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APD Manual Letters

Manual Letter #81

Effective Date: October 1, 2018
Reference: SS-PT-18-016, SS-PT-18-017

Manual changes are summarized below. Click on the related links. Most changes will be indicated with red text or a red line to the right of the text (you may need to scroll to find the related policy change). There is no red indication for the corresponding changes to the Administrative Rules. Check the above listed reference for all policy updates.

SNAP program updates are covered specifically in the Family Services Manual.

Manual Letter Index

Manual

Change

Section/Item

Rule Change

(available 10-1-2018 unless otherwise indicated)

OSIP(M)

The FUA amount was updated in the LTC income deduction sections and the Accommodation Allowance section.

WG 1, WG 2, WG 6, WG 12, and H.10 461-160-0420

 

  The worker guide was updated to reflect 10/1/18 rule change that clarified that 12-month extended EPD eligibility only applies when the individual experiences a loss of employment and that all other requirements must be met. A reminder was added about how the definition of self-employment is more stringent for EPD than other medical programs. OSIPM WG 11 461-135-0725
 

The Income Standards section (under Financial Requirements) was updated to reflect the 10/1/18 rule changes that clarified individuals residing in a 24-hour MH residential setting should be evaluated for all other standard living arrangement OSIPM programs first. It also established that individuals subject to the 150% FPL income standard have to be 18 or older. The 10/1/18 change to the income and payment standards and use of income rules to specify that adjusted income must be at or below 150% of the FPL and that an individual's financial group must also have income below the income standards (in addition to the individual income test).

This section was also updated to add clarification about how the $61.38 allowance works for individuals with countable income below that amount (i.e. they receive a check).

OSIPM E.2

461-135-0755

461-155-0250

461-160-0540

  The General Assistance worker guide was updated to reflect 10/1/18 rule amendment that limited housing assistance payments for incarcerated individuals to one calendar month if the release date is before the end of the month following the month of incarceration and the housing arrangement is still available. OSIPM WG 13, section D

461-135-0950

  The Prospective Eligibility and Budgeting section (under Financial Requirements) was updated to reflect the 10/1/18 rule change about the treatment of periodic and lump-sum income. Periodic income will now be averaged over the time period it covers and $10 and $20 exclusions apply to combined lump-sum and periodic income each month per individual. OSIPM E.14

461-140-0110

461-140-0120

  The Community Transition Services special needs section was updated to reflect the 10/1/18 rule change clarifying who is eligible for the payment and under what circumstances they are eligible. OSIPM H.2 461-155-0526
  The Diversion Services special needs section (renamed from Diversion and Transition Services) was updated to reflect the 10/1/18 rule change specifying who is eligible for the payment and under what circumstances. OSIPM H.14 461-155-0710
 

The Costs and Medical Costs sections (under Financial Requirements) were updated to reflect the 10/1/18 rule changes that specifically address when liability decreases caused by an increase in costs (i.e. when costs are used) take effect.

The Effective Dates section (under Issuing Benefits and Changes) was updated to reflect the 10/1/18 rule change specifying that income or deduction changes that result in a program upgrade are determined in accordance with the initial medical benefits effective date rule. It was also updated to reflect the 10/1/18 adoption of a new rule that specifies when other changes (besides income and deductions) result in increased benefits, such as changes in non-citizen status and pregnancy.

OSIPM E.5, E.6, F.4

461-180-0020

461-180-0083

  The Resource Computation for Couples with an Institutionalized Spouse worker guide was updated with the new Fidelity annuity calculator website OSIPM WG 2  
  The Disqualifying Transfer of Assets flowchart was updated OSIPM WG.7  
  The DAC worker guide was updated with clarifying language about calculating countable and adjusted income. OSIPM WG 9.2  
QMB

The Prospective Eligibility and Budgeting section (under Financial Requirements) was updated to reflect the 10/1/18 rule change about the treatment of periodic and lump-sum income. Periodic income will now be averaged over the time period it covers and $10 and $20 exclusions apply to combined lump-sum and periodic income each month per individual.

