Encourage the applicant to gather documents as soon as possible to expedite the process. ,! 4 word/_rels/document.xml.rels ( VOo0Ow| :lRt[h{sK1u\+2 \\U\K>LLhb=MMr[B\^dk*)a#L!? Center for Medicare and Medicaid Services (CMS) requires an annual review at least once a year for categorically needy (CN) Medicaid. 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. DSH Replacement State Plan Amendment 16-010. Repaying the state for medical and long-term services and supports, DSHS 14-501 Community resource declaration (used to evaluate resources (assets) for an applicant and their spouse based on date of institutionalization. Listed on 2023-03-03. 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. Good cause for a delay in processing the application does NOT exist when: Failing to ask you for information timely; or, Failing to act promptly on requested information when you provided it timely; or. An interview with the applicant or authorized representative is required to determine eligibility for institutional, HCB waiver services, or TSOA services. Olympia WA 98504-5826; or Need Mental Health Services? HRSA/HAB Division of State HIV/AIDS Programs National Monitoring Standards Program Part B April 2013. p. 42-43. A comprehensive evaluation of the clients health, psychosocial status, functional status, and home environment will be completed to include: Percentage of clients with documented evidence of needs assessment completed in the clients primary record. 0 6 /20 20 INSTRUCTIONS HOME AND COMMUNITY SERVICES Intake and Referral DATE Section 1. You may receive help filing an application. The application process begins and the application date is established when the request for benefits is received. Explain the Medicare Savings Program (MSP). Main Office . If the applicant is eligible for an MSP based on income and resource guidelines and all information is received to determine eligibility for MSP, don't hold up processing this program while the LTSS medical is pending. 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. All AAs and subrecipients must establish culturally and linguistically appropriate goals, policies, and management accountability, and infuse them throughout the organizations planning and operations. Review excess home equity, annuity and transfer of resource provisions that are specific to institutional and home and community-based (HCB) waivers. In-home or residential services, call 800-780-7094 or 425-977-6579, FAX 425-339-4859, Nursing home services, call 800-780-7094, FAX 206-373-6855, In-home or residential services, call 206-341-7750, FAX 206-373-6855. | 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. HRSA/HAB Division of State HIV/AIDS Programs National Monitoring Standards Program Part B April 2013. p. 42-43. If the client is unable to complete the interview due to a medical condition or because no one is available to assist the client. Benefits counseling: Services should facilitate a clients access to public/private health and disability benefits and programs. Ensure that service for clients will be provided in cooperation and in collaboration with other agency services and other community HIV service providers to avoid duplication of efforts and encouraging client access to integrated health care. 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. xar *O.c H?Y+oaB]6y&$i8]U}EvH*%94F%[%A PK ! | The DSHS consent form is preferred as it is used for all programs including medical, food and cash. The ALJ does not consider the previous absence of information or failure to respond in determining if you are eligible. If we denied your application because we do nothave enough information, the ALJ will consider the information we already have and any more information you give us. How do I notify PEBB that my loved one has passed away? Authorize in ACES for in-home or residential HCB waiver if the client is both functionally and financially eligible. For the Ryan White Part B/SS funded providers and Administrative Agencies, telehealth and telemedicine services are to be provided in real-time via audio and video communication technology which can include videoconferencing software. Apply to Event Coordinator, Van Driver, Employment Specialist and more! DSH Program State Plan Amendment 14-008. COPES, for short, is a Washington State Medicaid (Apple Health) waiver program designed to enable individuals who require nursing home level care to receive that care in their home or alternative care environment, such as an assisted living residence. There is good information on the Washington LawHelp site that explains the timing of an LTSSapplication. Provide advocacy to clients with a clear understanding of community services and support available for their situations. Ensure an Asset Verification System (AVS) Authorization is on file, and if not, follow these procedures. Client transfers services to another service program. Please take this short survey. An overpayment isn't established. the past two years? Open-ended questions often reveal that additional sources of income and assets may exist. At a department of social and health services (DSHS) community services office (CSO). Services may be authorized using Fast Track for a maximum of 90 days. As specified in subsection (2) of this section, if you are a child, pregnant, a parent or caretaker relative, or an adult age sixty-four and under without medicare. The agency will maintain ongoing communication with the multidisciplinary medical care team in compliance with Texas Medicaid and Medicare Guidelines. Case management that links a soon-to-be-released inmate with primary care is an example of appropriate transitional social services. For apple health programs for children, pregnant people, parents and caretaker relatives, and adults age sixty-four and under without medicare, (including people who have a disability or are blind), you may apply: Online via the Washington Healthplanfinder at. 