Rule-making Standards and Procedures
RULEMAKING PACKET
|Type of Rule: (complete a and b, below) |
|a. |X |Board | |Executive Director |
| | | | | |
|b. |X |Regular | |Emergency |
This package is submitted to State Board Administration as: (check all that apply)
|X |AG Initial Review |
| X |Amended Rules |
| X |New Rules |
| X |Repealed Rules |
| X |Reviewed Rules |
|What month is being requested for this rule to first go before the State Board? |December, 2019 |
| | |
|What date is being requested for this rule to be effective? |03/01/2020 |
|Is this date legislatively required? |No |
I hereby certify that I am aware of this rule-making and that any necessary consultation with the Executive Director’s Office, Budget and Policy Unit, and Office of Information Technology has occurred.
Office Director Approval: ____________________________________ Date: ___________
|REVIEW TO BE COMPLETED BY STATE BOARD ADMINISTRATION |
|Comments: |
| |
| |
| | | | |
|Estima|1st Board |
|ted | |
|Dates:| |
| |to preserve public health, safety and welfare |
Justification for emergency:
N/A
State Board Authority for Rule:
|Code |Description |
|26-1-107(5)(b), C.R.S. (2019) |State Board’s authority to adopt rules for programs administered and services provided by the State |
| |Department as set forth in Titles 26 and 27. |
| | |
|26-1-111(2)(d)(I), C.R.S. (2019) |State Department shall provide services to the county governments for the effective administration of |
| |public assistance and welfare functions as set out in the rules of the State Board. |
Program Authority for Rule: Give federal and/or state citations and a summary of the language authorizing the rule-making function AND authority.
|Code |Description |
|26-1-106(1)(a), C.R.S. (2019) |The Executive Director shall review the initial decision in accordance with a procedure adopted by the |
| |State Board. |
|26-1-107(7), C.R.S. (2019) |Rulemaking authority to define income disregards for public assistance benefits when federal law or |
| |regulations require. |
|26-1-112(2)(a), C.R.S. (2019) |Locating Violators- Recoveries. The request and provision of information regarding fraudulently obtained |
| |public benefits shall be established by rule of the State Department. |
|26-2-104(2)(b), C.R.S. (2019) |Public Assistance Programs- Electronic Benefits Transfer Service- The State Board is authorized to |
| |promulgate rules necessary to implement and administer the electronic benefits transfer service created by |
| |26-2-104(2), C.R.S. (2019) |
|26-2-106(2), (3), C.R.S. (2019) |Applications for Public Assistance – The rules of the State Department may provide for a simplified |
| |application for public assistance benefits and shall provide adequate safeguards and controls to ensure |
| |that only eligible persons receive public assistance under Title 26. The State Department, by its rules, |
| |shall prescribe the form and procedure for applications ro request for social services. |
|26-2-108(2), C.R.S. (2019) |Granting of Assistance Payments and Social Services - The State Department, by its rules, shall prescribe |
| |procedures for handling applications or requests for social services. Such rules may include, but need not |
| |be limited to, the determination of eligibility for social services, the services to be provided, the |
| |verification and record, and notice to applicants and the state department. |
|26-2-109(3)(a), C.R.S. (2019) |Right to Own Certain Property - The State Department, by its rules and regulations, may establish |
| |limitations on the value of real and personal property and other resources subject to statutory limitations|
| |which may be available to an applicant or recipient without affecting his eligibility for public |
| |assistance. |
|26-2-110, C.R.S. (2019) |Repayment not Required – Pursuant to the rules of the State Department, no person shall be required to |
| |repay or promise to repay the State of Colorado for money properly paid to him or her as a condition for |
| |receiving public assistance. |
|26-2-111.8(2)(c), (4), (5), C.R.S. (2019) |Eligibility of Noncitizens for Public Assistance – A qualified alien may receive benefits under statute |
| |pursuant to rules promulgated by the State Department. |
|26-2-114(2)(b)(I), C.R.S. (2019) |Amount of Assistance Payments- Old Age Pension - The rules and regulations of the State Department may |
| |require an applicant or recipient who may be eligible for benefits under another federal or state program |
| |or who may have a right to receive or recover other income or resources to take reasonable steps to apply |
| |for, otherwise pursue, and accept such benefits, income, or resources. |
|26-2-119(1)(b), C.R.S. (2019) |Amount of Assistance Payments- Aid to the Needy Disabled – Defining what the rules of the State Department |
| |must establish. |
|26-2-120(1), C.R.S. (2019) |Amount of Assistance Payments- Aid to the Blind - The rules of the state department may require an |
| |applicant or recipient who may be eligible for benefits under another federal or state program or who may |
| |have a right to receive or recover other income or resources to take reasonable steps to apply for, |
| |otherwise pursue, and accept such benefits, income, or resources. |
|26-2-122.3(1)(b)(III), C.R.S. (2019) |Adult Foster Care and Home Care Allowance– State Department rules shall specify: the services available |
| |under home care allowance program (HCA); the eligibility criteria for the HCA; the determination as to the |
| |client’s functional impairment and the client’s unmet need for paid care; the amounts awarded to persons |
| |eligible for HCA; the methods for determining the unmet need for paid care and the amount of a HCA that may|
| |be awarded to eligible clients. |
|26-2-123(1), C.R.S. (2019) |Removal to Another County – Generally describes the transfer of public assistance from one county to |
| |another when a recipient becomes a resident of another county, pursuant to the rules of the State |
| |Department. |
|26-2-124, C.R.S. (2019) |Reconsideration and Changes – Generally describes the reconsideration and change process, which is to be |
| |governed by the rules and regulations of the State Department. |
|26-2-127(1)(a)(I), (1)(a)(II), (1)(a)(IV), |Appeals – Generally describes the appeals process, which is to be governed by the rules promulgated by the |
|C.R.S. (2019) |State Department. |
|26-2-128(1), (3), C.R.S. (2018) |Recovery from Recipient- Estate – Generally describes the recovery process from a recipient whose estate |
| |exceeds the value permitted by statute while receiving public assistance, which is to be governed by the |
| |rules of the State Department. |
|26-2-129(10)(a), C.R.S. (2019) |Funeral- Burial- Cremation Expenses- Death Reimbursement- Definitions – The State Department shall adopt |
| |rules and regulations necessary to implement the burial expenses requirements in section 26-2-129. |
|26-2-133(4), C.R.S. (2019) |State Income Tax Refund Offset- Rules – The State Department shall adopt rules and regulations necessary to|
| |implement the tax refund offset statute, section 26-2-133. |
|26-2-137(2)(b), C.R.S. (2019) |Noncitizens Programs – The State Department shall promulgate rules requiring sponsors to meet their moral |
| |and financial commitments to the immigrants they sponsor. |
|26-2-205, C.R.S. (2019) |Optional State Supplementation - The state department is authorized to adopt rules and regulations for the |
| |provision of optional state supplementation to recipients of SSI benefits residing in the state. |
|Does the rule incorporate material by reference? |x |Yes | | |No |
|Does this rule repeat language found in statute? | |Yes | |X |No |
| | | | | | |
|If yes, please explain. | |
REGULATORY ANALYSIS
1. List of groups impacted by this rule.
County departments and SEPs as well as clients of the Old Age Pension (OAP), Aid to the Needy Disabled-State Only (AND-SO), Aid to the Needy Disabled-Colorado Supplement (AND-CS), Home Care Allowance (HCA), and Burial programs will benefit from the rule revisions. Individuals who may be interested in the Adult Foster Care (AFC) program will be impacted; however, the program has not been utilized in years and is not currently appropriated by the General Assembly. The Special Populations Home Care Allowance (SP-HCA) program was statutorily required to sunset due to the implementation of a consumer directed option in the Supported Living Services waiver. The program was discontinued in August 2018. The proposed rules are a product of collaboration between the Employment and Benefits Division and its partners and have been in development for more than four (4) years.
2. Describe the qualitative and quantitative impact.
All sixty-four (64) counties, twenty-four (24) SEPs and approximately 27,350 Adult Financial recipients will be affected. Implementation of the proposed rule changes will result in county workload reduction and increased economic stability among clients. In some circumstances, there may result in modest changes to a participant’s grant due to income disregards and deeming, or a client’s length of time spent in the program may increase due to changes to reporting requirements and rules requiring proper notice to individuals before their benefits end. Any potential cost increases would be within existing appropriations, which are currently underspent.
The anticipated benefits include less confusing application of program standards, consistency and alignment across programs. This will limit the need for a county to “interpret” a rule that is vague or written with overly obtuse language, helping ensure that the rules are applied in the same manner from one county to another, a definite benefit for clients. Also, the program anticipates less confusion for new workers, improved program accuracy and error reduction, and more streamlined training. The changes benefit clients and county workers by simplifying and making regulations more rational. A large time savings for counties is also anticipated due to reduced administrative burdens, aligning these program rules with other programs, and simplifying language and the statewide benefit management system.
3. Fiscal Impact
State Fiscal Impact
The statewide benefit management system must be updated to reflect the changes outlined in these proposed rules. System changes will be accomplished within the existing state resources.
There are no additional State fiscal impacts as a result of these rule changes. Any increases will be within the current appropriations.
County Fiscal Impact
Counties contribute a percentage of all AND and HCA benefits paid. The contribution is twenty percent for AND and five percent for HCA. There is no county contribution for OAP benefits. There are no additional county fiscal impacts as the increases will be within the appropriations.
The Department will continuously monitor caseload and expenditures to ensure counties have sufficient resources to operate the program.
Federal Fiscal Impact
There is no federal fiscal impact. Adult Financial programs are all State funded.
Other Fiscal Impact
There is no additional fiscal impact to any other provider or local governments.
4. Data Description
The Employment and Benefits Division relied on data from internal resources when developing this rule. Ad-hoc reports were created to analyze trends and create projections based on proposed changes to determine potential impacts. Data utilized included caseload information, specific impacts related to income and noticing changes, a fiscal review, and allocation review.
5. Alternatives to this Rule-making
The rules could remain as currently written. However, because of the issues previously identified (inefficient, misaligned, unclear), it is strongly recommended that the rules be updated.
OVERVIEW OF PROPOSED RULE
|Rule section |Issue |Old Language |New Language or Response |Reason / Example / Best Practice |Public |
|Number | | | | |Comment No |
| | | | | |/ Detail |
|3.510 |Clarification |“Actual value” means the true value of real property, as |“Actual value” means the true value of real property, as reported by the county |Removed unnecessary word. |No |
| |Needed |reported by the county assessor. |assessor. | | |
|3.510 |New Rule |"ADEQUATE NOTICE"-NEW |“ADMINISTRATIVE DISQUALIFICATION HEARING” (ADH) MEANS A DISQUALIFICATION HEARING|New definition added to distinguish |No |
| |Addition | |AGAINST AN INDIVIDUAL ACCUSED OF WRONGFULLY OBTAINING OR ATTEMPTING TO OBTAIN |between adequate notice and timely | |
| | | |ASSISTANCE. |notice. | |
|3.510 |New Rule |"ADMINISTRATIVE DISQUALIFICATION HEARING"-NEW |“ADMINISTRATIVE DISQUALIFICATION HEARING” (ADH) MEANS A DISQUALIFICATION HEARING|New definition added to describe the |No |
| |Addition | |AGAINST AN INDIVIDUAL ACCUSED OF WRONGFULLY OBTAINING OR ATTEMPTING TO OBTAIN |type of hearing that occurs during | |
| | | |ASSISTANCE. |the Intentional Program Violation | |
| | | | |process. | |
|3.510 |New Rule |"ADMINISTRATIVE ERROR CLAIM"-NEW |“ADMINISTRATIVE ERROR CLAIM” MEANS A GRANT PAYMENT WAS OVER-PAID AND A CLAIM |Addition of fraud rules from previous|No |
| |Addition | |VALIDATED BASED ON AN ERROR ON THE PART OF THE COUNTY DEPARTMENT OF HUMAN |Section 3.800 required new | |
| | | |SERVICES. |definition. | |
|3.510 |New Rule |"ADULT FINANCIAL APPROVED SETTING"- NEW |“ADULT FINANCIAL APPROVED SETTING” MEANS A FACILITY WITH THIS SPECIFIC |Added to clarify special facilities |No |
| |Addition | |DESIGNATION BY THE STATE DEPARTMENT. |designated by CDHS. Clients residing| |
| | | | |in these settings can receive a | |
| | | | |personal needs allowance payment. | |
|3.510 |New Rule | |“ADMINISTRATIVE LAW JUDGE” (ALJ) ADMINISTRATIVE LAW JUDGE MEANS AN |Adds definition to clarify term used |No |
| |Addition | |ADMINISTRATIVE LAW JUDGE APPOINTED PURSUANT TO SECTION 24-30-1003, C.R.S. |in multiple rule sections. | |
|3.510 |Clarification |“Applicant” means a person who is applying for benefits. |“Applicant” means ANY INDIVIDUAL OR FAMILY WHO INDIVIDUALLY OR THROUGH A |Recommended addition by the Chief |No |
| |Needed | |DESIGNATED REPRESENTATIVE OR SOMEONE ACTING RESPONSIBLY FOR HIM OR HER HAS |Adjudicator of appeals and aligns | |
| | | |APPLIED FOR BENEFITS UNDER THE PROGRAMS OF PUBLIC ASSISTANCE administered or |with statute. | |
| | | |supervised by the state department PURSUANT TO TITLE 26, ARTICLE 2, C.R.S., AS | | |
| | | |DEFINED AT SECTION 26-2-103(1), C.R.S. a person who is applying for benefits. | | |
|3.510 |Clarification |“Application” means a request on state approved forms for |“Application” means aAN INITIAL OR REDETERMINATION request on state approved |Recommended addition by the Chief |No |
| |Needed |benefits and/or services, which can include the electronic |forms (PAPER OR ELECTRONIC) for A GRANT PAYMENTbenefits and/or services, which |Adjudicator of appeals | |
| | |state prescribed form. |can include the electronic state prescribed form. | | |
|3.510 |Clarification |“Authorized representative” means someone acting reasonably|“Authorized representative” means someone acting reasonably for the client with |Clarified that the authorization must|No |
| |Needed |for the client with the authority to make decisions on |the authority to make decisions on behalf of the client and who has taken |be in writing and signed. | |
| | |behalf of the client and who has taken responsibility for |responsibility for the case including but not limited to signing documents and | | |
| | |the case including but not limited to signing documents and|speaking with county departments. THE AUTHORIZATION MUST BE IN WRITING AND | | |
| | |speaking with county departments. |SIGNED BY THE CLIENT. | | |
|3.510 |Clarification |“Availability of income or resources” means when actually |“AVAILABLE” (RELATED TO FUNDS OR ASSETS)Availability of income or resources” |Definition did not match language |No |
| |Needed |available and when the client has a legal interest in a sum|means when actually ACCESSIBLE available OR COULD BE ACCESSIBLE, and when the |found throughout rule. Also | |
| | |(includes cash or equity value of a resource) and has the |client has a legal interest in a sum (includes cash or equity value of a |eliminated redundancy in rule. | |
| | |legal ability to make such sum available for support and |resource), and has the legal ability to make such sum available for support and | | |
| | |maintenance. |maintenance. | | |
|3.510 |Clarification |“Bona fide loan” means a borrower receives money (from |“Bona fide loan” means a borrower receives money (from relatives, friends or |Align definition with SSA treatment |No |
| |Needed |relatives, friends or others) which creates a loan if there|others) which creates a loan if there is an understanding between the parties |of bona fide loan. | |
| | |is an understanding between the parties that the money |that the money borrowed is to be repaid and it is recognized as an enforceable | | |
| | |borrowed is to be repaid and it is recognized as an |contract under State COLORADO law. The transaction which creates a loan can be | | |
| | |enforceable contract under State law. The transaction which|in the form of a written or VERBAL oral agreement if enforceable under State | | |
| | |creates a loan can be in the form of a written or oral |COLORADO law. Absent a negotiable instrument, a bona fide loan must still be | | |
| | |agreement if enforceable under State law. Absent a |convertible to cash in order to be considered a resource. THE OBLIGATION TO | | |
| | |negotiable instrument, a bona fide loan must still be |REPAY CANNOT BE CONTINGENT ON FUTURE INCOME THAT MIGHT BE RECEIVED BY THE | | |
| | |convertible to cash in order to be considered a resource. |BORROWER. THE WRITTEN OR VERBAL AGREEMENT MUST BE IN EFFECT AT THE TIME OF THE | | |
| | | |TRANSACTION AND THERE MUST BE A REASONABLE PLAN FOR REPAYMENT. | | |
|3.510 |Unnecessary Rule|“Cash benefit” means a money payment provided to an |“Cash benefit” means a money payment provided to an eligible client, for the |Term not used in body of the rule. |No |
| | |eligible client, for the purpose of meeting day-to-day |purpose of meeting day-to-day ongoing living costs. | | |
| | |ongoing living costs. | | | |
|3.510 |New Rule | |“CERTIFICATION PERIOD” MEANS THE TIME PERIOD FOR WHICH AN ADULT FINANCIAL CLIENT|Added for clarification of term used |No |
| |Addition | |IS APPROVED TO RECEIVE GRANT PAYMENTS BEFORE A REDETERMINATION IS REQUIRED. |in body of rule. | |
|3.510 |Clarification |“Claim” means an overpayment of benefits that needs to be |“Claim” means an overpayment of A GRANT PAYMENT benefits that needs to be |Definition did not match language |No |
| |Needed |researched for validity and, if validated, must be |researched AND for validity and, if validated, must be collected from the client|found throughout rule. | |
| | |collected from the client by the county department. |by the county department. | | |
|3.510 |Clarification |“Client” means a current or past applicant or a current or |“Client” means a current or past applicant or a current or past recipient of AN |Clarification and to align with use |No |
| |Needed |past recipient of benefits. |ADULT FINANCIAL GRANT PAYMENT benefits. |of the term AF Grant Payment | |
| | | | |throughout rule. | |
|3.510 |New Rule |"CLIENT ERROR CLAIM"- NEW |“CLIENT ERROR CLAIM” MEANS A GRANT PAYMENT WAS OVER-PAID AND A CLAIM WAS |Addition of fraud rules from previous|No |
| |Addition | |VALIDATED BASED ON UNINTENTIONAL OR WILLFUL WITHHOLDING OF INFORMATION ON THE |Section 3.800 required new | |
| | | |PART OF THE CLIENT. |definition. | |
|3.510 |New Rule |“COLLATERAL CONTACT” -NEW |“COLLATERAL CONTACT” MEANS A PERSON OUTSIDE THE CLIENT’S HOUSEHOLD (EXCLUDING |New definition to clarify the use of |No |
| |Addition | |SPONSOR(S) AND LANDLORD WHO ALSO LIVE IN THE HOME) WHO HAS FIRST-HAND KNOWLEDGE |collateral contact as an acceptable | |
| | | |OF THE CLIENT’S CIRCUMSTANCE AND PROVIDES A VERBAL OR WRITTEN CONFIRMATION |verification source. Identifies who | |
| | | |THEREOF. THIS CONFIRMATION MAY BE MADE EITHER IN PERSON, IN WRITING, |is considered a collateral contact | |
| | | |ELECTRONICALLY SUBMITTED, OR BY TELEPHONE. ACCEPTABLE COLLATERAL CONTACTS |and the ways that information can be | |
| | | |INCLUDE BUT ARE NOT LIMITED TO: EMPLOYERS, LANDLORDS, SOCIAL/MIGRANT SERVICE |shared. | |
| | | |AGENCIES, AND MEDICAL PROVIDERS WHO CAN BE EXPECTED TO PROVIDE ACCURATE THIRD | | |
| | | |PARTY VERIFICATION. THE NAME/TITLE OF THE COLLATERAL CONTACT AS WELL AS THE | | |
| | | |INFORMATION OBTAINED MUST BE DOCUMENTED IN THE STATEWIDE AUTOMATED SYSTEM. | | |
|3.510 |Clarification |“Countable income” means income considered to be available |“Countable income” means income considered to be available to the client, spouse|Remove unnecessary words. |No |
| |Needed |to the client, spouse of the client, or sponsor(s) of the |of the client, or sponsor(s) of the client after the application of valid | | |
| | |client after the application of valid exemptions, |exemptions, disregards, and deductions. | | |
| | |disregards, and deductions. | | | |
|3.510 |Clarification |“Countable resource” means resources considered to be |“Countable resource” means resources considered to be available to the client, |Remove unnecessary words. |No |
| |Needed |available to the client, spouse of the client, or |spouse of the client, or sponsor(s) of the client after the application of valid| | |
| | |sponsor(s) of the client after the application of valid |exemptions, disregards, and deductions. | | |
| | |exemptions, disregards, and deductions. | | | |
|3.510 |New Rule | |“CREDITOR” MEANS A PERSON OR COMPANY, ASIDE FROM THE COLORADO DEPARTMENT OF |New definition to differentiate |No |
| |Addition | |HUMAN SERVICES, TO WHOM MONEY IS OWED. |between claims of CDHS and other | |
| | | | |entities. | |
| 3.510 |New Rule |“DATE OF ENTRY” OR “DATE OF ADMISSION” -NEW |“DATE OF ENTRY” OR “DATE OF ADMISSION” MEANS THE DATE ESTABLISHED BY THE UNITED |New definition to clarify when the |No |
| |Addition | |STATES CITIZENSHIP AND IMMIGRATION SERVICES (USCIS), FORMERLY KNOWN AS THE |sponsored noncitizen was admitted | |
| | | |IMMIGRATION AND NATURALIZATION SERVICE (INS), AS THE DATE THE SPONSORED |into the United States for permanent | |
| | | |NONCITIZEN WAS ADMITTED FOR PERMANENT RESIDENCE. |residence. | |
|3.510 |Clarification |“Denial” means that the client was not eligible for |“Denial” means that the client was not eligible for A GRANT PAYMENTbenefits upon|Clarification and to align with use |No |
| |Needed |benefits upon initial application. |initial application. |of the term AF Grant Payment | |
| | | | |throughout rule. | |
|3.510 |New Rule |"DEMONSTRABLE EVIDENCE"-NEW |“DEMONSTRABLE EVIDENCE” MEANS EVIDENCE THAT A COLORADO WORKS CASE IS CLOSED DUE |New definition to clarify term used |No |
| |Addition | |TO REFUSAL TO COMPLY WITH THE WORKFORCE PROGRAM. |for Colorado Works case closures. | |
|3.510 |New Rule | |“DISABLING CONDITION” MEANS A MEDICAL IMPAIRMENT WHICH PREVENTS AND INDIVIDUAL |New definition added to explain |No |
| |Addition | |FROM ENGAGING IN WORK. |situations in which resources may be | |
| | | | |treated differently. | |
|3.510 |Clarification |“Disability Benefits Guide (Guide)” means a representative |“Disability Benefits Guide (Guide)” means a representative appointed to assist |Deletion as definition is no longer |No |
| |Needed |appointed to assist an individual to work with the Social |an individual to work with the Social Security Administration (SSA). The Guide |used. | |
| | |Security Administration (SSA). The Guide is responsible for|is responsible for assisting the client with securing a protected filing date | | |
| | |assisting the client with securing a protected filing date |for Supplemental Security Income (SSI) within ten (10) days. The Guide must | | |
| | |for Supplemental Security Income (SSI) within ten (10) |assist the client in completing and submitting a thorough application for SSI. | | |
| | |days. The Guide must assist the client in completing and |This Guide may be selected by the client and must be: | | |
| | |submitting a thorough application for SSI. This Guide may |A. Any attorney licensed in Colorado or licensed to appear in any United States | | |
| | |be selected by the client and must be: |federal court, in good standing who: | | |
| | |A. Any attorney licensed in Colorado or licensed to appear |1. Is not disqualified or suspended from acting as a representative in dealings | | |
| | |in any United States federal court, in good standing who: |with the SSA; and, | | |
| | |1. Is not disqualified or suspended from acting as a |2. Is not prohibited by any law from acting as a representative; or, | | |
| | |representative in dealings with the SSA; and, |B. Any person who: | | |
| | |2. Is not prohibited by any law from acting as a |1. Has SSI/SSDI Outreach, Access, and Recovery (SOAR) certification or is | | |
| | |representative; or, |employed and endorsed by an organization that has experience in assisting with | | |
| | |B. Any person who: |the SSI application process. Experience is determined by the county worker | | |
| | |1. Has SSI/SSDI Outreach, Access, and Recovery (SOAR) |verifying place and type of employment; and, | | |
| | |certification or is employed and endorsed by an |2. Is not disqualified or suspended from acting as a representative in | | |
| | |organization that has experience in assisting with the SSI |interactions with the SSA or the county department; and, | | |
| | |application process. Experience is determined by the county|3. Is not prohibited by any law from acting as a representative. | | |
| | |worker verifying place and type of employment; and, |C. If the person selected by the client meets these requirements, the county | | |
| | |2. Is not disqualified or suspended from acting as a |department shall notify the client verbally or in writing that the person has | | |
| | |representative in interactions with the SSA or the county |been approved to work with them as the Guide. | | |
| | |department; and, |D. The county department or the SSA may refuse to recognize the person chosen by| | |
| | |3. Is not prohibited by any law from acting as a |the client if the person does not meet the requirements in this section. The | | |
| | |representative. |county department or the SSA will notify the client and the person disqualified | | |
| | |C. If the person selected by the client meets these |to act as the client’s Guide. If disqualified by the county department, the | | |
| | |requirements, the county department shall notify the client|county department must provide written notification within three (3) days of the| | |
| | |verbally or in writing that the person has been approved to|decision to disqualify. The client shall notify the county department within ten| | |
| | |work with them as the Guide. |(10) days if he/she has selected a new Guide. | | |
| | |D. The county department or the SSA may refuse to recognize|E. If a person is disqualified from acting as the Guide, and HE/SHE he or she | | |
| | |the person chosen by the client if the person does not meet|wishes to dispute this decision, he or she may request a formal review through | | |
| | |the requirements in this section. The county department or |the Colorado Department of Human Services, Employment and Benefits Division. The| | |
| | |the SSA will notify the client and the person disqualified |Division will review and make decisions on the dispute. | | |
| | |to act as the client’s Guide. If disqualified by the county| | | |
| | |department, the county department must provide written | | | |
| | |notification within three (3) days of the decision to | | | |
| | |disqualify. The client shall notify the county department | | | |
| | |within ten (10) days if he/she has selected a new Guide. | | | |
| | |E. If a person is disqualified from acting as the Guide, | | | |
| | |and he or she wishes to dispute this decision, he or she | | | |
| | |may request a formal review through the Colorado Department| | | |
| | |of Human Services, Employment and Benefits Division. The | | | |
| | |Division will review and make decisions on the dispute. | | | |
|3.510 |Clarification |“Discontinuation” means that the client who is currently |“Discontinuation” means that the client who is currently receiving A GRANT |Clarified by using the term grant |No |
| |Needed |receiving benefits is no longer eligible and his/her |PAYMENTbenefits is no longer eligible and his OR /her GRANT PAYMENTbenefits will|payment which is consistent | |
| | |benefits will be stopped. |be stopped. |throughout rule body. | |
|3.510 |New Rule Edition| |“EFFECTIVE DATE OF ELIGIBILITY” MEANS THE FIRST DATE A CLIENT IS ELIGIBLE FOR |Added to clarify term used in regards|No |
| | | |THE PUBLIC ASSISTANCE PROGRAM. |to initial payments. | |
|3.510 |New Rule Edition| |“ESTATE” MEANS THE PROPERTY OF THE DECEDENT, TRUST, OR OTHER PERSON WHOSE |Recommended addition by the AG’s |No |
| | | |AFFAIRS ARE SUBJECT TO THE COLORADO PROBATE CODE, TITLE 15, ARTICLE 10, OF THE |office | |
| | | |COLORADO REVISED STATUTES, AS ORIGINALLY CONSTITUTED AND AS IT EXISTS FROM TIME | | |
| | | |TO TIME DURING ADMINISTRATION, AS DEFINED IN SECTION 15-10-201(17), C.R.S. | | |
|3.510 |Clarification |“Equity value of real property” means actual value less |“Equity value of real property” means actual value less encumbrances. |Definition did not match language |No |
| |Needed |encumbrances. | |found throughout rule. | |
|3.510 |Clarification |“Facility” means the residence of a client where the intent|“Facility” means the residence of a client where the intent is either to care |Updated to reflect exclusion of |No |
| |Needed |is either to care for or provide treatment to the client. |for or provide treatment to the client. Facilities include general medical and |community corrections residential | |
| | |Facilities include general medical and surgical hospitals, |surgical hospitals, nursing homes, regional centers, group and host homes, and |programs as they still fall under the| |
| | |nursing homes, regional centers, group and host homes, and |mental health institutions. Facilities do not include penal institutions, such |jurisdiction of penal institution. | |
| | |mental health institutions. Facilities do not include penal|as federal and state prisons or county, local, and municipal jails, AND | | |
| | |institutions, such as federal and state prisons or county, |COMMUNITY CORRECTIONS RESIDENTIAL PROGRAMS. | | |
| | |local, and municipal jails. | | | |
|3.510 |New Rule | |“FEDERAL POVERTY GUIDELINES” ALSO CALLED FEDERAL POVERTY LEVEL (FPL) MEANS THE |New rule defining FPL and | |
| |Addition | |INCOME LEVEL FOR A HOUSEHOLD AS SET FORTH IN THE FEDERAL REGISTER 8 FR 1167, AS |incorporating by reference. | |
| | | |OF JANUARY 15, 2020. THIS RULE DOES NOT CONTAIN ANY LATER AMENDMENTS OR | | |
| | | |EDITIONS. THESE GUIDELINES ARE AVAILABLE FOR NO COST AT | | |
| | | |. THESE GUIDELINES ARE ALSO AVAILABLE FOR PUBLIC| | |
| | | |INSPECTION AND COPYING AT THE COLORADO DEPARTMENT OF HUMAN SERVICES, DIRECTOR OF| | |
| | | |THE EMPLOYMENT AND BENEFITS DIVISION, 1575 SHERMAN STREET, DENVER, COLORADO, | | |
| | | |80203, OR AT ANY STATE PUBLICATIONS LIBRARY DURING REGULAR BUSINESS HOURS. | | |
|3.510 |Clarification |“Fraud” means the deliberate and conscious violation of |“Fraud” means any person who obtains or any person who willfully aids or abets |Definition alignment with Colorado |No |
| |Needed |rules or law for personal economic gain, including making |another to obtain public assistance as defined in title 26 of the c.r.s. to |Works for consistency and to align | |
| | |any falsified claim for payment or benefit issued by the |which the person is not entitled or in an amount greater than that to which the |with statute. | |
| | |county department on behalf of the State Department by the |person is justly entitled or payment of any forfeited installment grants or | | |
| | |client or others or receiving financial benefit from the |benefits to which the person is not entitled or in a greater amount than that to| | |
| | |county department on behalf of the State Department by |which the person is entitled, by means of a willfully false statement or | | |
| | |means of willful misrepresentation including intentional |representation, or by impersonation, or by any other fraudulent device, AS | | |
| | |concealment of essential fact(s) pertinent to determining |DESCRIBED IN SECTION 26-1-127(1), c.r.s. the deliberate and conscious violation | | |
| | |eligibility. |of rules or law for personal economic gain, including making any falsified claim| | |
| | | |for payment or benefit issued by the county department on behalf of the State | | |
| | | |Department by the client or others or receiving financial benefit from the | | |
| | | |county department on behalf of the State Department by means of willful | | |
| | | |misrepresentation including intentional concealment of essential fact(s) | | |
| | | |pertinent to determining eligibility. | | |
|3.510 |Clarification |“Good cause” means the client is unable to provide |“Good cause” means the client is unable to provide verifications, completed |Recommended addition by the Chief |No |
| |Needed |verifications, completed redetermination packets, or |redetermination packets, or otherwise complete eligibility requirements timely |Adjudicator of appeals | |
| | |otherwise complete eligibility requirements timely because |because of circumstances beyond the control of the client. Good cause includes, | | |
| | |of circumstances beyond the control of the client. Good |but is not limited to, DOCUMENTED AND VERIFIABLE medical emergencies or | | |
| | |cause includes, but is not limited to, medical emergencies |hospitalization, A CLIENT an individual who has a disability or other medical | | |
| | |or hospitalization, an individual who has a disability or |condition(s) requiring additional time and/or assistance, a delayed appointment | | |
| | |other medical condition(s) requiring additional time and/or|with the Social Security Administration beyond the client's control, or other | | |
| | |assistance, a delayed appointment with the Social Security |good cause determined reasonable by the county department using THE prudent | | |
| | |Administration beyond the client's control, or other good |person principle. THE FOLLOWING CIRCUMSTANCES DO NOT CONSTITUTE GOOD CAUSE: AN | | |
| | |cause determined reasonable by the county department using |EXCESSIVE WORKLOAD OF A PARTY OR HIS OR HER REPRESENTATIVE OR ATTORNEY; WHEN A | | |
| | |prudent person principle. |PARTY OBTAINS LEGAL REPRESENTATION IN AN UNTIMELY MANNER; A PARTY’S FAILURE TO | | |
| | | |EITHER RECEIVE OR TIMELY RECEIVE, A TIMELY MAILED INITIAL DECISION, OR OTHER | | |
| | | |TIMELY MAILED CORRESPONDENCE FROM THE OFFICE OF ADMINISTRATIVE COURTS AND/OR THE| | |
| | | |OFFICE OF APPEALS, OR FROM THE COUNTY DEPARTMENT, WHEN A PARTY HAS FAILED TO | | |
| | | |ADVISE THE OFFICE OF ADMINISTRATIVE COURTS,THE COUNTY DEPARTMENT, OR THE OFFICE | | |
| | | |OF APPEALS OF A CHANGE OF ADDRESS OR FAILED TO PROVIDE A CORRECT ADDRESS; OR ANY| | |
| | | |OTHER CIRCUMSTANCE WHICH WAS FORESEEABLE OR PREVENTABLE. | | |
|3.510 |New Rule | |“GRANT PAYMENT” MEANS THE ADULT FINANCIAL PROGRAM PAYMENT AND MAY ALSO BE |Added to consolidate the use of |No |
| |Addition | |REFERRED TO AS THE BENEFIT. |multiple terms referring to the AF | |
| | | | |benefit. | |
|3.510 |New Rule | |“GRANT STANDARD” MEANS THE MAXIMUM ADULT FINANCIAL GRANT PAYMENT THAT CAN BE |Added to clarify the difference |No |
| |Addition | |PROVIDED TO A CLIENT BASED ON EACH SPECIFIC ADULT FINANCIAL PROGRAM. |between the payment to the client and| |
| | | | |the maximum amount of eligibility. | |
|3.510 |New Rule | |“HEALTH CARE POLICY AND FINANCING” (HCPF) MEANS THE COLORADO DEPARTMENT OF |Added to eliminate redundancy of |No |
| |Addition | |HEALTH CARE POLICY AND FINANCING. |repeating the full department name | |
| | | | |throughout. | |
|4.510 |New Rule |"HOMELESS"-NEW |“HOMELESS” MEANS A PERSON WITH NO PERMANENT LIVING ARRANGEMENT, I.E., NO REGULAR|Align definition with SSA and Food |No |
| |Addition | |NIGHTTIME OR FIXED PLACE OF RESIDENCE. HE OR SHE IS NEITHER A MEMBER OF A |Assistance definitions of homeless. | |
| | | |HOUSEHOLD NOR A RESIDENT OF AN INSTITUTION. THIS CAN MEAN SOMEONE WHO SLEEPS IN | | |
| | | |A DOORWAY; SUPERVISED SHELTER DESIGNED FOR TEMPORARY ACCOMMODATIONS; A HALFWAY | | |
| | | |HOUSE OR SIMILAR FACILITY THAT PROVIDES TEMPORARY RESIDENCE; A PLACE NOT | | |
| | | |DESIGNED FOR OR ORDINARILY USED AS REGULAR SLEEPING ACCOMMODATIONS FOR HUMAN | | |
| | | |BEINGS, SUCH AS PARKS, BUS STATIONS, ETC.; OR A PERSON WHO STAYS WITH A | | |
| | | |SUCCESSION OF FRIENDS OR RELATIVES AND HAS NO PERMANENT LIVING ARRANGEMENT. | | |
|3.510 |New Rule | |“IM-14” MEANS THE AUTHORIZATION FOR REIMBURSEMENT OF INTERIM ASSISTANCE |Defined term used for the IAR | |
| |Addition | |AVAILABLE AT THE COUNTY DEPARTMENT OR FOUND WITHIN THE STATEWIDE AUTOMATED |process. | |
| | | |SYSTEM. | | |
|3.510 |New Rule | |“IM-19” MEANS THE APPORTIONMENT NOTICE AVAILABLE AT THE COUNTY DEPARTMENT OR |Defined term used for the IAR | |
| |Addition | |FOUND WITHIN THE STATEWIDE AUTOMATED SYSTEM. |process. | |
|3.510 |Clarification |“Immediate family” means: the spouse, parents, and children|“Immediate family” means PEOPLE WITH THE FOLLOWING RELATIONSHIPS TO THE CLIENT: |Definition did not match language |No |
| |Needed |of the client. |the spouse, MINOR AND ADULT CHILDREN, STEPCHILDREN, ADOPTED CHILDREN, parents, |found throughout rule and provides | |
| | | |ADOPTIVE PARENTS, and children of the client AND THE SPOUSES OF THOSE PERSONS. |clarification. | |
|3.510 |Clarification |“In-kind income” means something of value received for the |“In-kind income” means something of value received for the benefit of a client, |Definition did not match language |No |
| |Needed |benefit of a client, spouse of a client, or sponsor(s) of a|spouse of a client, or sponsor(s) of a client AND IS CONSIDERED EITHER EARNED OR|found throughout rule. Also provided| |
| | |client. |UNEARNED INCOME. EXAMPLES OF THIS ARE FOOD OR SHELTER THAT THE CLIENT RECEIVED |additional clarification to the | |
| | | |FOR FREE OR AT FAIR MARKET VALUE OR LESS. |definition. | |
|3.510 |New Rule |“INTENT" AND/OR "INTENTIONALLY"-NEW |“INTENT” AND/OR “INTENTIONALLY" MEANS A PERSON’S CONSCIOUS OBJECTIVE IS TO CAUSE|Recommended addition by the Chief |No |
| |Addition | |THE SPECIFIC RESULT, WHETHER OR NOT THE RESULT OCCURRED, AS DESCRIBED IN SECTION|Adjudicator of appeals. New | |
| | | |18-1-501(5), C.R.S. |definition aligns with and refers | |
| | | | |back to statute. | |
|4.510 |New Rule |"INTENTIONAL PROGRAM VIOLATION (IPV)" NEW |"INTENTIONAL PROGRAM VIOLATION” (IPV) OCCURS WHEN AN INDIVIDUAL MAKES A FALSE OR|New definition adding Intentional |No |
| |Addition | |MISLEADING STATEMENT OR FAILS TO DISCLOSE BY MISREPRESENTATION OR CONCEALMENT OF|Program Violation to rules to comply | |
| | | |FACTS, OR ACTS IN A WAY THAT IS INTENDED TO MISLEAD OR CONCEAL ANY ELIGIBILITY |with statutory requirements. This | |
| | | |FACTOR ON ANY APPLICATION OR OTHER WRITTEN AND/OR ELECTRONIC COMMUNICATION FOR |definition aligns with the Colorado | |
| | | |THE PURPOSE OF ESTABLISHING OR MAINTAINING ELIGIBILITY TO: |Works definition. | |
| | | |1. RECEIVE A GRANT PAYMENT FOR WHICH THE CLIENT IS NOT ELIGIBLE; OR, | | |
| | | |2. INCREASE A GRANT PAYMENT FOR WHICH THE CLIENT IS NOT ELIGIBLE; OR, | | |
| | | |3. PREVENT A DENIAL, REDUCTION OR TERMINATION OF A GRANT PAYMENT. | | |
|3.510 |Clarification |“Intermittent redetermination” means a redetermination that|“Intermittent redetermination” means a redetermination that is generated prior |No longer using an intermittent |No |
| |Needed |is generated prior to the annual redetermination date due |to the annual redetermination date due to questionable circumstances surrounding|redetermination process. | |
| | |to questionable circumstances surrounding the case, a |the case, a client moving to a new county, or other reasons. | | |
| | |client moving to a new county, or other reasons. | | | |
|3.510 |New Rule |“IRREGULAR”-NEW |“IRREGULAR” (RELATED TO INCOME) MEANS INCOME WHICH AN INDIVIDUAL CANNOT |Clarify what is meant when income is |No |
| |Addition | |REASONABLY EXPECT TO RECEIVE ON A MONTHLY BASIS. |received sporadically. | |
|3.510 |New Rule | |“LEGAL FIDUCIARY” MEANS A PERSON OR AGENCY WHO HOLDS THE LEGAL POWER TO ACT ON |Added to define the term used in |No |
| |Addition | |BEHALF OF A CLIENT AND IS REQUIRED TO ACT IN THE BEST INTEREST OF THE CLIENT. |reference to resources and the | |
| | | | |pursuit of potential income. | |
|3.510 |New Rule | |“LIABLE INDIVIDUAL” MEANS A PERSON FINANCIALLY RESPONSIBLE FOR AN OVERPAYMENT |Added to | |
| |Addition | |INCLUDING THE CLIENT, SPONSOR(S) OF A CLIENT, A PAYEE, PARENTS OF DEPENDENT | | |
| | | |CHILDREN, AND/OR OTHER PERSONS DETERMINED TO BE FINANCIALLY LIABLE BY A COURT. | | |
|3.510 |Clarificaiton |“Life Estate” means a legal estate planning procedure in |“Life Estate” means a legal estate planning procedure in which the client |Clarify that the client is the life |No |
| |Needed |which the client transfers real property to another |transfers real property to another individual but retains the right of occupancy|tenant. | |
| | |individual but retains the right of occupancy and income |and income from the property during the client's lifetime. The life estate's | | |
| | |from the property during the client's lifetime. The life |duration is limited to the life of the individualCLIENT. The life tenantCLIENT, | | |
| | |estate's duration is limited to the life of the individual.|during his or her life, retains the use and possession of the property, the | | |
| | |The life tenant, during his or her life, retains the use |rights to rents and profits, and the costs of maintaining the property. The life| | |
| | |and possession of the property, the rights to rents and |tenantCLIENT cannot sell or waste the property without the consent of the | | |
| | |profits, and the costs of maintaining the property. The |person(s) to whom the property was transferred. | | |
| | |life tenant cannot sell or waste the property without the | | | |
| | |consent of the person(s) to whom the property was | | | |
| | |transferred. | | | |
|3.510 |New Rule | |“LOCAL SERVICE DELIVERY AGENCY” MEANS AN AGENCY OPERATING ON BEHALF OF THE |Addition of rules from previous |No |
| |Addition | |COUNTY DEPARTMENT OR STATE DEPARTMENT TO DETERMINE ALL OR PART OF A CLIENT’S |Section 3.800 required new | |
| | | |ELIGIBILITY FOR ADULT FINANCIAL PROGRAMS. |definition. | |
|3.510 |Clarification |“Marriage” (for the purpose of these rules) means a |“Marriage” (for the purpose of these rules) means a marriage as defined in |Updated statutory references needed. |No |
| |Needed |marriage as defined in Section 14-2-101, C.R.S., a common |Section 14-2-10114-2-104(1), C.R.S., a common law marriage as defined in Section| | |
| | |law marriage as defined in Section 14-2-101, C.R.S., and a |14-2-10114-2-104(2), C.R.S., and a civil union, as defined in Section 14- | | |
| | |civil union, as defined in Section 14-15-101, C.R.S. |15-10114-15-103(1), C.R.S. | | |
|34.510 |New Rule |"MATERIAL FACT"- NEW |“MATERIAL FACT” MEANS INFORMATION THAT HAS LOGICAL CONNECTION TO THE |Recommended addition by the Chief |No |
| |Addition | |CONSEQUENCES AND/OR THE DECISION BEING DETERMINED AND THE NATURE OF THE |Adjudicator of appeals. | |
| | | |INFORMATION OR FACT IS SUCH THAT A REASONABLE PERSON UNDER THE CIRCUMSTANCES | | |
| | | |WOULD ATTACH IMPORTANCE TO IT IN DETERMINING HIS OR HER COURSE OF ACTION. | | |
|3.510 |Clarification |“Non-recipient spouse” means the client's spouse who is not|“Non-recipient spouse” means the client's spouse who is not receiving AN ADULT |Added clarifying words. |No |
| |Needed |receiving financial benefits. |financial GRANT PAYMENT benefits. | | |
|3.510 |New Rule | |“OVERPAYMENT” MEANS A GRANT PAYMENT WAS MADE IN EXCESS OF THE AMOUNT A CLIENT |Addition of rules from previous |No |
| |Addition | |WAS ELIGIBLE FOR. |Section 3.800 required new | |
| | | | |definition. | |
|3.510 |Clarification |“Potential income” means a benefit or payment to which the |“Potential income” means a benefit or payment to which the client, spouse of a |Added missing types of income which |No |
| |Needed |client, spouse of a client, or sponsor(s) of a client may |client, or sponsor(s) of a client may be entitled and could secure, such as |are common to obtain. | |
| | |be entitled and could secure, such as annuities, pensions, |SPOUSAL SUPPORT, annuities, pensions, retirement or disability benefits, | | |
| | |retirement or disability benefits, veterans compensation |veterans compensation and pensions, workers' compensation, Social Security | | |
| | |and pensions, workers' compensation, Social Security |retirement or disability benefits, SUPPLEMENTAL SECURTIY INCOME (SSI) benefits, | | |
| | |retirement or disability benefits, SSI benefits, and |and unemployment compensation. | | |
| | |unemployment compensation. | | | |
|3.510 |Clarification |“Potential resource” means a resource to which the client, |“Potential resource” means a resource to which the client, spouse of a client, |Added examples to clarify. |No |
| |Needed |spouse of a client, or sponsor(s) of a client has the legal|or sponsor(s) of a client has the legal ability to acquire or reacquire rights | | |
| | |ability to acquire or reacquire rights of ownership. |of ownership, SUCH AS INHERITANCES, REAL AND PERSONAL PROPERTY, AND SETTLEMENTS.| | |
|3.510 |New Rule | |“PREPONDERANCE OF EVIDENCE” MEANS THAT THE EVIDENCE MUST PREPONDERATE OVER, OR |Addition of rules from previous |No |
| |Addition | |OUTWEIGH, EVIDENCE TO THE CONTRARY. |Section 3.800 required new | |
| | | | |definition. | |
|3.510 |Clarification |“Qualified non-citizen” means an individual who is not a |“Qualified non-citizen” ALSO CALLED QUALIFIED ALIEN means an individual who is |Updated the CFR reference and reduced|No |
| |Needed |citizen or national of the United States and who was |not a citizen or national of the United States and who was lawfully admitted to |text as the list included is in the | |
| | |lawfully admitted to the United States by the United States|the United States by the United States Citizenship and Immigration Services |federal code and subject to | |
| | |Citizenship and Immigration Services (USCIS) as an actual |(USCIS) as an actual or prospective permanent resident or whose physical |adjustments. | |
| | |or prospective permanent resident or whose physical |presence is known and allowed by the USCIS. A qualified non-citizen is defined | | |
| | |presence is known and allowed by the USCIS. A qualified |as follows, consistent with the provisions of federal regulations found at 45 | | |
| | |non-citizen is defined as follows consistent with the |CFR 1626.7 as of DECEMBER 30, 2016 October 1, 2010, WHICH ARE herein | | |
| | |provisions of federal regulations found at 45 CFR 1626.7 as|incorporated BY REFERENCE. This rule does not contain any later amendments or | | |
| | |of October 1, 2010, herein incorporated. This rule does not|editions. THESE REGULATIONS ARE AVAILABLE AT NO COST AT . | | |
| | |contain any later amendments or editions. Copies of these |THESE REGULATIONS ARE ALSO AVAILABLE FOR PUBLIC INSPECTION AND COPYING AT the | | |
| | |federal laws are available from the Colorado Department of |Colorado Department of Human Services, Director of the Employment and Benefits | | |
| | |Human Services, Director of the Employment and Benefits |Division, 1575 Sherman Street, Denver, Colorado, 80203, or at any state | | |
| | |Division, 1575 Sherman Street, Denver, Colorado, 80203, or |publications library DURING REGULAR BUSINESS HOURS.: | | |
| | |at any state publications library:A. A non-citizen lawfully|A. A non-citizen lawfully admitted for permanent residence; | | |
| | |admitted for permanent residence;B. A non-citizen paroled |B. A non-citizen paroled into the United States under Section 212(d)(5) of the | | |
| | |into the United States under Section 212(d)(5) of the |Immigration and Naturalization Act (INA) for a period of at least 1 year; | | |
| | |Immigration and Naturalization Act (INA) for a period of at|C. A non-citizen granted conditional entry pursuant to Section 203(a)(7) of the | | |
| | |least 1 year;C. A non-citizen granted conditional entry |INA prior to April 1, 1980; | | |
| | |pursuant to Section 203(a)(7) of the INA prior to April 1, |D. A refugee under Section 207 of the INA; | | |
| | |1980;D. A refugee under Section 207 of the INA;E. An asylee|E. An asylee under Section 208 of the INA; | | |
| | |under Section 208 of the INA;F. A non-citizen whose |F. A non-citizen whose deportation is withheld under Section 243(h) or 241(B)(3)| | |
| | |deportation is withheld under Section 243(h) or 241(B)(3) |of the INA; | | |
| | |of the INA;G. A Cuban or Haitian entrant as defined in |G. A Cuban or Haitian entrant as defined in Section 501(3) of the Refuge | | |
| | |Section 501(3) of the Refuge Education Assistance Act of |Education Assistance Act of 1980; | | |
| | |1980;H. A Victim of Severe Form of Trafficking who has been|H. A Victim of Severe Form of Trafficking who has been certified as such by the | | |
| | |certified as such by the U.S. Dept. of Health and Human |U.S. Dept. of Health and Human Services (HHS); | | |