QMB E.5

461-140-0110

461-140-0120

  The Income Limits section (under Financial Requirements) was updated to reflect the 10/1/18 rule change clarifying that the adjusted income of the financial group must be below the applicable income standards (or at or below for QMB), not the income of the individual. QMB B.2 461-160-0540
  The Effective Dates section (under Issuing Benefits and Changes) was updated to reflect the 10/1/18 rule change specifying that income or deduction changes that result in a program upgrade are determined in accordance with the initial medical benefits effective date rule. It was also updated to reflect the 10/1/18 adoption of a new rule that specifies when other changes (besides income and deductions) result in increased benefits (also determined in accordance with the initial medical benefits effective date rule). QMB F.3

461-180-0020

461-180-0083

  The Retroactive Medical section (under Nonfinancial Requirements) was updated to correct an error regarding when retroactive benefits can be approved. The retroactive period is three months prior to the date of request, not the effective date of benefits. QMB D.7  
  The Participant Fee section of the EPD WG was updated to clarify that EPD participants received a bill for their participant fee each month. EPD WG 11.5  
       
Counting Client Assets The Periodic Income and Lump-Sum Income sections were updated to reflect the 10/1/18 rule changes about the treatment of periodic and lump-sum income. Periodic income will now be averaged over the time period it covers and $10 and $20 exclusions apply to combined lump-sum and periodic income each month per individual. The Variable Income section was updated to address averaging periodic income that varies in amount. CCA A.4, A.5, A.6

461-140-0110

461-140-0120

  The Burial Arrangements and Burial Funds section was updated to reflect the 10/1/18 rule change clarifying that irrevocable burial trusts or arrangements that cover burial costs are excluded rather than treated as burial funds. CCA B.11 461-145-0040
The Child Support and Cash Medical Support section was updated to reflect the 10/1/18 rule change that addressed how child support paid in arrears is treated in the OSIPM and Medicare Savings Programs. CCA B.14 461-145-0080
  The Corporations and Other Business Entities section was updated to reflect the 10/1/18 rule change clarifying that stock in a corporation owned by individuals with an ownership interest in the corporation but not actively working for the corporation are treated according to the rule on stocks. CCA.B.16 461-145-0089
The Educational Account section was updated to reflect the 10/1/18 rule change that specified how distributions from accounts are treated in Medicare Savings Programs CCA B.25 461-145-0145
  The Loans and Repayment of Loans section was updated to reflect the 10/1/18 rule change that adds a condition that warrants a disqualifying transfer, clarify that its treatment is not dependent on whether an asset is a disqualifying transfer, and add clarity about how the loan is treated as a resource where that information is currently absent. It is also being amended to clarify how loans and interest on loans are treated in Medicare Savings Programs. CCA B.47 461-145-0330
  The Mineral Rights section was updated to reflect the 10/1/18 rule change that clarified how mineral rights were treated in Medicare Savings Programs CCA B.51 461-145-0348
  The Refunds and Rebates section was updated to reflect the 10/1/18 rule change that excluded this asset as a resource for Medicare Savings Programs and align APD medical programs on the treatment of refunds on merchandise and utility and rental deposits. CCA B.67 461-145-0435
  The Shelter In-Kind Income section was updated to reflect the 10/1/18 rule change that added the provision that there must be no option for the value of the shelter in-kind to be taken as cash in order to be excluded. CCA B.70 461-145-0470
  The Verification section was updated with a current list of acceptable tax forms (under Self Employment) CCA C.5  
  The Bank Account section was updated to clarify that the current month's (or applicable month) income deposits should be subtracted from the ending balance (subject to verification requirements). Also, clarification was added that business accounts not used for personal finances are excluded. CCA B.9  
APD Worker Guide

The Clients in State Psychiatric Hospitals and Training Centers section was updated to reflect the 10/1/18 rule change that 21-year-olds can only get OSIPM if they were receiving a certain level of certified services immediately before reaching age 21 and that eligibility ends at age 22.

Other updates were made regarding the referral process from the Oregon State Hospital, including an updated version of the referral form.
APD D.7 461-135-0950
 

The Decision Notice Preparation Tips was updated as follows:

