SI NY02003.005 Processing Initial Claims and Post-eligibility Situations (RTS 371 - 06/2003)
Routing and control of the IAR authorization may be negotiated locally but must conform to the national and regional instructions. Upon determining that an individual is a likely candidate for SSI eligibility, the local agency will secure from the individual an authorization permitting SSA to send the initial SSI payment to the IAR agency; the same is true for post-eligibility situations. The agencies have been instructed to forward signed IAR authorizations to the parallel SSA FO within 10 working days of execution. The state of New Jersey will continue to submit paper authorizations which is considered a manual process.
A. General Assistance
1. Effective June 1, 1989
The municipalities paying General Assistance (GA) to an individual will have that individual sign an "Authorization for Reimbursement of Initial SSI Payment or Initial SSI Post-eligibility Payment (GA-30) - General Assistance" containing that municipality's grant reimbursement (GR) Code. A small number municipalities continue to use GR 31260 to have funds reimbursed to the Division of Economic Assistance (DEA) in Trenton because they have not entered into a direct mail Agreement. Reimbursements for municipalities who have not entered into a direct mail Agreement will be sent to the DEA. The municipalities and DEA will have ten work days from the date they received the check to deduct the amount of assistance granted during the interim period and forward the remainder. Recipients who dispute the apportionment of the retroactive check have the right to request an administrative review of their cases from the Division Economic Assistance. Their addresses and telephone numbers are included on the authorization and apportionment forms sent to the recipients. (See SI NY02003.080 for large retroactive checks due after 12/01/96.)
2. Prior to June 1, 1989
Originally, the interim assistance program for GA was centralized in the Division of Economic Assistance (DEA) in Trenton. That is, only one GR code, 31260, was used for all GA cases in New Jersey and all reimbursement checks were directed to DEA in Trenton. The IAR checks were deposited by the DEA into the State's general treasury and a draft in the amount of the SSI check was sent to the municipality. Now very few payments go to DEA.
B. AFDC-N Segment
The authorization form used by the County Welfare Agencies (CWA) is the "Authorization for Reimbursement of Initial SSI Payment or Initial Post-eligibility Payment (PA-30)-AFDC-N". Reimbursement for assistance provided under the AFDC-N Segment program will be made directly to the individual counties. Upon receipt of the initial SSI check, the CWA will withhold the amount of assistance granted during the interim period and return the balance, if any, to the individual with a written explanation on a "Repayment of Interim Assistance Authorization (PA-31) - AFDC-N Segment Assistance" form showing how the balance was calculated within 10 working days from the date they received the check . CWAs will complete the locally overprinted SSA-8125 and forward the completed SSA-8125 directly to the Program operations Center (POS), 26 Federal Plaza, Room 4032 New York, N.Y. 10278, ATT: IAR. Recipients who dispute the apportionment of the retroactive check have the right to request an administrative review. The address and telephone number are included on the authorization and apportionment forms. (See SI NY02003.080 for large retroactive checks due after 12/01/96.)
C. Division of Mental Health and Hospitals (DMHH) - Community Placements Program
The State of New Jersey and the Social Security Administration have developed a system which permits State psychiatric hospital patients who are ready for discharge and who have applied for SSI benefits to receive payments for community, personal and boarding expenses during the pendency of their SSI claim. The Community Placement Program provides reimbursable financial assistance via the Interim Assistance Program. The Interim Assistance is a program designed for a client who is ready for discharge into the community. It is open to those patients who file for SSI benefits. When a hospital treatment team determines that a patient otherwise ready for discharge is in need of financial assistance, a referral for Interim Assistance will be made to the Discharge Coordinator or Designee. The Discharge Coordinator or Designee will secure an "Authorization for Reimbursement of Assistance from SSI Award (MH-30) Community Placements" and forward it to the parallel SSA FO within 15 days of the signing of the MH-30. The Discharge Coordinator or signee will also submit a completed SSI claims package consisting of an SSI application, income and resource information, medical information and proofs to the parallel FO. (See SI NY02003.080 for large retroactive checks due after 12/01/96.)
D. Division of Mental Health and Hospital (DMHH) - Pre-Placement Visit Program
As of 7/19/93 the Pre-Placement Visit Program has been available to all eligible patients at each of the State psychiatric facilities operated by DMHH. Community providers eligible to receive Pre-Placement Visit Program payments from the State psychiatric facility for the cost of Pre-Placement care shall include, but not be limited to, licensed boarding homes and residential health care facilities. Certain patients at State psychiatric facilities have received the maximum available benefit from their inpatient psychiatric hospitalization in the judgement of their Treatment Team but have not had opportunity to explore the suitability of or to demonstrate their ability to adjust to certain alternative available community placements. The purpose of the Pre-Placement Visit Program is to provide such patients with the opportunity to test out a possible community setting and to serve those patients whose psychiatric history and hospital behavior threaten their ability to succeed at these placements unless it is financially and programmatically supported. (See SI NY02003.080 for large retroactive checks due after 12/01/96.)
1. Eligibility for the Pre-Placement Visit Program
To be eligible for the Pre-Placement visit program the patient must: be an inpatient at a State psychiatric facility who is not judicially restrained from discharge; be 18 years of age or older; have been evaluated by their Interdisciplinary Treatment Team as able to adjust to community placement; be likely to meet the income and medical eligibility standards for SSI and indicate his/her willingness to apply for both IA and SSI, when appropriate.
2. Participation in the Pre-Placement Visit Program
Each eligible patient may participate in the Pre-Placement Visit Program up to a maximum of 14 calendar days. The patient may be returned to the facility within the 14 days. A patient must successfully complete a Pre-Placement for 14 days with a provider, and have an alternative financial source (such as SSI) in order to maintain ongoing placement with that provider.
3. Filing for SSI
The patient would sign the "Authorization for Reimbursement of Initial Supplemental Security Income (SSI) Payment or Initial SSI Post-eligibility Payment (MH-30) - Community Placements" the day of his/her release to the community; this will serve as protective filing. Within 15 calendar days of the individual's release to the community, DMHH will forward the MH-30 and a complete SSI claims package to the FO servicing the patient's residence. The SSI claims package will contain the MH-30, an SSI application, income and resource information, medical information and proofs.
E. Community Placement Program at Hudson County Meadowview Hospital and Camden County Health Services Center
Both the Psychiatric Hospital Division of the Camden County Health Services Center and the Hudson County Meadowview Hospital have implemented community placement programs whereby psychiatric patients who are being released from the hospital will receive Personal Needs Allowances. Their maintenance costs will be paid by the hospitals, while awaiting decisions on their SSI applications. Eligibility for the assistance will be contingent upon their filing an application for SSI benefits and their signing a "Community Placement - (County Psychiatric Hospitals) Authorization for Reimbursement of Assistance from SSI Award (CA-30)" The CA-30 will be forwarded to the parallel SSA FO along with the SSI application within five (5) working days. The grant reimbursement codes designated for the county hospitals are: Camden: 31666 and Hudson: 31333. The retroactive SSI payment will be directed to the appropriate County Treasurer who will notify the business office of its receipt. It will be the responsibility of the business office to deduct an amount equal to the amount of the assistance provided during the interim period and pay the balance to the individual, exclusive of any medical expenditures, along with an explanation, using form FS-9C within 10 working days. Recipients who dispute the apportionment of the retroactive payment may request an administrative review by the county. (See SI NY02003.080 for large retroactive payments due after 12/01/96.)