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. Website feedback: Tell us how were doing, Copyright 2023 Washington Health Care Authority, I help others apply for & access Apple Health, I help others apply for and access Apple Health, Long-term services & supports (LTSS) manual, www.hca.wa.gov/free-or-low-cost-health-care, Equal Access - Necessary Supplemental Accommodation (NSA) and long-term services and supports, HCA 80-020 Authorization for Release of Information, Apple Health for Workers with Disabilities (HWD), Medically Intensive Children's Program (MICP), Behavioral health services for prenatal, children & young adults, Wraparound with Intensive Services (WISe), Behavioral health services for American Indians & Alaska Natives (AI/AN), Substance use disorder prevention & mental health promotion, Introduction overview for general eligibility, General eligibility requirements that apply to all Apple Health programs, Modified Adjusted Gross Income (MAGI) based programs manual, Medical plans & benefits (including vision), Life, home, auto, AD&D, LTD, FSA, & DCAP benefits. A phone or in-person interview is required to determine initial financial eligibility for WAH long-term care services. We determine eligibility as quickly as possible and respond promptly to applications and information received. L@5f)a>%X5.auU!1qV!h%SAg,U--`8F ydjz 8 'gF$v5q~~ enLr38uX*#XH)'#+Uabj8 ,]-r8| HuS.q"1,4>5H0 v!Nya" &~'iOJZG8eCvvJj(FMuT_j4f18#/SiO*i )nJE3 UXO+!h(G;:iYB0^,-x;p =8rkOS%Paa"gb-wSc%@/-|FJxD:`Au$yLt'2xi? Refer the client to social service intakefor a CAREassessment if the client contacts the PBS first and document the date the client first requested in-home or residential care. Royal Military College, Duntroon Graduates List, Tungsten Lewis Dot Structure, Hairy Caterpillar Brisbane, Articles D
Por favor, responda a esta breve encuesta. adult daycare center) in accordance with a written, individualized plan of care established by a licensed physician. Training and social services development, delivery and evaluations; budget setting; and relationship cultivation. Applications for LTSS | Washington State Health Care Authority Referrals for health care and support services provided by outpatient/ambulatory health care professionals should be reported under Outpatient/Ambulatory Health Services (OAHS) category. Explain to the applicant that there is a Public Benefits Specialist (PBS) and a social service manager making determinations concurrently for LTSS eligibility. 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. If the 13-746 is not received timely, count back 5 businessdays from the date of receipt to determine the authorization date. Assist clients in making informed decisions on choices of available service providers and resources. NOTE: If an 18-005 is received on an active MAGI case and the client is in a NF or Hospice care center, no action is needed by the PBS. catholic community services hen program - Nissho-jyouhou.jp For ABD, SSI-related Washington Apple Health programs: This process applies toSSI-related programs only MAGI-based clients are not eligible for HCBwaiver. DOCX Social Service Intake - Washington Lakewood, WA. Disproportionate Share Hospital Program Eligibility. A request for service may not generate a referral. HRhk\ X?Nk; $-Yqiy*KB&I4"@W>eGI'tHaOBhVPRQq[^BJ] CONTACT(S): Rachelle Ames, HCS Program Manager 360-725-2353 amesrl@dshs.wa.gov Contact a navigator, health care authority volunteer assistor, or broker. Case Closure Summary: Clients who are no longer in need of assistance through Referral for Health Care and Support Services must have their cases closed with a case closure summary narrative documented in the client primary record. Staff will follow-up within 10 business days of a referral provided to HIA to determine if the client accessed HIA services. catholic community services hen program. $[53j(,U+/6-FBR[lvn! }k}HG4"jhznn'XwB$\HODuDX7o u'8>@)OLA@"yoTP8nd lAO A new application isn't required for clients active on ABD SSI-related Apple Health who need LTSS as long as the Public Benefit Specialist (PBS) is able to determine institutional eligibility using information in the current case record. PK ! This is used for any cash, food or medical care services (MCS) request as MCS is tied to ABD cash/HEN eligibility, HCA 14-194 Medical coverage information (used to report third party insurance coverage including LTC insurance), DSHS14-539 Revocable burial fund provision for SSI-related health care, DSHS 14-540 Irrevocable burial fund provision for SSI-related health care, DSHS 14-454 Estate recovery fact sheet. A simple and sleek portal for staff. TK6_ PK ! | word/document.xml\n8}_`u-c