  • A scenario was added to address reductions to QMB/SMB-only for failure to provide resource information
  • The withdrawal scenario was updated to reflect the 10/1/18 rule change specifying that no further notice is needed if the individual completes the 457D
  • Oregon Health Authority language was removed from the MAGI referral references since 5503 is now DHS
  • Three scenarios previously under Medical Denial were moved to a new Miscellaneous section
  • Translations of an older version of the worker guide were added in Spanish, Russian, Vietnamese, Somali, Simplified Chinese, and Traditional Chinese. IMPORTANT - These documents do not reflect the current English version of the worker guide and do not address all scenarios. There is an English version of the translated documents next to the links that should be used for reference until more current versions with English instructions can be obtained.
  • Various service scenarios were updated
APD G.9 461-175-0340
  The Eligibility Start Dates section (under Issuing Benefits and Changes) was updated to reflect the new in-home service effective date policy established in APD-PT-18-023 APD F.1  
The 150% FPL income standard for individuals in 24-hour MH residential care was added to the Income and Resource Standards section (under Financial Eligibility) APD E.5

 

       
SNAP

See SS-PT-18-016 and SS-PT-18-017 for more information on changes to SNAP.

 

 

APD MAGI Manual Language was added to the APD Referrals from 5503 section clarifying that the original MAGI DOR needs to be honored when determining eligibility for APD medical programs APD MAGI E.1  
This manual will be updated frequently; check periodically for new information. APD MAGI Manual

 

REF(M)

See SS-PT-18-016 and SS-PT-18-017 for more information on changes to REF(M).

 

 

Miscellaneous The Special Considerations for Incarcerated Clients section of Staff Tools was updated to correct an error regarding the circumstances under which former SSI recipients' OSIPM benefits can be reopened upon release. We cannot require this individuals to pursue SSI, instead we need to verify disability status (if under 65). Other miscellaneous updates were also added. APD Staff Tools - Incarcerated Clients  
  The Policy Analyst Contact List was updated Program Analyst Contact List  
  The Pay-In Cookbook was replaced with a more current version on the APD Training Page (under Desk Guides and Training Materials)

APD Training

Pay-In Cookbook

 
  Another link to the Policy Analyst Contact List was added under the Contacts section on the main APD Staff Tools site Contacts  
MMIS

 


 
Generic Program Elements The Special Considerations for Incarcerated Clients section of Staff Tools was updated to correct an error regarding the circumstances under which former SSI recipients' OSIPM benefits can be reopened upon release. We cannot require this individuals to pursue SSI, instead we need to verify disability status (if under 65). Other miscellaneous updates were also added.

Generic N.1

 
  The Notice Situations section (under Notices) was updated to reflect the 10/1/18 rule change adding withdrawals of applications to the actions for which the 457D form can serve as final notice.

Generic D.4

461-175-0340
Case Management Tools      

APD Client Pay-In section: No updates this quarter.

APD Client Pay-In  
 

APD Program October 2017 Changes section: No updates this quarter.

APD Program October 2017 Changes  
 

APD Training section:

  • Added the following:
    • SPAN Notice Flow Chart
    • SPAN Form Decision Notice (Forms Server version)
    • SPAN Instructions
    • New Decision Notice Training
APD Training

 

 

Assessment Tools section: No updates this quarter.

Client Details, Treatment, Forms & Miscellaneous LTC Info

 

 

Client Details, Treatment, Forms & Miscellaneous LTC Info section:

  • Updated the following:
    • SPAN Notice Flow Chart
    • SPAN Form Decision Notice (Forms Server Version)
    • SPAN Instructions
    • New Decision Notice Training
  • Added the following:
    • Transmittals:
      • APD-IM-18-074: Change to the 002N Assessment Summary Form
      • APD-IM-18-031: SPAN Notice
Client Details, Treatment, Forms & Miscellaneous LTC Info  
 

Complex Case Consultations section: No updates this quarter

Complex Case Consultations  
 

Diversion/Transition Section:

  • Updated the following:
    • Transition Team Contact List
Diversion/Transition

 

 

Employed Persons with Disabilities (EPD) Section: No updates this quarter

Employed Persons with Disabilities

 

 

Exceptions section: No updates this quarter

Exceptions  
 

Extended Waiver Eligibility (EWE) Section: No updates this quarter

Extended Waiver Eligibility (EWE)

 

 

Facilities section:

  • Added the following:
    • SDS 002N Cover Letter
    • FAQs Regarding Consumers in Facilities for CMs and Other Field Staff
    • Transmittals –
      • APD-IM-18-075: FAQs Regarding Consumers in Facilities
      • APD-AR-18-056/ APD-AR-18-054 / APD-AR-18-050 / APD-AR-18-048 / APD-AR-18-045: New CBC Facilities and Changes in Ownership, Name Changes, new Specific Needs contracts, and In-Home Care Agency Changes in Ownership and Name Changes
Facilities  
 

Home Delivered Meals (HDM) section: No updates this quarter.