| | |Services (HHS);I. Iraqis and Afghans granted Special |I. Iraqis and Afghans granted Special Immigrant Visa status under Section | | |
| | |Immigrant Visa status under Section 101(A)(27) of the |101(A)(27) of the INA; | | |
| | |INA;J. A non-citizen who has been battered or subjected to |J. A non-citizen who has been battered or subjected to extreme cruelty in the | | |
| | |extreme cruelty in the U.S. by a family member;K. A |U.S. by a family member; | | |
| | |non-citizen admitted to the U.S. as an Amerasian immigrant |K. A non-citizen admitted to the U.S. as an Amerasian immigrant pursuant to | | |
| | |pursuant to Section 584 of the Foreign Operations, Export |Section 584 of the Foreign Operations, Export Financing, and Related Programs | | |
| | |Financing, and Related Programs Appropriations Act of 1988 |Appropriations Act of 1988 (as amended by P.L. No. 100-461); or, | | |
| | |(as amended by P.L. No. 100-461); or,L. An individual who |L. An individual who was born in Canada and possesses at least fifty percent | | |
| | |was born in Canada and possesses at least fifty percent |(50%) American Indian blood or is a member of an Indian tribe as defined in 25 | | |
| | |(50%) American Indian blood or is a member of an Indian |U.S.C. Sec. 450B(E). | | |
| | |tribe as defined in 25 U.S.C. Sec. 450B(E). | | | |
|3.510 |New Rule |"QUESTIONABLE"-NEW |“QUESTIONABLE” MEANS THE INFORMATION PROVIDED IS UNCLEAR OR CONFLICTING OR THE |New definition added to clarify the |No |
| |Addition | |COUNTY HAS REASON TO BELIEVE THE FACTS PRESENTED ARE CONTRARY TO THE INFORMATION|term questionable and indicate when | |
| | | |PROVIDED BY THE CLIENT. |additional verification may be | |
| | | | |necessary. | |
|3.510 |Rule Deletion |“Recipient” means a person who is currently receiving or |“Recipient” means a person who is currently receiving or previously received. |Definition was duplicative of client.|No |
| | |previously received. | |The term client is used throughout | |
| | | | |for consistency. | |
|3.510 |Clarification |“Recovery” means the collection of a valid claim to repay |“Recovery” means the collection of a valid claim to repay GRANT PAYMENTSbenefits|Clarified using the term grant |No |
| | |benefits to which a client was not entitled. |to which a client was not entitled. |payment which is now used throughout | |
| | | | |rule to reference the AF benefit. | |
|3.510 |Clarification |“Resources” means real and personal property held as of the|“Resources” means real and personal property held as of the first day of a |Clarifying to expand beyond just the |No |
| |Needed |first day of a calendar month or as of the date of |calendar month or as of the date of application if not counted as income IN THE |application timeframe. | |
| | |application if not counted as income for the application |SAME for the application month. | | |
| | |month. | | | |
|3.510 |New Rule |"SCHEDULED APPOINTMENT" OR "SCHEDULED INTERVIEW"- NEW |“SCHEDULED APPOINTMENT” OR “SCHEDULED INTERVIEW” MEANS AN APPOINTMENT OR |Included to ensure adequate notice is|No |
| |Addition | |INTERVIEW SET USING A STATE PRESCRIBED OR STATE APPROVED APPOINTMENT NOTICE |provided. | |
| | | |PROVIDED TO THE CLIENT. | | |
|3.510 |New Rule |"SHELTER COSTS"- NEW |“SHELTER COSTS” MEANS MORTGAGE PAYMENTS, PROPERTY INSURANCE (IF REQUIRED), HOME |Definition provides greater |No |
| |Addition | |OWNER ASSOCIATION DUES, RENT, GAS, ELECTRICITY, HEATING FUEL, WATER, SEWER, |clarification of the items included | |
| | | |GARBAGE COLLECTION SERVICE, AND REAL PROPERTY TAXES. TELEPHONE, INTERNET AND |in shelter costs. | |
| | | |TELEVISION PROVIDER SERVICES ARE NOT ALLOWABLE SHELTER COSTS. | | |
|3.510 |New Rule |“SIGNATURE"- NEW |“SIGNATURE” MEANS HANDWRITTEN SIGNATURES, ELECTRONIC SIGNATURE TECHNIQUES, |Definition provides what is |No |
| |Addition | |RECORDED TELEPHONIC SIGNATURES, OR DOCUMENTED GESTURED SIGNATURES. A VALID |acceptable for a signature on an | |
| | | |HANDWRITTEN SIGNATURE INCLUDES A DESIGNATION OF AN X. |application. Aligns with Food | |
| | | | |Assistance. | |
|3.510 |Clarification |“Sponsor” means any person(s) who executed an affidavit of |“Sponsor” means any person(s) who executed an affidavit of support (INS USCIS |Definition provides guidance |No |
| |Needed |support or similar agreement with the United States |FORM I-864 OR I-864A (MARCH 6, 2018) OR ANOTHER FORM DEEMED LEGALLY BINDING BY |regarding the types of forms utilized| |
| | |Citizenship and Immigration Service (USCIS) on behalf of a |THE DEPARTMENT OF HOMELAND SECURITY or similar agreement with the United States |to obtain a sponsor and adds | |
| | |non-citizen as a condition of entry into the United States.|Citizenship and Immigration Service (USCIS) on behalf of a non-citizen as a |incorporation by reference. | |
| | | |condition of THE NON-CITIZEN'S DATE OF entry OR ADMISSION into the United States| | |
| | | |AS A PERMANENT RESIDENT. THESE FORMS ARE HEREIN INCORPORATED BY REFERENCE. THIS | | |
| | | |RULE DOES NOT CONTAIN ANY LATER AMENDMENTS OR EDITIONS. THESE FORMS ARE | | |
| | | |AVAILABLE AT NO COST FROM . THESE FORMS ARE ALSO | | |
| | | |AVAILABLE FOR PUBLIC INSPECTION AND COPYING AT THE COLORADO DEPARTMENT OF HUMAN | | |
| | | |SERVICES, DIRECTOR OF THE EMPLOYMENT AND BENEFITS DIVISION, 1575 SHERMAN STREET,| | |
| | | |DENVER, COLORADO, 80203, OR AT ANY STATE PUBLICATIONS LIBRARY DURING REGULAR | | |
| | | |BUSINESS HOURS. | | |
|3.510 |New Rule | |“SSI BENEFIT STANDARD” MEANS THE MAXIMUM MONTHLY FEDERAL AMOUNT FOR A SSI |Clarifies term used in deeming rules |No |
| |Addition | |RECIPIENT AS LISTED IN FEDERAL REGULATIONS FOUND AT 20 CFR 416.405-415 (2019), |and adds incorporation by reference. | |
| | | |WHICH ARE HEREIN INCORPORATED BY REFERENCE. THIS RULE DOES NOT CONTAIN ANY LATER| | |
| | | |AMENDMENTS OR EDITIONS. THESE REGULATIONS ARE AVAILABLE FOR NO COST AT | | |
| | | |. THESE REGULATIONS ARE ALSO AVAILABLE FOR PUBLIC | | |
| | | |INSPECTION AND COPYING AT THE COLORADO DEPARTMENT OF HUMAN SERVICES, DIRECTOR OF| | |
| | | |THE EMPLOYMENT AND BENEFITS DIVISION, 1575 SHERMAN STREET, DENVER, COLORADO, | | |
| | | |80203, OR AT ANY STATE PUBLICATIONS LIBRARY DURING REGULAR BUSINESS HOURS. | | |
|3.510 |Clarification |“State Department” means the Colorado Department of Human |“State Department” OR “THE DEPARTMENT” means the Colorado Department of Human |Added the term The Department which |No |
| |Needed |Services. |Services. |is used more commonly throughout the | |
| | | | |body of the rule. | |
|3.510 |New Rule | |“STATEWIDE AUTOMATED SYSTEM” MEANS THE ELECTRONIC PLATFORM USED TO CALCULATE |Added to define term used throughout |No |
| |Addition | |PUBLIC ASSISTANCE PROGRAM BENEFITS AND GRANT PAYMENTS. |rule. | |
|3.510 |Clarification |“Termination” means that the client who is currently |“Termination” means that the client who is currently receiving Adult Financial |Updated to use the term Grant Payment|No |
| |Needed |receiving Adult Financial program benefits is no longer |program GRANT PAYMENTS benefits is no longer eligible and his OR /her GRANT |which is used throughout rule to | |
| | |eligible and his/her benefits will be stopped. |PAYMENTSbenefits will be stopped. |reference AF benefits. | |
|3.510 |New Rule |"TIMELY NOTICE"- NEW |“TIMELY NOTICE” MEANS THE COUNTY SHALL GENERATE A NOTICE TO THE CLIENT AT LEAST |Definition necessary to ensure |No |
| |Addition | |ELEVEN (11) CALENDAR DAYS PRIOR TO THE INITIATION OF ANY DECREASE, SUSPENSION, |appropriate notice is given to | |
| | | |TERMINATION, OR DISCONTINUANCE IN GRANT PAYMENTS OR SERVICES. THIS SHALL BE SENT|individuals prior to a change in | |
| | | |TO HIS OR HER LAST KNOWN ADDRESS. |benefits. | |
|3.510 |Technical |“Transfer Without Fair Consideration (TWFC)” means a |“Transfer Without Fair Consideration” (TWFC)” means a property transaction in |Updated where the “ is to align with |No |
| |Clean-Up |property transaction in which the proceeds of the transfer,|which the proceeds of the transfer, assignment, or sale are less than the actual|other definitions. | |
| | |assignment, or sale are less than the actual value of the |value of the resource. | | |
| | |resource. | | | |
|3.510 |Clarification |“Unearned income” means any income that is not earned |“Unearned income” means any income that is not earned through employment or |Recommended addition by the Chief |No |
| |Needed |through employment or self-employment. |self-employment. IT INCLUDES MONEY TRANSFERS, SUCH AS THE TRANSFER OF MONEY INTO|Adjudicator of appeals. | |
| | | |ONE’S CHECKING ACCOUNT FROM THAT PERSON’S OR ANOTHER PERSON’S MONEY ACCOUNT | | |
| | | |REGARDLESS OF THE TYPE OF ACCOUNT, INCLUDING, BUT NOT LIMITED TO, SAVINGS | | |
| | | |ACCOUNT(S), RETIREMENT ACCOUNT(S), OR ANY OTHER TYPE OF MONEY ACCOUNT. | | |
|3.510 |New Rule |“UNINTENTIONAL" OR "WITHOUT INTENT”- NEW |“UNINTENTIONAL” OR “WITHOUT INTENT” MEANS AN ACT, OR SOMETHING DONE OR PERFORMED|Recommended addition by the Chief |No |
| |Addition | |THAT WAS NOT VOLUNTARY OR INTENDED. |Adjudicator of appeals. | |
|3.510 |Clarification |“Verification” means confirming the accuracy of statements,|“Verification” means confirming the accuracy of statements, application |Removal of redundant language. |No |
| |Needed |application information, and other case information by |information, and other case information by obtaining written, audio, or OTHER | | |
| | |obtaining written, audio, or video evidence or other |video evidence or other information that proves such fact or statement to be | | |
| | |information that proves such fact or statement to be true. |true. | | |
|3.510 |New Rule |"VERIFIED UPON RECEIPT"- NEW |“VERIFIED UPON RECEIPT” MEANS INFORMATION THAT IS PROVIDED DIRECTLY FROM THE |Added missing definition. |No |
| |Addition | |PRIMARY SOURCE AND IS NOT QUESTIONABLE AND NO ADDITIONAL VERIFICATION IS | | |
| | | |REQUIRED. | | |
|3.510 |New Rule |"WILLFUL"- NEW |“WILLFUL” MEANS THAT A PERSON IS AWARE THAT HIS OR HER CONDUCT IS PRACTICALLY |Recommended addition by the Chief |No |
| |Addition | |CERTAIN TO CAUSE THE RESULT AS DESCRIBED IN SECTION 18-1-501(6), C.R.S. |Adjudicator of appeals and aligns | |
| | | | |with statute. | |
|3.510 |New Rule |"WILLFUL WITHHOLDING OF INFORMATION"-NEW |"WILLFUL WITHHOLDING OF INFORMATION" INCLUDES: |Definition alignment with Colorado |No |
| |Addition | |A. WILLFUL MISSTATEMENT INCLUDING UNDERSTATEMENT, OVERSTATEMENT, OR OMISSION, |Works for consistency. | |
| | | |WHETHER VERBAL OR WRITTEN, MADE BY A CLIENT IN RESPONSE TO VERBAL OR WRITTEN | | |
| | | |QUESTIONS FROM THE COUNTY DEPARTMENT; | | |
| | | |B. WILLFUL FAILURE BY A CLIENT TO REPORT CHANGES IN INCOME OR OTHER | | |
| | | |CIRCUMSTANCES WHICH MAY AFFECT THE AMOUNT OF GRANT PAYMENT; AND/OR, | | |
| | | |C. WILLFUL FAILURE BY THE CLIENT TO REPORT RECEIPT OF A GRANT PAYMENT MADE BY | | |
| | | |THE COUNTY DEPARTMENT TO THE CLIENT WHICH THE CLIENT KNEW REPRESENTED AN | | |
| | | |OVERPAYMENT. | | |
|3.510 |Clarification |“Withdrawal” means an application is not processed because |“WITHDRAW” OR “Withdrawal” means an application is not processed because the |Modification necessary to capture |No |
| |Needed |the client who submitted the application withdraws his/her |client who submitted the application withdraws his OR /her request for |term used most often in rules. | |
| | |request for assistance prior to eligibility determination. |assistance prior to eligibility determination, OR REQUESTS HIS OR HER GRANT | | |
| | | |PAYMENT BE DISCONTINUED. | | |
|3.520.1 |Clarification |A. Information concerning public assistance programs shall |A. Information concerning public assistance programs shall be available to all |Add statutory requirement of the |No |
| |Needed |be available to all persons in the community. Available |persons in the community. Available information shall include: |State and County Departments to | |
| | |information shall include: |1. Benefits and programs available; |provide outreach for the PTC program.| |
| | |1. Benefits and programs available; |2. Eligibility requirements; |Also added provision of info on EITC | |
| | |2. Eligibility requirements; |3. Related services; and, |which is a great benefit for clients | |
| | |3. Related services; and, |4. Rights and responsibilities of clients; |who have children or may be caring | |
| | |4. Rights and responsibilities of clients. |5. THE PROPERTY TAX/RENT/HEAT CREDIT (PTC) REBATE ELIGIBILITY INFORMATION |for grandchildren in the home. | |
| | | |AVAILABLE THROUGH THE COLORADO DEPARTMENT OF REVENUE; AND, | | |
| | | |6. EARNED INCOME TAX CREDIT (EITC). | | |
|3.520.1 |Clarification |B. The county department shall:1. Receive applications and |B. The county department shall: |Modify rule to include additional |No |
| |Needed |assist the client to complete the application and secure |1. Receive applications AND DATE ALL APPLICATIONS and assist the client to |referrals the county should give the | |
| | |documentation when needed;2. Provide language translation |complete the application and secure documentation when needed; |client. Also clarifies the | |
| | |via an interpreter, as needed;3. Inform the client of |2. Provide language translation via an interpreter, as needed; |requirement to request verification | |
| | |his/her responsibility to accurately and fully complete the|3. Inform the client of his OR /her responsibility to accurately and fully |and obtain collateral contacts. | |
| | |application and provide documents to substantiate |complete the application and provide documents to substantiate eligibility | | |
| | |eligibility factors;4. Inform the client that he/she may |factors; | | |
| | |use friends, relatives, or other persons to assist in the |4. Inform the client that he OR /she may use friends, relatives, or other | | |
| | |completion of the application;5. Inform the client, in |persons to assist in the completion of the application; | | |
| | |writing at the time of application, that the county |5. Inform the client, in writing at the time of application, that the county | | |
| | |department shall use the client's Social Security Number |department shall use the client's Social Security Number (SSN) to obtain | | |
| | |(SSN) to obtain information available through the Income |information available through the Income and Eligibility Verification System | | |
| | |and Eligibility Verification System (IEVS) to verify income|(IEVS) to verify income and that such information may be shared with other | | |
| | |and that such information may be shared with other |assistance programs, other states, the Social Security Administration, the | | |
| | |assistance programs, other states, the Social Security |Department of Labor and Employment, and the Child Support SERVICES Enforcement | | |
| | |Administration, the Department of Labor and Employment, and|program; | | |
| | |the Child Support Enforcement program;6. Refer the client |6. CONDUCT AN EVALUATION OF NEEDS RELATED TO THE CLIENT’S HEALTH AND WELL-BEING.| | |
| | |to other agencies or services available in the community, |BASED ON IDENTIFIED NEEDS, THE COUNTY WORKER WILL RRefer the client to other | | |
| | |such as food banks, Area Agencies on Aging, or the Division|agencies or services available in the community, such as food banks, Area | | |
| | |of Vocational Rehabilitation;7. Refer the client to the |Agencies on Aging (AAA), AGING AND DISABILITY RESOURCES FOR COLORADO (ADRC), or | | |
| | |other benefits for which he/she may be eligible;8. Inform |the Division of Vocational Rehabilitation (DVR); | | |
| | |the client that he/she may terminate the application |7. Refer the client to the other benefits for which he OR /she may be eligible; | | |
| | |process at any time;A decision by the applicant to |8. Inform the client that he OR /she may terminate the application process at | | |
| | |“withdraw” shall be treated as a denial by the county |any time; | | |
| | |department. The applicant shall be notified of the county |A decision by the applicant CLIENT to “withdraw” shall be treated as a denial by| | |
| | |department's action by the state approved Notice of Action |the county department. The applicant CLIENT shall be notified of the county | | |
| | |form within ten (10) calendar days of the action.9. Review |department's action by the state approved Notice of Action form within ELEVEN | | |
| | |applications and determine eligibility for assistance; |(11) ten (10) calendar days of the action. | | |
| | |and,10. Calculate all claims, initiate recoveries, and |9. Review applications, MAKE NECESSARY COLLATERAL CONTACTS OR REQUEST ANY NEEDED| | |
| | |prepare for and appear at all appeals. |VERIFICATION, and determine eligibility for assistance; and, | | |
| | | |10. Calculate all claims, initiate recoveries, and prepare for and appear at all| | |
| | | |appeals. | | |
|3.520.1 |Clarification |C. The county department shall require a written |C. The county department shall require a written application, signed under |Rule changed to align with Food |No |
| |Needed |application, signed under penalty of perjury, using the |penalty of perjury, using the State Department's prescribed public assistance |Assistance of what information is | |
| | |State Department's prescribed public assistance application|application form. THE DATE OF APPLICATION SHALL BE THE FIRST WORKING DAY THE |necessary to accept an application. | |
| | |form. The application form shall be used as the primary |COUNTY DEPARTMENT RECEIVES A SIGNED APPLICATION FORM, INDICATING THE CLIENT'S |Further input provided during the | |
| | |source of information and shall contain, at a minimum:1. |DESIRE TO RECEIVE PUBLIC ASSISTANCE BENEFITS. INCOMPLETE APPLICATIONS SHALL BE |work group so does not fully align | |
| | |The name, date of birth, and residence of the client;2. The|DENIED FOLLOWING THE POLICIES OUTLINED IN SECTION 3.554. FOR CLIENTS WHO HAVE |with Food Assistance. | |
| | |program(s) requested by the client;3. A list of all income |BEEN COMMITTED TO A FACILITY BY ORDER OF THE DISTRICT OR PROBATE COURT OR WHO | | |
| | |and resources available to the client at the time of |HAVE BEEN MADE A WARD OF THE STATE, APPLICATION FOR AN ADULT FINANCIAL PROGRAM | | |
| | |application;4. Any other information required by state and |SHALL BE COMPLETED BY THE FACILITY'S ADMINISTRATION OR THE CLIENT'S GUARDIAN. | | |
| | |federal law or regulation; and,5. The signature of the |The application form shall be used as the primary source of information and TO | | |
| | |client, parent, legal guardian, or authorized |BE CONSIDERED COMPLETE, shall contain, at a minimum: | | |
| | |representative.a. A client who may be partially or totally |1. The name, date of birth, and residence of the client; | | |
| | |illiterate or cannot write his/her name shall make a |2. The program(s) requested by the client; | | |
| | |mark.b. The mark shall be witnessed by the signature and |3. A list of all income and resources available to the client at the time of | | |
| | |address of at least one witness.c. A county department |application; | | |
| | |staff member may act as witnesses if he/she is not related |4. Any other information required by state and federal law or regulation; and, | | |
| | |to the client; and,6. The date of application shall be the |5. The NAME OF THE APPLICANT AND signature of the APPLICANT client, parent, | | |
| | |first working day the county department receives a signed |legal guardian, FACILITY ADMINISTRATION or authorized representative AND AN | | |
| | |application form, indicating the client's desire to receive|ADDRESS FOR THE APPLICANT WHICH CAN INCLUDE GENERAL DELIVERY OR A COUNTY OFFICE.| | |
| | |public assistance benefits.7. Incomplete applications shall|IF AN ADDRESS IS NOT PROVIDED, ANOTHER MEANS OF CONTACT SUCH AS PHONE NUMBER OR | | |
| | |be denied. |EMAIL ADDRESS SHALL BE UTILIZED TO OBTAIN AN ADDRESS. | | |
| | | |A CLIENT WHO MAY BE PARTIALLY OR TOTALLY ILLITERATE CAN SATISFY THE SIGNATURE | | |
| | | |REQUIREMENT BY: | | |
| | | |1.a. A client who may be partially or totally illiterate or cannot write his/her| | |
| | | |name shall makeMAKING a mark ON THE SIGNATURE LINE. | | |
| | | |2.b. The mark shall be witnessed by AT LEAST ONE OTHER INDIVIDUAL. THE WITNESS | | |
| | | |SHALL PROVIDE HIS OR HER OWNthe signature and address NEXT TO THE CLIENT’S MARK | | |
| | | |IN THE SIGNATURE BLOCK of at least one witness. | | |
| | | |3.c. A county department staff member may act as witnesses if he OR /she is not | | |
| | | |related to the client.; and, | | |
| | | |6. The date of application shall be the first working day the county department | | |
| | | |receives a signed application form, indicating the client's desire to receive | | |
| | | |public assistance benefits. | | |
| | | |7. Incomplete applications shall be denied. | | |
|3.520.1 |Clarification |D. The client shall be required to answer all applicable |D. The client shall be required to answer all applicable questions on the |Clarifies that information not |No |
| |Needed |questions on the application form. If the client does not |application form. If the client does not answer any question(s) in writing on |initially declared by the applicant | |
| | |answer any question(s) in writing on the form, the |the form, the question(s) shall be asked of the client during the interview and |must be updated on the application or| |
| | |question(s) shall be asked of the client during the |the client must provide an answer at that time. ANY QUESTIONS NOT ANSWERED IN |within CBMS. | |
| | |interview and the client must provide an answer at that |WRITING ON THE APPLICATION SHALL BE ASKED OF THE CLIENT DURING THE INTERVIEW AND| | |
| | |time. |THE CLIENT MUST PROVIDE AN ANSWER AT THAT TIME. THE RESPONSE MUST BE DOCUMENTED | | |
| | | |ON THE APPLICATION OR ENTERED INTO THE STATEWIDE AUTOMATED SYSTEM. | | |
|3.520.1 |New Rule |NEW |G. THE CLIENT HAS THE RIGHT TO DECIDE HOW TO USE HIS OR HER GRANT PAYMENT. THE |Alignment with Colorado Works for |No |
| |Addition | |COUNTY DEPARTMENT SHALL NOT: |consistency. | |
| | | |1. IMPOSE ANY RESTRICTION, EITHER DIRECT OR IMPLIED, ON A CLIENT’S USE OF HIS OR| | |
| | | |HER GRANT PAYMENT INCLUDING, BUT NOT LIMITED TO, REQUESTING A CLIENT TO PROVIDE | | |
| | | |RECEIPTS OR PROOF OF HOW THE MONEY HAS BEEN SPENT; OR, | | |
| | | |2. REQUIRE THE CLIENT TO ACCOUNT FOR THE USE OF THE GRANT PAYMENT, EXCEPT FOR | | |
| | | |THE ELECTRONIC BENEFITS TRANSFER (EBT) CARD POINT OF SALE LIMITATIONS LISTED IN | | |
| | | |26-2-104(2), C.R.S.; OR, | | |
| | | |3. GIVE ASSISTANCE TO CREDITORS IN THE COLLECTION OF THE CLIENT’S DEBTS. | | |
|3.520.1 |Incorporation of|NEW |H. EACH CLIENT OF FINANCIAL ASSISTANCE PROVIDED UNDER ADULT FINANCIAL PROGRAMS, |Addition of rules from previous |No |
| |9 C.C.R. 2503-8 | |SHALL RECEIVE PRIOR WRITTEN NOTICE OF ANY AGENCY ACTION AFFECTING HIS OR HER |Section 3.800 | |
| | | |ELIGIBILITY FOR OR RECEIPT OF GRANT PAYMENTS. | | |
| | | |1. THE CLIENT SHALL BE NOTIFIED IN WRITING OF COUNTY DEPARTMENT APPROVAL OF: | | |
| | | |A. AN APPLICATION FOR FINANCIAL ASSISTANCE THROUGH THE ADULT FINANCIAL PROGRAMS;| | |
| | | |B. AN INCREASE IN THE AMOUNT OF GRANT PAYMENT. TO THE EXTENT PRACTICABLE, NOTICE| | |
| | | |SHALL BE IN HIS OR HER PRIMARY LANGUAGE AND SHALL BE MAILED OR DELIVERED WITHIN | | |
| | | |ELEVEN CALENDAR DAYS AFTER THE DETERMINATION IS MADE. IF THE CLIENT NEEDS | | |
| | | |ASSISTANCE IN UNDERSTANDING THE ACTION, THE ACTION SHALL BE EXPLAINED VERBALLY. | | |
| | | |C. IF THE CLIENT IS DISSATISFIED WITH THE EFFECTIVE DATE OF ELIGIBILITY, OR THE | | |
| | | |AMOUNT OR TYPE OF ASSISTANCE AUTHORIZED, HE OR SHE HAS THE RIGHT TO A COUNTY | | |
| | | |CONFERENCE AND/OR STATE LEVEL FAIR HEARING. | | |
| | | |2. A CLIENT SHALL BE GIVEN NOTICE OF ANY ACTION BY THE COUNTY DEPARTMENT, OR ANY| | |
| | | |PERSON OR AGENCY ACTING ON ITS BEHALF, WHICH ADVERSELY AFFECTS THE CLIENT’S | | |
| | | |ELIGIBILITY FOR, OR RIGHT TO GRANT PAYMENTS AUTHORIZED UNDER THE ADULT FINANCIAL| | |
| | | |PROGRAMS. FAILURE TO GIVE NOTICE OF AN ADVERSE ACTION SHALL BE GROUNDS FOR | | |
| | | |SETTING ASIDE THE ACTION ON APPEAL. THE NOTICE MUST MEET THE FOLLOWING | | |
| | | |STANDARDS: | | |
| | | |A. THE NOTICE MUST BE IN WRITING; AND, | | |
| | | |B. IT MUST DESCRIBE CLEARLY AND IN PLAIN LANGUAGE THE ACTION TO BE TAKEN AND THE| | |
| | | |REASON(S) FOR THE ACTION; AND, | | |
| | | |C. IT MUST REFER SPECIFICALLY BY NUMBER TO THE SECTION(S) OF THE STATE | | |
| | | |DEPARTMENT'S RULES THAT REQUIRE OR PERMIT THE ACTION BEING TAKEN, OR CITE THE | | |
| | | |SPECIFIC CHANGES IN FEDERAL OR STATE LAW REQUIRING THE ACTION; AND, | | |
| | | |D. IT MUST STATE THE EFFECTIVE DATE OF THE PROPOSED ACTION; AND, | | |
| | | |E. IT MUST EXPLAIN THE CLIENT’S RIGHT TO REQUEST A COUNTY CONFERENCE AND STATE | | |
| | | |LEVEL FAIR HEARING, THE TIME PERIOD FOR REQUESTING A CONFERENCE OR HEARING, AND | | |
| | | |THE STEPS WHICH MUST BE TAKEN TO OBTAIN A CONFERENCE OR HEARING; AND, | | |
| | | |F. IT MUST EXPLAIN THE CLIENT'S RIGHT TO CONTINUED GRANT PAYMENTS AND THE | | |
| | | |OBLIGATION TO REPAY IF IT IS DETERMINED THAT THE CLIENT WAS NOT ELIGIBLE TO | | |
| | | |RECEIVE THEM; AND, | | |
| | | |G. IT MUST INFORM THE CLIENT OF HIS OR HER RIGHT TO BE REPRESENTED OR ASSISTED | | |
| | | |BY LEGAL COUNSEL, A RELATIVE, A FRIEND OR A SPOKESPERSON OF HIS OR HER CHOOSING;| | |
| | | |AND, | | |
| | | |H. TO THE EXTENT PRACTICABLE, NOTICE SHALL BE IN HIS OR HER PRIMARY LANGUAGE. IF| | |
| | | |HE OR SHE IS ILLITERATE, THE ACTION SHALL ALSO BE EXPLAINED VERBALLY. | | |
| | | |3. ANY NEGATIVE ACTION TAKEN ON THE CASE SHALL BE PRECEDED BY A TIMELY NOTICE | | |
| | | |PERIOD OF AT LEAST ELEVEN (11) CALENDAR DAYS. THE 11 DAY TIMELY NOTICE PERIOD | | |
| | | |CONSTITUTES THE PERIOD DURING WHICH ASSISTANCE IS CONTINUED AND NO NEGATIVE | | |
| | | |ACTION IS TO BE TAKEN DURING THIS TIME UNLESS DESCRIBED IN SECTION 3.554. | | |
| | | |4. WHEN CHANGES IN EITHER STATE OR FEDERAL LAW REQUIRE GRANT PAYMENT ADJUSTMENTS| | |
| | | |FOR ALL PERSONS RECEIVING ADULT FINANCIAL ASSISTANCE, ADEQUATE NOTICE SHALL | | |
| | | |INCLUDE: | | |
| | | |A. A STATEMENT OF THE INTENDED ACTION; | | |
| | | |B. THE REASONS FOR SUCH ACTION; | | |
| | | |C. THE SPECIFIC CHANGE IN LAW REQUIRING SUCH ACTION; AND, | | |
| | | |D. THE CIRCUMSTANCES UNDER WHICH A COUNTY CONFERENCE AND/OR STATE LEVEL FAIR | | |
| | | |HEARING MAY BE OBTAINED AND FINANCIAL ASSISTANCE CONTINUED. A COUNTY CONFERENCE | | |
| | | |OR STATE LEVEL FAIR HEARING NEED NOT BE GRANTED UNLESS THE REASON FOR AN | | |
| | | |INDIVIDUAL APPEAL IS INCORRECT GRANT COMPUTATION. | | |
|3.520.1 |Incorporation of|NEW |I. A CLIENT WHO DISAGREES WITH A PROPOSED ACTION HAS THE RIGHT TO: |Addition of rules from previous |No |
| |9 C.C.R. 2503-8 | |1. A COUNTY CONFERENCE THAT MUST BE REQUESTED NO LATER THAN NINETY (90) CALENDAR|Section 3.800. Alignment with Food | |
| | | |DAYS FROM THE DATE THE NOTICE OF ACTION IS MAILED TO THE CLIENT; |Assistance on continued benefits. | |
| | | |2. A STATE LEVEL FAIR HEARING BEFORE AN ALJ WHICH CAN BE REQUESTED IF THE CLIENT| | |
| | | |DOES NOT WISH TO UTILIZE THE COUNTY CONFERENCE TO RESOLVE THE DISPUTE OR IS | | |
| | | |DISSATISFIED WITH THE OUTCOME OF THE COUNTY CONFERENCE. THE CLIENT MUST SUBMIT A| | |
| | | |WRITTEN REQUEST FOR A FAIR HEARING BY MAIL OR DELIVERY TO THE OAC NO LATER THAN | | |
| | | |NINETY (90) CALENDAR DAYS FROM THE DATE THE NOTICE OF ACTION IS MAILED TO THE | | |
| | | |CLIENT; | | |
| | | |3. JUDICIAL REVIEW OF THE FINAL AGENCY DECISION IN THE APPROPRIATE STATE | | |
| | | |DISTRICT COURT, AFTER EXHAUSTING THE ADMINISTRATIVE APPEAL RIGHTS GRANTED UNDER | | |
| | | |THESE RULES; AND, | | |
| | | |4. CONTINUED GRANT PAYMENTS AS DESCRIBED IN SECTION 3.554. | | |
|3.520.1 |Incorporation of|NEW |J. CLIENT CONFIDENTIALITY MUST BE TREATED AS FOLLOWS: |Addition of rules from previous |No |
| |9 C.C.R. 2503-8 | |1. ALL INFORMATION OBTAINED BY THE COUNTY DEPARTMENT CONCERNING A CLIENT OF |Section 3.800. | |
| | | |ADULT FINANCIAL PROGRAMS IS CONFIDENTIAL INFORMATION. | | |
| | | |A. THE COUNTY DEPARTMENT SHALL INFORM COUNTY OFFICIALS AND OTHER PERSONS WHO | | |
| | | |HAVE DEALINGS WITH THE DEPARTMENT AS TO THE CONFIDENTIAL NATURE OF PERSONALLY | | |
| | | |IDENTIFIABLE INFORMATION, WHICH MAY COME INTO THEIR POSSESSION THROUGH | | |
| | | |TRANSACTION OF DEPARTMENT BUSINESS. | | |
| | | |WHEN A COUNTY WORKER CONSULTS A BANK, CURRENT/ FORMER EMPLOYER OF A CLIENT, | | |
| | | |ANOTHER SOCIAL AGENCY, AND OTHER SIMILAR AGENCIES, TO OBTAIN INFORMATION OR | | |
| | | |ELIGIBILITY VERIFICATION INFORMATION, THE IDENTIFICATION OF THE COUNTY WORKER AS| | |
| | | |AN EMPLOYEE OF THE COUNTY DEPARTMENT CAN, IN ITSELF, DISCLOSE THAT AN | | |
| | | |APPLICATION FOR ASSISTANCE HAS BEEN MADE BY A CLIENT. IN THIS TYPE OF CONTACT, | | |
| | | |AS WELL AS OTHER COMMUNITY CONTACTS, THE DEPARTMENT SHALL MAINTAIN | | |
| | | |CONFIDENTIALITY WHENEVER POSSIBLE. | | |
| | | |B. ENSURING PRIVACY WHILE INTERVIEWING AND THE CONTINUOUS CONFIDENTIALITY OF | | |
| | | |INFORMATION IS ESSENTIAL. THIS INVOLVES BOTH OFFICE FACILITIES AND COUNTY WORKER| | |
| | | |DISCRETION. OFFICE PROCEDURES AND FACILITIES SHOULD BE SUCH THAT INFORMATION IS | | |
| | | |NOT INADVERTENTLY REVEALED TO PERSONS NOT CONCERNED WITH THE AFFAIRS OF A | | |
| | | |PARTICULAR CLIENT. THE COUNTY WORKER MUST ALSO USE DISCRETION IN MENTIONING | | |
| | | |DEPARTMENT BUSINESS OUTSIDE THE OFFICE. | | |
| | | |2. GENERAL INFORMATION NOT IDENTIFIED WITH ANY CLIENT IS NOT CONFIDENTIAL AND | | |
| | | |MAY BE RELEASED FOR ANY PURPOSE. | | |
| | | |3. INFORMATION SECURED BY THE COUNTY DEPARTMENT FOR THE PURPOSE OF DETERMINING | | |
| | | |ELIGIBILITY AND NEED IS CONFIDENTIAL. | | |
| | | |4. UNLESS DISCLOSURE IS SPECIFICALLY PERMITTED BY THE STATE DEPARTMENT, THE | | |
| | | |FOLLOWING TYPES OF INFORMATION ARE THE EXCLUSIVE PROPERTY OF, AND ARE RESTRICTED| | |
| | | |TO USE BY, THE STATE AND COUNTY DEPARTMENTS: | | |
| | | |A. NAMES AND ADDRESSES OF ADULT FINANCIAL CLIENTS, AND/OR THE GRANT PAYMENT | | |
| | | |AMOUNT; | | |
| | | |B. INFORMATION CONTAINED IN APPLICATIONS, REPORTS OF MEDICAL EXAMINATIONS, | | |
| | | |CORRESPONDENCE, AND OTHER INFORMATION CONCERNING ANY PERSON FROM WHOM, OR ABOUT | | |
| | | |WHOM, INFORMATION IS OBTAINED BY THE COUNTY DEPARTMENT; | | |
| | | |C. RECORDS OF STATE OR COUNTY DEPARTMENTAL EVALUATIONS OF THE ABOVE INFORMATION.| | |
| | | |D. ALL INFORMATION OBTAINED THROUGH THE INCOME AND ELIGIBILITY VERIFICATION | | |
| | | |SYSTEM (IEVS). | | |
| | | |5. NO ONE OUTSIDE THE STATE OR COUNTY DEPARTMENT SHALL HAVE ACCESS TO RECORDS OF| | |
| | | |THE DEPARTMENT EXCEPT FOR THE FOLLOWING INDIVIDUALS: THOSE EXECUTING THE INCOME | | |
| | | |AND ELIGIBILITY VERIFICATION SYSTEM (IEVS); CHILD SUPPORT SERVICES OFFICIALS; | | |
| | | |THE SSA; FEDERAL AND STATE AUDITORS AND PRIVATE AUDITORS FOR THE COUNTY; AND | | |
| | | |SINGLE ENTRY POINTS. THESE INDIVIDUALS SHALL HAVE ACCESS ONLY FOR PURPOSES | | |
| | | |NECESSARY FOR THE ADMINISTRATION OF THE PROGRAM. | | |
| | | |A. CLIENT RECORDS MAY BE USED AS EXHIBITS FOR ADMINISTRATIVE, CIVIL AND/OR | | |
| | | |CRIMINAL PROCEEDINGS WHEN THE PROCEEDINGS RELATE DIRECTLY TO THE RECEIPT OF | | |
| | | |ADULT FINANCIAL PROGRAMS. | | |
| | | |B. ADDITIONAL INDIVIDUALS SHALL HAVE ACCESS TO THE CLIENT’S RECORDS AS LONG AS | | |
| | | |THE CLIENT IS NOTIFIED AND HIS OR HER PRIOR PERMISSION FOR RELEASE OF | | |
| | | |INFORMATION IS OBTAINED, UNLESS THE INFORMATION IS TO BE USED TO VERIFY INCOME | | |
| | | |OR ELIGIBILITY UNDER ADMINISTRATION OF THE IEVS. | | |
| | | |C. IF THE INFORMATION IS NEEDED TO PROVIDE BENEFITS TO A CLIENT IN AN EMERGENCY | | |
| | | |SITUATION, AND THE CLIENT IS PHYSICALLY OR MENTALLY INCAPACITATED TO THE EXTENT | | |
| | | |THAT HE OR SHE CANNOT SIGN THE RELEASE FORM, AND TIME DOES NOT PERMIT OBTAINING | | |
| | | |THE CLIENT’S CONSENT PRIOR TO RELEASE OF INFORMATION, THE COUNTY DEPARTMENT MUST| | |
| | | |NOTIFY THE CLIENT WITHIN ELEVEN (11) CALENDAR DAYS AFTER SUPPLYING THE | | |
| | | |INFORMATION. IF THE APPLICANT OR CLIENT DOES NOT HAVE A TELEPHONE OR CANNOT BE | | |
| | | |PERSONALLY CONTACTED WITHIN ELEVEN (11) DAYS, THE COUNTY DEPARTMENT MUST SEND | | |
| | | |WRITTEN NOTIFICATION CONTAINING THE REQUIRED INFORMATION. THE VERBAL OR WRITTEN | | |
| | | |NOTIFICATION SHALL INCLUDE THE NAME AND ADDRESS OF THE AGENCY THAT REQUESTED THE| | |
| | | |INFORMATION, THE REASON THE INFORMATION WAS REQUESTED AND A SUMMARY OF THE | | |
| | | |INFORMATION RELEASED. | | |
| | | |D. THE FOLLOWING INDIVIDUALS SHALL HAVE ACCESS TO THE RECORDS OF THE DEPARTMENT,| | |
| | | |EXCLUDING IEVS INFORMATION, IF THE PREVIOUSLY IDENTIFIED CONSENT OR NOTICE | | |
| | | |CONDITIONS ARE MET: | | |
| | | |1. A DISTRICT ATTORNEY UPON PRESENTATION OF A WRITTEN REQUEST ACCOMPANIED BY | | |
| | | |EVIDENCE THAT FRAUD IS THE REASON FOR THE REQUEST. | | |
| | | |2. A COUNTY HUMAN SERVICES BOARD MEMBER, AS DESCRIBED IN SECTION 26-1-116, | | |
| | | |C.R.S. | | |
| | | |E. WHEN A COUNTY BOARD MEMBER OR A DISTRICT ATTORNEY NEEDS INFORMATION ABOUT A | | |
| | | |CLIENT THAT IS NOT IN THE POSSESSION OF THE COUNTY DEPARTMENT, THE REQUESTOR, | | |
| | | |WITH THE AID OF THE COUNTY DEPARTMENT, MAY CONTACT THE STATE DEPARTMENT TO | | |
| | | |INQUIRE AS TO THE APPROPRIATE METHODS OF SECURING IT. | | |
| | | |F. THE RELEASE OF RECORDS IS STRICTLY CONDITIONED UPON THE INFORMATION BEING | | |
| | | |USED SOLELY FOR THE PURPOSE AUTHORIZED AND THE PERSON REQUESTING THE INFORMATION| | |
| | | |MUST CERTIFY THE USE TO BE MADE OF THE INFORMATION AND THAT IT WILL NOT BE | | |
| | | |DISCLOSED OR USED FOR ANY OTHER PURPOSE. | | |
| | | |6. COUNTY DEPARTMENTS SHALL NOT RELEASE INFORMATION REGARDING APPLICANTS OR | | |
| | | |CLIENTS TO LAW ENFORCEMENT AGENCIES UNLESS A VALID SEARCH WARRANT IS RECEIVED BY| | |
| | | |THE COUNTY OR STATE DEPARTMENT, EXCEPT AS PROVIDED IN SECTION 3.520.1.J.5.A. | | |
| | | |7. UPON REQUEST TO THE STATE DEPARTMENT BY THE COLORADO BUREAU OF INVESTIGATION,| | |
| | | |WITH THE RESPONSIBILITY FOR LOCATION AND APPREHENSION OF FLEEING FELONS (I.E., A| | |
| | | |PERSON WITH AN OUTSTANDING FELONY ARREST WARRANT), THE ADDRESSES OF A FLEEING | | |
| | | |FELON WHO IS A CLIENT OF ADULT FINANCIAL PROGRAMS SHALL BE RELEASED PURSUANT TO | | |
| | | |SECTION 26-1-114(3)(A)(III) C.R.S. | | |
| | | |8. THE CLIENT SHALL HAVE AN OPPORTUNITY TO EXAMINE SUCH PERTINENT RECORDS | | |
| | | |CONCERNING HIM OR HER AS CONSTITUTES A BASIS FOR ADVERSE ACTION AND IN THE CASE | | |
| | | |OF A COUNTY CONFERENCE OR A STATE LEVEL FAIR HEARING. OTHER REQUESTS FOR | | |
| | | |INFORMATION BY THE CLIENT SHALL BE HONORED ONLY WHEN THE CLIENT MAKES THE | | |
| | | |REQUEST IN PERSON AND HIS OR HER IDENTITY IS VERIFIED OR THE REQUEST IS IN THE | | |
| | | |FORM OF A WRITTEN AND SIGNED STATEMENT. | | |
| | | |THE CLIENT MAY DESIGNATE AN INDIVIDUAL, FIRM, OR AGENCY TO REPRESENT HIM OR HER | | |
| | | |AT CONFERENCES AND HEARINGS. THE CLIENT MUST PUT THE DESIGNATION OF SUCH | | |
| | | |REPRESENTATIVE IN WRITING. THE REPRESENTATIVE SHALL HAVE ACCESS TO ALL PERTINENT| | |
| | | |RECORDS. | | |
| | | |9. THE CLIENT MAY GIVE A FORMAL WRITTEN RELEASE FOR DISCLOSURE OF INFORMATION TO| | |
| | | |OTHER AGENCIES, SUCH AS HOSPITALS OR ADVOCATE AGENCIES. IF THE CLIENT IS NOT | | |
| | | |PRESENT, OR THE OPPORTUNITY TO AGREE OR OBJECT TO THE USE OR DISCLOSURE CANNOT | | |
| | | |PRACTICABLY BE PROVIDED BECAUSE OF THE CLIENT’S INCAPACITY OR AN EMERGENCY | | |
| | | |CIRCUMSTANCE, THE DEPARTMENT MAY, IN THE EXERCISE OF PROFESSIONAL JUDGMENT, | | |
| | | |DETERMINE WHETHER THE DISCLOSURE IS IN THE BEST INTERESTS OF THE CLIENT AND, IF | | |
| | | |SO, DISCLOSE ONLY THE MINIMUM PROTECTED HEALTH INFORMATION NECESSARY THAT IS | | |
| | | |DIRECTLY RELEVANT TO THE CLIENT’S CARE. | | |
| | | |10. INFORMATION PROVIDED TO AGENCIES AND/ OR INDIVIDUALS MUST BE LIMITED TO THE | | |
| | | |SPECIFIC INFORMATION REQUIRED TO DETERMINE ELIGIBILITY, CONDUCT ONGOING CASE | | |
| | | |MANAGEMENT, OR OTHERWISE NECESSARY FOR THE ADMINISTRATION OF THE ADULT FINANCIAL| | |
| | | |PROGRAM. INFORMATION OBTAINED THROUGH IEVS WILL BE STORED AND PROCESSED SO THAT | | |
| | | |NO UNAUTHORIZED PERSONNEL CAN ACQUIRE OR RETRIEVE THE INFORMATION. COUNTY | | |
| | | |DEPARTMENTS ARE RESPONSIBLE FOR LIMITING IEVS DATA TO ONLY THOSE INDIVIDUALS | | |
| | | |REQUIRING ACCESS TO DETERMINE ELIGIBILITY OR OTHERWISE ADMINISTER THE PROGRAMS. | | |
| | | |ALL PERSONS WITH ACCESS TO INFORMATION OBTAINED PURSUANT TO THE INCOME AND | | |
| | | |ELIGIBILITY VERIFICATION REQUIREMENTS WILL BE ADVISED OF THE CIRCUMSTANCES UNDER| | |
| | | |WHICH ACCESS IS PERMITTED, HOW DATA WILL BE UTILIZED, CONFIDENTIALITY OF DATA, | | |
| | | |AND THE SANCTIONS IMPOSED FOR ILLEGAL USE OR DISCLOSURE OF THE INFORMATION. | | |
|3.520.1 |Incorporation of|NEW | |Addition of rules from previous |No |
| |9 C.C.R. 2503-8 | | |Section 3.800. | |
|3.520.1 |Incorporation of|NEW |K. COUNTY DEPARTMENTS AND CONTRACTORS ARE TO ADMINISTER ADULT FINANCIAL PROGRAMS|Addition of rules from previous |No |
| |9 C.C.R. 2503-8 | |IN SUCH A MANNER THAT NO PERSON WILL, ON THE BASIS OF RACE, COLOR, RELIGION, |Section 3.800. Included transgender | |
| | | |CREED, NATIONAL ORIGIN, ANCESTRY, SEX/GENDER (INCLUDING TRANSGENDER STATUS), |status. | |
| | | |PREGNANCY, AGE, SEXUAL ORIENTATION, GENDER IDENTITY, POLITICAL AFFILIATION, OR | | |
| | | |PHYSICAL OR MENTAL DISABILITY, OR ANY OTHER PROTECTED GROUPS AS DESCRIBED IN THE| | |
| | | |STATE DEPARTMENT’S ANTI-DISCRIMINATION POLICY, BE EXCLUDED FROM PARTICIPATION, | | |
| | | |BE DENIED ANY AID, CARE, OR SERVICES, OR OTHER BENEFITS OF, OR BE OTHERWISE | | |
| | | |SUBJECTED TO DISCRIMINATION IN HIS OR HER INTERACTIONS WITH ADULT FINANCIAL | | |
| | | |PROGRAMS. | | |
| | | |1. THE REFERENCES TO "AID" INCLUDES ALL FORMS OF ASSISTANCE, INCLUDING | | |
| | | |INFORMATION AND REFERRAL SERVICES. | | |
| | | |2. THE COUNTY DEPARTMENT SHALL NOT, DIRECTLY OR THROUGH CONTRACTUAL OR OTHER | | |
| | | |ARRANGEMENTS, ON THE BASIS OF RACE, COLOR, RELIGION, CREED, NATIONAL ORIGIN, | | |
| | | |ANCESTRY, SEX/GENDER (INCLUDING TRANSGENDER STATUS), PREGNANCY, AGE, SEXUAL | | |
| | | |ORIENTATION, GENDER IDENTITY, POLITICAL AFFILIATION, OR PHYSICAL OR MENTAL | | |
| | | |DISABILITY, OR ANY OTHER PROTECTED STATUS: | | |
| | | |A. PROVIDE ANY AID TO AN INDIVIDUAL THAT IS DIFFERENT, OR IS PROVIDED IN A | | |
| | | |DIFFERENT MANNER, FROM THAT PROVIDED TO OTHERS; | | |
| | | |B. SUBJECT AN INDIVIDUAL TO SEGREGATION BARRIERS OR SEPARATE TREATMENT IN ANY | | |
| | | |MANNER RELATED TO ACCESS TO OR RECEIPT OF ASSISTANCE, CARE, SERVICES, OR OTHER | | |
| | | |BENEFITS; | | |
| | | |C. RESTRICT AN INDIVIDUAL IN ANY WAY IN THE ENJOYMENT OR ANY ADVANTAGE OR | | |
| | | |PRIVILEGE ENJOYED BY OTHERS RECEIVING AID PROVIDED UNDER ADULT FINANCIAL | | |
| | | |PROGRAMS; | | |
| | | |D. TREAT AN INDIVIDUAL DIFFERENTLY FROM OTHERS IN DETERMINING WHETHER HE OR SHE | | |
| | | |SATISFIES ANY ELIGIBILITY OR OTHER REQUIREMENTS OR CONDITIONS WHICH INDIVIDUALS | | |
| | | |MUST MEET IN ORDER TO RECEIVE AID, SERVICES, CARE, OR OTHER BENEFITS PROVIDED | | |
| | | |UNDER ADULT FINANCIAL PROGRAMS; | | |
| | | |E. DENY AN INDIVIDUAL AN OPPORTUNITY TO PARTICIPATE IN ASSISTANCE PROGRAMS | | |
| | | |THROUGH THE PROVISION OF SERVICES OR OTHERWISE, OR AFFORD HIM OR HER AN | | |
| | | |OPPORTUNITY TO DO SO WHICH IS DIFFERENT FROM THAT AFFORDED TO OTHERS UNDER | | |
| | | |PROGRAMS OF ASSISTANCE. | | |
| | | |F. DENY AN INDIVIDUAL THE OPPORTUNITY TO PARTICIPATE AS A MEMBER OF A PLANNING | | |
| | | |OR ADVISORY BODY THAT IS AN INTEGRAL PART OF THE PROGRAM. | | |
| | | |3. NO DISTINCTION IS PERMITTED IN RELATION TO THE USE OF PHYSICAL FACILITIES, | | |
| | | |INTAKE AND APPLICATION PROCEDURES, CASELOAD ASSIGNMENTS, DETERMINATION OF | | |
| | | |ELIGIBILITY, AND THE AMOUNT AND TYPE OF BENEFITS EXTENDED BY THE COUNTY | | |
| | | |DEPARTMENT TO CLIENTS. | | |
| | | |4. THE COUNTY DEPARTMENT SHALL ENSURE THAT OTHER NON-FEDERAL AGENCIES, PERSONS, | | |
| | | |CONTRACTORS AND OTHER ENTITIES WITH WHICH IT CONTRACTS BUSINESS ARE IN | | |
| | | |COMPLIANCE WITH THE ABOVE PROHIBITION AGAINST DISCRIMINATION REQUIREMENTS ON A | | |
| | | |CONTINUING BASIS. THE COUNTY DEPARTMENT STAFF IS RESPONSIBLE FOR BEING ALERT TO | | |
| | | |ANY DISCRIMINATORY ACTIVITY OF OTHER AGENCIES AND FOR NOTIFYING THE STATE | | |
| | | |DEPARTMENT CONCERNING THE SITUATION. | | |
| | | |5. THE STATE DEPARTMENT, THROUGH ITS VARIOUS CONTACTS WITH AGENCIES, PERSONS, | | |
| | | |AND REFERRAL SOURCES, WILL BE CONTINUOUSLY ALERT TO DISCRIMINATORY ACTIVITY AND | | |
| | | |WILL TAKE APPROPRIATE ACTION TO ENSURE COMPLIANCE WITH THESE PROHIBITIONS | | |
| | | |AGAINST DISCRIMINATION. THE COUNTY DEPARTMENT, ON NOTIFICATION BY THE STATE | | |
| | | |DEPARTMENT, WILL ALSO TERMINATE PAYMENTS TO THE OFFENDER OR ASSOCIATION WITH ANY| | |
| | | |AGENCY, PERSON, OR RESOURCE BEING USED THAT HAS BEEN FOUND BY THE STATE | | |
| | | |DEPARTMENT OR THE COLORADO CIVIL RIGHTS DIVISION TO CONTINUE DISCRIMINATORY | | |
| | | |ACTIVITY IN REGARD TO APPLICANTS OR CLIENTS. | | |
| | | |6. AN INDIVIDUAL WHO BELIEVES HE OR SHE IS BEING DISCRIMINATED AGAINST MAY FILE | | |
| | | |A COMPLAINT WITH THE COUNTY DEPARTMENT, THE STATE DEPARTMENT, THE COLORADO CIVIL| | |
| | | |RIGHTS DIVISION, OR DIRECTLY WITH THE FEDERAL GOVERNMENT. | | |
| | | |WHEN A COMPLAINT IS FILED WITH THE COUNTY DEPARTMENT, THE COUNTY DIRECTOR IS | | |
| | | |RESPONSIBLE FOR INITIATING AN IMMEDIATE INVESTIGATION OF THE MATTER AND TAKING | | |
| | | |NECESSARY CORRECTIVE ACTION TO ELIMINATE ANY DISCRIMINATORY ACTIVITIES FOUND. IF| | |
| | | |SUCH ACTIVITIES ARE NOT FOUND, THE INDIVIDUAL IS GIVEN A WRITTEN EXPLANATION OF | | |
| | | |THE OUTCOME. IF THE PERSON IS NOT SATISFIED, HE OR SHE IS REQUESTED TO DIRECT | | |
| | | |HIS OR HER COMPLAINT, IN WRITING, TO THE STATE DEPARTMENT, COMMUNICATIONS | | |
| | | |SECTION, WHICH WILL BE RESPONSIBLE FOR FURTHER INVESTIGATION AND OTHER NECESSARY| | |
| | | |ACTION. | | |
|3.520.2 |Clarification |A. The county department shall create a case record upon |A. The county department shall create a case record upon initial application and|Updated to use the term grant payment|No |
| |Needed |initial application and maintain the record while the case |maintain the record while the case is open for assistance. The major purposes of|which is now consistent throughout | |
| | |is open for assistance. The major purposes of a case record|a case record shall be: |rule and refers to the amount of AF | |
| | |shall be: |1. To assist the county department in reaching a valid decision concerning |benefit. | |
| | |1. To assist the county department in reaching a valid |eligibility and for the amount of GRANT PAYMENT A CLIENT IS ELIGIBLE TO | | |
| | |decision concerning eligibility and for the amount of |RECEIVEpayment; | | |
| | |payment; |2. To ensure eligibility is based on factual information; | | |
| | |2. To ensure eligibility is based on factual information; |3. To provide for continuity of assistance when a worker is absent, when a case | | |
| | |3. To provide for continuity of assistance when a worker is|is reopened, and when a case is transferred from one county department to | | |
| | |absent, when a case is reopened, and when a case is |another; and, | | |
| | |transferred from one county department to another; and, |4. To provide accountability for the county department's actions. | | |
| | |4. To provide accountability for the county department's | | | |
| | |actions. | | | |
|3.520.2 |Clarification |B. The county department shall document all income, |B. The county department shall document all income, resources, and non-financial|Clarified the specific items needing |No |
| |Needed |resources, and non-financial eligibility information into |eligibility information into the statewide automated system. |to be documented in the automated | |
| | |the statewide automated system. |1. The county department shall not omit case information from the statewide |system. | |
| | |1. The county department shall not omit case information |automated system based on the assumption that the information is unnecessary for| | |
| | |from the statewide automated system based on the assumption|eligibility determination. | | |
| | |that the information is unnecessary for eligibility |2. All case information USED TO DETERMINE ELIGIBILITY AND CHANGES IN BASIC | | |
| | |determination. |BIOGRAPHICAL INFORMATION shall be updated at the time of redetermination. | | |
| | |2. All case information shall be updated at the time of | | | |
| | |redetermination. | | | |
|3.520.2 |Clarification |C. The county department shall document all case actions in|C. The county department shall document all case actions in case comments. THIS |Further clarifies the types of |No |
| |Needed |case comments, to include:1. All case decisions related to |INFORMATION SHALL INCLUDE ACTIONS TAKEN BY THE COUNTY DEPARTMENT, THE BASIS OF |information that must be documented | |
| | |prudent person principle;2. All decisions related to the |SUCH ACTIONS, AND THE RESULT OR OUTCOME OF THE ACTION TAKEN ON THE CASE AND MUST|in case comments to include | |
| | |disposition of claims;3. Any atypical interactions with the|ALSO, to include: |eligibility determinations as well as| |
| | |client;4. Actions related to a county conference and/or |1. All case decisions related to prudent person principle; |frequency. This aligns with Colorado| |
| | |state level hearing;5. Cause of untimely processing of the |2. All decisions related to the disposition of claims; |Works case comment requirements. | |
| | |application or redetermination; and,6. Other information |3. Any atypical interactions with the client; | | |
| | |that would be critical to document county department |4. Actions related to a county conference and/or state level FAIR hearing; | | |
| | |actions and/or would be necessary to justify case decisions|5. Cause of untimely processing of the application or redetermination; and, | | |
| | |during a case review, audit, appeal, or lawsuit. |6. Other information that would be critical to document county department | | |
| | | |actions and/or would be necessary to justify case decisions during a case | | |
| | | |review, audit, appeal, or lawsuit.; AND, | | |
| | | |7. INFORMATION PERTAINING TO ELIGIBILITY, VERIFICATIONS, AND COLLATERAL | | |
| | | |CONTACTS. | | |
|3.520.2 |Clarification |D. Unless otherwise specified in rule, all forms, packets, |D. Unless otherwise specified in rule, all forms, packets, notices, and |Adding additional flexibility. |No |
| |Needed |notices, and applications, shall be state-prescribed. |applications, shall be state-prescribed OR STATE APPROVED. | | |
|3.520.2 |Clarification |E. The county department shall be responsible for securely |E. The county department shall be responsible for securely storing paper and/or |Unnecessary language deleted. |No |
| |Needed |storing paper and/or electronic case records and other |electronic case records and other confidential material to prevent accidental or| | |
| | |confidential material to prevent accidental or intentional |intentional disclosure or access by unauthorized persons. If a county department| | |
| | |disclosure or access by unauthorized persons. If a county |shares building space with other county offices, case materials shall be stored | | |
| | |department shares building space with other county offices,|in locked files. Janitors and other maintenance personnel shall be instructed | | |
| | |case materials shall be stored in locked files. Janitors |concerning the confidential nature of information. | | |
| | |and other maintenance personnel shall be instructed | | | |
| | |concerning the confidential nature of information. | | | |
|3.520.2 |Clarification |G. Case files shall be kept for a minimum of three (3) |G. Case files shall be kept for a minimum of three (3) years beyond the year of |Added language to extend retention of|No |
| |Needed |years beyond the year of the case closure date. |the case closure date UNLESS THERE HAS BEEN A CLAIM, AUDIT, NEGOTIATION, |records if there is a claim, audit, | |
| | | |LITIGATION OR OTHER ACTION STARTED BEFORE THE EXPIRATION OF THE THREE-YEAR |negotiation, litigation or other | |
| | | |PERIOD. IN SUCH CASES, THE RETENTION PERIOD SHALL INITIATE AT THE CONCLUSION OF |action after the case closure. | |
| | | |THE CLAIM, AUDIT, NEGOTIATION, LITIGATION, OR OTHER ACTION. | | |
|3.520.3 |Clarification |C. The focus of State Department monitoring shall be to |C. The focus of State Department monitoring shall be to identify: |Added additional actions that the |No |
| |Needed |identify: |1. Compliance with program statutes and rules; |county may need to take if errors are| |
| | |1. Compliance with program statutes and rules; |A. THE COUNTY DEPARTMENT SHALL PROVIDE WRITTEN RESPONSES TO THE STATE REGARDING |identified in the review process. | |
| | |2. Best practices that can be shared with other county |ACTION TAKEN TO CORRECT AREAS OF NON-COMPLIANCE. THE STATE DEPARTMENT MUST | | |
| | |offices; and, |APPROVE THE ACTION(S) TAKEN. | | |
| | |3. Training needs. |B. THE COUNTY DEPARTMENT SHALL PROVIDE TO THE STATE A WRITTEN PLAN, INCLUDING | | |
| | | |STEPS AND MEASURES, TO MITIGATE THE ERROR(S) FROM RECURRING. THIS PLAN MUST BE | | |
| | | |APPROVED BY THE STATE DEPARTMENT. | | |
| | | |2. Best practices that can be shared with other county offices; and, | | |
| | | |3. Training needs. ; and, | | |
| | | |4. PERFORMANCE OUTCOMES. | | |