t?mk[X`aKHJ|Mf2DUSU~~=DX~PJ6u`r]u+K(q` Qy'AD5}]qT"{J|}]6+t. | For in-home service applicants, discuss the food assistance program and inquire if the household would like to apply for food benefits. !ISWvuutZWh'gfG0^$n6g%LjQ:@(]t)eh -^k]8 zAG s#d General open-ended questions about resources and income should also be asked. In the case of the community spouse, explain how all resources in excess of the $2,000 resource limit must be transferred to the spouse within 1 year and the requirement to provide verification of this by the first annual review. Request verification of transfers, gifts or property sales, if applicable. Intake and Referral - DocsLib | | DSHS HIV Care Services requires that for Ryan White Part B or SS funded services providers must use features to protect ePHI transmission between client and providers. Ask if there are unpaid medical expenses and request verification if medical expenses exist. Explain what changes of circumstances need to be reported. Apply in-person at a local Home & Community Services office. We follow the rules about notices and letters in chapter. If you are experiencing a mental health crisis and need immediate assistance, please call "911" and explain the nature of your problem to the operator. For jobs with more than one level, the posted range reflects the minimum of the lowest level and the maximum of the highest level. Has your contact information changed in Percentage of clients who received a referral for other core services who have documented evidence of the education provided to the client on how to access these services in the primary client record. Life, home, auto, AD&D, LTD, & FSA benefits, Overview of prior authorization (PA), claims & billing, Step-by-step guide for prior authorization (PA), Program benefit packages & scope of services, Community behavioral support (CBHS) services, First Steps (maternity support & infant care), Ground emergency medical transportation (GEMT), Home health care services: electronic visit verification, Substance use disorder (SUD) consent management guidance, Enroll as a health care professional practicing under a group or facility, Enroll as a billing agent or clearinghouse, Find next steps for new Medicaid providers, Washington Prescription Drug Program (WPDP), Governor's Indian Health Advisory Council, Analytics, research & measurement (ARM) data dashboard suite, Foundational Community Supports provider map, Medicaid maternal & child health measures, Washington State All Payer Claims Database (WA-APCD), Personal injury, casualty recoveries & special needs trusts, Information about novel coronavirus (COVID-19). | Careers Home and Community-Based Health Services | Texas DSHS Home and Community Services - LTSS z, /|f\Z?6!Y_o]A PK ! The PBS may waive the interview requirement. Policy Notices and Program Letters, Ryan White HIV/AIDS Program Services: Eligible Individuals & Allowable Uses of Funds Policy Clarification Notice (PCN) #16-02, Health Education-Risk Reduction (HE/RR) - Minority AIDS Initiative, Health Insurance Premium and Cost Sharing Assistance for Low-Income Individuals, Local AIDS Pharmaceutical Assistance (LPAP), Medical Case Management (including Treatment Adherence Services), Outreach Services - Minority AIDS Initiative (MAI), Interim Guidance for the Use of Telemedicine, Teledentistry, and Telehealth for HIV Core and Support Services - Users Guide and FAQs, Interim Guidance for the Use of Telemedicine, Teledentistry, and Telehealth for HIV Core and Support Services, Referral to health care/supportive services, Health Insurance Plans/Payment Options (CARE/, Pharmaceutical Patient Assistance Programs (PAPS). REGION 1 - Pend Oreille, Stevens, Ferry Okanagan, Chelan, Douglas, Grant, Lincoln, Spokane, Adams, Whitman, Klickitat, Kittitas, . Full Time position. Massachusetts Department of Public Health Bureau of Infectious Disease Office of HIV/AIDS Standards of Care for HIV/AIDS Services 2009, San Francisco EMA Home-Based Home Health Care Standards of Care February 2004, Texas Administrative Code, Title 40, Part 1, Chapter 97, Subchapter B, Rule 97.211. Explain how to request an extension if more time is needed. When working on a case that has ACES Equal Access (EA) requirements: If changing ACES EA requirements, clearly document the reason. Cases without a delay reason code or updated with "No Good Cause (NG)" to the DSHS secretary. Have you received Accurintand/or AVS results and reviewed the assets reported? 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 reside in one of the following counties: Island, King (ZIP codes 98011, 98019, 98072, 98077, 98133, 98177) San Juan, Skagit, Snohomish, or Whatcom and are interested in: If you reside in King County in a ZIP code not listed above and are interested in: If you reside in one of the following counties: Clallam, Clark, Cowlitz, Grays Harbor, Jefferson, Kitsap, Lewis, Mason, Pacific, Pierce, Skamania, Thurston, or Wahkiakum 800-786-3799, FAX 360-586-0499. Determine the client's financial eligibility for LTSSmedicaid and/or noninstitutional medical assistance including a request for retro medical if needed. Ryan White Providers using telehealth must also follow DSHS HIV Care Services guidelines for telehealth and telemedicine outlined in DSHS Telemedicine Guidance. Questions to consider when making aFast Track recommendation: Social services cant begin Fast Track until a CAREassessment is completed. APPLICANT'S MAILING ADDRESS (IF DIFFERENT)CITYSTATEZIP CODE 7. 