Questions to consider when making aFast Track recommendation: Social services cant begin Fast Track until a CAREassessment is completed. 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. Explain Estate Recovery and mail the Estate Recovery fact sheet. 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. 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. Por favor, responda a esta breve encuesta. APPPLICANT'S NAME: LAST, FIRST, MI 2. Note: The HCA 80-020 Authorization for Release of Information is for medical benefits under Health Care Authority and will be accepted as a release of information for all medical programs including LTSSprograms. Call the HCS intake line in the area in which you reside to schedule an assessment. General open-ended questions about resources and income should also be asked. Percentage of clients who received a referral for other support services who have documented evidence of the education provided to the client on how to access these services in the primary client record. Provide feedback on your experience with DSHS facilities, staff, communication, and services. Appendix 2 to Attachment 4.19-A. Based on the agencys perception of the client's condition, the client requires a higher level of care than would be considered reasonable in a home/community setting. z, /|f\Z?6!Y_o]A PK ! Caring at Home Respite, In-home Services, Skills, Caregiver Help, Kinship Caregiving, Services, Conferences RW Providers must use a telehealth vendor that provides assurances to protect ePHI that includes the vendor signing a business associate agreement (BAA). Any assaults, verbal or physical, must be reported to the monitoring entity within one (1) business day and followed by a written report. PK ! A simple and sleek portal for staff. Referral for Health Care and Support Services includes benefits/entitlement counseling and referral to health care services to assist eligible clients to obtain access to other public and private programs for which they may be eligible. Home and Community Services - LTSS 3602 Pacific Ave., Suite 200 . If the NF admission is on a weekend or holiday, the NF has until the first business day to report the admission. 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. Subrecipients must provide easy-to-understand print and multimedia materials and signage in the languages commonly used by the populations in the service area to inform all individuals of the availability of language assistance services. Care plan is updated at least every sixty (60) calendar days. 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. Activities provided under this service category may include referrals to assist HRSA Ryan White HIV/AIDS Program (RWHAP)-eligible clients to obtain access to other public or private programs for which they may be eligible (e.g., Medicaid, Medicare Part D, State Pharmacy Assistance Programs, Pharmaceutical Manufacturers Patient Assistance Programs, and other state or local health care and supportive services, or health insurance Marketplace plans). There are a a few sites that do not have IHSS details, however you can use the links below to find the appropriate Social Services office contact information. Provide PBSstaff with the following information: Whether the client meets nursing facility level of care (NFLOC). 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. Percentage of clients accessingHome and Community-Based Health Services have follow up documentation to the referral offered in the clients primary record. 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. 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. Did you receive verification of resources with the application? 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. You mayapply for apple health for another person if you are: An authorized representative (as described in WAC. The LTSS authorization date, which is described in WAC, If there is a transfer penalty as described in WAC. If the 13-746 is not received timely, count back 5 businessdays from the date of receipt to determine the authorization date. Eligibility decisions made, or next steps. As the primary applicant or head of household, you may start an application for apple health by providing your: Physical address, and mailing addresses (if different). Transitional social services should NOT exceed 180 days. Has your contact information changed in Per Diem. Please report broken links or content problems. Progress notes will be kept in the client's primary record and must be written the day services are rendered. The Aging and Disability Resources Program offers a wide range of community-based services that allow older adults and adults with disabilities to remain at home as long as possible. 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. Authorize payment for NF care if the client is both functionally and financially eligible. 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. HRSA/HAB Division of Metropolitan HIV/AIDS Programs Program Monitoring Standards Part A April 2013. p. 43-44. Name Unit Division Phone *Medicaid Helpline: Medicaid: HCS: 1-800-562-3022: Abbott, Amy: Director's Office, RCS: RCS: 360.725.2401: Acoba, Curtis: OT - IT Security If there is other medical coverage and you can obtain the information during the interview, complete a. HCA 18-003 Rights and responsibilities (translations can be found at Health Care Authority (HCA) forms under 14-113), HCA 18-005 Washington Apple Health application for aged, blind, disabled/long-term care coverage, HCA 18-008 Washington Apple Health application for tailored supports for older adults (TSOA), DSHS14-001 Application for cash or food assistance. The agency must document the situation in writing and contact the referring primary medical care provider. The agency or its designee may contact an individual by phone or in writing to gather any additional information that is needed to make an eligibility determination. Listed on 2023-03-03. BIRTH DATE 4. Services cannot be provided in the following facilities: inpatient hospital facilities, nursing homes, and other long term care facilities. Open-ended questions often reveal that additional sources of income and assets may exist. For HCS clients, both functional and financial eligibility are determined concurrently. 