|3.520.3 |Clarification |F. County department supervisory personnel shall review |F. County department supervisory personnel AND/OR QUALITY ASSURANCE STAFF shall |Revising to align with processes for |No |
| |Needed |eligibility determinations (certifications, denials, and/or|review eligibility determinations (certifications, denials, and/or pending |Colorado Works and to allow | |
| | |pending cases) monthly. The supervisor shall: |cases) monthly FOR THE PURPOSES SET FORTH IN 3.520.3.C. The supervisor |flexibility for counties to design | |
| | |1. Pull a random sample of a minimum of two determinations |SUPERVISORY PERSONNEL AND/OR QUALITY ASSURANCE STAFF shall: |their own QA sample plan. | |
| | |per technician; |1. REVIEW A MINIMUM NUMBER OF CASES, INCLUDING SPECIFIC PROGRAMS AND/OR ACTIONS,| | |
| | |2. Determine the correctness of eligibility determinations |PER MONTH AS OUTLINED ANNUALLY BY THE STATE DEPARTMENT BASED ON THE COUNTY | | |
| | |accomplished; |DEPARTMENT’S ADULT FINANCIAL CASELOAD SIZE. THE STATE DEPARTMENT WILL NOTIFY THE| | |
| | |3. Ensure timely correction of any determination errors; |COUNTY OF THE MINIMUM NUMBER OF CASES TO BE REVIEWED VIA MEMORANDUM. THE COUNTY | | |
| | |and, |MAY ELECT TO: | | |
| | |4. Maintain a record of the cases reviewed for audit |A. CREATE A PLAN TO PPull a random sample of THAT INCLUDES AT LEAST THE MINIMUM | | |
| | |purposes. |NUMBER OF ADULT FINANCIAL CASES SET FORTH BY THE STATE DEPARTMENT IN ITS | | |
| | | |MEMORANDUM AND SUBMIT THAT PLAN TO THE STATE FOR APPROVAL.a minimum of two | | |
| | | |determinations per technician; | | |
| | | |B. USE THE STATE PRESCRIBED RANDOM SAMPLE. | | |
| | | |2. Determine the correctness of eligibility determinations accomplished; | | |
| | | |3. Ensure timely correction OF ANY ERRORS WITHIN TEN (10) BUSINESS DAYS OR THE | | |
| | | |TIME FRAME SPECIFIED WITHIN THE APPROVED REVIEW PLAN of any determination | | |
| | | |errors; and, | | |
| | | |4. Maintain a record of the cases reviewed for audit purposes, INCLUDING AUDIT | | |
| | | |RESULTS AND ANY REQUIRED ACTIONS TAKEN BY THE COUNTY. COUNTY DEPARTMENTS MUST | | |
| | | |KEEP CASE FILE REVIEWS FOR A MINIMUM OF THREE (3) YEARS. | | |
| | | |5. REPORT THESE RESULTS AND ACTIONS TO THE STATE ON A MONTHLY BASIS VIA THE | | |
| | | |STATE PRESCRIBED PROCESS. | | |
|3.520.4 |Section |A. The county department shall utilize the following steps |A. The county department shall utilize the following steps to process the |3.520.4 Was rewritten and renumbered.|No |
| |Restructure |to process the application:1. Date-stamp the application on|application:1. Date-stamp the application on the date the signed application is |The entire section was struck | |
| | |the date the signed application is received by the county |received by the county department;2. Review the application;3. For AND only, |through. | |
| | |department;2. Review the application;3. For AND only, |provide the client with a medical disability certification form;4. Interview the| | |
| | |provide the client with a medical disability certification |client;5. Verify statements made by the client on the application and during the| | |
| | |form;4. Interview the client;5. Verify statements made by |interview using the statewide automated system interfaces, documents received | | |
| | |the client on the application and during the interview |from the client, or information gathered from other collateral sources;6. | | |
| | |using the statewide automated system interfaces, documents |Approve or deny the application within sixty (60) calendar days for AND and | | |
| | |received from the client, or information gathered from |within forty-five (45) calendar days for OAP from the date of receipt of a | | |
| | |other collateral sources;6. Approve or deny the application|completed and signed application. Delay in processing the application shall not | | |
| | |within sixty (60) calendar days for AND and within |be allowed for any of the following:a. When the client has applied for a Social | | |
| | |forty-five (45) calendar days for OAP from the date of |Security number and is awaiting action by the Social Security Administration; | | |
| | |receipt of a completed and signed application. Delay in |or,b. When the county department is awaiting receipt of information from the | | |
| | |processing the application shall not be allowed for any of |State Verification Exchange System (SVES); or,c. When the county department is | | |
| | |the following:a. When the client has applied for a Social |awaiting the response for required secondary verification through the Systematic| | |
| | |Security number and is awaiting action by the Social |Alien Verification for Entitlements (SAVE).7. Provide a notice of action to the | | |
| | |Security Administration; or,b. When the county department |client by postal or electronic mail or in person using the State Department's | | |
| | |is awaiting receipt of information from the State |prescribed form. | | |
| | |Verification Exchange System (SVES); or,c. When the county | | | |
| | |department is awaiting the response for required secondary | | | |
| | |verification through the Systematic Alien Verification for | | | |
| | |Entitlements (SAVE).7. Provide a notice of action to the | | | |
| | |client by postal or electronic mail or in person using the | | | |
| | |State Department's prescribed form. | | | |
|3.520.4 |Section |B. A request for benefits following an action to deny an |B. A request for benefits following an action to deny an application shall be |3.520.4 Was rewritten and renumbered.|No |
| |Restructure |application shall be considered in the following ways:1. If|considered in the following ways:1. If the client has good cause as outlined in |The entire section was struck | |
| | |the client has good cause as outlined in Section 3.510 and |Section 3.510 and notifies the county department that he/she is requesting |through. | |
| | |notifies the county department that he/she is requesting |benefits within thirty (30) calendar days of the denial, the county department | | |
| | |benefits within thirty (30) calendar days of the denial, |shall reschedule the interview and the current application date shall be used.2.| | |
| | |the county department shall reschedule the interview and |If the client does not have good cause and notifies the county department that | | |
| | |the current application date shall be used.2. If the client|he/she is requesting benefits, and the request is made within sixty (60) | | |
| | |does not have good cause and notifies the county department|calendar days of the current application, that application may be used but the | | |
| | |that he/she is requesting benefits, and the request is made|date of application shall be the most recent date the client requested benefits.| | |
| | |within sixty (60) calendar days of the current application,| | | |
| | |that application may be used but the date of application | | | |
| | |shall be the most recent date the client requested | | | |
| | |benefits. | | | |
|3.520.4 |Section |C. A face-to-face interview, either at the county |C. A face-to-face interview, either at the county department office or in the |3.520.4 Was rewritten and renumbered.|No |
| |Restructure |department office or in the client's home, is mandatory for|client's home, is mandatory for an initial application for Adult Financial |The entire section was struck | |
| | |an initial application for Adult Financial benefits, unless|benefits, unless there is good cause. |through. | |
| | |there is good cause. |1. If the client can show good cause, a telephone interview shall be conducted. | | |
| | |1. If the client can show good cause, a telephone interview|Good cause includes: | | |
| | |shall be conducted. Good cause includes: |a. Hospitalization of the client; | | |
| | |a. Hospitalization of the client; |b. Client resides in a long-term facility or has regular contact with a Single | | |
| | |b. Client resides in a long-term facility or has regular |Entry Point case manager; | | |
| | |contact with a Single Entry Point case manager; |c. Travel for the client would cause serious medical or physical harm; or, | | |
| | |c. Travel for the client would cause serious medical or |d. Other good cause determined by the county department using prudent person | | |
| | |physical harm; or, |principle. | | |
| | |d. Other good cause determined by the county department |2. If the county department determines good cause prevents a face-to-face | | |
| | |using prudent person principle. |interview upon initial application, it shall be documented as to why a telephone| | |
| | |2. If the county department determines good cause prevents |interview was conducted and proof of good cause shall be entered into the case | | |
| | |a face-to-face interview upon initial application, it shall|record. | | |
| | |be documented as to why a telephone interview was conducted| | | |
| | |and proof of good cause shall be entered into the case | | | |
| | |record. | | | |
|3.520.4 |Section |D. The interview shall include: 1. An explanation of the |D. The interview shall include: 1. An explanation of the various assistance |3.520.4 Was rewritten and renumbered.|No |
| |Restructure |various assistance programs available and an opportunity to|programs available and an opportunity to apply for those additional programs;2. |The entire section was struck | |
| | |apply for those additional programs;2. A brief explanation |A brief explanation of the eligibility process and the eligibility |through. | |
| | |of the eligibility process and the eligibility |requirements;3. A review of the application with the client to:a. Confirm all | | |
| | |requirements;3. A review of the application with the client|information on the application;b. Answer questions not completed on the | | |
| | |to:a. Confirm all information on the application;b. Answer |application; and,c. Provide the client an opportunity to clarify unclear, | | |
| | |questions not completed on the application; and,c. Provide |inconsistent, inaccurate, or questionable statements.d. For AND only, provide, | | |
| | |the client an opportunity to clarify unclear, inconsistent,|explain and obtain necessary signatures on the Authorization for Reimbursement | | |
| | |inaccurate, or questionable statements.d. For AND only, |of Interim Assistance form (IM-14).4. A request for verification of application | | |
| | |provide, explain and obtain necessary signatures on the |declarations.a. The client has the primary responsibility to provide information| | |
| | |Authorization for Reimbursement of Interim Assistance form |necessary to establish eligibility.b. If the client is unable to do so, the | | |
| | |(IM-14).4. A request for verification of application |county department shall assist the client to obtain verification through | | |
| | |declarations.a. The client has the primary responsibility |collateral contacts or a home visit.c. If the client returns the verifications | | |
| | |to provide information necessary to establish |within thirty (30) calendar days after denial, the following processing | | |
| | |eligibility.b. If the client is unable to do so, the county|requirements shall be implemented:1) If the client has good cause, the denial | | |
| | |department shall assist the client to obtain verification |shall be rescinded and eligibility determined, using the original application | | |
| | |through collateral contacts or a home visit.c. If the |date.2) If the client does not have good cause, the county department shall use | | |
| | |client returns the verifications within thirty (30) |the original application, but the date of the application shall be the date all | | |
| | |calendar days after denial, the following processing |verifications were received.d. If the client returns the verification thirty-one| | |
| | |requirements shall be implemented:1) If the client has good|(31) or more calendar days after the denial, the county department shall require| | |
| | |cause, the denial shall be rescinded and eligibility |the client to complete a new application. | | |
| | |determined, using the original application date.2) If the | | | |
| | |client does not have good cause, the county department | | | |
| | |shall use the original application, but the date of the | | | |
| | |application shall be the date all verifications were | | | |
| | |received.d. If the client returns the verification | | | |
| | |thirty-one (31) or more calendar days after the denial, the| | | |
| | |county department shall require the client to complete a | | | |
| | |new application. | | | |
|3.520.4 |Section |D. 5. Discussion of the client's rights and |D. 5. Discussion of the client's rights and responsibilities, to include:a. The |3.520.4 Was rewritten and renumbered.|No |
| |Restructure |responsibilities, to include:a. The county department's |county department's requirement to inform the client in writing at application |The entire section was struck | |
| | |requirement to inform the client in writing at application |and redetermination of the requirement for a client to report any changes in |through. | |
| | |and redetermination of the requirement for a client to |circumstances within thirty (30) calendar days.b. The client's responsibility to| | |
| | |report any changes in circumstances within thirty (30) |notify the county department in writing within thirty (30) calendar days of any | | |
| | |calendar days.b. The client's responsibility to notify the |change in resources or income or other change in circumstances which affects | | |
| | |county department in writing within thirty (30) calendar |eligibility or benefit amount.c. The county department's responsibility to | | |
| | |days of any change in resources or income or other change |maintain confidentiality of records and information.d. The client's right to | | |
| | |in circumstances which affects eligibility or benefit |non-discrimination provisions.e. The client's right to a county conference or | | |
| | |amount.c. The county department's responsibility to |state-level appeal.f. The client's right to review and copy his/her case file.6.| | |
| | |maintain confidentiality of records and information.d. The |An explanation provided regarding the process of utilizing the Electronic | | |
| | |client's right to non-discrimination provisions.e. The |Benefit Transfer (EBT) card. This explanation shall include prohibited | | |
| | |client's right to a county conference or state-level |establishments including, but not limited to, liquor stores, gambling | | |
| | |appeal.f. The client's right to review and copy his/her |establishments, adult oriented establishments, and marijuana shops; and, an | | |
| | |case file.6. An explanation provided regarding the process |explanation that the cash portion issued on the EBT card may be suspended with | | |
| | |of utilizing the Electronic Benefit Transfer (EBT) card. |identified misuse. | | |
| | |This explanation shall include prohibited establishments | | | |
| | |including, but not limited to, liquor stores, gambling | | | |
| | |establishments, adult oriented establishments, and | | | |
| | |marijuana shops; and, an explanation that the cash portion | | | |
| | |issued on the EBT card may be suspended with identified | | | |
| | |misuse. | | | |
|3.520.4 |Section |E. County departments shall require no more than one |E. County departments shall require no more than one interview per |3.520.4 Was rewritten and renumbered.|No |
| |Restructure |interview per application.1. The county department shall |application.1. The county department shall review the application for |The entire section was struck | |
| | |review the application for completeness for all programs |completeness for all programs requested and secure signed copies of the |through. | |
| | |requested and secure signed copies of the Authorization for|Authorization for Release of Information form and any other forms necessary to | | |
| | |Release of Information form and any other forms necessary |determine eligibility.2. If the client wishes to apply for benefits while | | |
| | |to determine eligibility.2. If the client wishes to apply |already receiving benefits under a different program, such as Food Assistance, | | |
| | |for benefits while already receiving benefits under a |the county department may use a redetermination packet if received within sixty | | |
| | |different program, such as Food Assistance, the county |(60) calendar days of the request; otherwise a new application will be required.| | |
| | |department may use a redetermination packet if received |A verbal request to apply for an Adult Financial program shall be documented in | | |
| | |within sixty (60) calendar days of the request; otherwise a|the statewide automated system and the date of the request will secure the | | |
| | |new application will be required. A verbal request to apply|application date for the client. | | |
| | |for an Adult Financial program shall be documented in the | | | |
| | |statewide automated system and the date of the request will| | | |
| | |secure the application date for the client. | | | |
|3.520.4 |Section |F. For clients who have been committed to a facility by |F. For clients who have been committed to a facility by order of the district or|3.520.4 Was rewritten and renumbered.|No |
| |Restructure |order of the district or probate court or who have been |probate court or who have been made a ward of the court, application for an |The entire section was struck | |
| | |made a ward of the court, application for an Adult |Adult Financial program shall be completed by the facility's administration or |through. | |
| | |Financial program shall be completed by the facility's |the client's guardian. | | |
| | |administration or the client's guardian. | | | |
|3.520.4 |Section |G. When the client does not keep a scheduled interview |G. When the client does not keep a scheduled interview appointment and does not |3.520.4 Was rewritten and renumbered.|No |
| |Restructure |appointment and does not request an alternate time or |request an alternate time or arrangement the county department shall assume the |The entire section was struck | |
| | |arrangement the county department shall assume the client |client is withdrawing his/her request for benefits and shall deny or discontinue|through. | |
| | |is withdrawing his/her request for benefits and shall deny |the case, as specified in 3.520.4, C. | | |
| | |or discontinue the case, as specified in 3.520.4, C. | | | |
|3.520.4 |Section | |THE COUNTY DEPARTMENT SHALL PROCESS APPLICATIONS AS EXPEDITIOUSLY AS POSSIBLE |Aligns with Colorado Works and Old |No |
| |Restructure & | |BUT NO LATER THAN FORTY-FIVE (45) CALENDAR DAYS FOLLOWING THE DATE THE |Age Pension processing standards. | |
| |Modernization | |APPLICATION WAS FILED. APPLICATIONS MEETING THE CRITERIA IDENTIFIED IN SECTION |Data supports that the OAP cases are | |
| | | |3.520.1.C, SHALL BE PROCESSED AS FOLLOWS: |processed typically within 19 days | |
| | | | |and AND cases are processed within 20| |
| | | | |days. | |
|3.520.4 |Section | |A. RECORD THE DATE THE SIGNED APPLICATION WAS RECEIVED BY THE COUNTY DEPARTMENT.|No change-just moved. |No |
| |Restructure & | | | | |
| |Modernization | | | | |
|3.520.4 |Section | |B. REVIEW THE APPLICATION FOR COMPLETENESS FOR ALL PROGRAMS APPLIED FOR AND/OR |Moved, updated applicant to client |No |
| |Restructure & | |ANY PROGRAMS NOT APPLIED FOR BUT THAT THE CLIENT IS POTENTIALLY ELIGIBLE FOR. |for consistency. | |
| |Modernization | | | | |
|3.520.4 |Section | |C. SCHEDULE AN INTERVIEW WITH THE CLIENT IF THE INTERVIEW IS NOT TAKING PLACE |Eliminating face-to-face |No |
| |Restructure & | |IMMEDIATELY. |requirement-it is now the choice of | |
| |Modernization | |1. THE CLIENT SHALL BE OFFERED AN IN-PERSON INTERVIEW. IF THE CLIENT DOES NOT |the client. Also clarifying that the | |
| | | |ELECT AN IN-PERSON INTERVIEW, THE COUNTY SHALL SCHEDULE AND CONDUCT A PHONE |interview must be scheduled with the | |
| | | |INTERVIEW. |client and that the client has the | |
| | | |2. THE CLIENT SHALL BE PROVIDED WRITTEN NOTICE OF THE INTERVIEW AT LEAST FOUR |opportunity to waive the written | |
| | | |(4) CALENDAR DAYS OF THE SCHEDULED INTERVIEW. THE CLIENT MAY PROVIDE A WRITTEN |notice scheduling the interview. | |
| | | |OR VERBAL WAIVER THAT WRITTEN NOTICE OF THE SCHEDULED INTERVIEW IS NOT NECESSARY|Modified to reflect new reporting | |
| | | |WHEN THE COUNTY DEPARTMENT IS ABLE TO CONDUCT THE INTERVIEW DURING APPLICATION |timeframe for changes. Clarified use | |
| | | |PROCESSING. NOTICE SHALL INCLUDE: |of application if benefits are | |
| | | |A. THE DATE AND TIME FOR THE INTERVIEW; |subsequently requested after a | |
| | | |B. IDENTIFICATION OF ANY DOCUMENTATION THAT MAY BE NEEDED; |denial. | |
| | | |C. THE OPPORTUNITY TO RESCHEDULE THE APPOINTMENT OR MAKE OTHER ARRANGEMENTS IN | | |
| | | |THE EVENT OF GOOD CAUSE. | | |
| | | |3. WHEN THE CLIENT DOES NOT KEEP THE INTERVIEW APPOINTMENT AND DOES NOT REQUEST | | |
| | | |AN ALTERNATE TIME OR ARRANGEMENT, AS DESCRIBED IN THIS SECTION, GRANT PAYMENTS | | |
| | | |WILL BE DENIED. | | |
| | | |4. THE INTERVIEW MUST BE DOCUMENTED AND SHALL INCLUDE: | | |
| | | |A. AN EXPLANATION OF THE VARIOUS ASSISTANCE PROGRAMS AVAILABLE TO THE APPLICANT,| | |
| | | |EVEN IF NOT SPECIFICALLY APPLIED FOR, AND AN OPPORTUNITY TO APPLY FOR THOSE | | |
| | | |ADDITIONAL PROGRAMS NOT IN THE CLIENT’S ORIGINAL APPLICATION; | | |
| | | |B. AN EXPLANATION OF THE ELIGIBILITY PROCESS AND THE ELIGIBILITY REQUIREMENTS; | | |
| | | |C. A REVIEW OF THE APPLICATION WITH THE CLIENT TO: | | |
| | | |1) CONFIRM ALL INFORMATION ON THE APPLICATION; | | |
| | | |2) ANSWER QUESTIONS NOT COMPLETED ON THE APPLICATION; AND, | | |
| | | |3) PROVIDE THE CLIENT AN OPPORTUNITY TO CLARIFY UNCLEAR, INCONSISTENT, | | |
| | | |INACCURATE, OR QUESTIONABLE STATEMENTS. | | |
| | | |4) FOR AID TO THE NEEDY DISABLED STATE ONLY (AND-SO), PROVIDE THE CLIENT WITH A | | |
| | | |MEDICAL DISABILITY CERTIFICATION FORM. PROVIDE, EXPLAIN AND OBTAIN NECESSARY | | |
| | | |SIGNATURES ON THE AUTHORIZATION FOR REIMBURSEMENT OF INTERIM ASSISTANCE FORM | | |
| | | |(IM-14), AS DEFINED IN SECTION 3.510, AND EXPLAIN THE REQUIREMENT TO APPLY FOR | | |
| | | |SUPPLEMENTAL SECURITY INCOME (SSI). | | |
| | | |D. A REQUEST FOR VERIFICATION OF APPLICATION DECLARATIONS. | | |
| | | |1) THE CLIENT HAS THE PRIMARY RESPONSIBILITY TO PROVIDE INFORMATION NECESSARY TO| | |
| | | |ESTABLISH ELIGIBILITY. | | |
| | | |2) THE COUNTY DEPARTMENT SHALL ASSIST THE CLIENT TO OBTAIN VERIFICATION THROUGH | | |
| | | |COLLATERAL CONTACTS, INTERFACES, OR A HOME VISIT. | | |
| | | |E. DISCUSSION OF THE CLIENT'S RIGHTS AND RESPONSIBILITIES THAT MUST INCLUDE: | | |
| | | |1) THE CLIENT'S RESPONSIBILITY TO NOTIFY AND PROVIDE VERIFICATION TO THE COUNTY | | |
| | | |DEPARTMENT IN WRITING BY THE 10TH OF THE MONTH FOLLOWING THE MONTH IN WHICH THE | | |
| | | |CHANGE OCCURRED OF ANY CHANGE IN RESOURCES OR INCOME OR OTHER CHANGE IN | | |
| | | |CIRCUMSTANCES WHICH AFFECTS ELIGIBILITY OR GRANT PAYMENT AMOUNT. | | |
| | | |2) THE CLIENT’S RIGHT TO CONFIDENTIALITY OF RECORDS AND INFORMATION. | | |
| | | |3) THE CLIENT'S RIGHT TO NON-DISCRIMINATION PROVISIONS, INCLUDING THE PROCESS IN| | |
| | | |SECTION 3.520.1.K.6, FOR FILING DISCRIMINATION COMPLAINTS. | | |
| | | |4) THE CLIENT'S RIGHT TO A COUNTY CONFERENCE OR STATE LEVEL FAIR HEARING. | | |
| | | |5) THE CLIENT'S RIGHT TO REVIEW AND COPY HIS OR HER CASE FILE. | | |
| | | |F. AN EXPLANATION PROVIDED REGARDING THE PROCESS OF UTILIZING THE EBT CARD. THIS| | |
| | | |EXPLANATION SHALL INCLUDE: | | |
| | | |1) IDENTIFICATION OF THE FOLLOWING ESTABLISHMENTS IN WHICH CLIENTS SHALL NOT BE | | |
| | | |ALLOWED TO ACCESS CASH GRANT PAYMENTS THROUGH THE EBT SERVICE FROM AUTOMATED | | |
| | | |TELLER MACHINES (ATM) AND POINT OF SALE (POS) DEVICES: | | |
| | | |A) LICENSED GAMING ESTABLISHMENTS; | | |
| | | |B) IN-STATE SIMULCAST FACILITIES; | | |
| | | |C) TRACKS FOR RACING; | | |
| | | |D) COMMERCIAL BINGO FACILITIES; | | |
| | | |E) STORES OR ESTABLISHMENTS IN WHICH THE PRINCIPAL BUSINESS IS THE SALE OF | | |
| | | |FIREARMS; | | |
| | | |F) RETAIL ESTABLISHMENTS LICENSED TO SELL MALT, VINOUS, OR SPIRITUOUS LIQUORS; | | |
| | | |G) ESTABLISHMENTS LICENSED TO SELL MEDICAL MARIJUANA OR MEDICAL | | |
| | | |MARIJUANA-INFUSED PRODUCTS, OR RETAIL MARIJUANA OR RETAIL MARIJUANA PRODUCTS, | | |
| | | |EFFECTIVE JUNE 30, 2015; | | |
| | | |H) ESTABLISHMENTS THAT PROVIDE ADULT-ORIENTED ENTERTAINMENT IN WHICH PERFORMERS | | |
| | | |DISROBE OR PERFORM IN AN UNCLOTHED STATE FOR ENTERTAINMENT, EFFECTIVE JUNE 30, | | |
| | | |2015. | | |
| | | |2) AN EXPLANATION THAT THE CASH GRANT PAYMENT PORTION ISSUED ON THE EBT CARD MAY| | |
| | | |BE SUSPENDED WITH IDENTIFIED MISUSE AS OUTLINED IN SECTION 3.520.4.F.1. | | |
| | | |G. AN ASSESSMENT OF OTHER NEEDS THE CLIENT MAY HAVE AND APPROPRIATE REFERRALS TO| | |
| | | |COMMUNITY RESOURCES, INCLUDING FOOD BANKS, AREA AGENCIES ON AGING (AAA), AGING | | |
| | | |AND DISABILITY RESOURCES FOR COLORADO (ADRC), CENTERS FOR INDEPENDENT LIVING, | | |
| | | |THE DIVISION OF VOCATIONAL REHABILITATION (DVR), LOW INCOME ENERGY ASSISTANCE | | |
| | | |PROGRAM (LEAP), PHONE ASSISTANCE, AND THE PROPERTY TAX/RENT/HEAT CREDIT (PTC) | | |
| | | |REBATE ELIGIBILITY INFORMATION. | | |
| | | |H. AN OPPORTUNITY TO REGISTER TO VOTE. | | |
| | | |5. COUNTY DEPARTMENTS SHALL REQUIRE NO MORE THAN ONE INTERVIEW PER APPLICATION. | | |
| | | |A. THE COUNTY DEPARTMENT SHALL SECURE SIGNED COPIES OF ANY OTHER FORMS NECESSARY| | |
| | | |TO DETERMINE ELIGIBILITY. IF THE CLIENT REFUSES TO SIGN ANY REQUIRED FORMS, THE | | |
| | | |CASE SHALL BE DENIED OR DISCONTINUED FOLLOWING THE POLICIES OUTLINED IN SECTION | | |
| | | |3.554. | | |
| | | |B. IF THE CLIENT WISHES TO APPLY FOR ADULT FINANCIAL BENEFITS WHILE APPLYING FOR| | |
| | | |OR ALREADY RECEIVING BENEFITS UNDER A DIFFERENT PROGRAM, SUCH AS FOOD | | |
| | | |ASSISTANCE, THE COUNTY DEPARTMENT MAY ACCEPT THE CLIENT’S VERBAL OR WRITTEN | | |
| | | |REQUEST FOR ADULT FINANCIAL BENEFITS AND USE THE CLIENT’S EXISTING APPLICATION | | |
| | | |OR REDETERMINATION FOR THE OTHER PROGRAM’S BENEFITS IF RECEIVED WITHIN SIXTY | | |
| | | |(60) CALENDAR DAYS OF THE REQUEST; OTHERWISE A NEW APPLICATION WILL BE REQUIRED.| | |
| | | |THE COUNTY DEPARTMENT MUST VERIFY AND DOCUMENT ANY CHANGES THAT OCCURRED BETWEEN| | |
| | | |THE INITIAL APPLICATION SUBMISSION OR REDETERMINATION AND THE REQUEST FOR ADULT | | |
| | | |FINANCIAL GRANT PAYMENTS. A VERBAL REQUEST TO APPLY FOR AN ADULT FINANCIAL | | |
| | | |PROGRAM SHALL BE DOCUMENTED IN THE STATEWIDE AUTOMATED SYSTEM AND THE DATE OF | | |
| | | |THE REQUEST WILL SECURE THE APPLICATION DATE FOR THE CLIENT. | | |
| | | |6. WHEN THE CLIENT DOES NOT KEEP A SCHEDULED INTERVIEW APPOINTMENT AND HAS NOT | | |
| | | |CONTACTED THE COUNTY DEPARTMENT TO RESCHEDULE, AS SPECIFIED IN THIS SECTION, THE| | |
| | | |COUNTY DEPARTMENT SHALL DENY THE APPLICATION FOLLOWING THE POLICIES OUTLINED IN | | |
| | | |SECTION 3.554. | | |
| | | |A. IF THE CLIENT MAKES A REQUEST FOR ADULT FINANCIAL GRANT PAYMENTS FOLLOWING | | |
| | | |THE COUNTY DEPARTMENT’S DENIAL OF HIS OR HER APPLICATION BASED ON THE CLIENT | | |
| | | |FAILING TO ATTEND THE INTERVIEW APPOINTMENT, THE FOLLOWING SHALL OCCUR: | | |
| | | |1) IF THE CLIENT HAS GOOD CAUSE AS OUTLINED IN SECTION 3.510 AND NOTIFIES THE | | |
| | | |COUNTY DEPARTMENT THAT HE OR SHE WISHES TO CONTINUE HIS OR HER APPLICATION FOR | | |
| | | |ADULT FINANCIAL GRANT PAYMENTS WITHIN THIRTY (30) CALENDAR DAYS OF THE DENIAL, | | |
| | | |THE COUNTY DEPARTMENT SHALL RESCHEDULE THE INTERVIEW AND THE INITIAL APPLICATION| | |
| | | |DATE SHALL BE USED. DURING THE INTERVIEW, THE COUNTY DEPARTMENT MUST VERIFY AND | | |
| | | |DOCUMENT ANY CHANGES THAT OCCURRED BETWEEN THE INITIAL APPLICATION SUBMISSION | | |
| | | |AND THE CLIENT’S REQUEST TO CONTINUE THE APPLICATION PROCESS. IF THE CONTINUED | | |
| | | |APPLICATION RESULTS IN A DENIAL FOR ANY REASON AND THE CLIENT MAKES A SUBSEQUENT| | |
| | | |REQUEST FOR ADULT FINANCIAL GRANT PAYMENTS, A NEW APPLICATION SHALL BE REQUIRED.| | |
| | | |2) IF THE CLIENT DOES NOT HAVE GOOD CAUSE AND NOTIFIES THE COUNTY DEPARTMENT | | |
| | | |THAT HE OR SHE WISHES TO CONTINUE HIS OR HER APPLICATION FOR ADULT FINANCIAL | | |
| | | |GRANT PAYMENTS WITHIN THIRTY (30) CALENDAR DAYS OF THE DENIAL, THE CURRENT | | |
| | | |APPLICATION MAY BE USED AND THE DATE OF APPLICATION SHALL BE THE MOST RECENT | | |
| | | |DATE THE CLIENT REQUESTED TO CONTINUE HIS OR HER APPLICATION FOR ADULT FINANCIAL| | |
| | | |GRANT PAYMENTS. THE COUNTY DEPARTMENT SHALL RESCHEDULE THE INTERVIEW AND MUST | | |
| | | |VERIFY AND DOCUMENT ANY CHANGES THAT OCCURRED BETWEEN THE INITIAL APPLICATION | | |
| | | |SUBMISSION AND THE REQUEST TO CONTINUE THAT APPLICATION. IF THE REQUEST TO | | |
| | | |CONTINUE THE APPLICATION RESULTS IN A DENIAL FOR ANY REASON AND THE CLIENT MAKES| | |
| | | |A SUBSEQUENT REQUEST FOR ADULT FINANCIAL GRANT PAYMENTS, A NEW APPLICATION SHALL| | |
| | | |BE REQUIRED. | | |
| | | |3) IF THE CLIENT REQUESTS GRANT PAYMENTS AFTER THIRTY (30) CALENDAR DAYS FROM | | |
| | | |THE DATE OF THE INITIAL DENIAL, HE OR SHE MUST SUBMIT A NEW APPLICATION. | | |
|3.520.4 |Section | |D. VERIFY STATEMENTS MADE BY THE CLIENT ON THE APPLICATION AND DURING THE |Moved. Clarified use of required |No |
| |Restructure & | |INTERVIEW USING THE STATEWIDE AUTOMATED SYSTEM INTERFACES DESCRIBED IN SECTION |verification if submitted untimely. | |
| |Modernization | |3.520.5, GATHERED FROM OTHER COLLATERAL CONTACTS OR REQUESTED FROM THE CLIENT. | | |
| | | |1. IF THE CLIENT IS MISSING ANY VERIFICATION, THE COUNTY DEPARTMENT SHALL | | |
| | | |REQUEST ADDITIONAL AND/OR REQUIRED VERIFICATIONS FROM THE CLIENT. THE REQUEST | | |
| | | |SHALL INCLUDE: | | |
| | | |A. A SPECIFIC LIST OF VERIFICATIONS NECESSARY TO DETERMINE ELIGIBILITY; | | |
| | | |B. THE DUE DATE FOR WHEN THE VERIFICATIONS MUST BE RETURNED, WHICH SHALL BE | | |
| | | |ELEVEN (11) CALENDAR DAYS FROM THE DATE THE VERIFICATION WAS REQUESTED IN | | |
| | | |WRITING UNLESS OTHERWISE SPECIFIED IN SECTION 3.540; AND, | | |
| | | |C. NOTIFICATION THAT IF THE CLIENT FAILS TO RETURN THE VERIFICATIONS BY THE DUE | | |
| | | |DATE, THE COUNTY DEPARTMENT SHALL PROCESS THE APPLICATION WITHOUT THOSE | | |
| | | |VERIFICATIONS, WHICH MAY LEAD TO A DENIAL OF GRANT PAYMENTS. | | |
| | | |2. THE CLIENT SHALL BE ADVISED THAT A COLLATERAL CONTACT OR HOME VISIT MAY BE | | |
| | | |USED TO CONFIRM QUESTIONABLE EVIDENCE, TO INVESTIGATE POTENTIAL FRAUD, OR WHEN | | |
| | | |DOCUMENTARY EVIDENCE IS INSUFFICIENT TO MAKE A DETERMINATION OF ELIGIBILITY OR | | |
| | | |GRANT PAYMENT AMOUNT OR CANNOT OTHERWISE BE OBTAINED. IF A COLLATERAL CONTACT IS| | |
| | | |NEEDED, THE COUNTY DEPARTMENT SHALL: | | |
| | | |A. REQUEST THE NAME OF AN APPROPRIATE COLLATERAL CONTACT FROM THE CLIENT; OR, | | |
| | | |B. INDEPENDENTLY DETERMINE AN APPROPRIATE COLLATERAL CONTACT; OR, | | |
| | | |C. SUBSTITUTE A HOME VISIT WHEN AN APPROPRIATE COLLATERAL CONTACT CANNOT BE | | |
| | | |IDENTIFIED; OR, | | |
| | | |D. DENY AN APPLICATION FOLLOWING THE POLICIES OUTLINED IN SECTION 3.554 IF A | | |
| | | |COLLATERAL CONTACT REFUSES TO PROVIDE DOCUMENTATION OF ESSENTIAL VERIFICATIONS | | |
| | | |AND THE APPLICANT IS UNWILLING TO COOPERATE IN OBTAINING SUCH DOCUMENTATION. | | |
| | | |1) THE CLIENT’S AUTHORIZATION FOR THE COLLATERAL CONTACT TO RELEASE SUCH | | |
| | | |INFORMATION OR DOCUMENTATION ALONE DOES NOT CONSTITUTE COOPERATION IF THE COUNTY| | |
| | | |DEPARTMENT REQUESTS FURTHER ASSISTANCE FROM THE CLIENT. DOCUMENTATION OF LACK OF| | |
| | | |COOPERATION MUST BE ENTERED IN THE CASE RECORD. | | |
| | | |2) HOWEVER, IF THE CLIENT IS WILLING TO COOPERATE, BUT UNABLE TO OBTAIN THE | | |
| | | |INFORMATION OR DOCUMENTATION FROM THE COLLATERAL CONTACT, THE COUNTY SHALL | | |
| | | |ASSIST HIM OR HER IN GAINING THE INFORMATION OR DOCUMENTATION REQUIRED TO MAKE A| | |
| | | |DETERMINATION OF ELIGIBILITY. IF THE COUNTY IS ALSO UNABLE TO OBTAIN THE | | |
| | | |INFORMATION OR DOCUMENTATION, ELIGIBILITY WILL BE DETERMINED BASED ON THE | | |
| | | |INFORMATION PROVIDED. | | |
| | | |E. MAINTAIN CLIENT CONFIDENTIALITY TO THE GREATEST EXTENT POSSIBLE WHEN USING A | | |
| | | |COLLATERAL CONTACT FOR VERIFICATION. | | |
| | | |3. RECORD THE DATE EACH VERIFICATION DOCUMENT WAS RECEIVED BY THE COUNTY | | |
| | | |DEPARTMENT OFFICE. | | |
| | | |4. UPON RECEIPT OF THE REQUIRED VERIFICATIONS, THE COUNTY DEPARTMENT SHALL ENTER| | |
| | | |VERIFICATIONS INTO THE STATEWIDE AUTOMATED SYSTEM. ONCE ALL VERIFICATIONS HAVE | | |
| | | |BEEN ENTERED, THE COUNTY DEPARTMENT SHALL REVIEW THE RESULTS, VERIFY ACCURACY, | | |
| | | |AND DETERMINE ELIGIBILITY. IF A CLIENT FAILS TO TIMELY RETURN VERIFICATIONS, THE| | |
| | | |CASE MAY BE DENIED FOLLOWING THE POLICIES OUTLINED IN SECTION 3.554. | | |
| | | |A. IF THE CLIENT PROVIDES NEW INFORMATION REGARDING A CHANGE IN CIRCUMSTANCES | | |
| | | |AFTER HE OR SHE WAS DETERMINED INELIGIBLE, THE CHANGE IN CIRCUMSTANCES SHALL BE | | |
| | | |TREATED AS FOLLOWS: | | |
| | | |1) IF THE CHANGE IN CIRCUMSTANCES OCCURRED WITHIN THIRTY (30) CALENDAR DAYS OF | | |
| | | |THE DENIAL, THE CLIENT’S ORIGINAL APPLICATION MAY BE USED AND THE DATE OF THE | | |
| | | |APPLICATION SHALL BE THE DATE ALL VERIFICATIONS WERE RECEIVED SUPPORTING THE NEW| | |
| | | |CIRCUMSTANCE. THE COUNTY DEPARTMENT SHALL VERIFY AND DOCUMENT ANY CHANGES THAT | | |
| | | |OCCURRED BETWEEN THE ORIGINAL APPLICATION SUBMISSION AND THE NEW REQUEST TO | | |
| | | |CONTINUE HIS OR HER APPLICATION. THE COUNTY DEPARTMENT SHALL ENTER THE | | |
| | | |VERIFICATIONS INTO THE STATEWIDE AUTOMATED SYSTEM, REVIEW THE RESULTS, VERIFY | | |
| | | |ACCURACY, AND DETERMINE ELIGIBILITY. IF THE CLIENT’S REQUEST TO CONTINUE HIS OR | | |
| | | |HER APPLICATION RESULTS IN A DENIAL FOR ANY REASON AND THE CLIENT MAKES A | | |
| | | |SUBSEQUENT REQUEST FOR ADULT FINANCIAL GRANT PAYMENTS, A NEW APPLICATION SHALL | | |
| | | |BE REQUIRED. | | |
| | | |2) IF THE CLIENT IDENTIFIES A CHANGE IN CIRCUMSTANCE MORE THAN THIRTY (30) | | |
| | | |CALENDAR DAYS FROM THE DATE OF THE DENIAL, HE OR SHE MUST SUBMIT A NEW | | |
| | | |APPLICATION. | | |
| | | |5. WHEN THE CLIENT DOES NOT SUBMIT THE REQUIRED VERIFICATIONS, AND THE CASE IS | | |
| | | |DENIED OR DISCONTINUED: | | |
| | | |A. IF A CLIENT RETURNS THE REQUIRED VERIFICATIONS WITHIN THIRTY (30) CALENDAR | | |
| | | |DAYS OF THE DENIAL OR DISCONTINUATION AND GOOD CAUSE IS PROVIDED FOR THE DELAYED| | |
| | | |SUBMISSION, THE COUNTY DEPARTMENT SHALL UTILIZE THE CURRENT APPLICATION DATE AND| | |
| | | |SHALL ENTER THE VERIFICATIONS INTO THE STATEWIDE AUTOMATED SYSTEM. WHEN ALL | | |
| | | |VERIFICATIONS HAVE BEEN ENTERED, THE COUNTY DEPARTMENT SHALL REVIEW THE RESULTS,| | |
| | | |VERIFY ACCURACY, AND DETERMINE ELIGIBILITY. IF THAT REQUEST TO CONTINUE THE | | |
| | | |APPLICATION RESULTS IN A DENIAL FOR ANY REASON AND THE CLIENT MAKES A SUBSEQUENT| | |
| | | |REQUEST FOR ADULT FINANCIAL GRANT PAYMENTS, A NEW APPLICATION SHALL BE REQUIRED.| | |
| | | |B. IF THE CLIENT DOES NOT HAVE GOOD CAUSE AND RETURNS THE REQUIRED VERIFICATIONS| | |
| | | |WITHIN THIRTY (30) CALENDAR DAYS OF THE DENIAL, THAT APPLICATION MAY BE USED AND| | |
| | | |THE DATE OF THE APPLICATION SHALL BE THE DATE ALL VERIFICATIONS WERE RECEIVED. | | |
| | | |THE COUNTY DEPARTMENT SHALL ENTER THE VERIFICATIONS INTO THE STATEWIDE AUTOMATED| | |
| | | |SYSTEM. WHEN ALL VERIFICATIONS HAVE BEEN ENTERED, THE COUNTY DEPARTMENT SHALL | | |
| | | |REVIEW THE RESULTS, VERIFY ACCURACY, AND DETERMINE ELIGIBILITY. IF THAT REQUEST | | |
| | | |TO CONTINUE THE APPLICATION RESULTS IN A DENIAL FOR ANY REASON AND THE CLIENT | | |
| | | |MAKES A SUBSEQUENT REQUEST FOR ADULT FINANCIAL GRANT PAYMENTS, A NEW APPLICATION| | |
| | | |SHALL BE REQUIRED. | | |
| | | |C. IF THE CLIENT PROVIDES THE VERIFICATIONS MORE THAN THIRTY (30) CALENDAR DAYS | | |
| | | |FROM THE DATE OF THE DENIAL, HE OR SHE MUST SUBMIT A NEW APPLICATION. | | |
| | | |6. IF A CLIENT BELIEVES THAT THE VALUE USED BY THE COUNTY DEPARTMENT FOR INCOME | | |
| | | |OR RESOURCE CALCULATION WAS INCORRECT, THE CLIENT MAY REQUEST VERBALLY OR IN | | |
| | | |WRITING TO HAVE HIS OR HER CASE REEVALUATED BY THE COUNTY WITHIN THIRTY (30) | | |
| | | |CALENDAR DAYS OF THE DENIAL. THE COUNTY DEPARTMENT SHALL EVALUATE AND REQUEST | | |
| | | |ADDITIONAL DOCUMENTATION IF NEEDED. IF AN INCORRECT DETERMINATION WAS MADE, THE| | |
| | | |COUNTY DEPARTMENT SHALL CORRECT THE CASE AND GRANT PAYMENTS SHALL BE | | |
| | | |RECALCULATED AND ISSUED BASED ON THE ORIGINAL APPLICATION DATE. | | |
| | | |7. DELAY IN PROCESSING THE APPLICATION SHALL NOT BE ALLOWED FOR ANY OF THE | | |
| | | |FOLLOWING: | | |
| | | |A. WHEN THE CLIENT HAS APPLIED FOR A SOCIAL SECURITY NUMBER AND IS AWAITING | | |
| | | |ACTION BY THE SSA; OR, | | |
| | | |B. WHEN THE COUNTY DEPARTMENT IS AWAITING RECEIPT OF INFORMATION FROM THE STATE | | |
| | | |VERIFICATION EXCHANGE SYSTEM (SVES). | | |
|3.520.4 |Section | |E. PROVIDE A NOTICE OF ACTION TO THE CLIENT BY MAIL, ELECTRONIC NOTIFICATION, OR|No change-just moved. |No |
| |Restructure & | |IN PERSON USING THE STATE DEPARTMENT'S PRESCRIBED FORM EXPLAINING THE | | |
| |Modernization | |ELIGIBILITY DETERMINATION RESULTS AND THE CLIENT'S APPEAL RIGHTS AS OUTLINED IN | | |
| | | |SECTION 3.586, ET SEQ. | | |
|3.520.5 |Clarification | |INTERFACES ARE ACCEPTABLE VERIFICATION SOURCES FOR THE ADULT FINANCIAL PROGRAMS.|Added introduction to section to | |
| |Needed | |APPROPRIATE INTERFACES FOR VERIFICATION PURPOSES ARE DESCRIBED BELOW. |clarify intent of information | |
| | | | |contained in the section. | |
|3.520.5 |Clarification |A. The Income and Eligibility Verification System (IEVS) |A. The Income and Eligibility Verification System (IEVS) provides for the |Align rule with Colorado Works as |No |
| |Needed |provides for the exchange of information on clients with |exchange of information on clients with the Social Security Administration |well as Federal rule on IEVS | |
| | |the Social Security Administration (SSA), Internal Revenue |(SSA), Internal Revenue Service (IRS) and the Colorado Department of Labor and |exceptions. | |
| | |Service (IRS) and the Colorado Department of Labor and |Employment (DOLE). The county department shall query IEVS, using the client's, | | |
| | |Employment (DOLE). The county department shall query IEVS, |client's spouse's, and client's sponsors' SSNSSocial Security Numbers. Source | | |
| | |using the client's, client's spouse's, and client's |agency records shall be matched on a regular basis to identify potential earned | | |
| | |sponsors' Social Security Numbers. Source agency records |and unearned income, resources, and assets, including: | | |
| | |shall be matched on a regular basis to identify potential |1. The following data shall be considered verified upon receipt: | | |
| | |earned and unearned income, resources, and assets, |a. SSA (BENEFICIARY AND EARNINGS DATA EXCHANGE (BENDEX) AND STATE DATA EXCHANGE | | |
| | |including:1. The following data shall be considered |(SDX)) Social Security benefits, SSI, pensions, self-employment earnings, | | |
| | |verified upon receipt:a. SSA (BENDEX, SDX) Social Security |federal employee earnings; and, | | |
| | |benefits, SSI, pensions, self-employment earnings, federal |b. IRS unearned income information including interest on checking or savings | | |
| | |employee earnings; and,b. IRS unearned income information |accounts, dividends, royalties, winnings from betting establishments, capital | | |
| | |including interest on checking or savings accounts, |gains, etc.; and, | | |
| | |dividends, royalties, winnings from betting establishments,|Bc. Unemployment benefits (UIB). | | |
| | |capital gains, etc.; and,c. Unemployment benefits (UIB).2. |2. DOLE wage data shall not be considered verified upon receipt. | | |
| | |DOLE wage data shall not be considered verified upon |A. ADDITIONAL VERIFICATION MUST BE OBTAINED TO VERIFY WAGE INFORMATION. THE | | |
| | |receipt. However, benefits shall not be delayed pending |COUNTY DEPARTMENT SHALL REQUEST THIS INFORMATION BE PROVIDED BY THE CLIENT | | |
| | |receipt of verification from a collateral source (e.g., |AND/OR HIS OR HER EMPLOYER IN WRITING. THIS INFORMATION MUST BE PROVIDED WITHIN | | |
| | |employers).3. The county department shall, at a minimum, |ELEVEN (11) DAYS FOLLOWING THE DATE OF THE COUNTY’S REQUEST OR THE CASE WILL BE | | |
| | |prior to approval of benefits, verify potential earnings or|DISCONTINUED OR DENIED FOLLOWING THE POLICIES OUTLINED IN SECTION 3.554. | | |
| | |unemployment benefits for the client, client's spouse, and |However, benefits shall not be delayed pending receipt of verification from a | | |
| | |sponsor(s).4. The county department shall act on all |collateral source (e.g., employers). | | |
| | |information received through IEVS within forty-five (45) |B. THE COUNTY DEPARTMENT SHALL QUERY DOLE AT INITIAL APPLICATION AND AT | | |
| | |calendar days of receipt. |REDETERMINATION. | | |
| | | |3. PRIOR TO APPROVAL OF GRANT PAYMENTS, TThe county department shall, at a | | |
| | | |minimum, prior to approval of benefits, verify potential earnings or | | |
| | | |unemployment benefits for the client, client's spouse, and sponsor(s). | | |
| | | |4. The county department shall act on all information received through IEVS | | |
| | | |within forty five (45) calendar days of receipt. | | |
| | | |5. THE COUNTY DEPARTMENT SHALL NOT DELAY PROCESSING OF IEVS BEYOND FORTY-FIVE | | |
| | | |(45) CALENDAR DAYS ON MORE THAN TWENTY (20) PERCENT OF THE INFORMATION TARGETED | | |
| | | |FOR FOLLOW-UP, IF: | | |
| | | |a. THE REASON THAT THE ACTION CANNOT BE COMPLETED WITHIN FORTY-FIVE (45) | | |
| | | |CALENDAR DAYS IS THE NONRECEIPT OF REQUESTED THIRD PARTY VERIFICATION; AND, | | |
| | | |b. ACTION IS COMPLETED PROMPTLY, WHEN THIRD PARTY VERIFICATION IS RECEIVED OR AT| | |
| | | |THE NEXT TIME ELIGIBILITY IS REDETERMINED, WHICHEVER IS EARLIER. IF ACTION IS | | |
| | | |COMPLETED WHEN ELIGIBILITY IS REDETERMINED AND THIRD PARTY VERIFICATION HAS NOT | | |
| | | |BEEN RECEIVED, THE COUNTY DEPARTMENT SHALL MAKE ITS DECISION BASED ON | | |
| | | |INFORMATION PROVIDED BY THE CLIENT AND ANY OTHER INFORMATION IN ITS POSSESSION. | | |
| | | |6. AT INITIAL APPLICATION AND AT REDETERMINATION, A CLIENT SHALL BE NOTIFIED | | |
| | | |THROUGH A WRITTEN STATEMENT PROVIDED ON OR WITH THE APPLICATION FORM THAT (1) | | |
| | | |THE INFORMATION AVAILABLE THROUGH IEVS WILL BE REQUESTED, AND THAT SUCH | | |
| | | |INFORMATION WILL BE USED FOR DETERMINATION OF ELIGIBILITY; (2) THE INFORMATION | | |
| | | |IN IEVS MUST BE VERIFIED THROUGH SOURCES, SUCH AS COLLATERAL CONTACTS WITH THE | | |
| | | |CLIENT, WHEN DISCREPANCIES ARE FOUND BY THE COUNTY DEPARTMENT; AND, (3) THAT THE| | |
| | | |VERIFIED INFORMATION MAY AFFECT THE CLIENT’S ELIGIBILITY AND GRANT PAYMENT | | |
| | | |AMOUNT. | | |
| | | |a. ALL VERIFICATION TYPES OBTAINED BY A COLLATERAL CONTACT TO VALIDATE OR | | |
| | | |INVALIDATE ANY IEVS DISCREPANCY SHALL BE DOCUMENTED; | | |
| | | |b. CASE DOCUMENTATION SHALL BE AVAILABLE IN THE CASE FILE OR STATEWIDE AUTOMATED| | |
| | | |SYSTEM DOCUMENTING THE ACTION TAKEN ON THE CASE WITHIN FORTY-FIVE (45) CALENDAR | | |
| | | |DAYS OF INITIAL RECEIPT. CASE DOCUMENTATION MUST INCLUDE THE PURPOSE OF THE | | |
| | | |REVIEW OF THE IEVS, THE ACTION TAKEN ON THE CASE, AND HOW THE COUNTY DEPARTMENT | | |
| | | |MADE THE DETERMINATION AND WHETHER THAT DETERMINATION SUPPORTS THE COUNTY’S | | |
| | | |ACTION ON THE CASE. | | |
|3.520.5 |Restructured |B. The county department shall query DOLE at initial |B. The county department shall query DOLE at initial application and at |Added SVES as a source of interface |No |
| |Section |application and at redetermination. DOLE wage data shall |redetermination. DOLE wage data shall not be considered verified upon receipt. |information. | |
| | |not be considered verified upon receipt. Dole unemployment |DOLE unemployment benefit data shall be considered verified upon receipt. | | |
| | |benefit data shall be considered verified upon receipt. |However, benefits shall not be delayed pending receipt of verification from a | | |
| | |However, benefits shall not be delayed pending receipt of |collateral source. THE STATE VERIFICATION EXCHANGE SYSTEM (SVES) MAY BE USED TO | | |
| | |verification from a collateral source. |VERIFY SOCIAL SECURITY NUMBER, SSA INCOME, AND SUPPLEMENTAL SECURITY INCOME | | |
| | | |APPLICATION STATUS. SVES MAY ALSO BE USED TO IDENTIFY POTENTIAL MARITAL STATUS, | | |
| | | |POTENTIAL RESOURCES, AND OTHER POTENTIAL SOURCES OF INCOME; ADDITIONAL | | |
| | | |VERIFICATION MAY BE NECESSARY. | | |
|3.520.5 |Clarification |C. The county department shall query the Public Assistance |C. The county department shall query the Public Assistance Reporting Information|Clarified that further action is |No |
| |Needed |Reporting Information System (PARIS) at initial application|System (PARIS) at initial application and at redetermination to determine |necessary in reviewing PARIS. | |
| | |and at redetermination to determine whether the client is |whether the client is receiving benefits in another state, veterans' benefits, | | |
| | |receiving benefits in another state, veterans' benefits, or|or military wages or allotments. THIS INFORMATION IS NOT CONSIDERED VERIFIED | | |
| | |military wages or allotments. |UPON RECEIPT AND ADDITIONAL VERIFICATION MUST BE OBTAINED TO VERIFY THE | | |
| | | |INFORMATION PROVIDED IN PARIS. THE COUNTY DEPARTMENT SHALL REQUEST THIS | | |
| | | |INFORMATION BE PROVIDED BY THE CLIENT AND/OR THE OTHER STATE, VETERAN’S AGENCY, | | |
| | | |OR MILITARY BRANCH IN WRITING. | | |
|3.520.5 |Clarification |D. The county department shall query the Systematic Alien |D. The county department shall query the Systematic Alien Verification for |Combined 2 & 3 to make clearer. |No |
| |Needed |Verification for Entitlements (SAVE) at initial application|Entitlements (SAVE) at initial application and at redetermination. INFORMATION | | |
| | |and at redetermination to: |OBTAINED THROUGH SAVE IS CONSIDERED VERIFIED UPON RECEIPT. THE PURPOSE OF THE | | |
| | |1. Determine whether a qualified non-citizen has a |SAVE QUERY IS to: | | |
| | |sponsor(s); and, |1. Determine whether a qualified non-citizen has a sponsor(s); and, | | |
| | |2. Verify the non-citizen registration number provided by |2. Verify the non-citizen registration number provided by the client; and, IF | | |
| | |the client; and, |THE NUMBER AND NAME SUBMITTED DO NOT MATCH, REFER THE CLIENT TO RESOLVE THE | | |
| | |3. If the number and name submitted do not match, the |DISCREPANCY, AND IF UNABLE TO RESOLVE, TAKE PROMPT ACTION TO TERMINATE | | |
| | |county department shall take prompt action to terminate |ASSISTANCE TO THE CLIENT FOLLOWING THE POLICIES OUTLINED IN SECTION 3.554; AND, | | |
| | |assistance to the client. |3. If the number and name submitted do not match, the county department shall | | |
| | |4. Determine if there has been a change in the |take prompt action to terminate assistance to the client. | | |
| | |non-citizen's status. |3.4. Determine if there has been a change in the non-citizen's IMMIGRATION | | |
| | | |status. | | |
|3.520.61 |Clarification |To be eligible for Adult Financial programs, a client |A. Be eighteen (18) through fifty-nine (59) years of age for AND-SO (unless |Technical cleanup |No |
| |Needed |shall: |diagnosed with blindness, then age zero (0) through 59 years of age); age zero | | |
| | |A. Be eighteen (18) through fifty-nine (59) years of age |(0) through 59 years of age for AND-CS; and age sixty (60) years of age or older| | |
| | |for AND-SO (unless diagnosed with blindness, then age zero |for OAP; and, | | |
| | |(0) through 59 years of age); age zero (0) through 59 years| | | |
| | |of age for AND-CS; and age sixty (60) years of age or older| | | |
| | |for OAP and, | | | |
|3.520.61 |Clarification |C. Be a citizen of the United States or be a qualified |C. Be a citizen of the United States or be a qualified non-citizen or legal |Added qualifier to lawful presence. | |
| |Needed |non-citizen or legal immigrant as outlined in Sections |immigrant as outlined in Sections 3.520.66 who is lawfully present IN THE UNITED| | |
| | |3.520.66 who is lawfully present; and, |STATES; and, | | |
|3.520.61 |Clarification |D. Have a valid Social Security Number, as outlined in |D. Have a valid Social Security Number, as outlined in Section 3.520.65; and, |Technical cleanup | |
| |Needed |Section 3.520.65; and, | | | |
|3.520.61 |Clarification |F. Not be currently receiving or eligible for financial |F. Not be currently receiving or eligible for financial assistance from Colorado|Technical cleanup. |No |
| |Needed |assistance from Colorado Works; and, |Works, AS OUTLINED IN SECTION 3.520.71, F; and, | | |
|3.520.61 |Clarification |G. Take reasonable steps to apply for and accept all |G. Take reasonable steps to aApply for and accept all retirement and public |Align with the language identified in|No |
| |Needed |retirement and public assistance benefits for which they |assistance benefits for which they may be eligible, UNLESS GOOD CAUSE IS |statute. | |
| | |may be eligible; and, |PROVIDED AS TO WHY SUCH BENEFITS WERE NOT APPLIED FOR OR ACCEPTED; and, | | |
|3.520.61 |Clarification |H. Pursue and accept all other income and resources that |H. Pursue and accept all other POTENTIAL income and resources that may be |Align with Definitions section of |No |
| |Needed |may be available; and, |available, AS OUTLINED IN SECTION 3.520.71; and, |rule. | |
