Monterey County Behavioral Health Policy and Procedure

Transcription

1 Monterey County Behavioral Health Policy and Procedure Policy Number 434 Policy Title AS CM Rep Payee Services Intake Procedure References MONTEREY COUNTY BOARD OF SUPERVISORS POLICY NO. 432 ADULT SERVICES/CASE MANAGEMENT REPRESENTATIVE PAYEE SERVICES DELEGATION POLICY NO. 433 ADULT SERVICES/CASE MANAGEMENT REPRESENTATIVE PAYEE SERVICES ELIGIBILITY PUBLIC ADMINISTRATOR PUBLIC GUARDIAN CONSERVATOR DIVISION DELEGATION OF AUTHORITY MEMEORANDUM OF 12/1/06 MONTEREY COUNTY BOARD OF SUPERVISORS RESOLUTION NO PUBLIC GUARDIAN TO ACT AS REPRESENTATIVE PAYEE Form ATTACHMENT 1 INTAKE SECTION ATTACHMENT 2 FINANCIAL SECTION ATTACHMENT 3 ADMINISTRATIVE/LEGAL SECTION ATTACHMENT 4 CLAIMS SECTION Effective OCTOBER 1, 1991 REVISED: APRIL 1, 2009 REVISED: JULY 1, POLICY As the appointed Representative Payee of the Monterey County Behavioral Health Division (MCBHD), the Adult Services Program is responsible for providing Representative Payee Services, under the assigned authority as indicated in the references above, to designated adult mental health consumers who meet the eligibility criteria for representative payee services. PROCEDURE A. Intake Process 1. All requests for identified needs for Representative Payee Services for designated mental health consumers shall be referred to the Monterey County Behavioral Health Division, Adult Services Program for investigation, assessment and eligibility determination. Page 1 of 26

2 All request/referrals for Representative Payee Services for designated mental health consumers shall be investigated and assessed according to all related Federal, State and County laws and regulations. 3. Documentation of the investigation shall give evidence of the consumer s incapability of managing or directing the management of Social Security benefits in regard to food, shelter, and clothing, and shall include the following facts on which that determination is based: a. Brief history of the consumer s psychiatric illness to include diagnosis, current medications, and list of places and dates of treatment. b. Description of the consumer s current behavior and current mental functioning, to include: does the consumer have an inability to reason properly; is the consumer confused and/or disoriented; does the consumer have impaired judgment; is the consumer unable to communicate effectively with others? c. The current living conditions/situations and the specific money management needs, to include an identification of income, assets, life insurance policies with or without a cash value, and medical benefits. d. Statement of the background and duration of the consumer s money management difficulties, as well as the efforts made to correct the problems by other interventions to prevent the need for a payee. e. Statements of collateral contact and significant others including all interviews with friends, neighbors, relative, hospital personnel or others. f. Why the current representative payee, if any, cannot continue. g. Description of contacts made to find another person who is interested, capable and willing to act as payee. 4. In addition to the eligibility determination the investigation shall include the following additional steps: a. The case manager shall develop, together with the consumer whenever possible, a plan for expenses. That money management plan must assess and determine the consumer s current and reasonably foreseeable total needs for living such as shelter, food, clothing, utilities, medical/dental care, personal hygiene, personal needs, education, rehabilitation and burial expenses. The plan to meet current needs shall never be sacrificed to pay other expenses, to conserve or invest benefits, or to accumulate benefits for a future purpose. The case manager shall document the results on the Money Management Plan Form (Attachment 1g), and secure the consumer s signature whenever possible. b. When the case manager determines the consumer has not accessed eligibility for Social Security Disability Insurance (SSDI) and/or Supplemental Security Income (SSI) and/or Page 2 of 26