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. All AAs and subrecipients must establish culturally and linguistically appropriate goals, policies, and management accountability, and infuse them throughout the organizations planning and operations. | Coordination of Services and Referrals: If referrals are appropriate or deemed necessary, the agency will: Percentage of clients accessingHome and Community-Based Health Services with documented evidence of referrals, as applicable, to other services as indicated in the clients primary record. 08/2017) Page 1 of 2 / Intake and Referral form for Social Services. If you disagree with our decision, you can ask for a hearing. If not already authorized, request authorization for AVS for the client and any applicable financially responsible people. 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. State Plan Amendments. (link is external) 360-918-8424. HRSA/HAB Division of State HIV/AIDS Programs National Monitoring Standards Program Part B April 2013. p. 42-43. Disproportionate Share Hospital Program. For medicaid recipients, the first date DSHS was notified of the admission by the nursing facility. Intake Coordinator. Home and Community-Based Health Services include the following: Home and Community-Based Health Providers work closely with the multidisciplinary care team that includes the client's case manager, primary care provider, and other appropriate health care professionals. adult daycare center) in accordance with a written, individualized plan of care established by a licensed physician. Explain to the applicant that there is a Public Benefits Specialist (PBS) and a social service manager making determinations concurrently for LTSS eligibility. TK6_ PK ! | 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. Posted wage ranges represent the entire range from minimum to maximum. Home. p9,u eV)Pp6B*Rk[g8=g S,8!ciLu`A^2 ntw]0+ *mhX1M[zQ=~yOF594 Y8-xf[rt(>zc|C1>4o ?|aBq}D.2L3jI>&,OXOG79Z5:%A PK ! The interview requirement described in subsection (3) of this section may be waived if the applicant is unable to comply: Because the applicant does not have a family member or another individual that is able to conduct the interview on his or her behalf. Assess the client's functional eligibility for in home or residential care. AGING AND LONG-TERM SUPPORT ADMINISTRATION (ALTSA) HOME AND COMMUNITY SERVICES (HCS) GOVERNOR'S OPPORTUNITY FOR SUPPORTIVE HOUSING (GOSH) GOSH Referral DATE HCS / AAA Case Manager (CM) to send completely filled-out Referral form, with all documents attached, toRegional GOSH PM. 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. You are subject to asset verification and do not provide authorization as described in WAC 182-503-0055. Screen all clients to determine potential for HCB services. A good cause code must be used when finalizing any medical(AU) historically beyond 45 days. Eligible clients are referred to additional support services (outside of a medical, MCM, NMCM appointment), as applicable to the clients needs, with education provided to the client on how to access these services. 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. HRSA/HAB Division of State HIV/AIDS Programs National Monitoring Standards Program Part B April, 2013, p. 13-15. We send you a written notice explaining why we denied your application (per chapter. Case actions and why the actions were taken, and. Client transfers services to another service program. xar *O.c H?Y+oaB]6y&$i8]U}EvH*%94F%[%A PK ! Your WAH coverage may not begin on the first day of the month if: Subsection (3) of this section applies to you. Appropriate mental health, developmental, and rehabilitation services; Day treatment or other partial hospitalization services; Home health aide services and personal care services in the home. When applicable, an employee of the agency has experienced a real or perceived threat to his/her safety during a visit to a client's home, in the company of an escort or not. The hospital requires you to stay overnight. Percentage of clients with documented evidence of completed progress notes in the clients primary record. Provider Fraud and Elder Abuse complaint line: Get Services IHSS; Medi-Cal Offices; County Public Authority; IHSS Recipients: IHSS Training/Information - Resources; Fact Sheets; Educational Videos; IHSS Providers: How to Become an IHSS Provider; How to Appeal if You are Denied; IHSS Provider Resources; IHSS Timesheet Issues/Questions: IHSS Service Desk for Providers & Recipients, (866) 376 . Progress notes will then be entered into the client record within 14 working days. 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. Funds cannot be used to duplicate referral services provided through other service categories. 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. Denos su opinin sobre sus experiencias con las instalaciones, el personal, la comunicacin y los servicios del DSHS. 6 [Content_Types].xml ( KO0#5.,5ec H0[i ~NhMsg[3xxw;) 'nY?7H(;1{H] Posted: October 21, 2022. Explain what changes of circumstances need to be reported. For jobs with more than one level, the posted range reflects the minimum of the lowest level and the maximum of the highest level. You must apply directly with the service provider for the following programs: The breast and cervical cancer treatment program under WAC, For the confidential pregnant minor program under WAC.

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