|3.520.62 |Clarification |The county department shall verify the client's age by |The county department shall verify the client's age by viewing the statewide |Combined A & B and eliminated barrier|No |
| |Needed |viewing the statewide automated system interface |automated system interface information or ANY OF THE FOLLOWING documents, as |to individuals unable to find at | |
| | |information or documents, as follows:A. One of the |follows: |least 1 of these verification types. | |
| | |following valid government issued documents or |A. One of the following valid government issued documents or identification: | | |
| | |identification:1. Birth certificate;2. Valid Colorado state|1. Birth certificate; | | |
| | |identification or driver's license;3. Valid out of state |2. Valid Colorado state identification or driver's license; | | |
| | |identification or driver's license;4. Naturalization, |3. Valid out of state identification or driver's license; | | |
| | |immigration, or passport papers;5. Legal documents from |4. Naturalization, immigration, or passport papers; | | |
| | |vital statistics; or,6. Social Security information (SOLQ, |5. Legal documents from vital statistics; or, | | |
| | |SVES, SDX, and BENDEX); or, |6. Social Security information (SOLQ, SVES, SDX, and BENDEX); or, | | |
| | | |B. Two or more of the following documents: | | |
| | | |71. School records; | | |
| | | |82. Baptismal certificates or other well documented church records; | | |
| | | |93. Genealogy records or other well documented family records of birth; | | |
| | | |104. Voting records; OR, | | |
| | | |115. United States census records. | | |
|3.520.62 | |B. Two or more of the following documents: |B. Two or more of the following documents: |Combined A & B and eliminated barrier|No |
| | |1. School records; |1. School records; |to individuals unable to find at | |
| | |2. Baptismal certificates or other well documented church |2. Baptismal certificates or other well documented church records; |least 1 of these verification types. | |
| | |records; |3. Genealogy records or other well documented family records of birth; | | |
| | |3. Genealogy records or other well documented family |4. Voting records; | | |
| | |records of birth; |5. United States census records. | | |
| | |4. Voting records; | | | |
| | |5. United States census records. | | | |
|3.520.63 |Clarification |A. The county department shall determine the client's |A. The county department shall determine AND VERIFY IF QUESTIONABLE the client's|Adding "verify if questionable" will |No |
| |Needed |marital status as one of the following: |marital status as one of the following: |reduce inappropriate denials for | |
| | |1. Single, never married; |1. Single, never married; |individuals that have been divorced | |
| | |2. Married; |2. Married; |or legally separated however no | |
| | |3. Widowed; or, |3. Widowed; or, |longer have the legal document | |
| | |4. Divorced or legally separated. |4. Divorced or legally separated. |supporting such status. | |
|3.520.63 |Clarification |C. If the client is divorced or legally separated, the |C. If the client is divorced, or legally separated OR WIDOWED, AND THIS STATUS |Adding "if questionable" will reduce |No |
| |Needed |client shall provide verification in the form of:1. Legal |IS QUESTIONABLE, the client shall provide verification in the form of: |inappropriate denials for individuals| |
| | |documents showing divorce or legal separation; or,2. |1. Legal COURT documents OR ALTERNATE VERIFICATION FROM A VITAL STATISTIC SOURCE|that have been divorced or legally | |
| | |Written statements by two or more persons who are unrelated|SUBSTANTIATING showing divorce or legal separation; or, |separated however no longer have the | |
| | |to each other and to the spouses, who can establish that |2. Written statements by two or more persons who are unrelated to each other and|legal document supporting such | |
| | |they are in a position to know and assert that both |to the spouses, who can establish that they are in a position to know and assert|status. | |
| | |physical and financial ties have been dissolved and a |that both physical and financial ties have been dissolved and a complete and | | |
| | |complete and permanent separation does, in fact, exist. The|permanent separation does, in fact, exist. The county department shall use | | |
| | |county department shall use prudent person principle and |prudent person principle and weigh the documentation and make a decision | | |
| | |weigh the documentation and make a decision regarding |regarding marital status. | | |
| | |marital status. |2. DEATH CERTIFICATE OR OBITUARY OF THE CLIENT’S SPOUSE. | | |
|3.520.63 |New Rule | |D. CLIENTS WHO ARE NOT LEGALLY SEPARATED OR DIVORCED ARE CONSIDERED MARRIED. |Providing additional clarification. |No |
| |Addition | | | | |
|3.520.64 |Clarification |B. Residency is established on the first day the client |B. Residency is established on the first day the client declares him/herself to |Clarifying that an individual would |No |
| |Needed |declares him/herself to be a resident of Colorado. |be a resident of Colorado. |only be ineligible if receiving cash | |
| | |1. A person shall not acquire residence while the person |1. A person shall not acquire residence while the person has established his/her|assistance in another state rather | |
| | |has established his/her permanent place of residence in |permanent place of residence in another state or country. |than all benefits. | |
| | |another state or country. |2. A person receiving FINANCIAL assistance from another state shall not be | | |
| | |2. A person receiving assistance from another state shall |eligible for Adult Financial programs in Colorado during any month in which a | | |
| | |not be eligible for Adult Financial programs in Colorado |payment is made by the other state. | | |
| | |during any month in which a payment is made by the other | | | |
| | |state. | | | |
|3.520.64 |Clarification |C. The client shall live in the county in which the |C. The client shall live in the county in which the application is made. |Use the term homeless as defined in | |
| |Needed |application is made. |1. A client who resides in a county but who IS HOMELESSdoes not reside in a |the definitions section. | |
| | |1. A client who resides in a county but who does not reside|permanent dwelling or have a fixed mailing address shall be considered eligible | | |
| | |in a permanent dwelling or have a fixed mailing address |for assistance, provided all other eligibility requirements are met. | | |
| | |shall be considered eligible for assistance, provided all |2. Clients who do not have a fixed address may provide a postal box within their| | |
| | |other eligibility requirements are met. |county as their mailing address, or may use the county department as their | | |
| | |2. Clients who do not have a fixed address may provide a |mailing address. It shall be the client's responsibility to go to the postal box| | |
| | |postal box within their county as their mailing address, or|or the county department to check for and pick up their mail. Failure to | | |
| | |may use the county department as their mailing address. It |regularly check for and pick up mail shall not be grounds for appealing timely | | |
| | |shall be the client's responsibility to go to the postal |notice. | | |
| | |box or the county department to check for and pick up their| | | |
| | |mail. Failure to regularly check for and pick up mail shall| | | |
| | |not be grounds for appealing timely notice. | | | |
|3.520.64 |Clarification |E. A client who is out of state temporarily shall be |E. A client who is out of state temporarily shall be considered a resident, with|Recommended addition by the Chief |No |
| |Needed |considered a resident, with the following exceptions:1. A |the following exceptions:1. A client who leaves the country for a period of |Adjudicator of appeals. | |
| | |client who leaves the country for a period of thirty (30) |thirty (30) or more consecutive days creates a rebuttable presumption (unless | | |
| | |or more consecutive days creates a rebuttable presumption |the client comes forward with enough information to prove otherwise) that the | | |
| | |(unless the client comes forward with enough information to|client shall no longer be considered a resident and shall be ineligible for | | |
| | |prove otherwise) that the client shall no longer be |Adult Financial programs. 2. A client who leaves the state for a period of | | |
| | |considered a resident and shall be ineligible for Adult |ninety (90) or more consecutive days creates a rebuttable presumption (unless | | |
| | |Financial programs.2. A client who leaves the state for a |the client comes forward with enough information to prove otherwise) that the | | |
| | |period of ninety (90) or more consecutive days creates a |client shall no longer be considered a resident and shall be ineligible for | | |
| | |rebuttable presumption (unless the client comes forward |Adult Financial programs. An exception to this is for individuals temporarily | | |
| | |with enough information to prove otherwise) that the client|out of the state to receive DOCUMENTED medical treatment. 3. A client who leaves| | |
| | |shall no longer be considered a resident and shall be |the state for a period of more than ONE HUNDRED EIGHTY (180) DAYS six (6) months| | |
| | |ineligible for Adult Financial programs. An exception to |in any calendar year, even if that time has not been consecutive time away, | | |
| | |this is for individuals temporarily out of the state to |creates a rebuttable presumption (unless the client comes forward with enough | | |
| | |receive medical treatment.3. A client who leaves the state |information to prove otherwise) that the client shall no longer be considered a | | |
| | |for a period of more than six (6) months in any calendar |resident and shall be ineligible for Adult Financial programs. 4. A client who | | |
| | |year, even if that time has not been consecutive time away,|leaves the state to care for an immediate family member injured in the line of | | |
| | |creates a rebuttable presumption (unless the client comes |military duty for a period of one hundred eighty (180) or more consecutive days | | |
| | |forward with enough information to prove otherwise) that |creates a rebuttable presumption (unless the client comes forward with enough | | |
| | |the client shall no longer be considered a resident and |information to prove otherwise) that the client shall no longer be considered a | | |
| | |shall be ineligible for Adult Financial programs.4. A |resident and shall be ineligible for Adult Financial programs. | | |
| | |client who leaves the state to care for an immediate family| | | |
| | |member injured in the line of military duty for a period of| | | |
| | |one hundred eighty (180) or more consecutive days creates a| | | |
| | |rebuttable presumption (unless the client comes forward | | | |
| | |with enough information to prove otherwise) that the client| | | |
| | |shall no longer be considered a resident and shall be | | | |
| | |ineligible for Adult Financial programs. | | | |
|3.520.64 |Clarification |F. When a determination of principal place of residence is |F. When a determination of principal place of residence is difficult to secure |Added “the” in front of prudent | |
| |Needed |difficult to secure due to conflicting documentation, other|due to conflicting documentation, other sources shall be used to gather |person principle for grammatical | |
| | |sources shall be used to gather verification and make a |verification and make a decision, such as addresses obtained from voter |correctness. | |
| | |decision, such as addresses obtained from voter |registrations, tax returns, Social Security and Medicare, a driver's license, | | |
| | |registrations, tax returns, Social Security and Medicare, a|car registrations, or other statements or documents. The county department shall| | |
| | |driver's license, car registrations, or other statements or|use THE prudent person principle to weigh the documentation and/or verification | | |
| | |documents. The county department shall use prudent person |and make a decision regarding residency. | | |
| | |principle to weigh the documentation and/or verification | | | |
| | |and make a decision regarding residency. | | | |
|3.520.64 |Clarification |G. The burden to prove residency shall be on the client. |G. The burden to prove residency shall be on the client. IF A CLIENT REFUSES TO |Providing additional clarification. |No |
| |Needed | |PROVIDE REQUESTED OR NECESSARY DOCUMENTATION OR INFORMATION TO VERIFY RESIDENCY,| | |
| | | |ADULT FINANCIAL BENEFITS SHALL BE DENIED FOLLOWING THE POLICIES OUTLINED IN | | |
| | | |SECTION 3.554. | | |
|3.520.65 |Clarification |A. Each Adult Financial program client shall provide |A. Each Adult Financial program client shall provide his OR /her Social Security|Technical cleanup | |
| |Needed |his/her Social Security number (SSN) to the county |number (SSN) to the county department. | | |
| | |department. |1. If a client has multiple numbers, all numbers shall be required. | | |
| | |1. If a client has multiple numbers, all numbers shall be |2. If a client is unable to provide their SSN, the client shall be required to | | |
| | |required. |apply for an SSN at the local Social Security office and provide the county | | |
| | |2. If a client is unable to provide their SSN, the client |department with verification of application for an SSN. | | |
| | |shall be required to apply for an SSN at the local Social |3. Refusal or failure to apply for or provide their SSN shall result in denial | | |
| | |Security office and provide the county department with |for Adult Financial programs. | | |
| | |verification of application for an SSN. |4. Upon proof of application for an SSN, the time required for issuance OF THE | | |
| | |3. Refusal or failure to apply for or provide their SSN |NUMBER or to secure verification of the number shall not be used as a basis for | | |
| | |shall result in denial for Adult Financial programs. |delaying action on the Adult Financial program application. | | |
| | |4. Upon proof of application for an SSN, the time required | | | |
| | |for issuance or to secure verification of the number shall | | | |
| | |not be used as a basis for delaying action on the Adult | | | |
| | |Financial program application. | | | |
|3.520.65 |Clarification |B. The county department shall verify the client's Social |B. The county department shall verify the client's Social Security Number (SSN) |Technical cleanup. |No |
| |Needed |Security Number (SSN) with the Social Security |with the Social Security Administration (SSA) in accordance with procedures | | |
| | |Administration (SSA) in accordance with procedures |established by the State Department for the State Verification Exchange System | | |
| | |established by the State Department for the State |(SVES). | | |
| | |Verification Exchange System (SVES).1. The county |1. The county department shall accept as verified a SSN that has been confirmed | | |
| | |department shall accept as verified a SSN that has been |by the SVES. | | |
| | |confirmed by the SVES.2. When the county department |2. When the county department receives notification that an SSN cannot be | | |
| | |receives notification that an SSN cannot be verified or is |verified or is otherwise discrepant (e.g., name or number do not match SSA | | |
| | |otherwise discrepant (e.g., name or number do not match SSA|records), the county department shall: | | |
| | |records), the county department shall:a. Conduct a case |a. Conduct a case record review to confirm that the SSN in the case record | | |
| | |record review to confirm that the SSN in the case record |matches the SSN submitted to the SSA for verification. | | |
| | |matches the SSN submitted to the SSA for verification.1) If|1) If an error occurred in the original submittal (e.g., digits transposed, | | |
| | |an error occurred in the original submittal (e.g., digits |incorrect name submitted) the county department shall correct the error and | | |
| | |transposed, incorrect name submitted) the county department|resubmit the SSN through SVES for verification. | | |
| | |shall correct the error and resubmit the SSN through SVES |2) If no error is identified, the county department shall advise the client in | | |
| | |for verification.2) If no error is identified, the county |writing that THE an SSN could not be verified, and instruct the client to | | |
| | |department shall advise the client in writing that an SSN |contact the local Social Security office to resolve the discrepancy. | | |
| | |could not be verified, and instruct the client to contact |b. Make every effort to assist the client to obtain available documents required| | |
| | |the local Social Security office to resolve the |by the SSA. | | |
| | |discrepancy.b. Make every effort to assist the client to |3. If the client is unable to provide his OR /her valid SSN, the application | | |
| | |obtain available documents required by the SSA.3. If the |shall be denied or the case terminated FOLLOWING THE POLICIES OUTLINED IN | | |
| | |client is unable to provide his/her valid SSN, the |SECTION 3.554. | | |
| | |application shall be denied or the case terminated. | | | |
|3.520.66 |Clarification |A. Pursuant to Section 24-76.5-103, C.R.S., Adult Financial|A. Pursuant to Section 24-76.5-103, C.R.S., Adult Financial program clients are |Utilize “grant payments” consistently| |
| |Needed |program clients are required to produce verification of |required to produce verification of lawful presence in the United States prior |to refer to AF benefits and technical| |
| | |lawful presence in the United States prior to receiving |to receiving GRANT PAYMENTSbenefits. For purposes of this section: |cleanup. | |
| | |benefits. For purposes of this section: |1. “Affidavit” means a State prescribed form wherein an applicant CLIENT | | |
| | |1. “Affidavit” means a State prescribed form wherein an |attests, subject to the penalties of perjury, that HE OR SHE ISthey are lawfully| | |
| | |applicant attests, subject to the penalties of perjury, |present in the United States. An affidavit need not be notarized. | | |
| | |that they are lawfully present in the United States. An |2. “Produce” means to provide for inspection either: 1) an original, or 2) a | | |
| | |affidavit need not be notarized. |true and complete copy of the original document. A document may be produced | | |
| | |2. “Produce” means to provide for inspection either: 1) an |either in person or by mail. | | |
| | |original, or 2) a true and complete copy of the original | | | |
| | |document. A document may be produced either in person or by| | | |
| | |mail. | | | |
|3.520.66 |Clarification |B. In order to verify his or her lawful presence in the |B. In order to verify his or her lawful presence in the United States, the |Technical cleanup. |No |
| |Needed |United States, the client shall:1. Execute an affidavit |client shall: | | |
| | |saying that:a. He or she is a United States citizen or |1. Execute an affidavit saying that: | | |
| | |legal permanent resident; or,b. He or she is otherwise |a. He or she is a United States citizen or legal permanent resident; or, | | |
| | |lawfully present in the United States pursuant to federal |b. He or she is otherwise lawfully present in the United States pursuant to | | |
| | |law; and,2. Produce and provide to the county department:a.|federal law; and, | | |
| | |A valid Colorado driver's license or a Colorado |2. Produce and provide to the county department: | | |
| | |identification card issued pursuant to Article 2 of Title |a. A valid Colorado driver's license or a Colorado identification card issued | | |
| | |42, C.R.S.; or,b. A United States military card or military|pursuant to Article 2 of Title 42, C.R.S.; or, | | |
| | |dependent's identification card; or,c. A United States |b. A United States military card or military dependent's identification card; | | |
| | |Coast Guard Merchant Mariner Card; or,d. A Native American |or, | | |
| | |tribal document; or,e. Any other document authorized by |c. A United States Coast Guard Merchant Mariner Card; or, | | |
| | |rules adopted by the Colorado Department of Revenue (1 |d. A Native American tribal document; or, | | |
| | |C.C.R. 201-17); or,f. Adult Financial program clients who |e. Any other document authorized by rules adopted by the Colorado Department of | | |
| | |cannot produce one of the required documents may |Revenue PERTAINING TO LAWFUL PRESENCE FOUND AT 1 C.C.R. 204-30:5 AS OF APRIL 14,| | |
| | |demonstrate lawful presence by both executing the affidavit|2019. THESE DEPARTMENT OF REVENUE RULES ARE HEREIN INCORPORATED BY REFERENCE AND| | |
| | |and executing a request for waiver. The request for waiver |DO NOT INCLUDE ANY LATER AMENDMENTS OR EDITIONS OF THESE RULES. THESE RULES ARE | | |
| | |must be provided to the Colorado Department of Revenue in |AVAILABLE FOR PUBLIC INSPECTION AT THE COLORADO DEPARTMENT OF REVENUE, 1375 | | |
| | |person, by mail, or online, and must be accompanied by all |SHERMAN ST., DENVER, CO 80261 OR FOR NO COST AT WWW.SOS.STATE.CO.US. COPIES OF | | |
| | |documents the client can produce to prove lawful presence. |THESE RULES ARE AVAILABLE FOR REASONABLE COST DURING NORMAL BUSINESS HOURS AT | | |
| | |An approved waiver must be issued by the Colorado |THE COLORADO DEPARTMENT OF HUMAN SERVICES, DIRECTOR OF THE EMPLOYMENT AND | | |
| | |Department of Revenue in accordance with 1 C.C.R. 201-17. |BENEFITS DIVISION, 1575 SHERMAN ST., DENVER, CO 80203 OR THE COLORADO DEPARTMENT| | |
| | |The county department is responsible for verifying that the|OF REVENUE, 1375 SHERMAN ST., DENVER, CO 80203; or, | | |
| | |applicant is the same individual indicated as being |f. Adult Financial program clients who cannot produce one of the required | | |
| | |lawfully present through the approved waiver. |documents may demonstrate lawful presence by both executing the affidavit and BY| | |
| | | |REQUESTING AND OBTAININGexecuting a request for waiver FROM THE COLORADO | | |
| | | |DEPARTMENT OF REVENUE. The request for waiver must be provided to the Colorado | | |
| | | |Department of Revenue in person, by mail, or online, and must be accompanied by | | |
| | | |all documents the client can produce to prove lawful presence. An approved | | |
| | | |waiver must be issued by the Colorado Department of Revenue in accordance with 1| | |
| | | |C.C.R. 201-17 204-30:5. The county department is responsible for verifying that | | |
| | | |the applicant CLIENT is the same individual indicated as being lawfully present | | |
| | | |through the approved waiver. | | |
|3.520.67 |Clarification |C. Citizenship may be verified by a birth certificate, |C. Citizenship may be verified by a birth certificate, possession of a U.S. |Changed Statutory reference. |No |
| |Needed |possession of a U.S. passport, a certificate of U.S. |passport, a certificate of U.S. citizenship (ISSUED BY USCIS form N-560 or | | |
| | |citizenship (CIS form N-560 or NH-561), a certificate of |NH-561), a certificate of naturalization (ISSUED BY USCIS form N-550 or N-570), | | |
| | |naturalization (CIS form N-550 or N-570), a certificate of |a certificate of birth abroad of a citizen of the United States (ISSUED BY THE | | |
| | |birth abroad of a citizen of the United States (Department |Department of State forms FS-545 or DS-1350), or Identification Cards for U.S. | | |
| | |of State forms FS-545 or DS-1350), or Identification Cards |citizens (ISSUED BY USCIS-I-179 or CIS-I-197). DOCUMENTS THAT ARE ACCEPTABLE AS | | |
| | |for U.S. citizens (CIS-I-179 or CIS-I-197). Documents that |VERIFICATION OF CITIZENSHIP CAN BE FOUND IN THE FEDERAL REGULATIONS AT 45 CFR | | |
| | |are acceptable as verification of citizenship can be found |1626.6 AS OF MAY 19, 2014, WHICH ARE HEREIN INCORPORATED BY REFERENCE. THIS RULE| | |
| | |in the Colorado Department of Revenue rules at 1 C.C.R. |DOES NOT CONTAIN LATER AMENDMENTS OR ADDITIONS. THESE REGULATIONS ARE AVAILABLE | | |
| | |201-17, Attachment A. |AT NO COST AT . THESE REGULATIONS ARE ALSO AVAILABLE FOR | | |
| | | |PUBLIC INSPECTION AND COPYING AT THE COLORADO DEPARTMENT OF HUMAN SERVICES, | | |
| | | |DIRECTOR OF THE EMPLOYMENT AND BENEFITS DIVISION, 1575 SHERMAN STREET, DENVER, | | |
| | | |COLORADO, 80203, OR AT ANY STATE PUBLICATIONS LIBRARY DURING REGULAR BUSINESS | | |
| | | |HOURS. | | |
|3.520.67 |Clarification |E. A qualified non-citizen, considered a legal immigrant by|E. A qQualified non-citizenS, WHO ARE considered a legal immigrantS by the |Technical Cleanup and added reference|No |
| |Needed |the United States Citizenship and Immigration Services |United States Citizenship and Immigration Services (USCIS), ARE ELIGIBLE TO |to Department of Revenue statute | |
| | |(USCIS), shall provide one of the following verification |APPLY FOR ADULT FINANCIAL PROGRAMS AND shall provide one of the following |regarding lawful presence. | |
| | |documents:1. I-94 Arrival/Departure Record.2. I-551: |verification OF LAWFUL PRESENCE ACCORDING TO 1 C.C.R. 204-30:5documents: AS OF | | |
| | |Resident Alien Card (I-551).3. Forms I-688B or I-766 |APRIL 14, 2019, WHICH IS HEREIN INCORPORATED BY REFERENCE. THIS RULE DOES NOT | | |
| | |Employment Authorization Document.4. A letter from CIS |CONTAIN ANY LATER AMENDMENTS OR ADDITIONS. THESE REGULATIONS ARE AVAILABLE IN | | |
| | |indicating a person's status.5. Letter from the U.S. Dept. |PERSON AT THE COLORADO DEPARTMENT OF REVENUE, 1375 SHERMAN ST., DENVER, CO | | |
| | |of Health and Human Services (HHS) certifying a person's |80261. THESE REGULATIONS ARE ALSO AVAILABLE FOR PUBLIC INSPECTION AND COPYING AT| | |
| | |status as a Victim of a Severe Form of Trafficking.6. Iraqi|THE COLORADO DEPARTMENT OF HUMAN SERVICES, DIRECTOR OF THE EMPLOYMENT AND | | |
| | |and Afghan individuals who worked as translators for the |BENEFITS DIVISION, 1575 SHERMAN STREET, DENVER, COLORADO, 80203, OR AT ANY STATE| | |
| | |U.S. military, or on behalf of the U.S. government, or |PUBLICATIONS LIBRARY DURING REGULAR BUSINESS HOURS. | | |
| | |families of such individuals; and have been admitted under |1. USCIS I-94 Arrival/Departure Record. | | |
| | |a Special Immigrant Visa (SIV) with specific visa |2. USCISI-551: Resident Alien Card (I-551). | | |
| | |categories of SI1, SI2, SI3, SI6, SI7, SI9, SQ1, SQ2, SQ3, |3. USCIS Forms I-688B or I-766 Employment Authorization Document. | | |
| | |SQ6, SQ7, or SQ9.7. Any of the documents permitted by the |4. A letter from USCIS indicating a person's status. | | |
| | |Colorado Department of Revenue rules for evidence of lawful|5. Letter from the U.S. Dept. of Health and Human Services (HHS) certifying a | | |
| | |presence (1 C.C.R. 201-17, Attachment B). |person's status as a Victim of a Severe Form of Trafficking. | | |
| | | |6. Iraqi and Afghan individuals who worked as translators for the U.S. military,| | |
| | | |or on behalf of the U.S. government, or families of such individuals; and have | | |
| | | |been admitted under a Special Immigrant Visa (SIV) with specific visa categories| | |
| | | |of SI1, SI2, SI3, SI6, SI7, SI9, SQ1, SQ2, SQ3, SQ6, SQ7, or SQ9. | | |
| | | |7. Any of the documents permitted by the Colorado Department of Revenue rules | | |
| | | |for evidence of lawful presence (1 C.C.R. 201-17 204-30-5, Attachment B). | | |
|3.520.67 |Clarification |G. The following non-citizens and temporary residents shall|G. The following non-citizens and temporary residents shall not be eligible for |Clarified that a non-citizen without |No |
| |Needed |not be eligible for Adult Financial programs: |Adult Financial programs: |a current qualified status is not | |
| | |1. A non-citizen with no status verification (undocumented)|1. A non-citizen with no status verification (undocumented) from the USCIS.S. |eligible for AF programs. | |
| | |from the U.S. Citizenship and Immigration Service; |Citizenship and Immigration Service; | | |
| | |2. A non-citizen granted a specific voluntary departure |2. A non-citizen granted a specific voluntary departure date; | | |
| | |date; |3. A non-citizen WITHOUT A CURRENT QUALIFIED STATUS, REGARDLESS OF APPLICATION | | |
| | |3. A non-citizen applying for a status; or, |applying for a status; or, | | |
| | |4. A citizen of foreign nations residing temporarily in the|4. A citizen of foreign nations residing temporarily in the United States on the| | |
| | |United States on the basis of a visa issued to permit |basis of a visa issued to permit employment, education, or a visit. | | |
| | |employment, education, or a visit. | | | |
|3.520.68 |Clarification |A. Qualified non-citizens arriving in the U.S. on or after |A. Qualified non-citizens arriving in the U.S. on or after August 22, 1996, are | | |
| |Needed |August 22, 1996, are generally barred from receiving Adult |generally barred from receiving Adult Financial programs for five years | | |
| | |Financial programs for five years beginning on the |beginning on the qualified non-citizen's date of admission into the United | | |
| | |qualified non-citizen's date of admission into the United |States for legal permanent residence, as verified through the Systematic Alien | | |
| | |States for legal permanent residence, as verified through |Verification for Entitlements (SAVE) system, unless they meet one of the | | |
| | |the Systematic Alien Verification for Entitlements (SAVE) |following exceptions consistent with the provisions of federal regulations found| | |
| | |system, unless they meet one of the following exceptions |at 45 CFR 286.5 as of February 18, 2000, herein incorporated by reference. This | | |
| | |consistent with the provisions of federal regulations found|rule does not contain any later amendments or editions. THESE REGULATIONS ARE | | |
| | |at 45 CFR 286.5 as of February 18, 2000, herein |AVAILABLE FOR NO COST AT . Copies of these federal laws | | |
| | |incorporated by reference. This rule does not contain any |REGULATIONS are available FOR PUBLIC INSPECTION AND COPYING AT from the Colorado| | |
| | |later amendments or editions. Copies of these federal laws |Department of Human Services, Director of the Employment and Benefits Division, | | |
| | |are available from the Colorado Department of Human |1575 Sherman Street, Denver, Colorado, 80203, or at any state publications | | |
| | |Services, Director of the Employment and Benefits Division,|library.: | | |
| | |1575 Sherman Street, Denver, Colorado, 80203, or at any |1. An honorably discharged U.S. veteran or active U.S. military personnel and/or| | |
| | |state publications library: |spouse, unmarried children, widow, or widower; | | |
| | |1. An honorably discharged U.S. veteran or active U.S. |2. A refugee, asylee, deportation withheld, a non-citizen granted status as a | | |
| | |military personnel and/or spouse, unmarried children, |Cuban or Haitian entrant, or a certified Victim of a Severe Form of Trafficking | | |
| | |widow, or widower; |(these humanitarian immigrants maintain their original status when adjusting to | | |
| | |2. A refugee, asylee, deportation withheld, a non-citizen |Legal Permanent Resident (LPR) status and remain exempt from the five year bar);| | |
| | |granted status as a Cuban or Haitian entrant, or a |3. An individual who was born in Canada and possesses at least fifty percent | | |
| | |certified Victim of a Severe Form of Trafficking (these |(50%) American Indian blood, or who is a member of an Indian tribe; | | |
| | |humanitarian immigrants maintain their original status when|4. An individual admitted to the U.S. as an Amerasian immigrant pursuant to | | |
| | |adjusting to Legal Permanent Resident (LPR) status and |Section 584 of the Foreign Operations, Export Financing, and Related Programs | | |
| | |remain exempt from the five year bar); |Appropriations Act of 1988, as amended by Public Law No. 100-461; | | |
| | |3. An individual who was born in Canada and possesses at |5. A lawfully admitted permanent resident who is a Hmong or Highland Lao veteran| | |
| | |least fifty percent (50%) American Indian blood, or who is |of the Vietnam War; | | |
| | |a member of an Indian tribe; |6. An Afghan or Iraqi Special Immigrant Visa (SIV) holder; | | |
| | |4. An individual admitted to the U.S. as an Amerasian |7. A qualified non-citizen who receives Supplemental Security Income (SSI) | | |
| | |immigrant pursuant to Section 584 of the Foreign |benefits. | | |
| | |Operations, Export Financing, and Related Programs | | | |
| | |Appropriations Act of 1988, as amended by Public Law No. | | | |
| | |100-461; | | | |
| | |5. A lawfully admitted permanent resident who is a Hmong or| | | |
| | |Highland Lao veteran of the Vietnam War; | | | |
| | |6. An Afghan or Iraqi Special Immigrant Visa (SIV) holder; | | | |
| | |7. A qualified non-citizen who receives Supplemental | | | |
| | |Security Income (SSI) benefits. | | | |
|3.520.68 |Clarification |B. For OAP only, a client that has a documented hardship, |B. For OAP only, a client that has a documented hardship, as follows, shall not |Clarification necessary for the |No |
| |Needed |as follows, shall not be subject to a five year bar from |be subject to a five-year bar from benefits: |determination of resource calculation| |
| | |benefits: |1. Abuse or mistreatment by the sponsor(s). Suspension of five-year bar from |related to determining indigence and | |
| | |1. Abuse or mistreatment by the sponsor(s). Suspension of |benefits is permitted if there is credible evidence that the qualified |technical cleanup. | |
| | |five-year bar from benefits is permitted if there is |non-citizen CLIENT has been physically abused, battered, or subjected to extreme| | |
| | |credible evidence that the qualified non-citizen has been |cruelty by his OR /her sponsor(s) in the United States, and meets the following | | |
| | |physically abused, battered, or subjected to extreme |requirements: | | |
| | |cruelty by his OR /her sponsor(s) in the United States, and|a. The qualified non-citizen CLIENT subject to such physical abuse, battery, or | | |
| | |meets the following requirements: |extreme cruelty does not live in the same household with the individual | | |
| | |a. The qualified non-citizen subject to such physical |responsible for the physical abuse, battery, or extreme cruelty; and, | | |
| | |abuse, battery, or extreme cruelty does not live in the |b. There is a substantial connection between the physical abuse, battery, or | | |
| | |same household with the individual responsible for the |extreme cruelty and the need for benefits; and, | | |
| | |physical abuse, battery, or extreme cruelty; and, |c. There is documented credible evidence of physical abuse, battery, or extreme | | |
| | |b. There is a substantial connection between the physical |cruelty, including, but not limited to: | | |
| | |abuse, battery, or extreme cruelty and the need for |1) A copy of the protection order issued against the abuser or batterer of the | | |
| | |benefits; and, |qualified non-citizen claimant CLIENT; or, | | |
| | |c. There is documented credible evidence of physical abuse,|2) A copy of the verdict and the judgment or sentence against the abuser or | | |
| | |battery, or extreme cruelty, including, but not limited to:|batterer committing the act of violence against the qualified non-citizen | | |
| | |1) A copy of the protection order issued against the abuser|claimant CLIENT; or, | | |
| | |or batterer of the qualified non-citizen claimant; or, |3) Reports or affidavits from police, judges, or other court officials; or, | | |
| | |2) A copy of the verdict and the judgment or sentence |4) Written statements from medical/health professionals treating the | | |
| | |against the abuser or batterer committing the act of |individualCLIENT; or, | | |
| | |violence against the qualified non-citizen claimant; or, |5) Verification from the USCIS.S. Citizenship and Immigration Services or the | | |
| | |3) Reports or affidavits from police, judges, or other |Executive Office for Immigration Review (EOIR) that a petition to qualify under | | |
| | |court officials; or, |this category has been approved. | | |
| | |4) Written statements from medical/health professionals |2. Indigence: Suspension of the five-year bar from benefits is permitted if the | | |
| | |treating the individual; or, |qualified non-citizen's income and resources, and income and resources of the | | |
| | |5) Verification from the U.S. Citizenship and Immigration |qualified non-citizen's sponsor(s) are inadequate. If the qualified non-citizen | | |
| | |Services or the Executive Office for Immigration Review |does not have a sponsor, then their own income and resources would be | | |
| | |(EOIR) that a petition to qualify under this category has |considered. | | |
| | |been approved. |a. It is the responsibility of the qualified non-citizen to obtain all required | | |
| | |2. Indigence: Suspension of the five-year bar from benefits|information and documentation from the sponsor(s). | | |
| | |is permitted if the qualified non-citizen's income and |b. The county department shall determine if the total household income available| | |
| | |resources, and income and resources of the qualified |exceeds 125% of the federal poverty guidelines AS DEFINED IN 3.510 for the | | |
| | |non-citizen's sponsor(s) are inadequate. If the qualified |household size. by dividing the total household income by the number of people | | |
| | |non-citizen does not have a sponsor, then their own income |in the household. | | |
| | |and resources would be considered. |1) For purposes of this section, the household includes the qualified | | |
| | |a. It is the responsibility of the qualified non-citizen to|non-citizen, the qualified non-citizen's spouse, the qualified non-citizen's | | |
| | |obtain all required information and documentation from the |dependent children, the sponsor(s), the spouse of the sponsor(s), and the | | |
| | |sponsor(s). |sponsor(s)' dependent children, i.e., the children the sponsor(s) claim on his | | |
| | |b. The county department shall determine if the total |OR /her income tax. | | |
| | |household income available exceeds 125% of the federal |2) The county department shall total the countable income of the household by | | |
| | |poverty guidelines for the household size by dividing the |adding together income of the non-citizen, and that of his OR her spouse, and | | |
| | |total household income by the number of people in the |the sponsor(s) AND THE SPONSOR(S) SPOUSE(S). | | |
| | |household. |3) If the total household income available exceeds the monthly amount of 125% of| | |
| | |1) For purposes of this section, the household includes the|the federal poverty guidelines, AS DEFINED IN 3.510, for the household size, the| | |
| | |qualified non-citizen, the qualified non-citizen's spouse, |indigence exception does not apply. If the total household income is less than | | |
| | |the qualified non-citizen's dependent children, the |125% of the monthly federal poverty guidelineS AS DEFINED IN 3.510 for the | | |
| | |sponsor(s), the spouse of the sponsor(s), and the |household size, then, | | |
| | |sponsor(s)' dependent children, i.e., the children the |a) The county department shall determine whether the household resources are | | |
| | |sponsor(s) claim on his/her income tax. |above the resource limits, as outlined in Section 3.520.72. If yes, the | | |
| | |2) The county department shall total the countable income |indigence exception does not apply. If no, then, | | |
| | |of the household by adding together income of the |b) The indigence exception applies. | | |
| | |non-citizen, and that of hisher spouse, and the sponsor(s) |A) DETERMINE THE SPONSOR(S) COUNTABLE RESOURCES. RESOURCES ARE ATTRIBUTED TO THE| | |
| | |3) If the total household income available exceeds the |SPONSOR IN THE SAME MANNER AS THE NON-CITIZEN, AS OUTLINED THROUGHOUT 3.520.72. | | |
| | |monthly amount of 125% of the federal poverty guidelines |B) ALL COUNTABLE RESOURCES OVER THE SPONSOR(S) RESOURCE LIMIT, AS OUTLINED IN | | |
| | |for the household size, the indigence exception does not |SECTION 3.520.72, ARE THEN APPLIED TO THE NON-CITIZEN. | | |
| | |apply. If the total household income is less than 125% of |C) THIS IS ADDED TO THE NON-CITIZEN’S COUNTABLE RESOURCES AND COMPARED TO THE | | |
| | |the monthly federal poverty guideline for the household |NON-CITIZEN’S RESOURCE LIMIT, AS OUTLINED IN SECTION 3.520.72. | | |
| | |size, then, |D) IF THE NON-CITIZEN IS UNDER THE RESOURCE LIMIT, THE INDIGENCE HARDSHIP | | |
| | |a) The county department shall determine whether the |EXCEPTION APPLIES. | | |
| | |household resources are above the resource limits, as |c. The county department shall determine if the non-citizen is receiving free | | |
| | |outlined in Section 3.520.72. If yes, the indigence |room and board from another source, such as a family member, friend, or a | | |
| | |exception does not apply. If no, then, |non-profit agency. If yes, the indigence exception does not apply. | | |
| | |b) The indigence exception applies. |3. Abandonment by the sponsor(s): suspension of the five-year bar from benefits | | |
| | |c. The county department shall determine if the non-citizen|may be applicable when the qualified non-citizen is abandoned by his OR /her | | |
| | |is receiving free room and board from another source, such |sponsor(s) and the qualified non-citizen's income and resources are so | | |
| | |as a family member, friend, or a non-profit agency. If yes,|inadequate that the qualified non-citizen is unable to obtain food and shelter. | | |
| | |the indigence exception does not apply. |a. The county department shall contact the sponsor to confirm the non-citizen's | | |
| | |3. Abandonment by the sponsor(s): suspension of the |allegations regarding amounts of income and resources the sponsor provides or | | |
| | |five-year bar from benefits may be applicable when the |makes available to the non-citizen. If the non-citizen does not know the | | |
| | |qualified non-citizen is abandoned by his/her sponsor(s) |sponsor's whereabouts, the county department shall obtain this information if | | |
| | |and the qualified non-citizen's income and resources are so|available through SAVE. | | |
| | |inadequate that the qualified non-citizen is unable to |b. If the county cannot locate the sponsor of the sponsored non-citizen, OR NO | | |
| | |obtain food and shelter. |SUPPORT IS BEING PROVIDED, a signed allegation FROM THE NON-CITIZEN (if the | | |
| | |a. The county department shall contact the sponsor to |allegation is credible and does not conflict with other information in the file)| | |
| | |confirm the non-citizen's allegations regarding amounts of |shall be utilized TO DETERMINE ABANDONMENT. If the allegations are not credible | | |
| | |income and resources the sponsor provides or makes |or conflict with other information in file, the county department shall weigh | | |
| | |available to the non-citizen. If the non-citizen does not |all information and use THE prudent person principle to make a decision | | |
| | |know the sponsor's whereabouts, the county department shall|REGARDING THE APPLICABILITY OF THE ABANDONMENT HARDSHIP based on all the | | |
| | |obtain this information if available through SAVE. |information obtained. IF SUPPORT IS BEING PROVIDED, THE ABANDONMENT HARDSHIP | | |
| | |b. If the county cannot locate the sponsor of the sponsored|EXCEPTION SHALL NOT APPLY. | | |
| | |non-citizen, a signed allegation if the allegation is |c. When a determination of abandonment is made, the county department shall | | |
| | |credible and does not conflict with other information in |notify the UNITED STATES Department of Homeland Security. | | |
| | |the file) shall be. If the allegations are not credible or | | | |
| | |conflict with other information in file, the county | | | |
| | |department shall weigh all information and use prudent | | | |
| | |person principle to make a decision based on all the | | | |
| | |information obtained. | | | |
| | |c. When a determination of abandonment is made, the county | | | |
| | |department shall notify the Department of Homeland | | | |
| | |Security. | | | |
|3.520.68 |Clarification |D. For OAP only, the county department shall pursue |D. For OAP only, the county department shall pursue recovery of OAP GRANT |Technical cleanup to ensure the use | |
| |Needed |recovery of OAP benefits from the sponsor(s). |PAYMENTS benefits from the sponsor(s). |of the term grant payments | |
| | |1. The qualified non-citizen shall be notified of the |1. The qualified non-citizen shall be notified of the recovery requirement at |consistently. | |
| | |recovery requirement at the time of request for a hardship |the time of request for a hardship exception from the five year bar from | | |
| | |exception from the five year bar from benefits; and, |benefits; and, | | |
| | |2. If granted a hardship, the client shall be notified |2. If granted a hardship, the client shall be notified during the interview of | | |
| | |during the interview of each redetermination of the |each redetermination of the requirement to recover funds from the sponsor(s). | | |
| | |requirement to recover funds from the sponsor(s). | | | |
|3.520.69 |Clarification |A. As a condition of eligibility for financial assistance, |A. As a condition of eligibility for financial assistance, any legal non-citizen|Technical cleanup | |
| |Needed |any legal non-citizen applying for or receiving financial |applying for or receiving financial assistance shall agree that, during the time| | |
| | |assistance shall agree that, during the time period the |period the client is receiving financial assistance, the client shall not sign | | |
| | |client is receiving financial assistance, the client shall |an affidavit of support for the purpose of sponsoring a non-citizen seeking | | |
| | |not sign an affidavit of support for the purpose of |permission from USCIS to enter or remain in the United States. A legal | | |
| | |sponsoring a non-citizen seeking permission from USCIS to |non-citizen's eligibility for financial assistance shall not be affected by the | | |
| | |enter or remain in the United States. A legal non-citizen's|fact that the legal non-citizen has signed an affidavit of support for a | | |
| | |eligibility for financial assistance shall not be affected |non-citizen prior to his OR /her application for benefits. | | |
| | |by the fact that the legal non-citizen has signed an | | | |
| | |affidavit of support for a non-citizen prior to his /her | | | |
| | |application for benefits. | | | |
|3.520.69 |Clarification |B. The sponsored qualified non-citizen shall be responsible|B. IF A CLIENT IS AThe sponsored qualified non-citizen, HE OR SHE shall be |Technical cleanup | |
| |Needed |for the provision of any information and documentation |responsible for the provision of any information and documentation related to | | |
| | |related to the sponsor(s) and shall obtain cooperation from|the sponsor(s) and shall obtain cooperation from the sponsor(s) necessary to | | |
| | |the sponsor(s) necessary to determine: |determine: | | |
| | |1. The identity and current address and contact information|1. The identity and current address and contact information of the sponsor(s); | | |
| | |of the sponsor(s); |2. The relationship of the sponsor(s) to the qualified non-citizen; | | |
| | |2. The relationship of the sponsor(s) to the qualified |3. Income and resources of the sponsor(s), which may be deemed available to the | | |
| | |non-citizen; |qualified non-citizen or recovered for repayment of GRANT PAYMENTSbenefits paid | | |
| | |3. Income and resources of the sponsor(s), which may be |to or on behalf of the qualified non-citizen. | | |
| | |deemed available to the qualified non-citizen or recovered | | | |
| | |for repayment of benefits paid to or on behalf of the | | | |
| | |qualified non-citizen. | | | |
| 3.520.69 |Clarification |C. It shall be presumed that an affidavit of support |C. It shall be presumed that an affidavit of support demonstrates the sponsor's |Additional status included to |No |
| |Needed |demonstrates the sponsor's ability to make income and |ability to make income and resources available to a non-citizen whom he or she |indicate sponsorship may be | |
| | |resources available to a non-citizen whom he or she |sponsors at a minimum of one hundred twenty-five percent (125%) of the federal |invalidated if there is a formal | |
| | |sponsors at a minimum of one hundred twenty-five percent |poverty levelGUIDELINES, AS DEFINED IN 3.510. Sponsors are expected to meet |court proceeding when the non-citizen| |
| | |(125%) of the federal poverty level. Sponsors are expected |their financial commitments to the qualified non-citizen whom they sponsor and |is going to be removed from the | |
| | |to meet their financial commitments to the qualified |for whom they signed an affidavit of support until such time as the: |country and is given a new grant of | |
| | |non-citizen whom they sponsor and for whom they signed an |1. Qualified non-citizen has obtained U.S. citizenship; or, |admission status. The current | |
| | |affidavit of support until such time as the:1. Qualified |2. Qualified non-citizen has worked, or can be credited with forty (40) |sponsor may no longer be identified, | |
| | |non-citizen has obtained U.S. citizenship; or,2. Qualified |qualifying quarters of coverage under Title II of the federal Social Security |however there is typically a new | |