3 Medicare/Medi-Cal benefits, the case manager shall establish a protective filing date for application or reinstatement of benefits by immediately completing and dating Form MH-54, and include that document in the Request for Representative Payee Services referral that is sent to the Office of the Public Guardian. c. The case manager shall discuss with the consumer the reasons for the need to request Representative Payee Services, inform the consumer of his/her right to contest the appointment with the Social Security Administration, request the consumer complete Form SSA (Attachment 1 d), Advance Notification of Representative Payment, and whenever possible to sign with the consumer the Agreement With MCHD for Representative Payee Services [Attachment 1 e (MH 366)]. The case manager is reminded that forms given to the consumer should be enlarged to at least font 14. d. The treating psychiatrist shall complete Form SSA-787, Physician s/medical Officer s Statement of Patient s Capability to Manage Benefits (Attachment 1 c). e. The case manager shall complete the Representative Payee Face Sheet (Attachment 1 a). 5. Upon completion of the above steps, the case file is submitted to the Adult Services Program to review for completeness and then to the Adult Services Unit Supervisor for signature of review and approval. 6. Upon approval by the Adult Services Unit Supervisor, The Adult Services Program shall submit a Request for Representative Payee Services referral package ( red file ) to the Office of the Public Guardian and enters the date of transmittal into the Adult Services Program case control log. The Request for Representative Payee Services referral package to be sent to the Office of the Public Guardian shall consist of the following documents (Attachments 1 4): a. Representative Payee Face Sheet. b. Initial Assessment Of Need Summary. c. Physician s Statement of Patient s Capability to Manage Benefits, Form SSA d. Advance Notification of Representative Payment Form SSA e. Agreement With MCHD For Representative Payee Services. f. MCHD Money Management Plan. g. Form RPS-54 (included only to establish a protective filing date to establish or reestablish eligibility for SSDI/SSI and/or Medicare/Medi-Cal benefits. h. MH-112 (Attachment 4 b Pg. 2) Receipt And Deposit Of Funds (use only when accepting assets from the consumer for deposit in the Public Guardian Trust Account). Page 3 of 26

4 The Adult Services Program staff shall serve as the liaison to the Office of the Public Guardian for the Adult Services Program Representative Payee referrals. The Adult Services will cooperatively assist the Principal Clerk in obtaining any information that will be needed to process applications for benefits and services. 8. The Office of Public Guardian shall: a. Review the Request For Representative Payee Services referral documents and, if needed, refer to the Adult Services Program all requests for additional information from the case manager to complete the application documents. The Adult Services Program will ensure that the additional information is complete and accurate before sending it to the Public Guardian staff. b. Complete and sign the Form SSA-11-BK, Request To Be Selected As Payee ( ). c. Apply for SSDI/SSI, Medicare/Medi-Cal, and County General Assistance and Medi- Cal benefits as appropriate. d. To notify SSA of any change in the Representative Payee s circumstances that would affect performance of the payee responsibilities. e. To report to SSA any event that will affect the amount of benefits the consumer receives or the right of the consumer to SSDI or SSI benefits. f. To give SSA written reports accounting for the use of the benefits, when requested to do so. 2. The ongoing responsibilities of the Office of the Public Guardian are: a. The Office of the Public Guardian shall have responsibility to maintain fiscally accountable records on the source, amount and type of income received by the consumer. b. The Office of the Public Guardian shall provide the Representative Payee with reports on the current/past action/status of the consumer s account. Immediate access to consumer account information can be found in the Public Guardian computer system. c. The Office of the Public Guardian shall have responsibility to monitor the accuracy of income received and the status of savings so that the consumer is not penalized by being discontinued or assessed an overpayment by the Social Security Administration. C. Audit Requirements 1. A supervisory audit is required for each case accepted for Representative Payee Services, at the time of approval, and at the completion of each semi-annual and annual Page 4 of 26