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. Ryan White Providers using telehealth must also follow DSHS HIV Care Services guidelines for telehealth and telemedicine outlined in DSHS Telemedicine Guidance. / % [Content_Types].xml ( N0EHC-j\X $@b/=>"RRQ{c%3X@LCV^i7 Sx[Ab7*@*HRf$g`E*} G;V )B~)K0{j17X$)+n7u9bf}^&i/52\ Are you enrolled in Medi-Cal? Intake Coordinator. Kirkland, WA. Privacy Policy Statements made by the client and/or their representative. Social Service Intake and Referral form (DSHS Form #10-570) The form is available here on the intranet: https://www.dshs.wa.gov/fsa/forms The form is available here on the internet for the public. 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. Complete a Financial Communication to Social Services (07-104) referral when an application is received on an active MAGI case, Add text stating that unless an assessment is completed and determines HCB Waiver is needed, the client will remain on MAGI. Hmoob Current assessment and needs of the client, including activities of daily living needs (personal hygiene care, basic assistance with cleaning, and cooking activities), Need forHome and Community-Based Health Services, Types, quantity, and length of time services are to be provided. APPPLICANT'S NAME: LAST, FIRST, MI 2. Functional eligibility for DDA is determined prior to the submission of a financial application. 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? BIRTH DATE 4. 12/1/2022 2:44 PM. Assessment of client's access to primary care, Need for nursing, caregiver, or rehabilitation services. Explain the medical service card, automatic Medicare D enrollment if not on a creditable coverage or Medicare D Prescription Drug Plan. (PDF) Accessed on October 12, 2020. Clients active on MAGI except AEM N21 and N25), don't need to submit an additional application if they are functionally eligible for, and in need of the following: If a client needs waiver services they must submit an application and may need a disability determination. Refusal of referral: The home or community-based health agency may refuse a referral for the following reasons only: The client's home or current residence is determined to not be physically safe (if not residing in a community facility) before services can be offered or continued. (link is external) 360-918-8424. DSHS 10-438 Long-term care partnership (LTCP) asset designation form (used to designate assets (resources) for those with a long-term care partnership insurance policy), DSHS 14-012 Consent (release of information form) (used for all DSHS programs), DSHS27-189Asset Verification Authorization. RW Providers must use a telehealth vendor that provides assurances to protect ePHI that includes the vendor signing a business associate agreement (BAA). Encourage the applicant to gather documents as soon as possible to expedite the process. ,! 4 word/_rels/document.xml.rels ( VOo0Ow| :lRt[h{sK1u\+2 \\U\K>LLhb=MMr[B\^dk*)a#L!? Center for Medicare and Medicaid Services (CMS) requires an annual review at least once a year for categorically needy (CN) Medicaid. 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. DSH Replacement State Plan Amendment 16-010. Repaying the state for medical and long-term services and supports, DSHS 14-501 Community resource declaration (used to evaluate resources (assets) for an applicant and their spouse based on date of institutionalization. Listed on 2023-03-03. 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. Good cause for a delay in processing the application does NOT exist when: Failing to ask you for information timely; or, Failing to act promptly on requested information when you provided it timely; or. An interview with the applicant or authorized representative is required to determine eligibility for institutional, HCB waiver services, or TSOA services. Olympia WA 98504-5826; or Need Mental Health Services? HRSA/HAB Division of State HIV/AIDS Programs National Monitoring Standards Program Part B April 2013. p. 42-43. A comprehensive evaluation of the clients health, psychosocial status, functional status, and home environment will be completed to include: Percentage of clients with documented evidence of needs assessment completed in the clients primary record. 0 6 /20 20 INSTRUCTIONS HOME AND COMMUNITY SERVICES Intake and Referral DATE Section 1. You may receive help filing an application. The application process begins and the application date is established when the request for benefits is received. Explain the Medicare Savings Program (MSP). Main Office . If the applicant is eligible for an MSP based on income and resource guidelines and all information is received to determine eligibility for MSP, don't hold up processing this program while the LTSS medical is pending. 