| | |non-citizen has worked, or can be credited with forty (40) |Act, 42 U.S.C. SECTION 413 (2018); or |sponsor identified. | |
| | |qualifying quarters of coverage under Title II of the |3. Qualified non-citizen leaves the United States and gives up lawful permanent | | |
| | |federal Social Security Act; or,3. Qualified non-citizen |resident status; or, | | |
| | |leaves the United States and gives up lawful permanent |4. Qualified non-citizen dies; or, | | |
| | |resident status; or,4. Qualified non-citizen dies; or,5. |5. Sponsor of the qualified non-citizen dies. The death of one sponsor does not | | |
| | |Sponsor of the qualified non-citizen dies. The death of one|terminate the support obligation of a joint sponsor. The sponsor's estate shall | | |
| | |sponsor does not terminate the support obligation of a |be required to repay public benefits.; OR, | | |
| | |joint sponsor. The sponsor's estate shall be required to |6. QUALIFIED NON-CITIZEN BECOMES SUBJECT TO REMOVAL PROCEEDINGS, BUT HE OR SHE | | |
| | |repay public benefits. |APPLIES FOR AND OBTAINS A NEW GRANT OF ADMISSION STATUS IN THOSE PROCEEDINGS | | |
| | | |BASED ON A NEW AFFIDAVIT OF SUPPORT, IF ONE IS REQUIRED. | | |
| 3.520.69 |Clarification |D. Income and resources of the sponsor(s) shall be deemed |D. Income and resources of the sponsor(s) shall be deemed to the client, as |Date revised to reflect timeframe of |No |
| |Needed |to the client, as follows:1. Deeming shall not apply to |follows: |legally enforceable I-864. | |
| | |qualified non-citizens admitted as refugees or as political|1. SPONSOR DDeeming shall not apply to qualified non-citizens admitted as |Additional clarification was | |
| | |asylees.2. Sponsors who signed sponsorship agreements prior|refugees or as political asylees. A NON-CITIZEN WHOSE STATUS AS A POLITICAL |necessary to identify specific | |
| | |to August 22, 1996, shall not be subject to resource and |ASYLEE OR REFUGEE HAS NOT YET BEEN DETERMINED OR FINALIZED BECAUSE HIS OR HER |remedies to be taken to pursue | |
| | |income deeming.3. Effective December 19, 1997 through |APPLICATION TO BECOME A QUALIFIED NON-CITIZEN IS IN A PENDING STATUS OR FOR SOME|payment from the sponsor. This | |
| | |December 31, 2013, sponsor deeming shall apply only to the |OTHER REASON SHALL NOT BE CONSIDERED A QUALIFIED NON-CITIZEN ADMITTED AS A |aligns closely with SSA. | |
| | |qualified non-citizen's spouse and/or non-relative |POLITICAL ASYLEE OR REFUGEE, AND THEREFORE, SUCH NON-CITIZEN IS NOT ELIGIBLE TO | | |
| | |sponsor(s) identified in sponsorship agreements signed on |RECEIVE GRANT PAYMENTS. | | |
| | |or after August 22, 1996.a. A relative is defined as any |2. Sponsors who signed sponsorship agreements prior to DECEMBER 19, 1997, August| | |
| | |relation by blood, adoption, or marriage.b. Kinship |22, 1996, shall not be subject to resource and income deeming. | | |
| | |relations by marriage continue to exist even if the |3. Effective December 19, 1997 through December 31, 2013, sponsor deeming shall | | |
| | |marriage is terminated by death or divorce.4. Effective |apply only to the qualified non-citizen's spouse and/or non-relative sponsor(s) | | |
| | |January 1, 2014, sponsor deeming shall apply to all of the |identified in sponsorship agreements signed on or after DECEMBER 19, 1997 August| | |
| | |qualified non-citizen's sponsors identified in sponsorship |22, 1996. | | |
| | |agreements signed on or after December 19, 1997, no matter |a. A relative is defined as any relation by blood, adoption, or marriage. | | |
| | |the sponsor's relationship to the client.5. For OAP only, |b. Kinship relations by marriage continue to exist even if the marriage is | | |
| | |the hardship exceptions as described in 3.520.68, B-D, |terminated by death or divorce. | | |
| | |shall also be evaluated in relation to sponsor deeming. If |4. Effective January 1, 2014, sponsor deeming shall apply to all of the | | |
| | |it is determined that hardship has been established, |qualified non-citizen's sponsors identified in sponsorship agreements signed on | | |
| | |sponsor deeming shall not be applied to the non-citizen. |or after December 19, 1997, no matter the sponsor's relationship to the client. | | |
| | |Eligibility under one of the hardship exceptions will be |5. For OAP only, the hardship exceptions as described in SECTION 3.520.68.B-D, | | |
| | |reviewed and reassessed at redetermination or when changes |shall also be evaluated in relation to sponsor deeming. If it is determined that| | |
| | |in circumstance are reported to determine if hardship still|hardship has been established, sponsor deeming shall not be applied to the | | |
| | |applies. The county department shall pursue recovery of OAP|non-citizen. Eligibility under one of the hardship exceptions will be reviewed | | |
| | |benefits from the sponsor(s).a. The qualified non-citizen |and reassessed at redetermination or when changes in circumstance are reported | | |
| | |shall be notified of the recovery requirement at the time |to determine if hardship still applies. The county department shall pursue | | |
| | |of request for a hardship exception from the sponsor |recovery of OAP benefits from the sponsor(s). | | |
| | |deeming; and,b. If granted a hardship, the client shall be |a. The qualified non-citizen shall be notified of the recovery requirement at | | |
| | |notified during the interview of each redetermination of |the time of request for a hardship exception from the sponsor deeming; and, UPON| | |
| | |the requirement to recover funds from the sponsor(s). |DETERMINATION THAT A NON-CITIZEN IS GRANTED A HARDSHIP EXCEPTION, THE COUNTY | | |
| | | |DEPARTMENT WILL NOTIFY THE SPONSOR OF ITS DETERMINATION AND REQUIREMENT OF | | |
| | | |REPAYMENT OF THE FULL AMOUNT OF THE GRANT PAYMENTS MADE TO THE NON-CITIZEN. THIS| | |
| | | |REQUIREMENT MAY BE WAIVED BY THE COUNTY DEPARTMENT IN CASES UTILIZING THE | | |
| | | |HARDSHIP EXCEPTIONS. SUCH WAIVER MUST BE DOCUMENTED IN THE CASE RECORD. | | |
| | | |b. If granted a hardship, the client shall be notified during the interview of | | |
| | | |each redetermination of the requirement to recover funds from the sponsor(s). | | |
| | | |IF THE SPONSOR FAILS TO COMPLY WITH THE REPAYMENT TERMS ESTABLISHED BY THE | | |
| | | |COUNTY DEPARTMENT, THE COUNTY DEPARTMENT WILL PURSUE OTHER REMEDIES FOR | | |
| | | |REPAYMENT, WHICH SHALL INCLUDE BUT ARE NOT LIMITED TO: | | |
| | | |1) INCOME ASSIGNMENTS; | | |
| | | |2) STATE INCOME TAX REFUND OFFSET; | | |
| | | |3) STATE LOTTERY WINNINGS OFFSET; AND, | | |
| | | |4) ADMINISTRATIVE LIEN AND ATTACHMENT. | | |
| | | |5. BECAUSE THE SPONSOR, NOT THE NON-CITIZEN, IS SOLELY LIABLE FOR REPAYMENT, THE| | |
| | | |SPONSOR CANNOT USE THE SPONSORED NON-CITIZEN'S GRANT PAYMENTS TO REPAY THE | | |
| | | |PAYMENTS. | | |
| 3.520.69 |Clarification |E. If the qualified non-citizen fails to provide |E. If the qualified non-citizen fails to provide information related to the |Removed redundancy from previous |No |
| |Needed |information related to the sponsor(s), as outlined in |sponsor(s), as outlined in Section 3.520.69.B, assistance shall be denied or |section. | |
| | |Section 3.520.69, B, assistance shall be denied or |discontinued FOLLOWING THE POLICIES OUTLINED IN SECTION 3.554. | | |
| | |discontinued.If it is determined that the client received |If it is determined that the client received Adult Financial program GRANT | | |
| | |Adult Financial program benefits because the client failed |PAYMENTS benefits because the client failed to provide necessary information | | |
| | |to provide necessary information related to the sponsor(s )|related to the sponsor(s) or the sponsor(s) failed to cooperate with the county | | |
| | |or the sponsor(s)failed to cooperate with the county |department in determining income and resources that are required to be deemed to| | |
| | |department in determining income and resources that are |the client, the county department shall recover such funds, AS OUTLINED IN | | |
| | |required to be deemed to the client, the county department |SECTION 3.520.69.D. from the sponsor(s) and/or the client via the following: | | |
| | |shall recover such funds from the sponsor(s) and/or the |1. Income assignments; | | |
| | |client via the following:1. Income assignments;2. State |2. State income tax refund offset; | | |
| | |income tax refund offset;3. State lottery winnings offset; |3. State lottery winnings offset; and, | | |
| | |and,4. Administrative lien and attachment. |4. Administrative lien and attachment. | | |
|3.520.71 |Clarification |A. To receive Adult Financial program assistance, the |A. To receive Adult Financial program assistance, the client shall meet all |Align with Definitions section of |No |
| |Needed |client shall meet all financial requirements in addition to|financial requirements in addition to all other program eligibility |rule. | |
| | |all other program eligibility requirements. The client |requirements. The client shall: | | |
| | |shall: |1. Have countable resources below the resource limit as outlined in Section | | |
| | |1. Have countable resources below the resource limit as |3.520.72; and, | | |
| | |outlined in Section 3.520.72; and, |2. Have income below the income limit, as outlined in Section 3.520.78; and, | | |
| | |2. Have income below the income limit, as outlined in |3. Make reasonable attempts to pursue all available POTENTIAL income and | | |
| | |Section 3.520.78; and, |resources at the client's disposal. | | |
| | |3. Make reasonable attempts to pursue all available income | | | |
| | |and resources at the client's disposal. | | | |
|3.520.71 |Clarification |B. The AND-SO client shall apply for Supplemental Security |B. The AND-SO client shall apply for Supplemental Security Income (SSI) |Aligns with SSA policy of |No |
| |Needed |Income (SSI) benefits. If the client has work hours during |benefits. If the client has work hours during his OR /her lifetime, the client |notification for an individual who is| |
| | |his/her lifetime, the client shall also apply for Social |shall also apply for Social Security Disability Insurance (SSDI). THE CLIENT |seeking to withdraw SSI application | |
| | |Security Disability Insurance (SSDI). The client shall |SHALL REPORT ANY DENIAL FOR SSI BENEFITS. The client shall appeal all negative |to accept the SSDI benefits. This | |
| | |appeal all negative decisions regarding their SSI |decisions regarding their SSI eligibility. Failure to appeal all negative |will create a stop gap where clients | |
| | |eligibility. Failure to appeal all negative decisions shall|decisions WITHIN THIRTY (30) CALENDAR DAYS OF SUCH DECISION, UNLESS ADDITIONAL |accept SSDI and do not have to | |
| | |result in denial or discontinuation of AND benefits.For |TIME IS GIVEN FOR GOOD CAUSE, shall result in denial or discontinuation of AND |reimburse the State for AND monies | |
| | |OAP, the client shall apply for Social Security and/or SSI |GRANT PAYMENTS benefits. |owed as part of the IAR Agreement. | |
| | |benefits, as follows:1. Clients sixty (60) years of age and|IF THE CLIENT IS APPROVED FOR SSI AND SSDI BENEFITS AT THE SAME TIME AND IS |The 2nd change is the addition of | |
| | |older who report a disability may be eligible for SSI or |GIVEN THE CHOICE BETWEEN THE TWO (2) BENEFIT OPTIONS, HE OR SHE MUST CONTACT THE|"and accept" any SSA benefits if | |
| | |SSDI.2. Clients sixty (60) years of age and older may be |COUNTY DEPARTMENT TO DETERMINE IF ANY INTERIM ASSISTANCE HE OR SHE RECEIVED FROM|determined eligible. This is | |
| | |eligible for Social Security survivor benefits.3. Clients |THE COUNTY IS REQUIRED TO BE REPAID. IF REPAYMENT IS REQUIRED, THE CLIENT SHALL |critical for individuals to pursuing | |
| | |sixty-two (62) years of age and older may be eligible for |BE ADVISED THAT HE OR SHE MUST ACCEPT THE SSI BENEFITS AND THAT IF HE OR SHE |potential income at the client's | |
| | |early Social Security retirement benefits; otherwise the |VOLUNTARILY WITHDRAWS HIS OR HER SSI APPLICATION, WITHDRAWAL WOULD VIOLATE THE |disposal. While early retirement | |
| | |client shall provide documentation from the SSA that he/she|AUTHORIZATION FOR REIMBURSEMENT OF INTERIM ASSISTANCE, AS OUTLINED IN SECTION |benefits may be lower than waiting | |
| | |is ineligible due to insufficient work hours.4. Clients |3.545. |until their designated retirement | |
| | |sixty-five (65) years of age and older may be eligible for |For OAP, the client shall apply for AND ACCEPT Social Security and/or SSI |age, it is (in most cases) greater | |
| | |Social Security retirement benefits and/or SSI benefits |benefits IF DETERMINED ELIGIBLE, as follows: |than the OAP maximum amount. If it | |
| | |when the client's income from any source is less than the |1. Clients sixty (60) years of age and older who report a disability may be |is lower than the OAP maximum amount,| |
| | |SSI grant standard plus $20.00. |eligible for SSI or SSDI. |OAP could still continue to | |
| | | |2. Clients sixty (60) years of age and older may be eligible for Social Security|supplement that income up to the | |
| | | |survivor benefits. |maximum. | |
| | | |3. Clients sixty-two (62) years of age and older may be eligible for early | | |
| | | |Social Security retirement benefits; otherwise the client shall provide | | |
| | | |documentation from the SSA that HE OR SHE he/she is ineligible due to | | |
| | | |insufficient work hours. | | |
| | | |4. Clients sixty-five (65) years of age and older may be eligible for Social | | |
| | | |Security retirement benefits and/or SSI benefits when the client's income from | | |
| | | |any source is less than the SSI grant BENEFIT standard, AS DEFINED IN SECTION | | |
| | | |3.510, plus $20.00. | | |
|3.520.71 |Clarification |C. For all Adult Financial programs other than AND-SO, |C. For all Adult Financial programs other than AND-SO, clients referred to the |Technical cleanup. | |
| |Needed |clients referred to the SSA to apply for any SSA related |SSA to apply for any SSA related benefit shall be required to provide | | |
| | |benefit shall be required to provide verification of |verification of application for such benefits within ELEVEN (11) ten (10) | | |
| | |application for such benefits within ten (10) calendar days|calendar days of HIS OR HER application for SSA benefits. | | |
| | |of application for SSA benefits. | For AND-SO, clients referred to the SSA to apply for any SSA related benefit | | |
| | | For AND-SO, clients referred to the SSA to apply for any |shall be required to provide verification of application for such benefits | | |
| | |SSA related benefit shall be required to provide |within sixty (60) calendar days from the initial interview date with the county | | |
| | |verification of application for such benefits within sixty |department. The client will have up to sixty days of conditional approval from | | |
| | |(60) calendar days from the initial interview date with the|the date of the initial interview with the county department for AND-SO. | | |
| | |county department. The client will have up to sixty days of|Subsequent applications for AND-SO submitted by the client shall not be approved| | |
| | |conditional approval from the date of the initial interview|prior to receipt of proof of application for SSA benefits. Subsequent | | |
| | |with the county department for AND-SO. Subsequent |applications for AND-SO require verification of application for SSA benefits | | |
| | |applications for AND-SO submitted by the client shall not |within thirty (30) calendar days. | | |
| | |be approved prior to receipt of proof of application for | | | |
| | |SSA benefits. Subsequent applications for AND-SO require | | | |
| | |verification of application for SSA benefits within thirty | | | |
| | |(30) calendar days. | | | |
|3.520.71 |Clarification |D. For OAP, the client shall apply for SSI or continue to |D. For OAP, the client shall apply for SSI, AND SHALL TIMELY SCHEDULE AND |Recommended addition by the Chief |No |
| |Needed |appeal negative decisions unless good cause is provided. |COMPLETE ANY AND ALL SCHEDULED INTERVIEWS WITH THE SSA, AND IN THE EVENT OF A |Adjudicator of appeals. | |
| | |Good cause is defined as follows: |DENIAL BY SSA, THE OAP CLIENT SHALL CONTINUE TO APPEAL ALL NEGATIVE DECISIONS | | |
| | |1. The client's and the client's spouse's gross income |FROM THE SSA UNTIL A FINAL RESOLUTION IS REACHED AND NO FURTHER RIGHT TO APPEAL | | |
| | |exceeds the maximum allowed for SSI for an individual or a |EXISTS. HOWEVER, THE REQUIREMENT TO CONTINUE TO APPEAL ALL NEGATIVE DECISIONS | | |
| | |couple; or, |MAY BE EXCUSED IF ANY OF THE FOLLOWING APPLY: or continue to appeal negative | | |
| | |2. The client's and the client's spouse's total resources |decisions unless good cause is provided. Good cause is defined as follows: | | |
| | |exceed that allowed for SSI for an individual or a couple; |1. The client's and the client's spouse's gross income exceeds the maximum | | |
| | |or, |allowed for SSI for an individual or a couple; or, | | |
| | |3. The client is not disabled as defined in Section 3.541; |2. The client's and the client's spouse's total resources exceed that allowed | | |
| | |or, |for SSI for an individual or a couple; or, | | |
| | |4. As otherwise directed by the SSA. |3. The client is not disabled as defined in Section 3.541; or, | | |
| | | |4. As otherwise directed by the SSA; OR, | | |
| | | |5. GOOD CAUSE EXISTS AS DEFINED IN SECTION 3.510. | | |
|3.520.71 |Clarification |E. Clients newly approved for SSI benefits who have been |E. Clients newly approved for SSI benefits who have been charged an in-kind |Technical cleanup. |No |
| |Needed |charged an in-kind support and maintenance (ISM) deduction |support and maintenance (ISM) deduction by the SSA shall apply to SSA to remove | | |
| | |by the SSA shall apply to SSA to remove the ISM as soon as |the ISM as soon as the client begins paying his OR /her fair share for shelter | | |
| | |the client begins paying his/her fair share for shelter |costs. The county department shall deduct an identical ISM amount for Adult | | |
| | |costs. The county department shall deduct an identical ISM |Financial programs until the SSA ISM is removed. | | |
| | |amount for Adult Financial programs until the SSA ISM is | | | |
| | |removed. | | | |
|3.520.71 |Clarification |F. The client shall apply for TANF/Colorado Works when |F. The client shall apply for AND ACCEPT TANF/Colorado Works when he OR /she |Adding in demonstrable evidence. |No |
| |Needed |he/she might be eligible, as follows: |might be eligible, as follows: | | |
| | |1. An Adult Financial program client with a dependent child|1. An Adult Financial program client with a dependent child is required to apply| | |
| | |is required to apply for and accept, if eligible, |for and accept, if eligible, TANF/Colorado Works financial benefits. | | |
| | |TANF/Colorado Works financial benefits. |a. A grandparent or any other specified caretaker who is not a parent is not | | |
| | |a. A grandparent or any other specified caretaker who is |required to be a member of the TANF/Colorado Works case when they are not | | |
| | |not a parent is not required to be a member of the |requesting assistance for hiMsELF OR /herself. | | |
| | |TANF/Colorado Works case when they are not requesting |b. A TANF/Colorado Works client is not required to apply for an extension to be | | |
| | |assistance for his/herself. |potentially eligible for Adult Financial program GRANT PAYMENTS benefits. | | |
| | |b. A TANF/Colorado Works client is not required to apply |c. The TANF/Colorado Works funds received for the support of a child are not | | |
| | |for an extension to be potentially eligible for Adult |used in determining the specified caretaker's eligibility for Adult Financial | | |
| | |Financial program benefits. |program GRANT PAYMENTS benefits. | | |
| | |c. The TANF/Colorado Works funds received for the support |2. The client shall be ineligible for Adult Financial program GRANT PAYMENTS | | |
| | |of a child are not used in determining the specified |benefits if his OR /her TANF/Colorado Works case was denied or discontinued: | | |
| | |caretaker's eligibility for Adult Financial program |a. Due to a sanction, DEMONSTRABLE EVIDENCE, or disqualification; OR, | | |
| | |benefits. |b. Because the client withdrew from the program prior to exhausting all | | |
| | |2. The client shall be ineligible for Adult Financial |benefits. ; and, | | |
| | |program benefits if his/her TANF/Colorado Works case was |c. The ineligibility period shall continue until the sanction or | | |
| | |denied or discontinued: |disqualification is removed or until the client rejoins the program and has | | |
| | |a. Due to a sanction or disqualification; or, |exhausted all TANF/Colorado Works benefits. | | |
| | |b. Because the client withdrew from the program prior to |3. AFTER BECOMING INELIGIBLE DUE TO THE REASONS OUTLINED IN SECTION | | |
| | |exhausting all benefits; and, |3.520.71.F.2, ABOVE, THE INELIGIBILITY PERIOD SHALL CONTINUE UNTIL THE SANCTION,| | |
| | |c. The ineligibility period shall continue until the |DEMONSTRABLE EVIDENCE, OR DISQUALIFICATION IS REMOVED; OR UNTIL THE CLIENT IS | | |
| | |sanction or disqualification is removed or until the client|FOUND OTHERWISE INELIGIBLE FOR TANF/COLORADO WORKS BENEFITS. | | |
| | |rejoins the program and has exhausted all TANF/Colorado | | | |
| | |Works benefits. | | | |
|3.520.71 |Clarification |G. The client shall apply for any other retirement income |G. The client OR LEGAL FIDUCIARY shall TAKE REASONABLE STEPS TO apply for AND |Aligns with statute which requires a |No |
| |Needed |for which the client is eligible. |ACCEPT any other retirement income for which the client is eligible. CLIENTS |person to access all other income and| |
| | | |REFERRED TO PURSUE OTHER INCOME SHALL BE REQUIRED TO PROVIDE VERIFICATION OF |resource options prior to accessing | |
| | | |APPLICATION FOR OR PURSUIT OF SUCH INCOME. GRANT PAYMENTS SHALL NOT BE APPROVED |State benefits. Aligns with | |
| | | |PRIOR TO RECEIPT OF PROOF OF APPLICATION OR PURSUIT OF OTHER INCOME, UNLESS IT |verification requirements for SSA | |
| | | |IS DEMONSTRATED THAT GOOD CAUSE EXISTS. |benefits. | |
| | | |1. IF THE CLIENT OR LEGAL FIDUCIARY REFUSES OR FAILS TO MAKE A REASONABLE EFFORT| | |
| | | |TO SECURE POTENTIAL INCOME, SUCH INCOME SHALL BE CONSIDERED AS IF AVAILABLE TO | | |
| | | |THE CLIENT, AND TIMELY NOTICE SHALL BE GIVEN REGARDING A PROPOSED ACTION TO | | |
| | | |DENY, REDUCE, OR TERMINATE ASSISTANCE. | | |
| | | |2. IF THE CLIENT OR LEGAL FIDUCIARY SECURES THE POTENTIAL INCOME PRIOR TO THE | | |
| | | |EFFECTIVE ACTION DATE IDENTIFIED IN THE NOTICE, THE PROPOSED ACTION TO DENY, | | |
| | | |REDUCE, OR TERMINATE ASSISTANCE SHALL BE WITHDRAWN BY THE COUNTY, AND THE CASE | | |
| | | |SHALL BE UPDATED. GRANT PAYMENTS MAY STILL BE DENIED, REDUCED, OR DISCONTINUED | | |
| | | |DUE TO A CHANGE IN INCOME. | | |
|3.520.71 |Clarification |H. The client shall take reasonable steps to pursue all |H. The client shall take reasonable steps to pursue all other income and |Align with Definitions section of |No |
| |Needed |other income and resources that may be available, to |resources that may be available, to include, but not be limited to, alimony, |rule. Aligns with verification | |
| | |include, but not be limited to, alimony, equitable |equitable distribution of resources in a divorce, inheritance income or |requirements for SSA benefits. | |
| | |distribution of resources in a divorce, inheritance income |resources, child support arrears, co-ownership of property, lottery or | | |
| | |or resources, child support arrears, co-ownership of |sweepstakes winnings that are due to the client, lawsuit judgments that are due | | |
| | |property, lottery or sweepstakes winnings that are due to |to the client, or insurance settlements, unless it is demonstrated that good | | |
| | |the client, lawsuit judgments that are due to the client, |cause exists. | | |
| | |or insurance settlements, unless it is demonstrated that |H. THE CLIENT OR LEGAL FIDUCIARY SHALL TAKE REASONABLE STEPS TO OBTAIN AND | | |
| | |good cause exists. |ACCEPT ANY OTHER POTENTIAL RESOURCES FOR WHICH THE CLIENT IS ELIGIBLE. CLIENTS | | |
| | | |REFERRED TO PURSUE OTHER RESOURCES SHALL BE REQUIRED TO PROVIDE VERIFICATION OF | | |
| | | |THE PURSUIT OF SUCH RESOURCE. GRANT PAYMENTS SHALL NOT BE APPROVED PRIOR TO | | |
| | | |VERIFICATION OF THE ATTEMPT TO SELL, LIQUIDATE, OR LEGALLY ACQUIRE A RESOURCE, | | |
| | | |UNLESS THE CLIENT DEMONSTRATES THAT GOOD CAUSE EXISTS. | | |
| | | |1. IF THE CLIENT OR LEGAL FIDUCIARY REFUSES OR FAILS TO MAKE A REASONABLE EFFORT| | |
| | | |TO SECURE POTENTIAL RESOURCE(S), SUCH RESOURCE(S) SHALL BE CONSIDERED AS IF | | |
| | | |AVAILABLE TO THE CLIENT, AND TIMELY NOTICE SHALL BE GIVEN REGARDING A PROPOSED | | |
| | | |ACTION TO DENY, REDUCE, OR TERMINATE ASSISTANCE. | | |
| | | |2. IF THE CLIENT OR LEGAL FIDUCIARY SECURES THE POTENTIAL RESOURCE(S) PRIOR TO | | |
| | | |THE EFFECTIVE ACTION DATE IDENTIFIED IN THE NOTICE, THE PROPOSED ACTION TO DENY,| | |
| | | |REDUCE, OR TERMINATE ASSISTANCE SHALL BE WITHDRAWN BY THE COUNTY, AND THE CASE | | |
| | | |SHALL BE UPDATED. GRANT PAYMENTS MAY STILL BE DENIED, REDUCED, OR DISCONTINUED | | |
| | | |DUE TO A CHANGE IN RESOURCE(S). | | |
|3.520.72 |Clarification |A. Unless otherwise specified, a resource is countable, and|A. Unless otherwise specified, a resource is countable, and together with all |The struck through information |No |
| |Needed |together with all other countable resources of the client, |other countable resources of the client, spouse, and sponsor(s) shall be |provides clarification that the | |
| | |spouse, and sponsor(s) shall be considered against the |considered against the resource limit. The resource limit is: |resource is only dependent upon | |
| | |resource limit. The resource limit is:1. $2,000 for:a. An |1. $2,000 for: |marital status and not | |
| | |unmarried client who is a citizen or non-sponsored |a. An unmarried client who is a citizen or non-sponsored qualified non-citizen; |citizenship/sponsor status. | |
| | |qualified non-citizen;b. An unmarried sponsor; and,c. A |b. An unmarried sponsor; and, | | |
| | |married sponsor whose spouse is a co-sponsor. Each sponsor |c. A married sponsor whose spouse is a co-sponsor. Each sponsor shall receive | | |
| | |shall receive the $2,000 resource limit for a combined |the $2,000 resource limit for a combined resource limit of $4,000. | | |
| | |resource limit of $4,000.2. $3,000 for:a. A married client |2. $3,000 for: | | |
| | |who is a citizen or non-sponsored qualified non-citizen; |a. A married client who is a citizen or non-sponsored qualified non-citizen; or,| | |
| | |or,b. A married sponsor whose spouse is not a co-sponsor. |b. A married sponsor whose spouse is not a co-sponsor. | | |
|3.520.72 |Clarification |B. Countable assets include, but are not limited to:1. Cash|B. Countable assets include, but are not limited to: |Added other accessible electronic |No |
| |Needed |on hand or in a savings or checking account.2. Equity value|1. Cash on hand, or in a savings or checking account, OR OTHER ACCESSIBLE |deposits to capture EBT accounts. | |
| | |of real property that is not used as the client's primary |ELECTRONIC CURRENCY AND/OR CRYPTOCURRENCY. |Struck through "Client" to broaden | |
| | |home or not exempt as income producing.3. Proceeds from the|2. Equity value of real property that is not used as the client's primary home |the rule to include other individuals| |
| | |sale of the primary home that are in excess of the cost of |or not exempt as income producing. |who may have resources contributing | |
| | |expenses incurred to purchase or build a replacement |3. Proceeds from the sale of the primary home that are in excess of the cost of |to the resource limit (spouse, | |
| | |home.4. Personal property or the proceeds from the sale of |expenses incurred to purchase or build a replacement home. |sponsor). Added clarification about | |
| | |personal property, such as mobile homes or recreational |4. Personal property or the proceeds from the sale of personal property, such as|trusts per recommendation of the | |
| | |vehicles not used as the client's primary home and not |mobile homes or recreational vehicles not used as the client's primary home and |Chief Adjudicator. | |
| | |exempt as income producing.5. Personal property or the |not exempt as income producing. | | |
| | |proceeds from the sale of personal property, such as motor |5. Personal property or the proceeds from the sale of personal property, such as| | |
| | |vehicles, recreational off road vehicles, boats, trailers, |motor vehicles, recreational off road vehicles, boats, trailers, or similar that| | |
| | |or similar that are not exempt per Section 3.520.77 or |are not exempt per Section 3.520.77 or exempt as income producing. | | |
| | |exempt as income producing.6. Stocks, bonds, mutual fund |6. Stocks, bonds, mutual fund shares, 401Ks, 457Ks, IRAs, Certificates of | | |
| | |shares, 401Ks, 457Ks, IRAs, Certificates of Deposit (CDs), |Deposit (CDs), and other retirement or investment accounts and investment | | |
| | |and other retirement or investment accounts and investment |vehicles. | | |
| | |vehicles.7. Mortgages, promissory notes, and similar |7. Mortgages, promissory notes, and similar properties that can be converted to | | |
| | |properties that can be converted to cash.8. Cash surrender |cash. | | |
| | |value of all life insurance policies as outlined in Section|8. Cash surrender value of all life insurance policies as outlined in Section | | |
| | |3.520.75.9. Prepaid revocable funeral or burial expense |3.520.75. | | |
| | |contracts or trust deposits, as outlined in Section |9. Prepaid revocable funeral or burial expense contracts or trust deposits, as | | |
| | |3.520.77, G.10. The value of the burial space in excess of |outlined in Section 3.520.77.G-H. | | |
| | |that required to meet the burial needs of the immediate |10. The value of the burial space in excess of that required to meet the burial | | |
| | |family, as outlined in Section 3.520.77, H.11. Proceeds of |needs of the immediate family, as outlined in Section 3.520.77.HI. | | |
| | |fire or casualty insurance payments that were in excess of |11. Proceeds of fire or casualty insurance payments that were in excess of the | | |
| | |the expenses incurred to repair or replace the damaged, |expenses incurred to repair or replace the damaged, lost, or stolen property. | | |
| | |lost, or stolen property.12. Proceeds of a loan when those |12. Proceeds of a loan when those proceeds were not expended to meet the purpose| | |
| | |proceeds were not expended to meet the purpose of the loan |of the loan or proceeds of a loan with no bona fide debt repayment schedule. | | |
| | |or proceeds of a loan with no bona fide debt repayment |13. The estate and all resources identified in the estate inventory for a client| | |
| | |schedule.13. The estate and all resources identified in the|adjudicated incapacitated by a court. | | |
| | |estate inventory for a client adjudicated incapacitated by |14. TRUSTS, BOTH REVOCABLE AND IRREVOCABLE, WILL BE COUNTABLE AS RESOURCES OR | | |
| | |a court. |INCOME ACCORDING TO THE GUIDELINES OF SSA, EXCEPT AS PROHIBITED BY SECTION | | |
| | | |15-14-412.5, C.R.S., ET SEQ. AND IS CONSISTENT WITH THE PROVISIONS OF FEDERAL | | |
| | | |GUIDELINES FOUND IN THE SSA PROGRAMS OPERATIONS MANUAL SYSTEM (POMS) AT SI | | |
| | | |CHI01120.201 (EFFECTIVE AS OF JUNE 29, 2009) AND SI 01120.200 (EFFECTIVE AS OF | | |
| | | |JUNE 7, 2018), WHICH ARE HEREIN INCORPORATED BY REFERENCE. THIS RULE DOES NOT | | |
| | | |CONTAIN ANY LATER AMENDMENTS OR EDITIONS. THESE GUIDELINES ARE AVAILABLE FOR NO | | |
| | | |COST AT . THESE GUIDELINES | | |
| | | |ARE ALSO AVAILABLE FOR PUBLIC INSPECTION AND COPYING AT THE COLORADO DEPARTMENT | | |
| | | |OF HUMAN SERVICES, DIRECTOR OF THE EMPLOYMENT AND BENEFITS DIVISION, 1575 | | |
| | | |SHERMAN STREET, DENVER, COLORADO, 80203, OR AT ANY STATE PUBLICATIONS LIBRARY | | |
| | | |DURING REGULAR BUSINESS HOURS. | | |
| | | |A. WHEN ALL OR A PORTION OF THE CORPUS OF A TRUST, CANNOT BE PAID TO OR FOR THE | | |
| | | |BENEFIT OF THE CLIENT, THE PORTION THAT CANNOT BE PAID IS CONSIDERED A TRANSFER | | |
| | | |OF RESOURCES FOR LESS THAN FAIR MARKET VALUE AND A PENALTY SHALL BE ASSESSED AS | | |
| | | |OUTLINED IN SECTION 3.520.76.D. | | |
| | | |B. REFUSAL OF A TRUSTEE TO MAKE PAYMENTS TO OR FOR THE BENEFIT OF THE CLIENT | | |
| | | |DOES NOT EXEMPT THE TRUST FROM BEING A COUNTABLE ASSET AND THE FULL AMOUNT OF | | |
| | | |THE TRUST SHALL BE CONSIDERED AVAILABLE AS A RESOURCE TO THE CLIENT. | | |
| | | |C. IF A CLIENT PLACES AN EXEMPT RESOURCE IN A TRUST THE RESOURCE EXEMPTION MAY | | |
| | | |STILL APPLY TO THAT RESOURCE. | | |
|3.520.72 |Clarification |C. If it is determined that a married couple is legally or |C. If it is determined that a married couple is legally or permanently separated|Align with the rule section |No |
| |Needed |permanently separated as identified in Section 3.520.63, |as identified in Section 3.520.63, sole ownership of property by the |referenced which only recognizes and | |
| | |sole ownership of property by the non-recipient spouse does|non-recipient spouse does not affect the client's eligibility for assistance. |defines legal separation not | |
| | |not affect the client's eligibility for assistance. | |permanent separation. | |
|3.520.72 |Clarification |D. The county department shall obtain verification of all |D. The county department shall obtain verification of all resources and |Changed to "contact" to be consistent|No |
| |Needed |resources and associated values.1. The county department |associated values. |with Definitions. Eliminated safety | |
| | |shall include case notes describing verification |1. The county department shall include case notes describing verification |deposit box. | |
| | |documentation in the statewide automated system.2. Original|documentation in the statewide automated system. | | |
| | |copies of verification documents shall be returned to the |2. Original copies of verification documents shall be returned to the client. | | |
| | |client.3. The client's authorization shall be obtained to |3. The client's authorization ON THE APPLICATION OR REDETERMINATION FORM shall | | |
| | |contact a collateral source for valuation information or |be obtained to contact a collateral CONTACT source for valuation information or | | |
| | |verification.4. The client shall disclose the contents of a|verification. | | |
| | |safety deposit box on request of the county department. The|4. The client shall disclose the contents of a safety deposit box on request of | | |
| | |value of the contents is determined by obtaining any |the county department. The value of the contents is determined by obtaining any | | |
| | |necessary valuations for countable items. |necessary valuations for countable items. | | |
|3.520.72 |Clarification |E. A sponsor(s)'s resources are only counted toward the |E. A sponsor(s)'s resources are only counted toward the non-citizen CLIENT they |Align description of resource deeming|No |
| |Needed |non-citizen they sponsor. Determine the total amount of the|sponsor. RESOURCES ARE ATTRIBUTED TO THE SPONSOR IN THE SAME MANNER AS THE |with Section 3.520.68, B, 2 | |
| | |non-citizen's resources after deeming, and use the SSI |NON-CITIZEN CLIENT, AS OUTLINED IN SECTION 3.520.7. ALL COUNTABLE RESOURCES OVER|(application of Indigence). This is | |
| | |individual resource standard to determine resource |THE SPONSOR(S) RESOURCE LIMIT, AS OUTLINED IN SECTION 3.520.72.A, ARE THEN |also how ALJs have been calculating | |
| | |eligibility for the sponsored non-citizen. To determine the|DEEMED TO THE NON-CITIZEN CLIENT. THE DEEMED AMOUNT FROM THE CLIENT’S SPONSOR(S)|deeming of resources in hearing | |
| | |amount of resources deemed to the non-citizen, subtract the|IS THEN ADDED TO THE NON-CITIZEN CLIENT’S COUNTABLE RESOURCES AND COMPARED TO |decisions. Removed redundant | |
| | |resource standard from the amount of the sponsor(s) |THE NON-CITIZEN CLIENT’S RESOURCE LIMIT, AS OUTLINED IN SECTION 3.520.72.A. |language about resource limits. | |
| | |resources. The difference is the amount of resources that |Determine the total amount of the non-citizen's resources after deeming, and use| | |
| | |is added to the non-citizen's own resources. |the SSI individual resource standard to determine resource eligibility for the | | |
| | |1. When a sponsor is married, but the spouse is not a |sponsored non-citizen. To determine the amount of resources deemed to the | | |
| | |sponsor to the non-citizen, use the couple resource |non-citizen, subtract the resource standard from the amount of the sponsor(s) | | |
| | |standard for SSI. |resources. The difference is the amount of resources that is added to the | | |
| | |2. When the sponsor is married and the sponsor's spouse is |non-citizen's own resources. | | |
| | |also a sponsor to the non-citizen, the individual resource |1. When a sponsor is married, but the spouse is not a sponsor to the | | |
| | |standard for SSI is applied separately to each spouse. |non-citizen, use the couple resource standard for SSI. | | |
| | | |2. When the sponsor is married and the sponsor's spouse is also a sponsor to the| | |
| | | |non-citizen, the individual resource standard for SSI is applied separately to | | |
| | | |each spouse. | | |
|3.520.72 |New Rule |NEW |F. IF A CLIENT IS APPROVED FOR SUPPLEMENTAL SECURITY INCOME (SSI) AS VERIFIED |Eliminates need to verify resources |No |
| |Addition | |THROUGH THE SVES INTERFACE, THERE SHALL BE NO ADDITIONAL REQUIREMENT TO VERIFY |if the applicant is receiving SSI | |
| | | |RESOURCES AT INITIAL APPLICATION, UNLESS THE RESOURCES REPORTED ARE |benefits as resources are already | |
| | | |QUESTIONABLE. |verified by the SSA. | |
| | | |1. IF THE COUNTY DEPARTMENT HAS OBTAINED OR RECEIVED INFORMATION RELATED TO | | |
| | | |RESOURCES THAT IS CONTRARY TO THE SVES INTERFACE, THE COUNTY DEPARTMENT SHALL | | |
| | | |INDEPENDENTLY VERIFY THE INFORMATION; AND, | | |
| | | |2. THE COUNTY DEPARTMENT SHALL FORWARD SUCH CONTRARY INFORMATION TO THE LOCAL | | |
| | | |SSA OFFICE. | | |
|3.520.73 |Clarification |A. Checking and savings accounts:1. The current amount in a|A. Checking and savings accounts OR OTHER ACCESSIBLE ELECTRONIC DEPOSITS: |Added other accessible electronic |No |
| |Needed |savings or checking account is determined by verifying the |1. The current amount in a savings or checking account OR OTHER ACCESSIBLE |deposits to capture EBT accounts. | |
| | |balance in the account:a. From a copy of a current |ELECTRONIC DEPOSITS is determined by verifying OWNERSHIP AND the AVAILABLE | | |
| | |statement of the account; or,b. With the financial |balance in the account: | | |
| | |institution online, by phone, or in writing.2. The balance |a. From a copy of a current statement of the account; or, | | |
| | |in a joint account shall be considered available to the |b. With the financial institution online, by phone, or in writing. | | |
| | |client in proportion to the number of persons on the |2. The balance in a joint account shall be considered available to the client in| | |
| | |account.a. If the co-owner of the joint account is the |proportion to the number of persons on the account. | | |
| | |client's legal fiduciary, such as a guardian, conservator, |a. If the co-owner of the joint account is the client's legal fiduciary, such as| | |
| | |or power of attorney, the account shall be considered to be|a guardian, conservator, or power of attorney, the account shall be considered | | |
| | |100% owned by the client and all funds in the account shall|to be 100% owned by the client and all funds in the account shall be considered | | |
| | |be considered available to the client.b. If the client |available to the client. | | |
| | |establishes clear and convincing evidence that the intent |b. If the client establishes BY A PREPONDERANCE OF clear and convincing evidence| | |
| | |of ownership is other than the client's equal and |that the intent of ownership is other than the client's equal and proportionate | | |
| | |proportionate share of the account balance, the county |share of the account balance, the county department shall apply the prudent | | |
| | |department shall apply the prudent person principle to the |person principle to the evidence to determine the amount to be considered | | |
| | |evidence to determine the amount to be considered available|available to the client. | | |
| | |to the client.c. In cases where it has been shown the |c. In cases where it has been shown the client has no interest in the account, | | |
| | |client has no interest in the account, the county |the county department shall request a change in the account designation removing| | |
| | |department shall request a change in the account |the client's name, and submittal of the original and revised account records | | |
| | |designation removing the client's name, and submittal of |showing the change was made. | | |
| | |the original and revised account records showing the change| | | |
| | |was made. | | | |
|3.520.741 |Clarification |A. In order for real property to be considered a resource |A. In order for real property to be considered a resource to the client, the |Struck through "Client" to broaden |No |
| |Needed |to the client, the following shall be determined:1. The |following shall be determined: |the rule to include other individuals| |
| | |actual value less encumbrances of the client's ownership |1. The actual value less encumbrances of the client's ownership interest: |who may have resources contributing | |
| | |interest:a. Actual value of real property may be obtained |a. Actual value of real property may be obtained by using the actual value |to the resource limit (spouse, | |
| | |by using the actual value reported by a county assessor or |reported by a county assessor or from the most recent property assessment |sponsor). | |
| | |from the most recent property assessment notice.b. The |notice. | | |
| | |assessed value shall be verified from a copy of the most |b. The assessed value shall be verified from a copy of the most recent property | | |
| | |recent property assessment notice or with the county |assessment notice or with the county assessor's office on the Internet, by | | |
| | |assessor's office on the Internet, by phone, personal |phone, personal contact, or in writing. | | |
| | |contact, or in writing.c. Encumbrances include mortgages, |c. Encumbrances include mortgages, liens, judgments, delinquent taxes, loan | | |
| | |liens, judgments, delinquent taxes, loan agreements, and |agreements, and other forms of indebtedness. Encumbrances shall be verified BY | | |
| | |other forms of indebtedness. Encumbrances shall be |SUCH METHODS AS COLLATERAL CONTACT, COUNTY RECORDER RECORDS, BANK RECORDS, AND | | |
| | |verified. Only direct and documented encumbrances against a|OTHER CREDIBLE SOURCES. Only direct and documented encumbrances against a | | |
| | |specific item or property shall be considered in |specific item or property shall be considered in determining its equity value. | | |
| | |determining its equity value. Verbal agreements of |Verbal agreements of indebtedness shall not be accepted. | | |
| | |indebtedness shall not be accepted.2. The negotiability of |2. The negotiability of the ownership interest (that is, there are no legal | | |
| | |the ownership interest (that is, there are no legal |restrictions from selling the client's property interest); and, | | |
| | |restrictions from selling the client's property interest); |3. The ability to sell the property interest (that is, that the ownership | | |
| | |and,3. The ability to sell the property interest (that is, |interest can, in fact, be sold on the open market at any price). | | |
| | |that the ownership interest can, in fact, be sold on the | | | |
| | |open market at any price). | | | |
|3.520.741 |Clarification |B. The degree of the client's ownership interest is |B. The degree of the client's ownership interest is determined by the type of |Added "spouse and sponsor(s) to |No |
| |Needed |determined by the type of ownership. Generally, the types |ownership. Generally, the types of ownership are: |broaden the rule to include other | |
| | |of ownership are:1. Sole ownership, in which the client is |1. Sole ownership, in which the client, THE CLIENT’S SPOUSE, OR SPONSOR(S) is |individuals who may have resources | |
| | |the only owner. If the client has the right to dispose of |the only owner. If the client, SPOUSE, OR SPONSOR(S) has the right to dispose of|contributing to the resource limit | |
| | |the property, the actual value less encumbrances of the |the property, the actual value less encumbrances of the property is determined |(spouse, sponsor). | |
| | |property is determined and counted as a resource;2. Shared |and counted as a resource; | | |
| | |ownership, in which the property is owned by the client and|2. Shared ownership, in which the property is owned by the client, SPOUSE, OR | | |
| | |one or more individuals. The actual value less encumbrances|SPONSOR(S) and one or more individuals. The actual value less encumbrances is | | |
| | |is determined and charged in proportion to the client's |determined and charged in proportion to the client's, CLIENT’S SPOUSE, OR | | |
| | |share of ownership. There are two kinds of shared |SPONSOR(S)’S share of ownership. There are two kinds of shared ownership: | | |
| | |ownership:a. Joint ownership or ownership in common, in |a. Joint ownership or ownership in common, in which the property's actual value | | |
| | |which the property's actual value less encumbrances is |less encumbrances is divided equally among the owners; and, | | |
| | |divided equally among the owners; and,b. Tenancy in common,|b. Tenancy in common, in which the property's actual value less encumbrances is | | |
| | |in which the property's actual value less encumbrances is |divided by the number of owners in proportion to their stated interest (which | | |
| | |divided by the number of owners in proportion to their |may not necessarily be equal). | | |
| | |stated interest (which may not necessarily be equal). | | | |
|3.520.741 |Clarification |C. Negotiability and, if applicable, the client's ability |C. Negotiability and, if applicable, the client's ability to sell the property |Added "spouse and sponsor(s) to |No |
| |Needed |to sell the property interest at a reasonable price must be|interest at a reasonable price must be determined. Negotiability refers to the |broaden the rule to include other | |
| | |determined. Negotiability refers to the client's legal |client's, CLIENT’S SPOUSE, OR SPONSOR(S)’S legal right to dispose of an |individuals who may have resources | |
| | |right to dispose of an ownership interest; ability to sell |ownership interest; ability to sell refers to a THE CLIENT, CLIENT’S SPOUSE. OR |contributing to the resource limit | |
| | |refers to a legal ability to sell. Reasonable price is |SPONSOR(S) legal ability to sell. Reasonable price is determined to be |(spouse, sponsor). | |
| | |determined to be two-thirds of the actual value.1. |two-thirds of the actual value. | | |
| | |Negotiability - there may be legal reasons why a client may|1. Negotiability - there may be legal reasons why a client, CLIENT’S SPOUSE, OR | | |
| | |not be able to sell the client's property interest, such as|SPONSOR(S) may not be able to sell the client's property interest, such as when | | |
| | |when the estate is in probate or there is a lawsuit pending|the estate is in probate or there is a lawsuit pending against the property. The| | |
| | |against the property. The refusal of co-owners to consent |refusal of co-owners to consent to the sale of a property interest is not a | | |
| | |to the sale of a property interest is not a legal |legal restriction of the client's, CLIENT’S SPOUSE, OR SPONSOR(S)’S right to | | |
| | |restriction of the client's right to sell.2. If the |sell. | | |
| | |co-owner of the property uses the property as the principal|2. If the co-owner of the property uses the property as the principal place of | | |
| | |place of residence and sale of the property would cause |residence and sale of the property would cause undue hardship, the client's, | | |
| | |undue hardship, the client's equity in the property shall |CLIENT’S SPOUSE, OR SPONSOR(S)’S equity in the property shall be exempted, | | |
| | |be exempted. Undue hardship for this purpose is defined |UNLESS THE CO-OWNER IS THE SPOUSE OR SPONSOR(S). Undue hardship for this purpose| | |
| | |as:a. The co-owner uses the property as his/her primary |is defined as: | | |
| | |residence; and,b. The co-owner would have to move as a |a. The co-owner uses the property as his OR /her primary residence; and, | | |
| | |result of the sale of the property; and,c. The co-owner has|b. The co-owner would have to move as a result of the sale of the property; and,| | |
| | |no other available housing, including relatives or income |c. The co-owner has no other available housing, including relatives or income to| | |
| | |to rent at fair market value; and,d. The co-owner |rent at fair market value; and, | | |
| | |documents, in writing, his/her undue hardship allegations; |d. The co-owner documents, in writing, his OR /her undue hardship allegations; | | |