Home Delivered Meals (HDM)

 

 

Homecare Worker section:

  • Updated the following:
    • 2015-2019 HCW CBA
  • Added the following:
    • Transmittals:
      • APD-AR-18-045: New CBC Facilities and Changes in Ownership, Name Changes, New Specific Needs Contracts, and In-Home Care Agency Changes in Ownership and Name Changes
Homecare Worker

Chap. 411, Div. 031

 

Independent Choices section:

  • Added the following:
    • ICP Benefit Calculation (546IC and 546IC2Wk) in the following languages–
      • Arabic
      • Chinese
      • Korean
      • Romanian
      • Russian
      • Somali
      • Spanish
      • Vietnamese
    • Workers Compensation Consent and Agreement (353) in the following languages-
      •  Arabic
      • Chinese
      • Korean
      • Romanian
      • Russian
      • Somali
      • Spanish
      • Vietnamese
  • Updated the following:
    • ICP Participant Handbook
Independent Choices 411-030-0100
 

In-Home Care Agencies section:

  • Added the following:
    • Transmittals –
      • APD-AR-18-045: New CBC Facilities and Changes in Ownership, Name Changes, New Specific Needs Contracts, and In-Home Care Agency Changes in Ownership and Name Changes
  • Updated the following:
    • In-Home Care Agencies List
In-Home Care Agencies

Chap. 411, Div. 033

 

In-Home Support Services section: No updates this quarter

In-Home Support Services

Chap. 411, Div. 030

 

K-Plan Services section:

  • Updated the following:
    • K-Plan Ancillary Services Provider List
  • Added the following:
    • Consumer Confirmation of Job Completed to Their Satisfaction
K-Plan Services Chap. 411, Div. 035
 

Long Term Care Rates section:

  • Added the following:
    • SPAN and Exception Requests (PPT/Audio)
Long Term Care Rates

Chap. 411: Div 027, Div. 030, Div. 031

 

Mandatory Case Manager In-Service Webinars section:

  • Added the following:
    • Decisions on Service Cases (PPT/Q&A/Audio)
    • In-home Services New Exception Requests Rules and Process (PPT)
    • Transmittals –
      • APD-IM-18-031 In-Home Rule Changes and Webinar Registration
Mandatory Case Manager In-Service Webinars  
 

Mental or Emotional Disorder Review Team (MED) section: No updates this quarter.

Mental or Emotional Disorder Review Team (MED) Chap. 411, Div. 015
 

Nursing Facilities & PAS section: No updates this quarter.

Nursing Facilities & PAS  
 

Oregon ACCESS & CA/PS Information section:

  • Added the following:
    • Transmittals –
      • APD-IM-18-074: Change to the 002N Assessment Summary Form
      • APD-IM-18-073: Developmental Disabilities Service Category Changes
Oregon ACCESS & CA/PS Information  
 

Oregon Project Independence: No updates this quarter.

Oregon Project Independence Chap. 411, Div. 032
 

Program of All-Inclusive Care for the Elderly (PACE) section:

  • Added the following:
    • Deeming with PACE Services
    • PACE Member Handbook and Enrollment Agreement
    • Transmittals:
      • APD-PT-18-038: Continued Eligibility and the Program for All-Inclusive Care for the Elderly (PACE)
      • APD-IM-18-071: Updated PACE Member Handbook and Enrollment Agreement
PACE Chap. 411, Div. 045
 

Provider Time Capture (PTC) Information section: No updates this quarter.

Provider Time Capture (PTC) Information  
 

Service Priority Level Information section:

  • Added the following:
    • Transmittals –
      • APD-IM-18-074: Change to the 002N Assessment Summary Form

Service Priority Level Information

Chapter 411, Division 015
 

Specialized Services/Specific Needs Contracts section:

  • Updated the following:
    • Specialized Service Vacancy Report (New Excel Version)

Specialized Services/Specific Needs Contracts

 
 

State Plan Personal Care section:

  • Updated the following:
    • Specialized Service Vacancy Report (New Excel Version)
State Plan Personal Care Chap. 411, Div. 034
 

Waivered Case Management section:

  • Added the following:
    • WCM Case Manager Statistics Tracking Spreadsheet (for local management)

       

Waivered Case Management Chapter 411, Division 028


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