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. All AAs and subrecipients must establish culturally and linguistically appropriate goals, policies, and management accountability, and infuse them throughout the organizations planning and operations. Review excess home equity, annuity and transfer of resource provisions that are specific to institutional and home and community-based (HCB) waivers. In-home or residential services, call 800-780-7094 or 425-977-6579, FAX 425-339-4859, Nursing home services, call 800-780-7094, FAX 206-373-6855, In-home or residential services, call 206-341-7750, FAX 206-373-6855. | 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. HRSA/HAB Division of State HIV/AIDS Programs National Monitoring Standards Program Part B April 2013. p. 42-43. If the client is unable to complete the interview due to a medical condition or because no one is available to assist the client. Benefits counseling: Services should facilitate a clients access to public/private health and disability benefits and programs. Ensure that service for clients will be provided in cooperation and in collaboration with other agency services and other community HIV service providers to avoid duplication of efforts and encouraging client access to integrated health care. 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. xar *O.c H?Y+oaB]6y&$i8]U}EvH*%94F%[%A PK ! | The DSHS consent form is preferred as it is used for all programs including medical, food and cash. The ALJ does not consider the previous absence of information or failure to respond in determining if you are eligible. If we denied your application because we do nothave enough information, the ALJ will consider the information we already have and any more information you give us. How do I notify PEBB that my loved one has passed away? Authorize in ACES for in-home or residential HCB waiver if the client is both functionally and financially eligible. For the Ryan White Part B/SS funded providers and Administrative Agencies, telehealth and telemedicine services are to be provided in real-time via audio and video communication technology which can include videoconferencing software. Apply to Event Coordinator, Van Driver, Employment Specialist and more! DSH Program State Plan Amendment 14-008. COPES, for short, is a Washington State Medicaid (Apple Health) waiver program designed to enable individuals who require nursing home level care to receive that care in their home or alternative care environment, such as an assisted living residence. There is good information on the Washington LawHelp site that explains the timing of an LTSSapplication. Provide advocacy to clients with a clear understanding of community services and support available for their situations. Ensure an Asset Verification System (AVS) Authorization is on file, and if not, follow these procedures. Client transfers services to another service program. Please take this short survey. An overpayment isn't established. the past two years? Open-ended questions often reveal that additional sources of income and assets may exist. At a department of social and health services (DSHS) community services office (CSO). Services may be authorized using Fast Track for a maximum of 90 days. As specified in subsection (2) of this section, if you are a child, pregnant, a parent or caretaker relative, or an adult age sixty-four and under without medicare. The agency will maintain ongoing communication with the multidisciplinary medical care team in compliance with Texas Medicaid and Medicare Guidelines. Case management that links a soon-to-be-released inmate with primary care is an example of appropriate transitional social services. For apple health programs for children, pregnant people, parents and caretaker relatives, and adults age sixty-four and under without medicare, (including people who have a disability or are blind), you may apply: Online via the Washington Healthplanfinder at. 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. Website feedback: Tell us how were doing, Copyright 2023 Washington Health Care Authority, I help others apply for & access Apple Health, I help others apply for and access Apple Health, Long-term services & supports (LTSS) manual, www.hca.wa.gov/free-or-low-cost-health-care, Equal Access - Necessary Supplemental Accommodation (NSA) and long-term services and supports, HCA 80-020 Authorization for Release of Information, Apple Health for Workers with Disabilities (HWD), Medically Intensive Children's Program (MICP), Behavioral health services for prenatal, children & young adults, Wraparound with Intensive Services (WISe), Behavioral health services for American Indians & Alaska Natives (AI/AN), Substance use disorder prevention & mental health promotion, Introduction overview for general eligibility, General eligibility requirements that apply to all Apple Health programs, Modified Adjusted Gross Income (MAGI) based programs manual, Medical plans & benefits (including vision), Life, home, auto, AD&D, LTD, FSA, & DCAP benefits. A phone or in-person interview is required to determine initial financial eligibility for WAH long-term care services. We determine eligibility as quickly as possible and respond promptly to applications and information received. L@5f)a>%X5.auU!1qV!h%SAg,U--`8F ydjz 8 'gF$v5q~~ enLr38uX*#XH)'#+Uabj8 ,]-r8| HuS.q"1,4>5H0 v!Nya" &~'iOJZG8eCvvJj(FMuT_j4f18#/SiO*i )nJE3 UXO+!h(G;:iYB0^,-x;p =8rkOS%Paa"gb-wSc%@/-|FJxD:`Au$yLt'2xi? Refer the client to social service intakefor a CAREassessment if the client contacts the PBS first and document the date the client first requested in-home or residential care.

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dshs home and community services intake and referral