| | |and,e. Using prudent person principle, the county |and, | | |
| | |department determines the undue hardship allegations to be |e. Using prudent person principle, the county department determines the undue | | |
| | |reasonable.3. If the client cannot sell the property for |hardship allegations to be reasonable. | | |
| | |two-thirds of the actual value, the property shall be |3. If the client, CLIENT’S SPOUSE OR SPONSOR(S) cannot sell the property for | | |
| | |exempted provided that the client continues reasonable |two-thirds of the actual value, the property shall be exempted provided that the| | |
| | |efforts to sell the property such as listing the property |client THERE continues TO BE reasonable efforts to sell the property such as | | |
| | |with an agency or by advertising in the local media.a. The |listing the property with an agency or by advertising in the local media. | | |
| | |county department shall verify on a quarterly basis that a |a. The county department shall verify on a quarterly basis that a reasonable | | |
| | |reasonable effort is being made to sell the property.b. The|effort is being made to sell the property. | | |
| | |property shall not be exempted if the county department, |b. The property shall not be exempted if the county department, using prudent | | |
| | |using prudent person principle, determines the client is |person principle, determines the client, CLIENT’S SPOUSE, OR SPONSOR(S) is not | | |
| | |not making a reasonable effort to sell.c. If the client |making a reasonable effort to sell. | | |
| | |rejects an offer to purchase the property that is at least |c. If the client, CLIENT’S SPOUSE, OR SPONSOR(S) rejects an offer to purchase | | |
| | |two-thirds the actual value of the property, the entire |the property that is at least two-thirds the actual value of the property, the | | |
| | |equity value of the property shall be considered a |entire equity value of the property shall be considered a countable resource. | | |
| | |countable resource.4. If the property interest cannot be |4. If the property interest cannot be disposed of because of legal | | |
| | |disposed of because of legal technicalities, the client's |technicalities, the client's, CLIENT’S SPOUSE, OR SPONSOR(S)’S equity value is | | |
| | |equity value is not a countable resource. The county |not a countable resource. The county department shall verify any limitations | | |
| | |department shall verify any limitations that prevent the |that prevent the disposition of the property and document those limitations in | | |
| | |disposition of the property and document those limitations |the statewide automated system case comments. | | |
| | |in the statewide automated system case comments. | | | |
|3.520.742 |Clarification |A. The actual value of any personal property which is |A. The actual value of any personal property which is assessed for taxation, |Technical cleanup | |
| |Needed |assessed for taxation, such as a mobile home, house |such as a mobile home, house trailer, or property used in a trade or business, | | |
| | |trailer, or property used in a trade or business, is |is determined by using the actual value reported by a county assessor or by | | |
| | |determined by using the actual value reported by a county |obtaining a copy of the most recent property assessment notice. If the actual | | |
| | |assessor or by obtaining a copy of the most recent property|value is not on the assessment notice, the value may be determined by: | | |
| | |assessment notice. If the actual value is not on the |1. Verifying the actual valuation from a copy of the most recent property | | |
| | |assessment notice, the value may be determined by: |assessment notice or with the county assessor's office on the Internet, by | | |
| | |1. Verifying the actual valuation from a copy of the most |phone, BY other personal contact, or in writing; or, | | |
| | |recent property assessment notice or with the county |2. When personal property valuation is necessary, and the usual means of | | |
| | |assessor's office on the Internet, by phone, other personal|valuation is not possible, the county department shall use available local | | |
| | |contact, or in writing; or, |resources or the classified ad section of the local or other state newspaper or | | |
| | |2. When personal property valuation is necessary, and the |THE IInternet to determine and verify the actual value. | | |
| | |usual means of valuation is not possible, the county |3. To determine the equity value of personal property, first determine the | | |
| | |department shall use available local resources or the |actual value; then subtract encumbrances. | | |
| | |classified ad section of the local or other state newspaper| | | |
| | |or Internet to determine and verify the actual value. | | | |
| | |3. To determine the equity value of personal property, | | | |
| | |first determine the actual value; then subtract | | | |
| | |encumbrances. | | | |
|3.520.742 |Clarification |B. The actual value of any personal property which is not |B. The actual value of any personal property which is not assessed for taxation |Clarified that vehicles are included |No |
| |Needed |assessed for taxation is determined by obtaining the |is determined by obtaining the appraised value less liabilities, i.e., VEHICLES,|in the list of personal property. | |
| | |appraised value less liabilities, i.e., farm equipment and |farm equipment and livestock or inventories of merchandise and materials, such | | |
| | |livestock or inventories of merchandise and materials, such|as art, jewelry or valuable collections, as appraised by a verifiable, industry | | |
| | |as art, jewelry or valuable collections, as appraised by a |recognized source. | | |
| | |verifiable, industry recognized source.1. The actual value |1. The actual value of automobiles and trucks is determined by using the | | |
| | |of automobiles and trucks is determined by using the |trade-in fair condition value as provided by an auto valuation company, such as | | |
| | |trade-in fair condition value as provided by an auto |Kelly Blue Book or NADA guides. A greater or lesser value shall be used if | | |
| | |valuation company, such as Kelly Blue Book or NADA guides. |verified by a statement from a reliable source, such as a car dealer, collector | | |
| | |A greater or lesser value shall be used if verified by a |car expert, or scrap yard professional. UNLESS QUESTIONABLE, IT SHALL BE | | |
| | |statement from a reliable source, such as a car dealer, |PRESUMED THAT THE VALUE OF THE VEHICLE IS FOUR HUNDRED DOLLARS ($400) WHEN THE | | |
| | |collector car expert, or scrap yard professional.2. For |INFORMATION IS NOT FOUND IN KELLY BLUE BOOK OR NADA GUIDES. | | |
| | |personal property which has not been assessed for taxation |2. For personal property which has not been assessed for taxation and vehicles | | |
| | |and vehicles which are not listed by an auto valuation |which are not listed by an auto valuation company, the client shall submit | | |
| | |company, the client shall submit verification of the |verification of the appraised value based on written statements received from | | |
| | |appraised value based on written statements received from |the following: | | |
| | |the following:a. Assessment standards obtained from the |a. Assessment standards obtained from the state or county motor vehicle office | | |
| | |state or county motor vehicle office or county assessor's |or county assessor's office; or, | | |
| | |office; or,b. Valuation obtained from a local merchant, |b. Valuation obtained from a local merchant, dealer, THE IInternet or other | | |
| | |dealer, Internet or other reliable source. |reliable source. | | |
|3.520.742 |Clarification |D. The current cash value of U.S. Savings Bonds, Treasury |D. The current cash value of U.S. Savings Bonds, Treasury Notes, and similar |Added the online verification system |No |
| |Needed |Notes, and similar investment vehicles is determined from |investment vehicles is determined from the value tables appearing on the bonds |for savings bonds and treasury notes.| |
| | |the value tables appearing on the bonds themselves or by |themselves, THROUGH THE ONLINE TREASURY DIRECT SYSTEM, or by contacting a | | |
| | |contacting a financial institution. |financial institution. | | |
|3.520.742 |Clarification |E. Personal property may be exempted if the client has made|E. Personal property may be exempted if the client, CLIENT’S SPOUSE, OR |Added "spouse and sponsor(s) to |No |
| |Needed |an attempt to sell and has been unable to do so.1. Failure |SPONSOR(S) has made an attempt to sell and has been unable to do so. |broaden the rule to include other | |
| | |to sell personal property at the asking price or for a |1. Failure to sell personal property at the asking price or for a reasonable |individuals who may have resources | |
| | |reasonable value the resource shall not be exempt. Under |value SHALL NOT EXEMPT, the resource FROM THE CLIENT’S COUNTABLE RESOURCES shall|contributing to the resource limit | |
| | |such circumstances, the county department shall determine |not be exempt. Under such circumstances, the county department shall determine |(spouse, sponsor). | |
| | |whether the property could be sold for two-thirds of the |whether the property could be sold for two-thirds of the actual value. | | |
| | |actual value.2. If the client receives an offer for at |2. If the client, CLIENT’S SPOUSE, OR SPONSOR(S) receives an offer for at least | | |
| | |least two-thirds of the actual value and refuses to sell |two-thirds of the actual value and refuses to sell the property, the property | | |
| | |the property, the property shall not be exempted.3. If the |shall not be exempted. | | |
| | |client cannot sell the property for two-thirds of the |3. If the client, CLIENT’S SPOUSE, OR SPONSOR(S) cannot sell the property for | | |
| | |actual value, the property shall be exempted provided that |two-thirds of the actual value, the property shall be exempted provided that the| | |
| | |the client continues reasonable efforts to sell the |client THERE continues TO BE reasonable efforts to sell the property, such as by| | |
| | |property such as, by listing the property with an agency or|listing the property with an agency or by advertising in the local media. | | |
| | |by advertising in the local media.a. The county department |a. The county department shall verify on a quarterly basis that a reasonable | | |
| | |shall verify on a quarterly basis that a reasonable effort |effort is being made to sell the property. | | |
| | |is being made to sell the property.b. The property shall |b. The property shall not be exempted if the county department, using prudent | | |
| | |not be exempted if the county department, using prudent |person principle, determines the client, CLIENT’S SPOUSE, OR SPONSOR(S) is not | | |
| | |person principle, determines the client is not making a |making a reasonable effort to sell. | | |
| | |reasonable effort to sell.c. If the client rejects an offer|c. If the client, CLIENT’S SPOUSE, OR SPONSOR(S) rejects an offer to purchase | | |
| | |to purchase the property that is at least two-thirds the |the property that is at least two-thirds the actual value of the property, the | | |
| | |actual value of the property, the entire equity value of |entire equity value of the property shall be considered a countable resource. | | |
| | |the property shall be considered a countable resource. | | | |
|3.520.742 |Clarification |G. The client shall have the right to submit evidence |G. The client, CLIENT’S SPOUSE, OR SPONSOR(S) shall have the right to submit |Added "spouse and sponsor(s) to |No |
| |Needed |establishing a lesser property value. Such value may be |evidence establishing a lesser property value. Such value may be established AS |broaden the rule to include other | |
| | |established to be zero. The county department shall |to be zero. The county department shall evaluate the evidence and determine the |individuals who may have resources | |
| | |evaluate the evidence and determine the property value. |property value. |contributing to the resource limit | |
| | | | |(spouse, sponsor). | |
|3.520.75 |Clarification |A. Life insurance policies owned by the client that have a |A. Life insurance policies owned by the client, CLIENT’S SPOUSE, OR SPONSOR(S) |Added "spouse and sponsor(s) to |No |
| |Needed |cash surrender value available to the client must be |that have a cash surrender value available (CSV) to the client must be evaluated|broaden the rule to include other | |
| | |evaluated for original face value at the time of purchase |for THE original face value at the time of purchase and for THE current CSV cash|individuals who may have resources | |
| | |and for current cash surrender value. |surrender value. |contributing to the resource limit | |
| | | | |(spouse, sponsor). | |
|3.520.75 |Clarification |B. Term life insurance policies should be reviewed to |B. Term life insurance policies should be reviewed to determine if a CSV cash |Technical cleanup | |
| |Needed |determine if a cash surrender value exists. |surrender value exists. | | |
|3.520.75 |Clarification |C. The county department shall obtain the most recent |C. The county department shall obtain the most recent documentation related to |Align with SSA's treatment of Life |No |
| |Needed |documentation related to the policy, to include active |the policyIES, to include active status, liens or encumbrances, and current CSV |Insurance. | |
| | |status, liens or encumbrances, and current cash surrender |cash surrender value, AND ANNUAL DIVIDEND STATEMENTS. | | |
| | |value. | | | |
|3.520.75 |Clarification |D. If the total face value of all life insurance policies |D. If the total face value of all life insurance policies owned by a client AND |Align with SSA's treatment of Life |No |
| |Needed |owned by a client is equal to $1,500 or less, the full cash|HIS OR HER SPOUSE is equal to $1,500 or less, the full CSV cash surrender value |Insurance. | |
| | |surrender value of all policies is exempt. |of all policies is exempt. SPONSOR(S) ARE ALLOWED THE SAME EXEMPTION. | | |
|3.520.75 | |E. For OAP only, if the total face value of all life |E. For OAP only, if the total face value of all life insurance policies owned by|Align with SSA's treatment of Life |No |
| | |insurance policies owned by a client is equal to more than |a client AND HIS OR HER SPOUSE is equal to more than $1,500 and the CSV cash |Insurance. | |
| | |$1,500 and the cash surrender value of all policies |surrender value of all policies combined is $250,000 $100,000 or less, then the | | |
| | |combined is $100,000 or less, then the following applies: |following applies: | | |
| | |1. If all policies were purchased more than forty-eight |1. If all policies were purchased more than forty-eight (48) months prior to the| | |
| | |(48) months prior to the eligibility determination date, |eligibility determination date, and no further contributions or payments to the | | |
| | |and no further contributions or payments to the policies |policies have been made in the past 48 months, all CSV cash surrender value is | | |
| | |have been made in the past 48 months, all cash surrender |exempt.; OR, | | |
| | |value is exempt. |2. If THERE HAVE BEEN the client has contributed additional monies CONTRIBUTED | | |
| | |2. If the client has contributed additional monies or made |or made payments MADE to any of the policies within 48 months of THE eligibility| | |
| | |payments to any of the policies within 48 months of |determination date, those additional monies contributed are counted toward the | | |
| | |eligibility determination date, those additional monies |resource limit; the original cash value amount prior to the 48 month period | | |
| | |contributed are counted toward the resource limit; the |remains exempt.; OR, | | |
| | |original cash value amount prior to the 48 month period |3. If any of the policies were purchased within the 48 months prior to | | |
| | |remains exempt. |eligibility determination date, the total CSV cash surrender value is a | | |
| | |3. If any of the policies were purchased within the 48 |countable resource.; AND, | | |
| | |months prior to eligibility determination date, the total |4. SPONSOR(S) ARE ALLOWED THE SAME EXEMPTIONS. | | |
| | |cash surrender value is a countable resource. | | | |
|3.520.75 |Clarification |F. For OAP only, if the total face value of all life |F. For OAP only, if the total face value of all life insurance policies owned by|Align with SSA's treatment of Life |No |
| |Needed |insurance policies owned by a client is equal to more than |a client AND HIS OR HER SPOUSE is equal to more than $1,500 and CSV cash |Insurance. | |
| | |$1,500 and cash surrender value of all policies combined is|surrender value of all policies combined is more than $250,000 $100,000, then | | |
| | |more than $100,000, then the following applies:1. If all |the following applies: | | |
| | |policies were purchased more than 48 months prior to |1. If all policies were purchased more than 48 months prior to eligibility | | |
| | |eligibility determination date, and no further |determination date, and no further contributions or payments to the policies | | |
| | |contributions or payments to the policies have been made in|have been made in the past 48 months, the CSV cash surrender value over $250,000| | |
| | |the past 48 months, the cash surrender value over $100,000 |$100,000 is countable; the first $250,000 $100,000 is exempt.; OR, | | |
| | |is countable; the first $100,000 is exempt.2. If the client|2. If THERE HAVE BEEN the client has contributed additional monies CONTRIBUTED | | |
| | |has contributed additional monies or made payments to any |or made payments MADE to any of the policies within 48 months of eligibility | | |
| | |of the policies within 48 months of eligibility |determination date, those additional monies contributed are counted toward the | | |
| | |determination date, those additional monies contributed are|resource limit and the CSV cash surrender value over $250,000 $100,000 is | | |
| | |counted toward the resource limit and the cash surrender |countable; the original cash value amount prior to the 48 month period remains | | |
| | |value over $100,000 is countable; the original cash value |exempt.; OR, | | |
| | |amount prior to the 48 month period remains exempt.3. If |3. If any of the policies were purchased within the 48 months prior to | | |
| | |any of the policies were purchased within the 48 months |eligibility determination date, the total CSV cash surrender value is a | | |
| | |prior to eligibility determination date, the total cash |countable resource.; AND, | | |
| | |surrender value is a countable resource. |4. SPONSOR(S) ARE ALLOWED THE SAME EXEMPTIONS. | | |
|3.520.75 |Clarification |G. The original face value of a policy may be increased |G. The original face value of a policy may be increased because of dividends and|Technical cleanup | |
| |Needed |because of dividends and reinvestment of dividends. This |reinvestment of dividends. This increased face value shall not be used to | | |
| | |increased face value shall not be used to determine |determine eligibility. The original face value of the policy shall be used to | | |
| | |eligibility. The original face value of the policy shall be|determine whether the CSV cash surrender value of the policy is exempt. | | |
| | |used to determine whether the cash surrender value of the | | | |
| | |policy is exempt. | | | |
| |New Rule |H. NEW |H. USE THE FOLLOWING CHART TO ESTIMATE A LIFE INSURANCE POLICY'S CSV IF NOT |Aligns with SSA estimation of CSV. |No |
| |Addition | |AVAILABLE FROM THE CLIENT, CLIENT’S SPOUSE, OR SPONSOR(S): | | |
| | | |YEARS LIFE INSURANCE POLICY HAS BEEN IN EFFECT | | |
| | | |ESTIMATED CSV IS THIS PERCENTAGE OF FACE VALUE: | | |
| | | | | | |
| | | |20 OR MORE | | |
| | | |60% | | |
| | | | | | |
| | | |15-19 | | |
| | | |50% | | |
| | | | | | |
| | | |11-14 | | |
| | | |45% | | |
| | | | | | |
| | | |6-10 | | |
| | | |30% | | |
| | | | | | |
| | | |4-5 | | |
| | | |20% | | |
| | | | | | |
| | | |3 | | |
| | | |10% | | |
| | | | | | |
| | | |2 | | |
| | | |5% | | |
| | | | | | |
| | | |1 | | |
| | | |0% | | |
| | | | | | |
|3.520.76 |Clarification |A. A Transfer Without Fair Consideration (TWFC) is a |A. A Transfer Without Fair Consideration (TWFC) is a transfer of any resource to|Align with SSA's treatment of |No |
| |Needed |transfer of any resource to another person at a price that |another person at a price that is below fair market value. TRANSFERS OF RESOURCE|Transfers AND State Statute 26-2-111.| |
| | |is below fair market value. A transfer of a resource shall |OWNERSHIP MAY OCCUR THROUGH TRANSACTIONS SUCH AS SALE OF PROPERTY; TRADE OR | | |
| | |be considered a TWFC if the transfer was:1. Voluntary; |EXCHANGE OF ONE PROPERTY FOR ANOTHER; SPEND-DOWN OF CASH; GIVING AWAY CASH; | | |
| | |and,2. Without fair and valuable consideration; and,3. Made|TRANSFERRING ANY FINANCIAL INSTRUMENT (E.G., STOCKS, BONDS); OR, GIVING AWAY | | |
| | |within thirty-six (36) months prior to the application |PROPERTY (INCLUDING ADDING ANOTHER PERSON'S NAME AS AN OWNER OF THE PROPERTY). A| | |
| | |date; and,4. For the purpose of rendering the client |transfer of a resource shall be considered a TWFC if the transfer was: | | |
| | |eligible for assistance; or,5. Made while receiving Adult |1. Voluntary; and, | | |
| | |Financial program benefits.a. The county department shall |2. Without fair and valuable consideration, and, | | |
| | |make a rebuttable presumption that the transaction was made|3. Made within thirty-six (36) months prior to the application date; OR WHILE | | |
| | |for the purpose of becoming or remaining eligible for Adult|RECEIVING ADULT FINANCIAL PROGRAM GRANT PAYMENTS; and, | | |
| | |Financial program benefits when the transfer was made any |4. For the purpose of rendering the client eligible for assistance. THE COUNTY | | |
| | |time during the thirty-six (36) month period immediately |WILL EVALUATE EVIDENCE PROVIDED BY THE CLIENT TO DETERMINE IF THE TRANSFER OF | | |
| | |prior to the filing of application for assistance or during|RESOURCES WAS EXCLUSIVELY FOR A PURPOSE OTHER THAN TO QUALIFY FOR BENEFITS.; or,| | |
| | |such time that assistance was being received.b. A client |5. Made while receiving Adult Financial program benefits. | | |
| | |shall be given the opportunity to disprove the presumption.|a. The county department shall make a rebuttable presumption that the | | |
| | |The presumption shall be nullified if the client can |transaction was made for the purpose of becoming or remaining eligible for Adult| | |
| | |demonstrate to the county department that the transfer was |Financial program benefits when the transfer was made any time during the | | |
| | |for another purpose.1) The client's primary purpose cannot |thirty-six (36) month period immediately prior to the filing of application for | | |
| | |be to acquire money or profit from the transaction; and,2) |assistance or during such time that assistance was being received. | | |
| | |The client shall provide written documentation of any |b. A client shall be given the opportunity to disprove the presumption. The | | |
| | |agreement made in relation to the transfer of property, |presumption shall be nullified if the client can demonstrate WITH EVIDENCE to | | |
| | |that was created at the time of the agreement to transfer |the county department that the transfer was for another purpose. | | |
| | |property; and,3) The county department shall weigh the |1) The client's primary purpose cannot be to acquire money or profit from the | | |
| | |evidence and use prudent person principle to determine |transaction; and, | | |
| | |whether there is sufficient evidence to disprove the |2) The client shall provide written documentation of any agreement made in | | |
| | |presumption. |relation to the transfer of property, that was created at the time of the | | |
| | | |agreement to transfer property; and, | | |
| | | |3) The county department shall weigh the evidence and use THE prudent person | | |
| | | |principle to determine whether there is sufficient evidence to disprove the | | |
| | | |presumption. | | |
|3.520.76 |Clarification |B. Circumstances at the time of the transaction may |B. Circumstances at the time of the transaction may indicate a reasonable |Technical Clean Up | |
| |Needed |indicate a reasonable rationale for a client's willingness |rationale for a client's willingness to accept a sum which is less than a fair | | |
| | |to accept a sum which is less than a fair consideration |consideration based on a hardship just prior to the transaction. Hardships | | |
| | |based on a hardship just prior to the transaction. |include: | | |
| | |Hardships include: |1. A period of unemployment resulting in an inability to meet monthly bills, and| | |
| | |1. A period of unemployment resulting in an inability to |costs of subsistence; or, | | |
| | |meet monthly bills, and costs of subsistence; or, |2. An accident or severe illness resulting in a need of funds to meet large | | |
| | |2. An accident or severe illness resulting in a need of |expenditures for medical care and services; or, | | |
| | |funds to meet large expenditures for medical care and |3. Other hardship deemed reasonable by the county department using THE prudent | | |
| | |services; or, |person principle. | | |
| | |3. Other hardship deemed reasonable by the county | | | |
| | |department using prudent person principle. | | | |
|3.520.76 |Clarification |C. A documented involuntary transfer of a resource shall |C. A documented involuntary transfer of a resource shall not affect eligibility.|Technical cleanup | |
| |Needed |not affect eligibility. Transfers that would be considered |Transfers that would be considered involuntary are: | | |
| | |involuntary are: |1. Loss of property through fraud, provided that the client can demonstrate that| | |
| | |1. Loss of property through fraud, provided that the client|every reasonable effort has been made to recover the property by court action or| | |
| | |can demonstrate that every reasonable effort has been made |other procedures as indicated; or, | | |
| | |to recover the property by court action or other procedures|2. Loss of property through legal action such as judgment, foreclosure, | | |
| | |as indicated; or, |delinquent tax sale; or, | | |
| | |2. Loss of property through legal action such as judgment, |3. Other involuntary transfer identified and determined reasonable by the county| | |
| | |foreclosure, delinquent tax sale; or, |department using THE prudent person principle. | | |
| | |3. Other involuntary transfer identified and determined | | | |
| | |reasonable by the county department using prudent person | | | |
| | |principle. | | | |
|3.520.76 |Unnecessary Rule|D. Transfers of up to a fifty percent (50%) share of the | |Resource limits would apply for the |No |
| | |equity value of a resource between the client and the |Transfers of up to a fifty percent (50%) share of the equity value of a resource|spouse so this rule is unnecessary. | |
| | |client's spouse, while legally married, shall not be a |between the client and the client's spouse, while legally married, shall not be | | |
| | |transfer without fair consideration. |a transfer without fair consideration. | | |
|3.520.76 |Clarification |E. The county department shall determine the eligibility |DE. The county department shall determine the eligibility penalty as a result of|Align with SSA's treatment of |No |
| |Needed |penalty as a result of a TWFC as follows:1. Determine the |a TWFC as follows: |Transfers. | |
| | |actual value of the resource less encumbrances and subtract|1. Determine the actual value of the resource less encumbrances and subtract the| | |
| | |the amount the client received for the resource from the |amount the client received for the resource from the determined actual value. | | |
| | |determined actual value. This is the uncompensated value.2.|This is the uncompensated value. | | |
| | |Determine the current Adult Financial program grant |2. Determine the current Adult Financial pProgram grant standard and add to the | | |
| | |standard and add to the Adult Financial program grant |Adult Financial program grant standard any monthly medical costs, including | | |
| | |standard any monthly medical costs, including health |health insurance premiums, for which the client is responsible to pay. This is | | |
| | |insurance premiums, for which the client is responsible to |the TWFC monthly penalty value. | | |
| | |pay. This is the TWFC monthly penalty value.3. Divide the |3. Divide the uncompensated value by the TWFC monthly penalty value and round | | |
| | |uncompensated value by the TWFC monthly penalty value and |down to the nearest whole number. | | |
| | |round down to the nearest whole number.4. This equals the |4. This equals the number of months of ineligibility for Adult Financial | | |
| | |number of months of ineligibility for Adult Financial |Pprogram GRANT PAYMENTS benefits. | | |
| | |program benefits. |5. THE PENALTY PERIOD BEGINS THE MONTH FOLLOWING THE DATE OF TRANSFER. IF THERE | | |
| | | |ARE MULTIPLE TRANSFERS, THE PERIOD OF INELIGIBILITY WOULD BEGIN THE MONTH | | |
| | | |FOLLOWING THE END DATE OF THE FIRST TRANSFER’S PERIOD OF INELIGIBILITY. | | |
| | | |6. IF THE CLIENT TRANSFERS A RESOURCE AND THE ENTIRE RESOURCE IS RETURNED IN THE| | |
| | | |SAME MONTH, THE PERIOD OF INELIGIBILITY DOES NOT APPLY. | | |
| | | |A. IF THE CLIENT TRANSFERS A RESOURCE AND THE ENTIRE RESOURCE IS RETURNED IN A | | |
| | | |SUBSEQUENT MONTH, THE PERIOD OF INELIGIBILITY CONTINUES THROUGH THE MONTH THE | | |
| | | |RESOURCE IS RETURNED (EVEN IF THE RESOURCE IS RETURNED ON THE FIRST DAY OF THE | | |
| | | |MONTH). THE PERIOD OF INELIGIBILITY DUE TO THE TRANSFER ENDS AS OF THE MONTH | | |
| | | |FOLLOWING THE MONTH THE RESOURCE IS RETURNED. IN THAT MONTH, THE RETURNED | | |
| | | |RESOURCE IS COUNTED TOWARDS THE CLIENT'S RESOURCE LIMIT. | | |
| | | |B. IF THE ENTIRE RESOURCE IS NOT RETURNED, THE PERIOD OF INELIGIBILITY DOES NOT | | |
| | | |END. INSTEAD, RECOMPUTE THE UNCOMPENSATED VALUE BASED ON HOW MUCH OF THE | | |
| | | |RESOURCE WAS NOT RETURNED. THEN, RECOMPUTE THE PERIOD OF INELIGIBILITY BASED ON | | |
| | | |THE ADJUSTED UNCOMPENSATED VALUE. IF ADDITIONAL FUNDS ARE SUBSEQUENTLY RETURNED,| | |
| | | |IT WILL BE NECESSARY TO RECOMPUTE THE UNCOMPENSATED VALUE AGAIN. | | |
|3.520.76 |Clarification |F. Upon the request of the client, the county department |EF. A PERIOD OF INELIGIBILITY CAN BE FROM 1 MONTH UP TO A MAXIMUM OF 36 MONTHS |Align with SSA's treatment of |No |
| |Needed |shall re-calculate the penalty when there is a subsequent |DEPENDING ON THE AMOUNT OF THE UNCOMPENSATED VALUE FOR EACH RESOURCE |Transfers. | |
| | |increase in the Adult Financial program grant standard or |TRANSFERRED. A PERIOD OF INELIGIBILITY CANNOT EXCEED 36 MONTHS REGARDLESS OF THE| | |
| | |in the client's monthly medical care costs. The county |UNCOMPENSATED VALUE OF THE TRANSFER. MONTHS IN THE PERIOD OF INELIGIBILITY CAN | | |
| | |shall notify the client of any change in the period of |COINCIDE WITH MONTHS OF INELIGIBILITY FOR OTHER REASONS. Upon the request of the| | |
| | |ineligibility. |client, the county department shall re-calculate the penalty when there is a | | |
| | | |subsequent increase in the Adult Financial program grant standard or in the | | |
| | | |client's monthly medical care costs. The county shall notify the client of any | | |
| | | |change in the period of ineligibility. | | |
|3.520.76 |Unnecessary Rule|G. A life estate established on the residence by the client|G. A life estate established on the residence by the client and/or the client's |Recommending deletion of this section|No |
| | |and/or the client's spouse within thirty-six (36) months |spouse within thirty-six (36) months from the date of application or while |as we rarely see life estates | |
| | |from the date of application or while receiving Adult |receiving Adult Financial program benefits shall be a TWFC. |utilized. SSA treats them | |
| | |Financial program benefits shall be a TWFC. | |differently depending on the | |
| | | | |circumstance-i.e. transfer or | |
| | | | |excluded. | |
|3.520.76 |Unnecessary Rule|H. The amount to be considered as a TWFC on a life estate |H. The amount to be considered as a TWFC on a life estate shall be calculated by|Recommending deletion of this section|No |
| | |shall be calculated by using equity value of the property |using equity value of the property and applying it to the life estate table |as we rarely see life estates | |
| | |and applying it to the life estate table pursuant to the |pursuant to the “Social Security Program Operations Manual System (POMS)”, 26 |utilized. SSA treats them | |
| | |“Social Security Program Operations Manual System (POMS)”, |CFR 20.2031-7, 49 Federal Register Vol. 49 No. 93/5-11-84, herein incorporated |differently depending on the | |
| | |26 CFR 20.2031-7, 49 Federal Register Vol. 49 No. |by reference. This rule does not contain any later amendments or editions. |circumstance-i.e. transfer or | |
| | |93/5-11-84, herein incorporated by reference. This rule |Copies of these federal laws are available from the Colorado Department of Human|excluded. | |
| | |does not contain any later amendments or editions. Copies |Services, Director of the Employment and Benefits Division, 1575 Sherman Street,| | |
| | |of these federal laws are available from the Colorado |Denver, Colorado, 80203, or at any state publications library contained in these| | |
| | |Department of Human Services, Director of the Employment |rules as follows:1. Determine the equity value of the property at the time the | | |
| | |and Benefits Division, 1575 Sherman Street, Denver, |life estate was established. The equity value of the residential property shall | | |
| | |Colorado, 80203, or at any state publications library |be determined by obtaining the actual value and subtracting encumbrances.2. | | |
| | |contained in these rules as follows:1. Determine the equity|Multiply the equity value of the property by the “Remainder” factor from the | | |
| | |value of the property at the time the life estate was |life estate table that corresponds to the client's age at the time the life | | |
| | |established. The equity value of the residential property |estate was established. The result is the amount to be considered as a transfer | | |
| | |shall be determined by obtaining the actual value and |of assets without fair consideration and is the uncompensated value.a. When a | | |
| | |subtracting encumbrances.2. Multiply the equity value of |life estate is established on the residence held by spouses in joint tenancy, | | |
| | |the property by the “Remainder” factor from the life estate|the age of the younger spouse shall be used.b. Once the uncompensated value is | | |
| | |table that corresponds to the client's age at the time the |calculated, the penalty period is determined by using the steps outlined in | | |
| | |life estate was established. The result is the amount to be|Section 3.520.76, E, 2-4. | | |
| | |considered as a transfer of assets without fair | | | |
| | |consideration and is the uncompensated value.a. When a life| | | |
| | |estate is established on the residence held by spouses in | | | |
| | |joint tenancy, the age of the younger spouse shall be | | | |
| | |used.b. Once the uncompensated value is calculated, the | | | |
| | |penalty period is determined by using the steps outlined in| | | |
| | |Section 3.520.76, E, 2-4. | | | |
|3.520.77 |Clarification |B. Household goods and personal effects such as |B. Household goods and personal effects FOUND IN OR ON THE PRIMARY RESIDENCE, |Align with SSA's treatment of |No |
| |Needed |furnishings, appliances, and clothing. |THAT THE CLIENT USES ON A REGULAR BASIS. THE CLIENT NEEDS HOUSEHOLD GOODS FOR |Personal Effects. | |
| | | |MAINTENANCE, USE, AND OCCUPANCY OF THE PREMISES AS A HOME. THIS ALSO INCLUDES | | |
| | | |PERSONAL EFFECTS WHICH ARE ORDINARILY WORN OR CARRIED BY THE CLIENT, OR ITEMS | | |
| | | |THAT HAVE AN INTIMATE RELATION TO THE CLIENT. THIS DOES NOT INCLUDE EFFECTS THAT| | |
| | | |THE CLIENT HOLDS BECAUSE OF THE VALUE OR AS AN INVESTMENT, WHICH ARE COUNTABLE | | |
| | | |AS PERSONAL PROPERTY AS OUTLINED IN SECTION 3.520.742. such as furnishings, | | |
| | | |appliances, and clothing. | | |
|3.520.77 |Clarification |C. A home in which a client and his OR /her spouse have an |C. A home in which a client and his OR /her spouse have an ownership interest |Technical cleanup | |
| |Needed |ownership interest and that serves as the client's |and that serves as the client's principal place of residence. This property | | |
| | |principal place of residence. This property includes the |includes the shelter in which the client resides, the land on which the | | |
| | |shelter in which the client resides, the land on which the |residence is located, and related outbuildings. | | |
| | |residence is located, and related outbuildings. |1. The home is not a countable resource regardless of its value. However, when | | |
| | |1. The home is not a countable resource regardless of its |there is an income producing property located on or adjacent to the home | | |
| | |value. However, when there is an income producing property |property, the income producing resource shall not qualify under the home | | |
| | |located on or adjacent to the home property, the income |exemption unless assessed collectively with the principal home. | | |
| | |producing resource shall not qualify under the home |2. When a client or his OR /her spouse requires long-term medical care that is | | |
| | |exemption unless assessed collectively with the principal |outside the client's county of residence, the home continues to be exempt so | | |
| | |home. |long as there is intent for the client and/or spouse to return to the home at | | |
| | |2. When a client or his/her spouse requires long-term |the conclusion of medical treatment. | | |
| | |medical care that is outside the client's county of |3. When a client requires care in a long-term care facility, the home continues | | |
| | |residence, the home continues to be exempt so long as there|to be exempt so long as there is intent for the client to return to the home. | | |
| | |is intent for the client and/or spouse to return to the |a. This intent to return home applies to the home in which the client or spouse | | |
| | |home at the conclusion of medical treatment. |was living prior to being admitted to the facility or to the replacement home. | | |
| | |3. When a client requires care in a long-term care |Such intent is documented by the following: | | |
| | |facility, the home continues to be exempt so long as there |1) A written statement from the client indicating the intent to return home for | | |
| | |is intent for the client to return to the home. |any reason; or, | | |
| | |a. This intent to return home applies to the home in which |2) A written statement from the client's spouse, legal fiduciary, doctor, or | | |
| | |the client or spouse was living prior to being admitted to |authorized representative indicating the client's intent to return home. | | |
| | |the facility or to the replacement home. Such intent is |b. An arrangement by the client for occupancy of the home by another person, | | |
| | |documented by the following: |either on a rental basis, rent free, or in exchange for home maintenance, during| | |
| | |1) A written statement from the client indicating the |a period of temporary absence shall not affect the home property exemption. | | |
| | |intent to return home for any reason; or, |4. The home of an OAP-C client, AS DEFINED IN SECTION 3.530.1, shall be exempt | | |
| | |2) A written statement from the client's spouse, legal |as a resource during the period of commitment. | | |
| | |fiduciary, doctor, or authorized representative indicating |5. If a client's home can no longer be excluded due to a change in his OR /her | | |
| | |the client's intent to return home. |principal place of residence, the equity value of the property shall count as a | | |
| | |b. An arrangement by the client for occupancy of the home |resource. | | |
| | |by another person, either on a rental basis, rent free, or | | | |
| | |in exchange for home maintenance, during a period of | | | |
| | |temporary absence shall not affect the home property | | | |
| | |exemption. | | | |
| | |4. The home of an OAP-C client, shall be exempt as a | | | |
| | |resource during the period of commitment. | | | |
| | |5. If a client's home can no longer be excluded due to a | | | |
| | |change in hisher principal place of residence, the equity | | | |
| | |value of the property shall count as a resource. | | | |
|3.520.77 | |D. Part or all of the value of property may be exempt if it|D. Part or all of the value of property may be exempt if it is essential to the |Align with SSA treatment of |No |
| | |is essential to the self-support of the client. To |self-support of the client. To determine whether property is producing income or|Self-Supporting property. | |
| | |determine whether property is producing income or being |being used in a trade or business, the county department shall obtain a copy of |Clarification provided that a boat | |
| | |used in a trade or business, the county department shall |the most recent tax returns from the client. If a return has not yet been filed,|can be excluded if used for | |
| | |obtain a copy of the most recent tax returns from the |obtain a current estimate of income and a copy of the previous year's return. |self-support vs for leisure purposes.| |
| | |client. If a return has not yet been filed, obtain a |Property used for self-support activities include: | | |
| | |current estimate of income and a copy of the previous |1. Property used in self-employment. | | |
| | |year's return. Property used for self-support activities |a. To be considered a valid trade or business as self-employment, the activity | | |
| | |include:1. Property used in self-employment.a. To be |shall be: | | |
| | |considered a valid trade or business as self-employment, |1) Currently ongoing rather than in the stage of preparation or inactivity; and,| | |
| | |the activity shall be:1) Currently ongoing rather than in |2) Intended to make a profit. | | |
| | |the stage of preparation or inactivity; and,2) Intended to |b. The liquid resources (e.g., cash, funds in a checking account) considered | | |
| | |make a profit.b. The liquid resources (e.g., cash, funds in|necessary for use in the trade or business shall BE EXCLUDED. not exceed three | | |
| | |a checking account) considered necessary for use in the |times the average monthly cash expenditure for operating the business, unless | | |
| | |trade or business shall not exceed three times the average |there is good cause, as determined and documented by the county department using| | |
| | |monthly cash expenditure for operating the business, unless|the prudent person principle. | | |
| | |there is good cause, as determined and documented by the |c. If property has been but is not currently in use, the exemption for such | | |
| | |county department using the prudent person principle.c. If |property shall continue for twelve (12) months if there is a reasonable | | |
| | |property has been but is not currently in use, the |expectation that the use of the property will resume within that time. The | | |
| | |exemption for such property shall continue for twelve (12) |exemption is for twenty-four (24) months where non-use is due to a disabling | | |
| | |months if there is a reasonable expectation that the use of|condition. | | |
| | |the property will resume within that time. The exemption is|2. Property owned by the client that is necessary to perform a job for wages, | | |
| | |for twenty-four (24) months where non-use is due to a |such as tools, safety equipment, or uniforms. If property has been but is not | | |
| | |disabling condition.2. Property owned by the client that is|currently in use the exemption for such property shall continue for twelve (12) | | |
| | |necessary to perform a job for wages, such as tools, safety|months if there is a reasonable expectation that the use of the property will | | |
| | |equipment, or uniforms. If property has been but is not |resume within that time. The exemption is for twenty-four (24) months where | | |
| | |currently in use the exemption for such property shall |non-use is due to a disabling condition. | | |
| | |continue for twelve (12) months if there is a reasonable |3. Non-business property used to produce goods necessary for the client's daily | | |
| | |expectation that the use of the property will resume within|activities. | | |
| | |that time. The exemption is for twenty-four (24) months |a. A maximum of six thousand dollars ($6,000) of the equity value of such | | |
| | |where non-use is due to a disabling condition. |property shall be exempt as a resource. Any equity value in excess of $6,000 | | |
| | | |shall be a countable resource. | | |
| | | |b. Examples of this type of property include land which is used to produce | | |
| | | |vegetables or livestock only for personal consumption in the client's household,| | |
| | | |and personal property necessary to perform that function (e.g., a garden | | |
| | | |tractor, A BOAT USED FOR SUBSISTENCE FISHING), but do not include motor | | |
| | | |vehicles, boats USED FOR LEISURE OR RECREATION, or other special vehicles. | | |
| | | |c. If property has been but is not currently in use, the exemption for such | | |
| | | |property shall continue for twelve (12) months if there is a reasonable | | |
| | | |expectation that the use of the property will resume within that time. The | | |
| | | |exemption period shall be twenty-four (24) months where nonuse is due to a | | |
| | | |disabling condition. | | |
| | | |4. Non-business, income-producing property shall be exempt, but the income shall| | |
| | | |be countable. | | |
| | | |a. If a client owns non-business, income-producing property, a maximum of six | | |
| | | |thousand dollars ($6,000) of the equity value of such property is an exempt | | |
| | | |resource, as long as the property produces a net annual income of at least six | | |
| | | |percent (6%) of the excluded equity. If the equity value of such | | |
| | | |income-producing, non-business property exceeds $6,000, only the equity value | | |
| | | |above $6,000 will be counted as a resource. If there is more than one | | |
| | | |potentially exempt property, the rate-of-return requirement applies individually| | |
| | | |to each. However, the total combined exemption for all such properties shall not| | |
| | | |exceed $6,000. | | |
| | | |b. “Non-business” means that the property is not used in a trade or business as | | |
| | | |defined in Section 3.520.76. Non-business, income-producing property may include| | |
| | | |but is not limited to houses or apartments for rent and land other than home | | |
| | | |property. | | |
| | | |c. If non-business, income-producing property is not producing net income of at | | |
| | | |least six percent (6%) of the excluded equity, the entire equity value is | | |
| | | |counted as a resource. However, the exemption for up to $6,000 of the property's| | |
| | | |equity may continue if the property is earning less than 6% due to circumstances| | |
| | | |beyond the client's control (e.g., crop failure, illness, etc.), and there is a | | |
| | | |reasonable expectation that, within twenty-four (24) months, the property will | | |
| | | |again produce a 6% return. | | |
| | | |5. A permit, license, or other similar authority granted by a governmental | | |
| | | |agency to engage in an income-producing activity is not a countable resource. | | |
|3.520.77 |Clarification |E. Proceeds from fire or casualty insurance shall be |E. Proceeds from fire or casualty insurance shall be considered exempt to the |Technical cleanup | |
| |Needed |considered exempt to the extent that they are used to |extent that they are used to restore or replace an exempt resource. This | | |
| | |restore or replace an exempt resource. This exemption shall|exemption shall be allowed for up to three (3) months for restoration or | | |
| | |be allowed for up to three (3) months for restoration or |replacement of exempt personal property and six (6) months for restoration or | | |
| | |replacement of exempt personal property and six (6) months |replacement of exempt real property from the date the client receives such sums.| | |
| | |for restoration or replacement of exempt real property from|1. Establishing eligibility for the duration of the replacement exemption | | |
| | |the date the client receives such sums. |requires: | | |
| | |1. Establishing eligibility for the duration of the |a. Obtaining appropriate documentation to verify the amount of proceeds and date| | |
| | |replacement exemption requires: |they were received; and, | | |
| | |a. Obtaining appropriate documentation to verify the amount|b. Obtaining the client's signed statement verifying that the proceeds will be | | |
| | |of proceeds and date they were received; and, |used for restoration or replacement of exempt property. | | |
| | |b. Obtaining the client's signed statement verifying that |2. The COUNTY DEPARTMENT MUST CONTACT THE client must be contacted upon the | | |