5 review. Supervisory approval shall be granted only after all applicable items are completed and their content is consistent. 2. In addition to the random reviews specified above, the Adult Services Behavioral Program Manager shall review, on a monthly basis, all cases receiving SSI/Medi-Cal benefits to ensure that no case will have an account balance in excess of $2,000 and thereby loose eligibility for benefits due to an excess assets or an overpayment status. The Behavioral Health Program Manager shall direct the case manager to take immediate action to spend down the account to meet the consumer s needs and interests in order to ensure that the consumer does not loose eligibility for benefits due to excess savings. The Adult Services Program Manager shall receive timely notice, on a monthly basis, from the Office of the Public Guardian on all said cases identified above. D. Case Files 1. The Representative Payee case files shall consist of four Sections: Intake; Financial; Administrative/Legal; and, Claims. a. The Intake Section (ATTACHMENT 1) shall contain the Representative Payee Services Face Sheet. That document will constitute the referral notice to the Office of the Public Guardian. The Intake Section will also contain: The Initial Assessment of Need For Representative Payee Services; the Physician s Statement of Patient s Ability to Manage Benefits; the Advance Notification Of Representative Payment; the Agreement With MCHD For Representative Payee Services; the Representative Payee Placement Sheet, the Money Management Budget; and the Notice of Appointment of Representative Payee. b. The Financial Section (ATTACHMENT 2) shall contain: the Award Letters; Revised Money Management Plans and Budgets; Notices of Action; Pending Claims; Notices of Overpayments/Underpayment; Applications and Correspondence regarding benefits. c. The Administrative/Legal Section (ATTACHMENT 3) shall contain: all correspondence regarding denial or appeal of benefits; complaints regarding the Service and the response to same; requests for and notices of discontinuance of Representative Payee Services; Correspondence with the Public Administrator, the County Counsel, the Office of the Public Guardian, lawyers for the estate and heirs regarding a deceased consumer. d. The Claims Section (ATTACHMENT 4) shall contain copies of the Letters of Authorization for Purchase, the Pay-Out Authorization/Requests, and correspondence about purchases and claims. Page 5 of 26

6 SECTION ONE INTAKE SECTION REPRESENTATIVE PAYEE SERVICES FACE SHEET (1 a) INITIAL ASSESSMENT OF NEED FOR REPRESENTATIVE PAYEE SERVICES (1 b) PHYSICIAN S STATEMENT OF PATIENT S ABILITY TO MANAGE BENEFITS (SSA-787) (1 c Pgs. 1&2) ADVANCE NOTIFICATION OF REPRESENTATIVE PAYMENT (SSA-4164) (1 d) AGREEMENT WITH MCHD FOR REPRESENTATIVE PAYEE SERVICES (1 e Pgs. 1 3) REPRESENTATIVE PAYEE PLACEMENT SHEET (1 f Pgs. 1&2) MONEY MANAGEMENT BUDGET (1 g) NOTICE OF APPOINTMENT OF REPRESENTATIVE PAYEE (1 h) Page 6 of 26

7 Attachment Page 7 of 26

8 Attachment 1a Page 8 of 26

9 Attachment 1b Page 9 of 26

10 Attachment 1c Page 10 of 26

11 Attachment 1c (cont d) Page 11 of 26

12 Attachment 1d Page 12 of 26

13 Attachment 1e Page 13 of 26

14 Attachment 1e (cont d) Page 14 of 26

15 Attachment 1e (cont d) Page 15 of 26

16 Attachment 1f Page 16 of 26

17 Attachment 1g Page 17 of 26

18 Attachment 1h SECTION TWO FINANCIAL SECTION AWARD LETTERS REVISED MONEY MANAGEMENT PLANS AND BUDGETS (2 b) NOTICES OF ACTION PENDING CLAIMS NOTICES OF OVERPAYMENT/UNDERPAYMENT APPLICATIONS CORRESPONDENCE PHOTOCOPIES OF MEDI-CAL/MEDICARE CARDS Page 18 of 26

19 Attachment Page 19 of 26

20 Attachment 2a SECTION THREE ADMINISTRATIVE/LEGAL SECTION CORRESPONDENCE REGARDING DENIAL OR APPEAL OF BENEFITS COMPLAINTS REGARDING THE SERVICE AND THE RESPONSE TO SAME REQUESTS AND NOTICES OF DISCONTINUANCE OF REPRESENTATIVE PAYEE SERVICES (3 c) CORRESPONDENCE WITH THE PUBLIC ADMINISTRATOR/COUNTY COUNSEL/OFFICE OF THE PUBLIC GUARDIAN/LAWYERS FOR THE ESTATE (3 d) Page 20 of 26

21 Attachment Page 21 of 26

22 Attachment 3a Page 22 of 26

23 Attachment 3b SECTION FOUR CLAIMS SECTION LETTERS OF AUTHORIZATION FOR PURCHASE (4 a) PAY-OUT AUTHORIZATION/REQUESTS (4 b Pgs. 1&2) CORRESPONDENCE ABOUT PURCHASES AND CLAIMS Page 23 of 26

24 Attachment Page 24 of 26

25 Attachment 4a Page 25 of 26

26 Attachment 4b Page 26 of 26