| | |the proceeds will be used for restoration or replacement of|expiration of the allowable time period to verify that restoration or | | |
| | |exempt property. |replacement has occurred. Restoration or replacement shall be considered to | | |
| | |2. The client must be contacted upon the expiration of the |occur when payment for such is made or contracted in writing to be made. | | |
| | |allowable time period to verify that restoration or |3. When the allowable time period ends, proceeds in excess of payments made or | | |
| | |replacement has occurred. Restoration or replacement shall |contracted to be made must be counted as a resource in the month following the | | |
| | |be considered to occur when payment for such is made or |month in which the time period expired, unless good cause for an extension is | | |
| | |contracted in writing to be made. |determined by the county department using the prudent person principle. | | |
| | |3. When the allowable time period ends, proceeds in excess | | | |
| | |of payments made or contracted to be made must be counted | | | |
| | |as a resource in the month following the month in which the| | | |
| | |time period expired, unless good cause for an extension is | | | |
| | |determined by the county department using the prudent | | | |
| | |person principle. | | | |
|3.520.77 |Clarification |F. Proceeds from sale of the home property, relocation |F. Proceeds from sale of the home property, relocation payments, or condemnation|This section only pertains to |No |
| |Needed |payments, or condemnation awards from a governmental agency|awards from a governmental agency shall be considered exempt to the extent that |replacement property. | |
| | |shall be considered exempt to the extent that they are used|they are used to purchase or build a replacement home. This exemption is allowed| | |
| | |to purchase or build a replacement home. This exemption is |for up to six (6) months from the date the client receives such sums. Proceeds | | |
| | |allowed for up to six (6) months from the date the client |of a home sale are the net payments received by the seller after satisfaction of| | |
| | |receives such sums. Proceeds of a home sale are the net |all actual encumbrances and sales expenses. | | |
| | |payments received by the seller after satisfaction of all |1. Establishing eligibility for and the duration of the replacement exemption | | |
| | |actual encumbrances and sales expenses.1. Establishing |requires: | | |
| | |eligibility for and the duration of the replacement |a. Obtaining appropriate documentation to verify the amount of proceeds and date| | |
| | |exemption requires:a. Obtaining appropriate documentation |they were received; and, | | |
| | |to verify the amount of proceeds and date they were |b. Obtaining the client's signed statement verifying that the proceeds will be | | |
| | |received; and,b. Obtaining the client's signed statement |used for restoration or replacement of exempt property. | | |
| | |verifying that the proceeds will be used for restoration or|2. The client must be contacted upon the expiration of the allowable time period| | |
| | |replacement of exempt property.2. The client must be |to verify that restoration or replacement has occurred. Restoration or | | |
| | |contacted upon the expiration of the allowable time period |rReplacement shall be considered to occur when payment for such is made or | | |
| | |to verify that restoration or replacement has occurred. |contracted in writing to be made. | | |
| | |Restoration or replacement shall be considered to occur |3. When the allowable time period ends, proceeds in excess of payments made or | | |
| | |when payment for such is made or contracted in writing to |contracted to be made must be counted as a resource in the month following the | | |
| | |be made.3. When the allowable time period ends, proceeds in|month in which the time period expired, unless good cause for an extension is | | |
| | |excess of payments made or contracted to be made must be |determined by the county department using the prudent person principle. | | |
| | |counted as a resource in the month following the month in | | | |
| | |which the time period expired, unless good cause for an | | | |
| | |extension is determined by the county department using the | | | |
| | |prudent person principle. | | | |
|3.520.77 |Clarification |G. An irrevocable trust or prepaid contract for burial |G. BURIAL TRUSTS ARE CONSIDERED AS FOLLOWS: An irrevocable trust or prepaid |Align with SSA treatment of Burial |No |
| |Needed |expense. Irrevocable means that the contract cannot be |contract for burial expense. Irrevocable means that the contract cannot be |Trusts. | |
| | |terminated, sold, or transferred. |terminated, sold, or transferred. | | |
| | | |1. FOR ALL TRUSTS, THE AGREEMENT DOES NOT HAVE TO BE PREEXISTING AND NEED NOT | | |
| | | |HAVE BEEN PURCHASED IN COLORADO. | | |
| | | |2. AN IRREVOCABLE BURIAL TRUST cannot be terminated, sold, or transferred. AN | | |
| | | |IRREVOCABLE BURIAL TRUST PLUS ANY ACCRUED INTEREST IS EXEMPT IF ALL OF THE | | |
| | | |FOLLOWING CRITERIA ARE MET: | | |
| | | |A. THE TRUST IS MADE WITH A FEDERALLY INSURED BANK OR SAVINGS AND LOAN | | |
| | | |ASSOCIATION, OR WITH A TRUST COMPANY UNDER SUPERVISION OF THE STATE BANKING | | |
| | | |COMMISSIONER; | | |
| | | |B. THE TRUST IS IRREVOCABLE DURING THE LIFETIME OF THE CLIENT AND IS TO BE PAID | | |
| | | |BY THE TRUSTEE ONLY UPON DEATH OF THE CLIENT FOR THE PURPOSE OF BURIAL EXPENSE; | | |
| | | |C. THE TRUST PROVIDES FOR PAYMENT OF THE TRUST FUNDS WITHOUT LIMITATION AS TO | | |
| | | |PLACE OF BURIAL OR PROVIDER OF RELATED SERVICES. IN ANY CASE, HOWEVER, THE | | |
| | | |CLIENT IS NOT PRECLUDED FROM INDICATING A PREFERENCE AS TO PLACE OF BURIAL OR | | |
| | | |PROVIDER OF RELATED SERVICES; AND | | |
| | | |D. THE TRUSTOR AND THE BENEFICIARY OF THE TRUST CANNOT BE ONE AND THE SAME. IF | | |
| | | |HE OR SHE IS BOTH THE TRUSTOR AND THE BENEFICIARY, THE VALUE EXCEEDING $1500 IS | | |
| | | |A COUNTABLE RESOURCE. | | |
| | | |3. A REVOCABLE BURIAL TRUST CAN BE TERMINATED, SOLD, OR TRANSFERRED. A REVOCABLE| | |
| | | |BURIAL TRUST IS EXEMPT IF THE VALUE OF THE TRUST DOES NOT EXCEED ONE THOUSAND | | |
| | | |FIVE HUNDRED DOLLARS ($1,500). ANY INTEREST ON THE EXEMPT $1,500 IS ALSO EXEMPT.| | |
| | | |ANY AMOUNT OVER $1,500 IS A COUNTABLE RESOURCE. | | |
|3.520.77 |Clarification |H. A revocable trust if the following conditions are met:1.|H. PREPAID BURIAL CONTRACTS ARE EXEMPT A revocable trust if ANY OF the following|Align with SSA treatment of Burial |No |
| |Needed |Revocable means that the contract can be terminated, sold, |conditions are met: |Trusts. | |
| | |or transferred.2. The burial prepaid contract is exempt if |1. THE PREPAID BURIAL CONTRACT IS IRREVOCABLE. Revocable means that the contract| | |
| | |it is revocable and does not exceed one thousand five |can be terminated, sold, or transferred. | | |
| | |hundred dollars ($1,500).a. To evaluate a prepaid revocable|2. THE PREPAID BURIAL CONTRACT IS The burial prepaid contract is exempt if it is| | |
| | |burial contract, the following shall apply:1) Only the |revocable and does not exceed one thousand five hundred dollars ($1,500). ANY | | |
| | |paid-up amount of the contract, not the face value, is |AMOUNT IN EXCESS OF $1,500 SHALL BE A COUNTABLE RESOURCE. | | |
| | |taken into consideration;2) The interest on the exempt |a. To evaluate a prepaid revocable burial contract, the following shall apply: | | |
| | |$1,500 is also exempt;b. To evaluate a trust deposit for |1) Only the paid-up amount of the contract, not the face value, is taken into | | |
| | |burial expense, the $1,500 exemption applies only when the |consideration; | | |
| | |trust:1) Is made with a federally insured bank or savings |B. ANY INTEREST ON THE EXEMPT $1500 IS ALSO EXEMPT. | | |
| | |and loan association, or with a trust company under |2) The interest on the exempt $1,500 is also exempt; | | |
| | |supervision of the State Banking Commissioner;2) Is |b. To evaluate a trust deposit for burial expense, the $1,500 exemption applies | | |
| | |revocable during the lifetime of the client and is to be |only when the trust: | | |
| | |paid by the trustee only upon death of the client for the |1) Is made with a federally insured bank or savings and loan association, or | | |
| | |purpose of burial expense; and,3) Provides for payment of |with a trust company under supervision of the State Banking Commissioner; | | |
| | |the trust funds without limitation as to place of burial or|2) Is revocable during the lifetime of the client and is to be paid by the | | |
| | |provider of related services unless the trust was |trustee only upon death of the client for the purpose of burial expense; and, | | |
| | |established prior to November 1966. In any case, however, |3) Provides for payment of the trust funds without limitation as to place of | | |
| | |the client is not precluded from indicating a preference as|burial or provider of related services unless the trust was established prior to| | |
| | |to place of burial or provider of related services. |November 1966. In any case, however, the client is not precluded from indicating| | |
| | | |a preference as to place of burial or provider of related services. | | |
|3.520.77 |Clarification |I. The value of burial spaces required to meet the burial |I. The value of burial spaces required to meet the burial needs of the immediate|Align with SSA treatment of Burial |No |
| |Needed |needs of the immediate family, even if not living in the |family AS WELL AS BROTHERS, SISTERS, AND SPOUSES OF THOSE PERSONS, even if not |Space. | |
| | |home. The immediate family includes the client's spouse, |living in the home. The immediate family includes the client's spouse, minor and| | |
| | |minor and adult children, stepchildren, adopted children, |adult children, stepchildren, adopted children, brothers, sisters, parents, | | |
| | |brothers, sisters, parents, adoptive parents, and the |adoptive parents, and the spouses of those persons. A BURIAL SPACE INCLUDES: | | |
| | |spouses of those persons. |1. BURIAL PLOT; | | |
| | | |2. GRAVESITE; | | |
| | | |3. CRYPT; | | |
| | | |4. MAUSOLEUM; | | |
| | | |5. CASKET; | | |
| | | |6. URN; | | |
| | | |7. NICHE; | | |
| | | |8. OTHER REPOSITORY CUSTOMARILY AND TRADITIONALLY USED FOR THE DECEDENT'S BODILY| | |
| | | |REMAINS; | | |
| | | |9. VAULTS; | | |
| | | |10. HEADSTONES, MARKERS, OR PLAQUES; | | |
| | | |11. ARRANGEMENTS FOR THE OPENING AND CLOSING OF THE GRAVESITE; AND, | | |
| | | |12. CONTRACTS FOR CARE AND MAINTENANCE OF THE GRAVESITE. | | |
|3.520.77 |Clarification |K. An income tax refund shall be exempt in the month |K. An income tax refund, INCLUDING THE PROPERTY TAX/RENT/HEAT CREDIT (PTC) |Addition of PTC Rebate program. |No |
| |Needed |received. Any remaining balance shall be counted as a |REBATE, shall be exempt in the month received. Any remaining balance shall be | | |
| | |resource after twelve (12) months. |counted as a resource after twelve (12) months. | | |
|3.520.77 |New Rule |M. NEW |M. MONIES SPECIFICALLY PLACED IN AN ACHIEVING A BETTER LIFE EXPERIENCE (ABLE) |Addition of ABLE account to align |No |
| |Addition | |ACCOUNT, AS DESCRIBED IN THE ACHIEVING A BETTER LIFE EXPERIENCE ACT OF 2014, 26 |with SSA. | |
| | | |U.S.C. SECTION 529A (2018). | | |
|3.520.781 |Clarification |A. If a client's income equals or exceeds the Adult |A. If a client's TOTAL COUNTABLE income equals or exceeds the Adult Financial |Revised to ensure looking at |No |
| |Needed |Financial program grant standard, the client shall not be |program grant standard, the client shall not be eligible for that specific Adult|countable income which includes | |
| | |eligible for that specific Adult Financial program. |Financial program. |applicable disregards and exclusions | |
| | | | |are deducted from income. Once | |
| | | | |disregards and exclusions are | |
| | | | |applied, if still over the grant | |
| | | | |standard, will not be eligible. | |
|3.520.781 |Clarification |D. Certain income shall have deductions, herein termed as |D. Certain income shall have deductions, herein termed as income “disregards,” |Clarifying "total" versus "final". |No |
| |Needed |income “disregards,” applied before determining final |applied before determining final TOTAL countable income as outlined in Sections | | |
| | |countable income as outlined in Section 3.533. |3.533, 3.544, or 3.549. | | |
|3.520.781 |Clarification |E. The income of a spouse who is not receiving public |E. CERTAIN INCOME SHALL BE DEEMED FROM THE CLIENT’S SPOUSE, PARENT, AND/OR |Revised to identify the specific |No |
| |Needed |assistance benefits, SSI benefits or Medicaid assistance, |SPONSOR TO DETERMINE THE CLIENT’S TOTAL COUNTABLE INCOME AS OUTLINED IN SECTIONS|exceptions to spousal income deeming.| |
| | |and the income of the sponsor(s) shall be countable, herein|3.534, 3.544 OR 3.549. The income of a spouse who is not receiving public | | |
| | |termed as “deemed,” to the client as outlined in Section |assistance benefits, SSI benefits, or Medicaid assistance; and the income of the| | |
| | |3.534. |sponsor(s) shall be countable, herein termed as “deemed,” to the client as | | |
| | | |outlined in Section 3.534. | | |
|3.520.781 |Clarification |F. The total countable income of the client shall be |F. The total countable income of the client shall be deducted from the AND or |Technical cleanup | |
| |Needed |deducted from the AND or OAP grant standard to determine |OAP grant standard to determine the GRANT payment amount. | | |
| | |the payment amount. | | | |
|3.520.782 |Clarification |A. Earned income is monetary wages received by the client |A. Earned income is GROSS monetary wages received by the client for services |Clarified gross versus net income. |No |
| |Needed |for services performed as an employee or as profit from |performed as an employee or as profit from self-employment. |Removed "By the client" to broaden | |
| | |self-employment. | |the applicability of the statement. | |
|3.520.782 |Clarification |B. In-kind earned income is non-monetary benefits received |B. In-kind earned income is non-monetary benefits received by the client for |Removed "By the client" to broaden |No |
| |Needed |by the client for services performed as an employee or as |services performed as an employee or as self-employment profit, such as shelter |the applicability of the statement. | |
| | |self-employment profit, such as shelter as payment for |as payment for building maintenance or babysitting or other barter goods in | | |
| | |building maintenance or babysitting or other barter goods |exchange for services. | | |
| | |in exchange for services.1. In-kind income received in |1. In-kind income received in exchange for employment is employment income and | | |
| | |exchange for employment is employment income and shall have|shall have the appropriate earned income disregards applied to the total value | | |
| | |the appropriate earned income disregards applied to the |of the income. | | |
| | |total value of the income.2. The amount considered as |2. The amount considered as earned income when the client, CLIENT’S SPOUSE, OR | | |
| | |earned income when the client is paid in-kind shall be the |SPONSOR(S) is paid in-kind shall be the value of the item supplied. The current | | |
| | |value of the item supplied. The current market value of the|market value of the item is used if the value of the item is not provided. | | |
| | |item is used if the value of the item is not provided. | | | |
|3.520.783 |Clarification |B. To determine the net profit of a self-employed client, |B. To determine the net profit of a self-employed client, CLIENT’S SPOUSE, OR |Added "spouse and sponsor(s) to |No |
| |Needed |deduct the cost of doing business from the gross income. |SPONSOR(S), deduct the cost of doing business from the gross income. |broaden the rule to include other | |
| | |1. Cost of doing business expenses include, but are not |1. Cost of doing business expenses include, but are not limited to, the rent of |individuals who may have income | |
| | |limited to, the rent of business premises, wholesale cost |business premises, wholesale cost of merchandise, utilities, interest, taxes, |(spouse, sponsor). | |
| | |of merchandise, utilities, interest, taxes, labor, and |labor, and upkeep of necessary equipment. | | |
| | |upkeep of necessary equipment. |2. Depreciation of equipment shall not be considered as a business expense. | | |
| | |2. Depreciation of equipment shall not be considered as a |3. The cost of and payments on the principal of loans for capital assets or | | |
| | |business expense. |durable goods shall not be considered as a business expense. | | |
| | |3. The cost of and payments on the principal of loans for |4. Personal expenses such as personal income tax payments, meals, and | | |
| | |capital assets or durable goods shall not be considered as |transportation to and from work are not business expenses. | | |
| | |a business expense. | | | |
| | |4. Personal expenses such as personal income tax payments, | | | |
| | |meals, and transportation to and from work are not business| | | |
| | |expenses. | | | |
|3.520.783 |Clarification |C. Some types of self-employment income shall be calculated|C. Some types of self-employment income shall be calculated using a method |Added "spouse and sponsor(s) to |No |
| |Needed |using a method specific to the type of self-employment, as |specific to the type of self-employment, as follows: |broaden the rule to include other | |
| | |follows:1. Farm income shall be considered on a yearly |1. Farm income shall be considered on a yearly basis. Net income for the prior |individuals who may have income | |
| | |basis. Net income for the prior year shall be determined |year shall be determined and averaged for the succeeding year and counted as |(spouse, sponsor). | |
| | |and averaged for the succeeding year and counted as earned |earned income. When a client, CLIENT’S SPOUSE, OR SPONSOR(S) ceases to farm, the| | |
| | |income. When a client ceases to farm, the income is no |income is no longer deducted from the grant standard. | | |
| | |longer deducted from the grant standard.2. Rental income |2. Rental income shall be considered as follows: | | |
| | |shall be considered as follows:a. When the client actively |a. When the client, CLIENT’S SPOUSE, OR SPONSOR(S) actively manages a self-owned| | |
| | |manages a self-owned rental property at least twenty (20) |rental property at least twenty (20) hours a week, treat rental income as | | |
| | |hours a week, treat rental income as self-employment |self-employment income. Average the rental income over a twelve (12) month | | |
| | |income. Average the rental income over a twelve (12) month |period to determine monthly earned income. | | |
| | |period to determine monthly earned income.b. Board (to |b. Board (to provide a person with regular meals only) payments to the client, | | |
| | |provide a person with regular meals only) payments to the |SPOUSE, OR SPONSOR(S) shall be considered earned income in the month received. | | |
| | |client shall be considered earned income in the month |For each boarder, calculate documentable expenses directly related to provision | | |
| | |received. For each boarder, calculate documentable expenses|of board. Subtract the result from the board payment to determine the countable | | |
| | |directly related to provision of board. Subtract the result|earned income. | | |
| | |from the board payment to determine the countable earned |c. Room (to provide a person with lodging only) payments to the client, CLIENT’S| | |
| | |income.c. Room (to provide a person with lodging only) |SPOUSE, OR SPONSOR(S) shall be considered earned income in the month received. | | |
| | |payments to the client shall be considered earned income in|For each boarder calculate the documentable expenses directly related to the | | |
| | |the month received. For each boarder calculate the |provision of the room. Subtract the result from the room payment to determine | | |
| | |documentable expenses directly related to the provision of |the countable earned income. | | |
| | |the room. Subtract the result from the room payment to |d. Room and board (to provide a person regular meals and lodging) payments shall| | |
| | |determine the countable earned income.d. Room and board (to|be considered earned income in the month received. For each boarder, calculate | | |
| | |provide a person regular meals and lodging) payments shall |the documentable expenses directly related to the provision of room and board. | | |
| | |be considered earned income in the month received. For each|Subtract the result from the room and board payment to determine the countable | | |
| | |boarder, calculate the documentable expenses directly |earned income. | | |
| | |related to the provision of room and board. Subtract the |3. Appropriate allowances for cost of doing business for A clients, CLIENT’S | | |
| | |result from the room and board payment to determine the |SPOUSE, OR SPONSOR(S) who IS/ARE A are licensed child care providers are: | | |
| | |countable earned income.3. Appropriate allowances for cost |a. For the first child for whom day care is provided, deduct $55; and, | | |
| | |of doing business for clients who are licensed child care |b. For each additional child deduct $22. | | |
| | |providers are:a. For the first child for whom day care is |c. Subtract the total allowances from the documented expenses to determine the | | |
| | |provided, deduct $55; and,b. For each additional child |earned income. | | |
| | |deduct $22.c. Subtract the total allowances from the |d. If the client, CLIENT’S SPOUSE, OR SPONSOR(S) can document a cost of doing | | |
| | |documented expenses to determine the earned income.d. If |business that is greater than the amounts above, the procedure, described in | | |
| | |the client can document a cost of doing business that is |Section 3.520.783, B, shall be used to calculate earned income. | | |
| | |greater than the amounts above, the procedure, described in| | | |
| | |Section 3.520.783, B, shall be used to calculate earned | | | |
| | |income. | | | |
| |New Rule |E. NEW |E. SELF-EMPLOYMENT VERIFICATION MAY CONSIST OF TAX DOCUMENTS, SELF-EMPLOYMENT |Aligns w/Colorado Works and provides |No |
| |Addition | |LEDGERS, RECEIPTS, OR OTHER DOCUMENTS USED FOR VERIFYING AND DOCUMENTING THE |clarification of how to verify. | |
| | | |SELF-EMPLOYMENT INCOME AND EXPENSES. IF, AT THE TIME OF THE COUNTY DEPARTMENT’S | | |
| | | |ELIGIBILITY DETERMINATION, A CLIENT IS RECENTLY SELF-EMPLOYED OR DOES NOT HAVE | | |
| | | |ADEQUATE DOCUMENTATION OF THE SELF-EMPLOYMENT INCOME AND EXPENSES, THE COUNTY | | |
| | | |DEPARTMENT SHALL USE THE BEST INFORMATION AVAILABLE TO DETERMINE THE MONTHLY | | |
| | | |INCOME. THE CLIENT SHALL BE ENCOURAGED TO KEEP RECORDS OF INCOME AND EXPENSES | | |
| | | |FOR SUBSEQUENT CERTIFICATIONS. NO SPECIFIC VERIFICATION SHALL BE REQUIRED AND | | |
| | | |THE DOCUMENTATION PROVIDED BY THE CLIENT SHALL BE ACCEPTED UNLESS QUESTIONABLE. | | |
| |New Rule |F. NEW |F. ALL SELF-EMPLOYMENT INCOME SHALL BE CONSIDERED INCOME IN THE MONTH RECEIVED. |Aligns w/Colorado Works and provides |No |
| |Addition | |IF RECEIPT OF SELF-EMPLOYMENT INCOME IS IRREGULAR, IT SHALL BE AVERAGED OVER A |clarification of how to average | |
| | | |TWELVE-MONTH PERIOD. THE TWELVE-MONTH PERIOD CAN EITHER BE THE PREVIOUS TAX YEAR|infrequent self-employment income. | |
| | | |(JANUARY TO DECEMBER) OR THE MOST RECENT TWELVE-MONTHS PRIOR TO THE APPLICATION | | |
| | | |DATE. | | |
|3.520.784 |Clarification |A. Work hours or personal services, for which monetary |A. Work hours or personal services, for which monetary compensation is not |Added "spouse and sponsor(s) to |No |
| |Needed |compensation is not realized, provided to a business, to a |realized, provided to a business, to a person who is self-employed, or to any |broaden the rule to include other | |
| | |person who is self-employed, or to any other person or |other person or business in need of a regular, temporary, or non-traditional |individuals who may have income | |
| | |business in need of a regular, temporary, or |employee, such as a seasonal worker, shall be considered countable earned income|(spouse, sponsor). | |
| | |non-traditional employee, such as a seasonal worker, shall |when the work: | | |
| | |be considered countable earned income when the work: |1. Is regular and scheduled; and, | | |
| | |1. Is regular and scheduled; and, |2. Is a necessary service; and, | | |
| | |2. Is a necessary service; and, |3. If not performed by the client, CLIENT’S SPOUSE, OR SPONSOR(S) someone would | | |
| | |3. If not performed by the client someone would have to be |have to be hired to perform the work; and, | | |
| | |hired to perform the work; and, |4. Is greater than five (5) hours per week. | | |
| | |4. Is greater than five (5) hours per week. | | | |
|3.520.785 |Clarification |B. Countable unearned income includes the following and any|B. Countable unearned income includes the following and any other payments that |General cleanup of rule language. |No |
| |Needed |other payments that could be construed to be a gain or |could be construed to be a gain or benefit to the client, CLIENT’S SPOUSE, OR |Added missing countable unearned | |
| | |benefit to the client and which are not earned income. |SPONSOR(S) and which are not earned income. |income types. | |
| | |1. Benefits issued by the Social Security Administration, |1. Benefits issued by the SSA. Social Security Administration, such as Social | | |
| | |such as Social Security retirement, Social Security |Security retirement, Social Security Disability Insurance (SSDI), or | | |
| | |Disability Insurance (SSDI), or Supplemental Security |Supplemental Security Income (SSI). | | |
| | |Income (SSI). |a. Lump sum payments shall be counted as income in the month received. Any | | |
| | |a. Lump sum payments shall be counted as income in the |unspent amount will be treated as a resource after nine (9) months. | | |
| | |month received. Any unspent amount will be treated as a |b. A recovery of Adult Financial program benefits shall be established if the | | |
| | |resource after nine (9) months. |lump sum payment is received too late in the month to adjust the Adult Financial| | |
| | |b. A recovery of Adult Financial program benefits shall be |program grant paid to the client. | | |
| | |established if the lump sum payment is received too late in|c. If the Social Security Administration (SSA) is recovering any portion of the | | |
| | |the month to adjust the Adult Financial program grant paid |SSI payment from the client, CLIENT’S SPOUSE, OR SPONSOR(S) due to an | | |
| | |to the client. |overpayment of benefits, Adult Financial program GRANT PAYMENTS shall be | | |
| | |c. If the Social Security Administration (SSA) is |calculated based on the gross SSI payment, not the received amount. | | |
| | |recovering any portion of the SSI payment from the client |2. Pension or retirement payments made by a former employer or from any | | |
| | |due to an overpayment of benefits, Adult Financial program |insurance or other public or private fund. If a lump sum payment for the value | | |
| | |shall be calculated based on the gross SSI payment, not the|of the pension or retirement is an option, the client shall pursue the lump sum | | |
| | |received amount. |payment. | | |
| | |2. Pension or retirement payments made by a former employer|3. Disability or survivor's benefits made by an employer or from any insurance | | |
| | |or from any insurance or other public or private fund. If a|or other public or private fund. | | |
| | |lump sum payment for the value of the pension or retirement|4. Veteran compensation and pension based on service in the armed forces. Such | | |
| | |is an option, the client shall pursue the lump sum payment.|payments may be made by the U.S. Veterans Administration (VA), another country, | | |
| | |3. Disability or survivor's benefits made by an employer or|a state or local government, or other organization. Any portion of a VA pension | | |
| | |from any insurance or other public or private fund. |paid to a veteran for support of a dependent shall be considered countable | | |
| | |4. Veteran compensation and pension based on service in the|unearned income to the dependent rather than to the veteran. | | |
| | |armed forces. Such payments may be made by the U.S. |5. Railroad retirement payments, such as sick pay, annuities, pensions, and | | |
| | |Veterans Administration (VA), another country, a state or |unemployment insurance benefits, which are paid by the Railroad Retirement Board| | |
| | |local government, or other organization. Any portion of a |(RRB) to a client, CLIENT’S SPOUSE, OR SPONSOR(S) who is or was a railroad | | |
| | |VA pension paid to a veteran for support of a dependent |worker, or to such worker's dependents or survivors. | | |
| | |shall be considered countable unearned income to the |6. Unemployment Compensation. | | |
| | |dependent rather than to the veteran. |7. Union strike benefits. | | |
| | |5. Railroad retirement payments, such as sick pay, |8. Amounts withheld from unearned income because of a garnishment. | | |
| | |annuities, pensions, and unemployment insurance benefits, |9. Workers' Compensation payments awarded under federal and state law to an | | |
| | |which are paid by the Railroad Retirement Board (RRB) to a |injured employee. Payments for medical, legal, or related expenses incurred by | | |
| | |client who is or was a railroad worker, or to such worker's|the client, CLIENT’S SPOUSE, OR SPONSOR(S) in connection with such claim are | | |
| | |dependents or survivors. |deducted prior to determining the amount of countable unearned income. | | |
| | |6. Unemployment Compensation. |10. Dividends and interest received on financial accounts, savings bonds, | | |
| | |7. Union strike benefits. |leases, etc. | | |
| | |8. Amounts withheld from unearned income because of a |11. Annuity payments. If a lump sum payment for the value of the annuity is an | | |
| | |garnishment. |option, the client shall pursue the lump sum payment. PAYMENTS SHOULD BE | | |
| | |9. Workers' Compensation payments awarded under federal and|ACCEPTED AS FREQUENTLY AS POSSIBLE, E.G. MONTHLY, QUARTERLY, OR ANNUALLY. A LUMP| | |
| | |state law to an injured employee. Payments for medical, |SUM SHOULD ONLY BE ACCEPTED IF THE PREVIOUSLY IDENTIFIED INCREMENTS ARE | | |
| | |legal, or related expenses incurred by the client in |UNAVAILABLE. | | |
| | |connection with such claim are deducted prior to |12. Inheritance. | | |
| | |determining the amount of countable unearned income. |13. Gifts and prizes. | | |
| | |10. Dividends and interest received on financial accounts, |14. Proceeds of a life insurance policy to the extent that they exceed the | | |
| | |savings bonds, leases, etc. |amount expended by the beneficiary for the purpose of the insured recipient's | | |
| | | |last illness and burial which are not covered by other benefits. | | |
| | | |15. Proceeds of a health insurance policy or personal injury lawsuit to the | | |
| | | |extent that they exceed the amount to be expended or are required to be expended| | |
| | | |for medical care. | | |
| | | |16. VA educational assistance (G.I. Bill) payments or other military or veterans| | |
| | | |benefits, which are conditional upon school attendance, are income to the extent| | |
| | | |that they exceed expenses necessary for school attendance. | | |
| | | |17. Income from jointly owned property in a percentage at least equal to the | | |
| | | |percentage of ownership or, if receiving more than percentage of ownership, the | | |
| | | |actual amount received. | | |
| | | |18. Lease bonuses (oil or mineral) received by the lessor as an inducement to | | |
| | | |lease land for exploration are income in the month received. | | |
| | | |19. Oil or mineral royalties verified through tax documents such as the 1099 | | |
| | | |from the prior year shall be considered averagable income. | | |
| | | |20. Income from rental property is considered as unearned income when the client| | |
| | | |is not actively managing the property on an average of at least twenty (20) | | |
| | | |hours a week. Rental income is countable to the extent it exceeds allowable | | |
| | | |expenses. Allowable expenses are maintenance, taxes, management fees, interest | | |
| | | |on mortgage, and utilities paid, and do not include the purchase of the rental | | |
| | | |property and payments on the principal of loans for the rental property. | | |
| | | |21. Income derived from monies (or other property acquired with such monies) | | |
| | | |received pursuant to the “Civil Liberties Act of 1988” (by eligible persons of | | |
| | | |Japanese ancestry or certain specified survivors, and certain eligible Aleuts), | | |
| | | |P.L. 100-383, AS OF AUGUST 10, 1988 AND ARE herein incorporated by reference. | | |
| | | |This rule does not contain any later amendments or editions. THESE REGULATIONS | | |
| | | |ARE AVAILABLE IN PERSON AT THE OFFICE OF FEDERAL REGISTER, 800 NORTH CAPITOL | | |
| | | |STREET NW., SUITE 700 , WASHINGTON,DC 20002 DURING REGULAR BUSINESS HOURS OR BY | | |
| | | |MAIL AT THE OFFICE OF FEDERAL REGISTER, THE NATIONAL ARCHIVES AND RECORDS | | |
| | | |ADMINISTRATION, 8601 ADELPHI ROAD, COLLEGE PARK, MD 20740-6001 OR AT | | |
| | | |. THESE REGULATIONS ARE AVAILABLE FOR PUBLIC INSPECTION AND| | |
| | | |CCopYINGies of these federal laws are available from AT the Colorado Department | | |
| | | |of Human Services, Director of the Employment and Benefits Division, 1575 | | |
| | | |Sherman Street, Denver, Colorado, 80203, or at any state publications library. | | |
| | | |22. PAYMENTS RECEIVED FROM Trusts. SUCH PAYMENTS CAN BE ON BEHALF OF, OR TO OR | | |
| | | |FOR THE BENEFIT OF THE CLIENT, CLIENT’S SPOUSE, OR SPONSOR(S), EXCLUDING MEDICAL| | |
| | | |OR PERSONAL ATTENDANT CARE. | | |
| | | |23. ALIMONY AND SPOUSAL SUPPORT. | | |
| | | |24. MINIMUM MONTHLY MAINTENANCE NEEDS ALLOWANCE (MMMNA) RETAINED FROM AN | | |
| | | |INSTITUTIONALIZED SPOUSE’S INCOME. | | |
|3.520.786 |Clarification |Earned and unearned income that is not countable to the |CERTAIN Earned and unearned income that is not countable to the client, CLIENT’S|Clarified the language in the | |
| |Needed |client, in whole or in part is exempt, including: |SPOUSE, OR SPONSOR(S) in whole or in part is exempt. SUCH EXEMPT INCOME IS |introduction, added spouses and | |
| | | |LIMITED TO THE FOLLOWING, including: |sponsors. | |
|3.520.786 |Clarification |A. Income tax refunds in the month received. Any remaining |A. Income tax refunds, INCLUDING THE PROPERTY TAX/RENT/HEAT CREDIT (PTC) REBATE,|Added PTC rebate as an exempt income |No |
| |Needed |funds shall be a countable resource after twelve (12) |in the month received. Any remaining funds shall be a countable resource after |type. | |
| | |months. |twelve (12) months. | | |
|3.520.786 |Clarification |H. Work study income that exceeds the need-based grant |H. Work study income that exceeds the need-based grant shall be earned income in|Align with Colorado Works. |No |
| |Needed |shall be earned income in the month received. |the month received. | | |
|3.520.786 |Clarification |I. Wages received by persons fifty-five (55) years of age |I. Wages received by persons fifty-five (55) years of age and older under the |SSI does not exempt SCSEP. Generous |No |
| |Needed |and older under the Senior Community Service Employment |Senior Community Service Employment Program (SCSEP) under Title V of the Older |income disregards are sufficient. | |
| | |Program (SCSEP) under Title V of the Older Americans Act; |Americans Act;. | | |
|3.520.786 |Clarification |J. Income and resources set aside as part of a Plan to |IJ. Income and resources set aside as part of a Plan to Achieve Self Support |Adjusting lettering due to |No |
| |Needed |Achieve Self Support (PASS) approved by the Social Security|(PASS) approved by the Social Security Administration. |strikethrough in previous letter. | |
| | |Administration. | | | |
|3.520.786 |Clarification |K. Compensation received by the client pursuant to the |JK. Compensation received by the client pursuant to the Colorado Crime Victims |Adjusting lettering due to |No |
| |Needed |Colorado Crime Victims Compensation Act; and, |Compensation Act IN ARTICLE 4.1 OF TITLE 24, C.R.S.; and, |strikethrough in previous letter. | |
|3.520.786 |Clarification |L. Certain unearned income as defined in the Social |KL. Certain uUnearned income as defined in the Social Security Program |Adjusting lettering due to |No |
| |Needed |Security Program Operations Manual System (POMS), Section |Operations Manual System (POMS), Section SI 00830.099 Guide to Unearned Income |strikethrough in previous letter. | |
| | |SI 00830.099 Guide to Unearned Income Exclusions. |Exclusions (EFFECTIVE JANUARY 20, 2011) AND CONSISTENT WITH THE PROVISIONS OF | | |
| | | |FEDERAL REGULATIONS FOUND AT 20 CFR 416.1124 (EFFECTIVE SEPTEMBER 7, 2010), | | |
| | | |WHICH ARE HEREIN INCORPORATED BY REFERENCE. THIS RULE DOES NOT CONTAIN ANY LATER| | |
| | | |AMENDMENTS OR EDITIONS. THESE GUIDELINES ARE AVAILABLE FOR NO COST AT | | |
| | | | (POMS); WHILE THE | | |
| | | |REGULATIONS ARE AVAILABLE FOR NO COST AT . THESE GUIDELINES| | |
| | | |AND REGULATIONS ARE ALSO AVAILABLE FOR PUBLIC INSPECTION AND COPYING AT THE | | |
| | | |COLORADO DEPARTMENT OF HUMAN SERVICES, DIRECTOR OF THE EMPLOYMENT AND BENEFITS | | |
| | | |DIVISION, 1575 SHERMAN STREET, DENVER, COLORADO, 80203, OR AT ANY STATE | | |
| | | |PUBLICATIONS LIBRARY DURING REGULAR BUSINESS HOURS. | | |
|3.520.786 |Clarification |M. Reverse mortgage loan payments. |LM. Reverse mortgage loan payments. |Adjusting lettering due to |No |
| |Needed | | |strikethrough in previous letter. | |
|3.520.786 |New Rule |N. NEW |M. PAYMENTS RECEIVED FOR PROVIDING FOSTER CARE. ANY AMOUNT PAID TO A PROVIDER OF|Align with Colorado Works. |No |
| |Addition | |FOSTER CARE IN EXCESS OF THE FOSTER CARE PAYMENT NOT INTENDED FOR THE CARE OF | | |
| | | |THE CHILD IS COUNTABLE INCOME TO THE PROVIDER. | | |
|3.520.786 |New Rule |O. NEW |N. CHILD SUPPORT PAYMENTS MADE TO THE CLIENT, CLIENT’S SPOUSE, OR SPONSOR(S). |Align with Colorado Works. |No |
| |Addition | |THESE PAYMENTS CAN EITHER BE CURRENT OR ARREARAGE PAYMENTS. | | |
|3.520.786 |New Rule |P. NEW |O. INFREQUENT OR IRREGULAR INCOME OF LESS THAN $60 IN A CALENDAR QUARTER. |Align with Colorado Works. |No |
| |Addition | | | | |
|3.520.79 |Clarification |A. For certain clients who are not paying their fair share |A. For certain clients who are not paying their fair share of SHELTERhousing |Aligned with definition of shelter | |
| |Needed |of housing costs, an In-kind Support and Maintenance (ISM) |costs, an In-kind Support and Maintenance (ISM) amount shall be determined and |costs and technical cleanup. | |
| | |amount shall be determined and counted as unearned income. |counted as unearned income. | | |
|3.520.79 |Clarification |B. The ISM calculation does not apply to a client:1. |B. The ISM calculation does not apply to a client: |Modified to include rules previously |No |
| |Needed |Residing in and owning his/her primary residence;2. |1. WHO IS RResiding in and owning his OR /her primary residence; OR, |identified under "D" to be clear that| |
| | |Residing in subsidized housing;3. Who is homeless;4. Who is|2. WHO IS RECEIVING Residing in subsidized housing; OR, |even if an individual falls into one | |
| | |paying his/her fair share of shelter when shelter costs are|3. Who is homeless; OR, |of these exception categories, if SSI| |
| | |market value or greater, even if the fair share is less |4. Who is paying his OR /her fair share of shelter COSTS when shelter costs are |is applying an ISM, AF will also | |
| | |than the current ISM amount.a. Fair share is calculated by |market value or greater, even if the fair share is less than the current ISM |apply an ISM. | |
| | |totaling rent and utility costs and dividing by the number |amount. | | |
| | |of people living in the household.b. Market value is the |a. Fair share is calculated by totaling SHELTER rent and utility costs and | | |
| | |amount a landlord or property manager would charge if the |dividing by the number of people living in the household. | | |
| | |dwelling were rented on the open market. Rent may include |b. Market value is the amount a landlord or property manager would charge if the| | |
| | |heating fuel, gas, electricity, water, sewage and garbage |dwelling were rented on the open market. Rent may include heating fuel, gas, | | |
| | |collection; or,5. Who is paying shelter costs in an amount |electricity, water, sewage and garbage collection; or, | | |
| | |equal to or greater than the current maximum ISM amount |5. Who is paying shelter costs in an amount equal to or greater than the current| | |
| | |established for the shelter component, whether or not the |maximum ISM amount established for the shelter component, whether or not the | | |
| | |costs are the client's fair share or market value. |costs are the client's fair share or market value.; UNLESS, | | |
| | | |6. A CLIENT IS RECEIVING SSI AND BEING CHARGED AN ISM BY THE SOCIAL SECURITY | | |
| | | |ADMINISTRATION (SSA). THE CLIENT SHALL BE CHARGED A MATCHING ISM FOR ADULT | | |
| | | |FINANCIAL PROGRAMS, UNLESS GOOD CAUSE IS PROVIDED DUE TO SSA BACKLOG. | | |
| | | |A. THE CLIENT SHALL BE INSTRUCTED TO WORK WITH THE SSA TO REMOVE OR REDUCE THE | | |
| | | |ISM ONCE THE CLIENT IS PAYING HIS OR HER FAIR SHARE OF SHELTER COSTS. | | |
| | | |B. ONCE THE SSA REMOVES OR REDUCES THE ISM, THE CLIENT SHALL REPORT THE CHANGE | | |
| | | |IN ORDER TO HAVE THE ADULT FINANCIAL ISM REMOVED OR REDUCED. | | |
|3.520.79 |Clarification |C. If the client's monthly shelter costs are less than the |C. If the client's DECLARED monthly shelter costs are less than the current |Technical cleanup by adding |No |
| |Needed |current maximum ISM amount established for the shelter |maximum ISM amount established for the shelter component and the client is not |"declared". | |
| | |component and the client is not paying his/her fair share, |paying his OR /her fair share, the county department shall determine the ISM | | |
| | |the county department shall determine the ISM amount to be |amount to be applied, as follows: | | |
| | |applied, as follows:1. If the client's shelter costs are |1. If the client's shelter costs are less than the current market value, then | | |
| | |less than the current market value, then the amount the |the amount the client is actually paying is subtracted from the current maximum | | |
| | |client is actually paying is subtracted from the current |ISM amount. The result is counted as in-kind unearned income to the client. | | |
| | |maximum ISM amount. The result is counted as in-kind |2. If the shelter costs are market value but the client is paying less than his | | |
| | |unearned income to the client.2. If the shelter costs are |OR /her fair share, then the amount the client is actually paying is subtracted | | |
| | |market value but the client is paying less than his/her |from the client's fair share amount or the current maximum ISM amount, whichever| | |
| | |fair share, then the amount the client is actually paying |is less. The result is counted as in-kind unearned income to the client. | | |
| | |is subtracted from the client's fair share amount or the |3. If the client is paying no shelter costs, and all shelter costs are supplied | | |
| | |current maximum ISM amount, whichever is less. The result |in full, then the current maximum ISM amount is counted as in-kind unearned | | |
| | |is counted as in-kind unearned income to the client.3. If |income to the client. | | |
| | |the client is paying no shelter costs, and all shelter | | | |
| | |costs are supplied in full, then the current maximum ISM | | | |
| | |amount is counted as in-kind unearned income to the client.| | | |
|3.520.79 |Unnecessary Rule|D. A client receiving SSI and being charged an ISM by the |D. A client receiving SSI and being charged an ISM by the Social Security |Rule duplicated in another |No |
| | |Social Security Administration (SSA) shall be charged a |Administration (SSA) shall be charged a matching ISM for Adult Financial |section-redundant. | |
| | |matching ISM for Adult Financial programs. |programs. | | |
| | |1. The client shall be instructed to work with the SSA to |1. The client shall be instructed to work with the SSA to remove or reduce the | | |
| | |remove or reduce the ISM once the client is paying a fair |ISM once the client is paying a fair share of his/her shelter costs. | | |
| | |share of his/her shelter costs. |2. Once the SSA removes or reduces the ISM, the county department shall remove | | |
| | |2. Once the SSA removes or reduces the ISM, the county |or reduce the Adult Financial programs ISM. | | |
| | |department shall remove or reduce the Adult Financial | | | |
| | |programs ISM. | | | |
|3.520.79 |Clarification |E. If the client has an established life estate and |DE. If the client has an established life estate and THE client's shelter COSTS |Clarified that an ISM would be |No |
| |Needed |client's shelter is being provided in full, the shelter |ARE is being provided in full, AN ISM SHALL BE CALCULATED the shelter component |calculated and removed language about| |
| | |component shall be deducted from the Adult Financial |shall be deducted from the Adult Financial programs grant. |shelter component. | |
| | |programs grant. | | | |
|3.520.79 |Clarification |F. A client may purchase occupancy in a non-profit |F. A client may purchase occupancy in a non-profit congregate home for the aged |Unnecessary as living arrangement and|No |
| |Needed |congregate home for the aged or in an individual private |or in an individual private owner home. If all or part of the client's shelter |fair share would be looked at | |
| | |owner home. If all or part of the client's shelter is being|is being provided in such an arrangement, an ISM shall be calculated. |regardless. No need to call this | |
| | |provided in such an arrangement, an ISM shall be | |arrangement out specifically. | |
| | |calculated. | | | |
|3.520.79 |Clarification |G. If the client receives an educational grant or loan that|G. If the client receives an educational grant or loan that provides for the |Exempting to match with exempt income|No |
| |Needed |provides for the client's shelter in full, an ISM deduction|client's shelter in full, an ISM deduction shall be applied. |section. | |
| | |shall be applied. | | | |
|3.520.79 |Clarification |H. The Adult Financial programs maximum shelter in-kind |EH. The Adult Financial programs maximum shelter in-kind support and maintenance|Modified to align with previous use |No |
| |Needed |support and maintenance (ISM) shall be determined as |(ISM) shall be determined as follows: |of shelter costs. Definition section| |
| | |follows: |1. The ISM includes shelter COSTS and utilities. |explains that specific utilities are | |
| | |1. The ISM includes shelter and utilities. |2. The ISM is calculated by multiplying the current SSI grant BENEFIT standard, |included. | |
| | |2. The ISM is calculated by multiplying the current SSI |AS DEFINED IN SECTION 3.510, by 33.33%, then adding a $20.00 disregard and | | |
| | |grant standard by 33.33%, then adding a $20.00 disregard |rounding to the nearest whole dollar. | | |
| | |and rounding to the nearest whole dollar. | | | |
|3.530 |Clarification |The Old Age Pension (OAP) program provides financial |The Old Age Pension (OAP) program provides financial assistance and may provide |Minor language adjustment. |No |
| |Needed |assistance and may provide health care benefits for |health care benefits for low-income Colorado residents who are sixty (60) years | | |
| | |low-income Colorado residents who are sixty (60) years of |of age or older who meet ALL FINANCIAL AND NON-FINANCIAL basic eligibility | | |
| | |age or older who meet basic eligibility requirements. |requirements. | | |
| | |A. The total monthly OAP grant standard, as set by the |A. The total monthly OAP grant standard, as set by the State Board of Human | | |
| | |State Board of Human Services, is $809.00, effective |Services, is $80921.00, effective January 1, 201920. | | |
| | |January 1, 2019. | | | |
|3.530 |Clarification |B. Effective January 1, 2019, the maximum monthly In-Kind |B. Effective January 1, 201920, the maximum monthly In-Kind Support and |Modified to align with previous use |No |
| |Needed |Support and Maintenance (ISM) deduction amount for shelter,|Maintenance (ISM) deduction amount for shelter COSTS, including utilities, is |of shelter costs. Definition section| |
| | |including utilities, is $277.00. |$28177.00. |explains that specific utilities are | |
| | | | |included. | |
|3.530.1 |Clarification |“OAP A” is a program for a client sixty-five (65) years of |“OAP A” is a program for a client sixty-five (65) years of age or older. |Combining OAP A & B as these are |No |
| |Needed |age or older. | |solely used in CBMS and were | |
| | | | |previously used to differentiate | |
| | | | |between those eligible for Medicaid | |
| | | | |and those who weren't. | |
|3.530.1 |Clarification |“OAP B” is a program for a client sixty to sixty-four |“OAP B” is a program for a client sixty (60) years of age or older to sixty-four|Combining OAP A & B as these are |No |
| |Needed |(60-64) years of age. |(60-64) years of age. |solely used in CBMS and were | |
| | | | |previously used to differentiate | |
| | | | |between those eligible for Medicaid | |
| | | | |and those who weren't. | |
|3.530.1 |Clarification |“OAP C” is a program for a client age sixty (60) or older |“OAP-C” is a program for a client age sixty (60) or older who has been committed|Adding a hyphen to OAP-C. |No |
| |Needed |who has been committed to the Colorado Mental Health |to the Colorado Mental Health Institute or to a Regional Center by order of the | | |
| | |Institute or to a Regional Center by order of the district |district or probate court. | | |
| | |or probate court. | | | |
|3.531 |Clarification |A. The county department shall enter all client, resource, |A. The county department shall enter all client, resource, and income |Moved with technical cleanup to the |No |
| |Needed |and income information into the statewide automated system.|information into the statewide automated system. |"Application Processing" section. | |
| | |1. The county department shall determine eligibility. |1. The county department shall determine eligibility. |Struck through to eliminate | |
| | |2. If the client is missing any verification, the county |2. If the client is missing any verification, the county department shall |redundancy. | |
| | |department shall request additional and/or required |request additional and/or required verifications from the client. The request | | |
| | |verifications from the client. The request shall include: |shall include: | | |
| | |a. A specific list of verifications necessary to determine |a. A specific list of verifications necessary to determine eligibility; | | |
| | |eligibility; |b. The due date for when the verifications must be returned, which shall be ten | | |
| | |b. The due date for when the verifications must be |(10) calendar days from the date the verification was requested in writing; and,| | |
| | |returned, which shall be ten (10) calendar days from the |c. Notification that if the client fails to return the verifications by the due | | |
| | |date the verification was requested in writing; and, |date, the county department shall process the application without those | | |
| | |c. Notification that if the client fails to return the |verifications, which may lead to a denial of benefits. | | |
| | |verifications by the due date, the county department shall | | | |
| | |process the application without those verifications, which | | | |
| | |may lead to a denial of benefits. | | | |
|3.531 |Clarification |B. The client shall be advised that a collateral contact or|B. The client shall be advised that a collateral contact or home visit may be |Moved with technical cleanup to the |No |
| |Needed |home visit may be used to confirm questionable evidence, to|used to confirm questionable evidence, to investigate potential fraud, or when |"Application Processing" section. | |
| | |investigate potential fraud, or when documentary evidence |documentary evidence is insufficient to make a determination of eligibility or |Struck through to eliminate | |
| | |is insufficient to make a determination of eligibility or |benefit level or cannot otherwise be obtained.1. A collateral contact is a |redundancy. | |
| | |benefit level or cannot otherwise be obtained.1. A |verbal or written confirmation of a client's circumstances by a person outside | | |
| | |collateral contact is a verbal or written confirmation of a|of the household. The county department shall:a. Request the name of an | | |
| | |client's circumstances by a person outside of the |appropriate collateral contact from the client; or,b. Independently determine an| | |
| | |household. The county department shall:a. Request the name |appropriate collateral contact; or,c. Substitute a home visit when an | | |
| | |of an appropriate collateral contact from the client; or,b.|appropriate collateral contact cannot be identified.2. An application may be | | |
| | |Independently determine an appropriate collateral contact; |denied if a collateral contact refuses to provide documentation of essential | | |
| | |or,c. Substitute a home visit when an appropriate |verifications and the applicant is unwilling to cooperate in obtaining such | | |
| | |collateral contact cannot be identified.2. An application |information personally.a. Authorization of the release of such information alone| | |
| | |may be denied if a collateral contact refuses to provide |does not constitute cooperation if the county department requests further | | |
| | |documentation of essential verifications and the applicant |assistance from the applicant. Documentation of lack of cooperation must be | | |
| | |is unwilling to cooperate in obtaining such information |entered in the case record.b. However, if the applicant is willing to cooperate | | |
| | |personally.a. Authorization of the release of such |but unable to obtain the information, no denial or delayed action shall be | | |
| | |information alone does not constitute cooperation if the |taken. The county shall assist the participant in gaining the information | | |
| | |county department requests further assistance from the |required to make a determination of eligibility.3. Client confidentiality shall | | |
| | |applicant. Documentation of lack of cooperation must be |be maintained to the greatest extent possible when using a collateral contact | | |
| | |entered in the case record.b. However, if the applicant is |for verification. | | |
| | |willing to cooperate but unable to obtain the information, | | | |
| | |no denial or delayed action shall be taken. The county | | | |
| | |shall assist the participant in gaining the information | | | |
| | |required to make a determination of eligibility.3. Client | | | |
| | |confidentiality shall be maintained to the greatest extent | | | |
| | |possible when using a collateral contact for verification. | | | |
|3.531 |Clarification |C. Each verification document shall be date-stamped with |C. Each verification document shall be date-stamped with the date it was |Moved with technical cleanup to the |No |
| |Needed |the date it was received in the county department office. |received in the county department office. |"Application Processing" section. | |
| | | | |Struck through to eliminate | |
| | | | |redundancy. | |
|3.531 |Clarification |D. Upon timely receipt of the required verifications, the |D. Upon timely receipt of the required verifications, the county department |Moved with technical cleanup to the |No |
| |Needed |county department shall enter verifications into the |shall enter verifications into the statewide automated system. When all |"Application Processing" section. | |
| | |statewide automated system. When all verifications have |verifications have been entered, the county department shall review the results,|Struck through to eliminate | |
| | |been entered, the county department shall review the |verify accuracy, and determine eligibility. If a client fails to return |redundancy. | |
| | |results, verify accuracy, and determine eligibility. If a |verifications, the case will be denied. | | |
| | |client fails to return verifications, the case will be | | | |
| | |denied. | | | |
|3.531 |Clarification |E. If a client returns the required verifications late, the|E. If a client returns the required verifications late, the county department |Moved with technical cleanup to the |No |
| |Needed |county department shall enter verifications into the |shall enter verifications into the statewide automated system. When all |"Application Processing" section. | |
| | |statewide automated system. When all verifications have |verifications have been entered, the county department shall review the results,|Struck through to eliminate | |
| | |been entered, the county department shall review the |verify accuracy, determine if good cause exists, and determine eligibility. If |redundancy. | |
| | |results, verify accuracy, determine if good cause exists, |the client does not have good cause and informs the county department that | | |
| | |and determine eligibility. If the client does not have good|he/she is requesting benefits, the client shall be required to reapply for | | |
| | |cause and informs the county department that he/she is |benefits. | | |
| | |requesting benefits, the client shall be required to | | | |
| | |reapply for benefits. | | | |
|3.531 |Clarification |F. If a client believes that the value used for income or |F. If a client believes that the value used for income or resource calculation |Moved with technical cleanup to the |No |
| |Needed |resource calculation was incorrect, the client shall |was incorrect, the client shall provide supporting documentation. If such |"Application Processing" section. | |
| | |provide supporting documentation. If such documentation |documentation confirms an incorrect calculation, the county department shall |Struck through to eliminate | |
| | |confirms an incorrect calculation, the county department |correct the case. |redundancy. | |
| | |shall correct the case. | | | |
|3.531 |Clarification |G. The county department shall send the client a notice |G. The county department shall send the client a notice explaining the |Moved with technical cleanup to the |No |
| |Needed |explaining the eligibility determination results and the |eligibility determination results and the client's appeal rights as outlined ins|"Application Processing" section. | |
| | |client's appeal rights as outlined ins Section 3.850, et |Section 3.850, et seq. (9 C.C.R. 2503-8). |Struck through to eliminate | |
| | |seq. (9 C.C.R. 2503-8). | |redundancy. | |
|3.531 |Clarification |H. The client shall have the right to decide how to spend |BH. The client shall have the right to decide how to spend his OR /her OAP GRANT|Adjusting lettering due to |No |
| |Needed |his/her OAP benefit. |PAYMENT benefit. |strikethrough in previous letter. | |
| | | | |Technical cleanup | |
|3.531 |Clarification |I. The county department shall promptly act to make changes|I. The county department shall promptly act to make changes in food assistance |Removing prescriptive language about |No |
| |Needed |in food assistance eligibility and other public assistance |eligibility and other public assistance benefits as necessary in all instances |other HLPGs. | |
| | |benefits as necessary in all instances where a client or |where a client or mass change in OAP eligibility or payment occurs. | | |
| | |mass change in OAP eligibility or payment occurs. | | | |
|3.531 |New Rule |C. NEW |C. THE GRANT STANDARD FOR OAP, AS LISTED IN SECTION 3.530.A, SHALL BE ADJUSTED |Rule inadvertently excluded during |No |
| |Addition | |TO REMAIN WITHIN AVAILABLE APPROPRIATIONS. APPEALS SHALL NOT BE ALLOWED FOR |the last rule rewrite. | |
| | | |GRANT STANDARD ADJUSTMENTS NECESSARY TO STAY WITHIN AVAILABLE APPROPRIATIONS. | | |
|3.531 |New Rule |D. NEW |D. IN ADDITION TO THE REGULAR MONTHLY OAP GRANT PAYMENTS, SUPPLEMENTAL PAYMENTS |Rule inadvertently excluded during |No |
| |Addition | |NECESSARY TO COMPLY WITH THE FEDERAL MAINTENANCE OF EFFORT (MOE) REQUIREMENTS |the last rule rewrite. | |
| | | |MAY BE PROVIDED. THESE PAYMENTS ARE SUPPLEMENTS TO REGULAR GRANT PAYMENTS, ARE | | |
| | | |NOT ENTITLEMENTS, AND DO NOT AFFECT GRANT STANDARDS. APPEALS SHALL NOT BE | | |
| | | |ALLOWED FOR MOE PAYMENT ADJUSTMENTS. THE FEDERAL MOE IS LOCATED IN FEDERAL | | |
| | | |REGULATIONS FOUND AT 45 CFR 1321.49 (EFFECTIVE AS OF 1988 AND CURRENT THROUGH | | |
| | | |NOVEMBER 7, 2019), WHICH ARE HEREIN INCORPORATED BY REFERENCE. THIS RULE DOES | | |
| | | |NOT CONTAIN ANY LATER AMENDMENTS OR EDITIONS. THESE REGULATIONS ARE AVAILABLE AT| | |
| | | |NO COST AT . THESE REGULATIONS ARE ALSO AVAILABLE FOR | | |
| | | |PUBLIC INSPECTION AND COPYING AT THE COLORADO DEPARTMENT OF HUMAN SERVICES, | | |
| | | |DIRECTOR OF THE EMPLOYMENT AND BENEFITS DIVISION, 1575 SHERMAN STREET, DENVER, | | |
| | | |COLORADO, 80203, OR AT ANY STATE PUBLICATIONS LIBRARY DURING REGULAR BUSINESS | | |
| | | |HOURS. | | |
|3.532 |Clarification |A. OAP grants shall be calculated on an individual basis, |A. OAP grants PAYMENTS shall be calculated on an individual basis, with just one|Technical cleanup | |
| |needed |with just one client per case. |client per case. | | |
|3.532 |Clarification |B. When a client has been found eligible based upon |B. When a client has been found eligible based upon eligibility rules as |Removed incorrect citation. |No |
| |Needed |eligibility rules as outlined in Sections 3.520.6 and |outlined in Sections 3.520.6 and 3.520.71, the amount of the client's authorized| | |
| | |3.520.71, the amount of the client's authorized OAP benefit|OAP GRANT PAYMENT benefit shall be determined by deducting the client's total | | |
| | |shall be determined by deducting the client's total |countable income from the OAP grant standard LISTED IN SECTION 3.530.A. | | |
| | |countable income from the OAP grant standard. |1. If determined eligible on the first of the month, the client shall receive | | |
| | |1. If determined eligible on the first of the month, the |his OR /her authorized GRANT PAYMENT benefit in the initial and subsequent | | |
| | |client shall receive his/her authorized benefit in the |months. | | |
| | |initial and subsequent months. |2. If determined eligible on any other day of the month, the client's first | | |
| | |2. If determined eligible on any other day of the month, |month GRANT PAYMENT benefit shall be prorated according to the number of days | | |
| | |the client's first month benefit shall be prorated |remaining in the month; the client shall receive their authorized GRANT PAYMENTS| | |
| | |according to the number of days remaining in the month; the|benefit in subsequent months. | | |
| | |client shall receive their authorized benefit in subsequent|3. If a client is receiving services in another Adult Financial (AF) program in | | |
| | |months. |the month he OR /she turns sixty (60) years of age and is otherwise eligible for| | |
| | |3. If a client is receiving services in another Adult |OAP, the client shall transition from the other AF program to OAP effective the | | |
| | |Financial (AF) program in the month he/she turns sixty (60)|first day of the client's birth month, and receive his OR /her authorized GRANT | | |
| | |years of age and is otherwise eligible for OAP, the client |PAYMENT benefits for the birthday month and subsequent months. | | |
| | |shall transition from the other AF program to OAP effective| | | |
| | |the first day of the client's birth month, and receive | | | |
| | |his/her authorized benefits for the birthday month and | | | |
| | |subsequent months. | | | |
|3.532 |Clarification |C. If found eligible, the client's eligibility date shall |C. If found eligible, the client's eligibility date shall be determined as |Moved with technical clean up to the |No |
| |Needed |be determined as follows:1. If the client returns all |follows:1. If the client returns all verifications within the forty-five (45) |"Application Processing" section. | |
| | |verifications within the forty-five (45) day processing |day processing time frame, the eligibility date shall be the application date.2.|Struck through to eliminate | |
| | |time frame, the eligibility date shall be the application |If the client returns all verifications after the forty-five (45) day processing|redundancy. | |
| | |date.2. If the client returns all verifications after the |time frame, but within sixty (60) calendar days of the original application | | |
| | |forty-five (45) day processing time frame, but within sixty|date, the eligibility date shall be the date the verifications were returned.3. | | |
| | |(60) calendar days of the original application date, the |If the client returns all verifications after sixty (60) days from the original | | |
| | |eligibility date shall be the date the verifications were |application date, the client shall be required to re-apply for benefits. | | |
| | |returned.3. If the client returns all verifications after | | | |
| | |sixty (60) days from the original application date, the | | | |
| | |client shall be required to re-apply for benefits. | | | |
|3.532 |Clarification |D. If a client is actively attempting to sell, liquidate, |D. If a client is actively attempting to sell, liquidate, or legally acquire a |Moved with technical cleanup to the |No |
| |Needed |or legally acquire a resource or secure available income, |resource or secure available income, the county department shall not delay |"Application Processing" section. | |
| | |the county department shall not delay action on an |action on an application. |Struck through to eliminate | |
| | |application. |1. OAP shall be continued without adjustment until the resource or income is |redundancy. | |
| | |1. OAP shall be continued without adjustment until the |available. The county department is urged to monitor the attempts to access the | | |
| | |resource or income is available. The county department is |resource or income. | | |
| | |urged to monitor the attempts to access the resource or |2. If the client refuses or fails to make a reasonable effort to secure a | | |
| | |income. |potential resource or income, such resource or income shall be considered as if | | |
| | |2. If the client refuses or fails to make a reasonable |available, and timely and adequate notice shall be given regarding a proposed | | |
| | |effort to secure a potential resource or income, such |action to deny, reduce, or terminate assistance. | | |
| | |resource or income shall be considered as if available, and|3. If the client secures the potential resource or income prior to the effective| | |
| | |timely and adequate notice shall be given regarding a |action date identified in the notice, the proposed action to deny, reduce, or | | |
| | |proposed action to deny, reduce, or terminate assistance. |terminate assistance shall be withdrawn by the county, and the case shall be | | |
| | |3. If the client secures the potential resource or income |corrected. Benefits may still be denied, reduced, or discontinued due to a | | |
| | |prior to the effective action date identified in the |change in income or resources. | | |
| | |notice, the proposed action to deny, reduce, or terminate | | | |
| | |assistance shall be withdrawn by the county, and the case | | | |
| | |shall be corrected. Benefits may still be denied, reduced, | | | |
| | |or discontinued due to a change in income or resources. | | | |
|3.532 |Clarification |E. The OAP benefit shall be made directly to the client or |CE. The OAP GRANT PAYMENT benefit shall be made VIA ELECTRONIC BENEFITS |Inserted current methods the grant is|No |
| |Needed |to a legally designated person, such as a representative |TRANSFER, DIRECT DEPOSIT, OR WARRANT directly to the client, TO A FACILITY |made available to the client. | |
| | |payee, fiduciary, or conservator.For OAP-C clients, the |DESIGNATED BY THE CLIENT, or to a legally designated person, such as a | | |
| | |financial officer of the facility or the client's guardian |representative payee, fiduciary, or conservator. | | |
| | |shall establish a reserve for the client in the amount of |For OAP-C clients, the financial officer of the facility or the client's | | |
| | |the current Personal Needs Allowance (PNA) grant standard |guardian shall establish a reserve for the client in the amount of the current | | |
| | |for the client's personal needs. |Personal Needs Allowance (PNA) grant standard for the client's personal needs. | | |
|3.532 |Clarification |F. The client shall be eligible only for a monthly personal|DF. The client shall be eligible only for a monthly Ppersonal Nneeds Aallowance |Addition of Adult Financial approved |No |
| |Needed |needs allowance when program requirements are met and the |when program requirements are met and the client is a resident FOR of a facility|setting to allow for non-Medicaid | |
| | |client is a resident of a facility at least thirty (30) |at least thirty (30) consecutive days, IN ONE OF THE FOLLOWING FACILITIES as |residential treatment facilities such| |
| | |consecutive days, as follows: |follows: |as the Fort Lyon Supportive | |
| | |1. In a general medical and surgical hospital. |1. In a general medical and surgical hospital.; |Residential Community. | |
| | |2. In a nursing home, assisted living residence, or, |2. In a nursing home, assisted living residence, or, intermediate care facility,| | |
| | |intermediate care facility, group home, host home, or other|group home, host home, or other long-term care facility, OR ADULT FINANCIAL | | |
| | |long-term care facility. |APPROVED SETTING; OR. | | |
| | |3. In a psychiatric facility when sixty-five (65) years of |3. In a psychiatric facility when sixty-five (65) years of age or older. | | |
| | |age or older. | | | |
|3.532 | |G. The following persons are not eligible for a personal |EG. The following persons are not eligible for a Ppersonal Nneeds Aallowance or |Adjusting lettering due to |No |
| | |needs allowance or OAP benefit: |OAP GRANT PAYMENTS benefit: |strikethrough in previous letter. | |
| | |1. Inmates in a penal institution; or, |1. Inmates in a penal institution; or, | | |
| | |2. Residents in an unlicensed private or uncertified public|2. Residents in an unlicensed private or uncertified public facility. | | |
| | |facility. | | | |
|3.532 | |H. For every full calendar month that the client is a |FH. For every full calendar month that the client is a resident in an approved A|Adjusting lettering due to |No |
| | |resident in an approved facility, the OAP personal needs |facility LISTED IN SECTION 3.532.D, the OAP Ppersonal Nneeds Aallowance maximum |strikethrough in previous letter. | |
| | |allowance maximum shall be seventy nine dollars ($79), |shall be seventy-nine dollars ($79), effective October 1, 2016. | | |
| | |effective October 1, 2016. | | | |
|3.533 |Clarification |Disregards shall not be applied if a client's total income |Disregards shall BE APPLIED BEFORE DETERMINING A CLIENT’S TOTAL COUNTABLE |Disregards need to be applied to | |
| |Needed |equals or exceeds the OAP grant standard. |INCOME. not be applied iIf a client's total COUNTABLE income equals or exceeds |income first and then determine if | |
| | | |the OAP grant standard AFTER THE DISREGARDS ARE APPLIED, HE OR SHE SHALL BE |the individual is equal to exceeds | |
| | | |DENIED OR DISCONTINUED FOLLOWING THE POLICIES OUTLINED IN SECTION 3.554. |the OAP grant standard. Based on | |
| | | | |statute, income should be based on | |
| | | | |net income, not gross. | |
|3.533 |Clarification |A. If the client's gross earnings are less than the OAP |A. If the CLIENT HAS INCOME client's gross earnings are less than the OAP grant |Disregards need to be applied to |No |
| |Needed |grant standard, apply the following income disregards:1. To|standard, apply the following income disregards: |income first and then determine if | |
| | |determine countable earned income:a. Deduct $65 from the |1. To determine countable earned income: |the individual is equal to exceeds | |
| | |gross earned income; and,b. Divide the remainder by two |a. Deduct $65 from the gross earned income; and, |the OAP grant standard. Based on | |
| | |(2).c. The result is the countable earned income.2. To |b. Divide the remainder by two (2). |statute, income should be based on | |
| | |determine countable unearned income:a. A client who |c. The result is the countable earned income. |net income, not gross. | |
| | |receives SSI only, and does not receive any other unearned |2. To determine countable unearned income: | | |
| | |income, does not receive an unearned income disregard.b. An|a. A client who receives SSI only, and does not receive any other unearned | | |
| | |OAP client living in an Adult Foster Care facility is not |income, does not receive an unearned income disregard. | | |
| | |eligible to receive an unearned income disregard.c. To |b. An OAP client living in an Adult Foster Care facility is not eligible to | | |
| | |determine countable unearned income of a client who does |receive an unearned income disregard. | | |
| | |not receive SSI or who receives SSI and has other unearned |c. To determine countable unearned income of a client who does not receive SSI | | |
| | |income:1) Deduct $20 from the gross unearned income;2) The |or who receives SSI and has other unearned income: | | |
| | |result is the countable unearned income.3) If the client's |1) Deduct $20 from the gross unearned income; | | |
| | |unearned income is less than $20, the difference between |2) The result is the countable unearned income. | | |
| | |the gross unearned income and the $20 deduction shall be |3) If the client's unearned income is less than $20, the difference between the | | |
| | |applied to the earned income calculation if applicable.d. |gross unearned income and the $20 deduction shall be applied to the earned | | |
| | |Only one $20 unearned income disregard is allowed per |income calculation if applicable. | | |
| | |couple and is divided equally between the two spouses. |TO DETERMINE COUNTABLE UNEARNED INCOME: | | |
| | | |A. DETERMINE THE CLIENT'S GROSS UNEARNED INCOME FROM ALL SOURCES. | | |
| | | |B. SUBTRACT ANY AMOUNT RECEIVED FROM SSI. | | |
| | | |C. DEDUCT $20.00 FROM THE REMAINDER. | | |
| | | |1. IF THE CLIENT IS MARRIED, THE $20.00 DISREGARD SHALL BE SPLIT EQUALLY BETWEEN| | |
| | | |THE CLIENT AND THE CLIENT’S SPOUSE SO THAT NO MORE THAN A $20.00 DISREGARD IS | | |
| | | |APPLIED FOR THE MARRIED COUPLE. | | |
| | | |2. A CLIENT WHO RECEIVES SSI ONLY, AND DOES NOT RECEIVE ANY OTHER UNEARNED | | |
| | | |INCOME, DOES NOT RECEIVE AN UNEARNED INCOME DISREGARD. | | |
| | | |D. ADD THE FULL SSI INCOME BACK TO THE REMAINDER. | | |
| | | |E. THE REMAINDER IS COUNTABLE UNEARNED INCOME. | | |
| | | |F. IF THE CLIENT'S GROSS UNEARNED INCOME IS LESS THAN $20.00, THE DIFFERENCE | | |
| | | |BETWEEN THE GROSS UNEARNED INCOME AND THE $20.00 DEDUCTION SHALL BE APPLIED TO | | |
| | | |THE EARNED INCOME CALCULATION, IF APPLICABLE. | | |
| | | |d. Only one $20 unearned income disregard is allowed per couple and is divided | | |
| | | |equally between the two spouses. | | |
|3.533 |Clarification |B. Subtract the countable earned and countable unearned |B. Subtract the countable earned and countable unearned income from the OAP |Technical cleanup | |
| |Needed |income from the OAP grant standard to determine the benefit|grant standard to determine the GRANT PAYMENT benefit amount. | | |
| | |amount. | | | |
|3.534 |Clarification |A. To determine the amount of income to deem from a |A. To determine the amount of income to deem TO A CLIENT from a THE CLIENT’S |Referred to appropriate rule section |No |
| |Needed |non-recipient spouse to a recipient spouse calculate the |SPOUSE WHO DOES NOT MEET THE CRITERIA DESCRIBED BELOW IN ‘C’, non-recipient |to determine if the spouse meets the | |
| | |countable earned income of the non-recipient spouse as |spouse to a recipient spouse calculate the countable earned income of the |criteria to have their income deemed.| |
| | |follows:1. Deduct $65 from the non-recipient spouse's gross|non-recipient spouse as follows: | | |
| | |earned income; and,2. Divide the remainder by two (2); |1. Deduct $65 from the CLIENT’S non-recipient spouse's gross earned income; and,| | |
| | |and,3. The remainder is the amount of earned income deemed |2. Divide the remainder by two (2); and, | | |
| | |to the client.4. The deemed earned income shall be |3. The RESULT remainder is the amount of earned income deemed to the client. | | |
| | |considered income to the client and shall be deducted, |4. The deemed earned income shall be considered income to the client and shall | | |
| | |together with any other income, from the grant of the |be deducted, together with any other income, from the grant of the client. | | |
| | |client.5. Wages being garnished by the court are countable |5. Wages being garnished by the court are countable earned income. | | |
| | |earned income. | | | |
|3.534 |Clarification |B. To determine the amount of unearned income to deem from |B. To determine the amount of unearned income to deem TO A CLIENT from a THE |Referred to appropriate rule section |No |
| |Needed |a non-recipient spouse to a recipient spouse, calculate the|CLIENT’S SPOUSE WHO DOES NOT MEET THE CRITERIA AS DESCRIBED BELOW IN ‘C’, |to determine if the spouse meets the | |
| | |countable unearned income of the non-recipient spouse as |non-recipient spouse to a recipient spouse, calculate the countable unearned |criteria to have their income deemed.| |
| | |follows: |income of the non-recipient spouse as follows: | | |
| | |1. Calculate the total amount of unearned income of the |1. Calculate the total amount of unearned income of the non-recipient spouse; | | |
| | |non-recipient spouse; |2. Deduct the OAP grant standard from the total unearned income of the | | |
| | |2. Deduct the OAP grant standard from the total unearned |non-recipient spouse; | | |
| | |income of the non-recipient spouse; |3. Deduct an amount to meet the needs of each dependent child LIVING IN THE | | |
| | |3. Deduct an amount to meet the needs of each dependent |HOUSEHOLD of the non-recipient spouse equal to half the maximum SSI grant | | |
| | |child of the non-recipient spouse equal to half the maximum|BENEFIT standard, AS DEFINED IN SECTION 3.510, less the dependent child's own | | |
| | |SSI grant standard less the dependent child's own income; |income; | | |
| | |4. Deduct any medical care payments by the non-recipient |4. Deduct any medical care payments by the non-recipient spouse for his OR /her | | |
| | |spouse for his/her dependents who are not covered by |dependents who are not covered by Medicare, Medicaid, or other health programs; | | |
| | |Medicare, Medicaid, or other health programs; |5. Deduct any amount of obligation of the non-recipient spouse due to orders of | | |
| | |5. Deduct any amount of obligation of the non-recipient |judgment or for support by a court, unless there is a garnishment. Income being | | |
| | |spouse due to orders of judgment or for support by a court,|garnished by the court is countable as unearned income. | | |
| | |unless there is a garnishment. Income being garnished by |6. The remainder is the amount of unearned income deemed to the client. | | |
| | |the court is countable as unearned income. |7. The deemed unearned income shall be considered income to the client and shall| | |
| | |6. The remainder is the amount of unearned income deemed to|be deducted, together with any other income, from the grant of the client. | | |
| | |the client. | | | |
| | |7. The deemed unearned income shall be considered income to| | | |
| | |the client and shall be deducted, together with any other | | | |
| | |income, from the grant of the client. | | | |
|3.534 |Clarification |C. A sponsor's income can only be deemed towards the |C. IF A CLIENT’S SPOUSE IS RECEIVING ADULT FINANCIAL GRANT PAYMENTS, SSI |Added rules to clarify when a |No |
| |Needed |non-citizen they sponsor. To determine the amount of earned|BENEFITS, OR MEDICAID ASSISTANCE AND HAS INCOME NO GREATER THAN THE OAP LIMIT, |spouse's income is excluded from | |
| | |and unearned income to deem from a sponsor(s) to a client, |HIS OR HER INCOME SHALL NOT BE CONSIDERED AS AVAILABLE TO THE CLIENT AND SHALL |deeming. | |
| | |calculate, as follows:1. The total earned and unearned |NOT BE DEEMED. IF A CLIENT’S SPOUSE IS INSTITUTIONALIZED AND THE CLIENT HAS | | |
| | |income of the sponsor are added together.2. The following |RETAINED THE MINIMUM MONTHLY MAINTENANCE NEEDS ALLOWANCE (MMMNA), THE MMMNA | | |
| | |deductions are subtracted from the total income of the |SHALL BE DEDUCTED FROM THE INSTITUTIONALIZED SPOUSE’S TOTAL INCOME. A sponsor's | | |
| | |sponsor:a. A deduction for the sponsor equal to the current|income can only be deemed towards the non-citizen they sponsor. To determine the| | |
| | |SSI benefit standard for an individual for the month in |amount of earned and unearned income to deem from a sponsor(s) to a client, | | |
| | |which eligibility is being determined; plusb. A deduction |calculate, as follows: | | |
| | |for the sponsor's spouse living in the same household with |1. The total earned and unearned income of the sponsor are added together. | | |
| | |the sponsor, equal to one-half the current SSI benefit |2. The following deductions are subtracted from the total income of the sponsor:| | |
| | |standard for an individual; or a deduction for the |a. A deduction for the sponsor equal to the current SSI benefit standard for an | | |
| | |sponsor's spouse, who is also a co-sponsor of the |individual for the month in which eligibility is being determined; plus, | | |
| | |non-citizen, equal to the current SSI benefit standard for |b. A deduction for the sponsor's spouse living in the same household with the | | |
| | |an individual; plus,c. A deduction equal to one-half the |sponsor, equal to one-half the current SSI benefit standard for an individual; | | |
| | |SSI benefit standard for an individual for each person who |or a deduction for the sponsor's spouse, who is also a co-sponsor of the | | |
| | |is a dependent of the sponsor (other than the non-citizen |non-citizen, equal to the current SSI benefit standard for an individual; plus, | | |
| | |and the non-citizen's spouse).3. The difference between the|c. A deduction equal to one-half the SSI benefit standard for an individual for | | |
| | |total income and the total deductions is deemed as unearned|each person who is a dependent of the sponsor (other than the non-citizen and | | |
| | |income to the non-citizen. This deemed income is added to |the non-citizen's spouse). | | |
| | |the non-citizen's own income to determine the total |3. The difference between the total income and the total deductions is deemed as| | |
| | |countable income.4. Compare the non-citizen's countable |unearned income to the non-citizen. This deemed income is added to the | | |
| | |income to the income standard of the Adult Financial |non-citizen's own income to determine the total countable income. | | |
| | |program for which the non-citizen is applying to determine |4. Compare the non-citizen's countable income to the income standard of the | | |
| | |eligibility and/or the benefit amount.5. If more than one |Adult Financial program for which the non-citizen is applying to determine | | |
| | |non-citizen has the same sponsor, deem all of the sponsor's|eligibility and/or the benefit amount. | | |
| | |income to each non-citizen. Do not divide the sponsor's |5. If more than one non-citizen has the same sponsor, deem all of the sponsor's | | |
| | |income among the non-citizens. |income to each non-citizen. Do not divide the sponsor's income among the | | |
| | | |non-citizens. | | |
|3.534 |New Rule |D. NEW |D. A SPONSOR'S INCOME CAN ONLY BE DEEMED TO THE NON-CITIZEN CLIENT HE OR SHE |Moved rule from previous letter. |No |
| |Addition | |SPONSORS. THE AMOUNT OF EARNED AND UNEARNED INCOME TO DEEM FROM A SPONSOR(S) TO | | |
| | | |A NON-CITIZEN CLIENT IS CALCULATED AS FOLLOWS: | | |
| | | |1. THE TOTAL GROSS EARNED AND UNEARNED INCOME OF THE SPONSOR ARE ADDED TOGETHER.| | |
| | | |2. THE FOLLOWING DEDUCTIONS ARE SUBTRACTED FROM THE TOTAL GROSS INCOME OF THE | | |
| | | |SPONSOR: | | |
| | | |A. A DEDUCTION FOR THE SPONSOR EQUAL TO THE CURRENT SSI BENEFIT STANDARD, AS | | |
| | | |DEFINED IN SECTION 3.510, FOR AN INDIVIDUAL FOR THE MONTH IN WHICH ELIGIBILITY | | |
| | | |IS BEING DETERMINED; PLUS, | | |
| | | |B. A DEDUCTION FOR THE SPONSOR'S SPOUSE LIVING IN THE SAME HOUSEHOLD WITH THE | | |
| | | |SPONSOR, EQUAL TO ONE-HALF THE CURRENT SSI BENEFIT STANDARD. AS DEFINED IN | | |
| | | |SECTION 3.510, FOR AN INDIVIDUAL; OR A DEDUCTION FOR THE SPONSOR'S SPOUSE, WHO | | |
| | | |IS ALSO A CO-SPONSOR OF THE NON-CITIZEN, EQUAL TO THE CURRENT SSI BENEFIT | | |
| | | |STANDARD FOR AN INDIVIDUAL; PLUS, | | |
| | | |C. A DEDUCTION EQUAL TO ONE-HALF THE SSI BENEFIT STANDARD, AS DEFINED IN SECTION| | |
| | | |3.510, FOR AN INDIVIDUAL FOR EACH PERSON WHO IS A DEPENDENT OF THE SPONSOR | | |
| | | |(OTHER THAN THE NON-CITIZEN CLIENT AND THE NON-CITIZEN CLIENT'S SPOUSE), AS | | |
| | | |DEFINED IN SECTION 3.520.68.B.2.B.1. | | |
| | | |3. THE DIFFERENCE BETWEEN THE TOTAL INCOME AND THE TOTAL DEDUCTIONS IS DEEMED AS| | |
| | | |UNEARNED INCOME TO THE NON-CITIZEN CLIENT. THIS DEEMED INCOME IS ADDED TO THE | | |
| | | |NON-CITIZEN CLIENT'S OWN INCOME TO DETERMINE THE TOTAL COUNTABLE INCOME. | | |
| | | |4. THE NON-CITIZEN CLIENT'S COUNTABLE INCOME IS COMPARED TO THE INCOME STANDARD | | |
| | | |OF THE ADULT FINANCIAL PROGRAM FOR WHICH THE NON-CITIZEN CLIENT IS APPLYING TO | | |
| | | |DETERMINE ELIGIBILITY AND/OR THE GRANT PAYMENT AMOUNT. | | |
| | | |5. IF MORE THAN ONE NON-CITIZEN CLIENT HAS THE SAME SPONSOR, ALL OF THE | | |
| | | |SPONSOR'S INCOME IS DEEMED TO EACH NON-CITIZEN CLIENT. DO NOT DIVIDE THE | | |
| | | |SPONSOR'S INCOME AMONG THE NON-CITIZEN CLIENTS. | | |
|3.540 |Clarification |The Aid to the Needy Disabled State Only (AND-SO) program |The Aid to the Needy Disabled State Only (AND-SO) program provides interim |All rules for the AND-CS program have|No |
| |Needed |provides interim assistance to clients age eighteen (18) |assistance to clients age eighteen (18) through fifty-nine (59) years of age |been moved to a new section specific | |
| | |through fifty-nine (59) years of age (unless diagnosed with|(unless diagnosed with blindness, then age zero (0) through 59 years of age); |to that program. This was a request | |
| | |blindness, then age zero (0) through 59 years of age); who |who are disabled or blind but have not been approved for Supplemental Security |from stakeholders. | |
| | |are disabled or blind but have not been approved for |Income (SSI) or Social Security Disability Insurance (SSDI). INDIVIDUALS ARE | | |
| | |Supplemental Security Income (SSI) or Social Security |REQUIRED TO MEET THE TOTAL DISABILITY REQUIREMENTS IDENTIFIED IN THIS SECTION, | | |
| | |Disability Insurance (SSDI). The AND-Colorado Supplement |IN ADDITION TO THE NON-FINANCIAL AND FINANCIAL ELIGIBILITY REQUIREMENTS. | | |
| | |(AND-CS) program provides a supplemental payment for |INDIVIDUALS WHO ARE PARTIALLY DISABLED OR HAVE A SHORT-TERM DISABILITY ARE NOT | | |
| | |client's age zero (0) to 59 who are receiving SSI due to a |ELIGIBLE. The AND-Colorado Supplement (AND-CS) program provides a supplemental | | |
| | |disability or blindness, but are not receiving the full SSI|payment for client's age zero (0) to 59 who are receiving SSI due to a | | |
| | |grant standard. |disability or blindness, but are not receiving the full SSI grant standard. | | |
|3.540 |Clarification |B. The total AND-CS grant standard is $771.00, effective |B. The total AND-CS grant standard is $771.00, effective January 1, 2019. |All rules for the AND-CS program have|No |
| |Needed |January 1, 2019. | |been moved to a new section specific | |
| | | | |to that program. This was a request | |
| | | | |from stakeholders. | |
|3.540 |Clarification |C. The grant standards for AND-SO and AND-CS shall be |BC. The grant standards for AND-SO and AND-CS shall be adjusted as needed to |All rules for the AND-CS program have|No |
| |Needed |adjusted as needed to remain within available |remain within available appropriations. Appeals shall not be allowed for grant |been moved to a new section specific | |
| | |appropriations. Appeals shall not be allowed for grant |standard adjustments necessary to stay within available appropriations. |to that program. This was a request | |
| | |standard adjustments necessary to stay within available | |from stakeholders. | |
| | |appropriations. | | | |
|3.540 |Clarification |D. In addition to the regular monthly AND-CS grant |D. In addition to the regular monthly AND-CS grant payments, supplemental |All rules for the AND-CS program have|No |
| |Needed |payments, supplemental payments necessary to comply with |payments necessary to comply with the federal Maintenance of Effort (MOE) |been moved to a new section specific | |
| | |the federal Maintenance of Effort (MOE) requirements may be|requirements may be provided. These payments are supplements to regular grant |to that program. This was a request | |
| | |provided. These payments are supplements to regular grant |payments, are not entitlements, and do not affect grant standards. Appeals shall|from stakeholders. | |
| | |payments, are not entitlements, and do not affect grant |not be allowed for MOE payment adjustments. | | |
| | |standards. Appeals shall not be allowed for MOE payment | | | |
| | |adjustments. | | | |
|3.540 |Clarification |E. Effective January 1, 2019, the maximum ISM amount for |E. Effective January 1, 2019, the maximum ISM amount for shelter, including |All rules for the AND-CS program have|No |
| |Needed |shelter, including utilities, is $277.00. |utilities, is $277.00. |been moved to a new section specific | |
| | | | |to that program. This was a request | |
| | | | |from stakeholders. | |
|3.540.1 |Clarification |“Administrative error” means the county department |“Administrative error” means the county department incorrectly applied the |Unnecessary definition as there is no|No |
| |Needed |incorrectly applied the disability certification, as |disability certification, as documented on the medical certification form, |distinction between administrative or| |
| | |documented on the medical certification form, and/or |and/or incorrectly applied the social factors used to determine the client's |disability determination errors. | |
| | |incorrectly applied the social factors used to determine |residual functional capacity. | | |
| | |the client's residual functional capacity. | | | |
|3.540.1 |Clarification |“Aid to the Needy Disabled (AND)” includes the Aid to the |“Aid to the Needy Disabled (AND)” includes the Aid to the Needy Disabled-State |Definition unnecessary as it is |No |
| |Needed |Needy Disabled-State Only (AND-SO) , which include persons |Only (AND-SO) , which include persons disabled due to blindness, and the Aid to |currently defined under Program | |
| | |disabled due to blindness, and the Aid to the Needy |the Needy Disabled-Colorado Supplement (AND-CS) programs. |Purpose section. | |
| | |Disabled-Colorado Supplement (AND-CS) programs. | | | |
|3.540.1 |Clarification |“Disability” means a physical or mental impairment that is |“Disability” means a physical or mental impairment that is disabling and |Removed unnecessary definition. Now |No |
| |Needed |disabling and combined with other factors impacting the |combined with other factors impacting the client's residual functional capacity |using total disability to align with | |
| | |client's residual functional capacity substantially |substantially precludes the client from engaging in a useful occupation in any |statute. | |
| | |precludes the client from engaging in a useful occupation |employment in the community for which he /she has competence as a wage earner or| | |
| | |in any employment in the community for which he/she has |through self-employment. Disability also means blindness, as defined in this | | |
| | |competence as a wage earner or through self-employment. |Section. | | |
| | |Disability also means blindness, as defined in this | | | |
| | |Section. | | | |
|3.540.1 |Clarification |“Disability determination error” means the prior |“Disability determination error” means the prior determination of disability was|Unnecessary definition as there is no|No |
| |Needed |determination of disability was incorrect, based on |incorrect, based on documented evidence. |distinction between administrative or| |
| | |documented evidence. | |disability determination errors. | |
|3.540.1 |Clarification |“Improvement” related to the client's medical condition |“Improvement” related to the client's medical condition means that in comparison|Clarified Substantial gainful |No |
| |Needed |means that in comparison to the most recent medical |to the most recent medical certification, the physical or mental impairment(s) |activity rather than useful | |
| | |certification, the physical or mental impairment(s) which |which prevented the client from engaging in a SGAuseful occupation has decreased|occupation. | |
| | |prevented the client from engaging in a useful occupation |to the point that the client is able to engage in a SGA useful occupation or the| | |
| | |has decreased to the point that the client is able to |client's residual functional capacity has increased to the point that the client| | |
| | |engage in a useful occupation or the client's residual |is able to engage in a SGA useful occupation. | | |
| | |functional capacity has increased to the point that the | | | |
| | |client is able to engage in a useful occupation. | | | |
|3.540.1 |Clarification |“Residual functional capacity” means the client's remaining|“Residual functional capacity” means the client's MAXIMUM remaining ability to |Align with SSA definition. |No |
| |Needed |ability to perform work of any type despite some disabling |perform work of any type ON A REGULAR AND CONTINUING BASIS despite some | | |
| | |limitations. |disabling limitations. | | |
|3.540.1 |Deletion |“Self-supporting” means a job or self-employment that |“Self-supporting” means a job or self-employment that provides wages or income |Definition no longer needed as not |No |
| | |provides wages or income in an amount greater than the |in an amount greater than the AND-SO grant standard. |used in rule body. | |
| | |AND-SO grant standard. | | | |
|3.540.1 |Clarification |“Semi-skilled work” means sufficient knowledge and ability |“Semi-skilled work” means sufficient knowledge and ability is required to |Align with SSA definition. | |
| |Needed |is required to complete a job. The job tasks are not so |complete a job. The job tasks are not so specialized as to be labeled “skilled” | | |
| | |specialized as to be labeled “skilled” work, but some |work, but some specialized training is required. A semi-skilled employee can | | |
| | |specialized training is required. A semi-skilled employee |work with a moderate level of supervision. | | |
| | |can work with a moderate level of supervision. | | | |
|3.540.1 |Clarification |“Skilled work” means special knowledge, expertise, or |“Skilled work” means special knowledge, expertise, or ability is required to |Align with SSA definition. | |
| |Needed |ability is required to complete the job. This may be |complete the job. This may be learned in higher education or in a technical | | |
| | |learned in higher education or in a technical school. The |school. The skill could also be learned via on-the-job or other vocational | | |
| | |skill could also be learned via on-the-job or other |education. A skilled employee is capable of working independently and | | |
| | |vocational education. A skilled employee is capable of |accurately. | | |
| | |working independently and accurately. | | | |
|3.540.1 |New Rule |“SUBSTANTIAL GAINFUL ACTIVITY (SGA)”- NEW |“SUBSTANTIAL GAINFUL ACTIVITY (SGA)” MEANS THE PERFORMANCE OF SIGNIFICANT |Created definition in the appropriate|No |
| |Addition | |PHYSICAL AND/OR MENTAL ACTIVITIES IN WORK FOR PAY OR PROFIT, OR IN WORK OF A |section of rules-previously embodied | |
| | | |TYPE GENERALLY PERFORMED FOR PAY OR PROFIT, REGARDLESS OF THE LEGALITY OF THE |outside of definitions section. | |
| | | |WORK. “SIGNIFICANT ACTIVITIES” ARE USEFUL IN THE ACCOMPLISHMENT OF A JOB OR THE | | |
| | | |OPERATION OF A BUSINESS, AND HAVE ECONOMIC VALUE. WORK MAY BE SUBSTANTIAL EVEN | | |
| | | |IF IT IS PERFORMED ON A PART-TIME BASIS, OR EVEN IF THE INDIVIDUAL DOES LESS, IS| | |
| | | |PAID LESS, OR HAS LESS RESPONSIBILITY THAN IN PREVIOUS WORK. WORK ACTIVITY IS | | |
| | | |GAINFUL IF IT IS THE KIND OF WORK USUALLY DONE FOR PAY, WHETHER IN CASH OR IN | | |
| | | |KIND, OR FOR PROFIT, WHETHER OR NOT A PROFIT IS REALIZED. ACTIVITIES INVOLVING | | |
| | | |SELF-CARE, HOUSEHOLD TASKS, UNPAID TRAINING, HOBBIES, THERAPY, SCHOOL | | |
| | | |ATTENDANCE, CLUBS, SOCIAL PROGRAMS, ETC., ARE NOT GENERALLY CONSIDERED TO BE | | |
| | | |SGA. | | |
|3.540.1 |New Rule | |“TOTAL DISABILITY” MEANS A PHYSICAL OR MENTAL IMPAIRMENT WHICH IS DISABLING AND |Align with language in statute. | |
| |Addition | |WHICH, BECAUSE OF OTHER FACTORS SUCH AS AGE, TRAINING, EXPERIENCE, AND SOCIAL | | |
| | | |SETTING, SUBSTANTIALLY PRECLUDES THE PERSON HAVING SUCH DISABILITY FROM ENGAGING| | |
| | | |IN A USEFUL OCCUPATION AS A HOMEMAKER OR AS A WAGE EARNER IN ANY EMPLOYMENT | | |
| | | |WHICH EXISTS IN THE COMMUNITY FOR WHICH HE OR SHE HAS COMPETENCE, AS DEFINED IN | | |
| | | |SECTION 26-2-103(14)(A), C.R.S. | | |
|3.540.1 |Clarification |“Unskilled work” means a job that requires little or no |“Unskilled work” means a job that requires little or no special training or |Align with SSA definition. | |
| |Needed |special training or experience and involves performing |experience and involves performing simple duties. Little or no independent | | |
| | |simple duties. Little or no independent judgment is |judgment is required to be made by the employee and a moderate to heavy level of| | |
| | |required to be made by the employee and a moderate to heavy|supervision in the job is required. | | |
| | |level of supervision in the job is required. | | | |
|3.540.1 |Clarification |“Useful occupation” means any occupation which can be |“Useful occupation” means any occupation which can be considered as |Using Substantial Gainful Activity |No |
| |Needed |considered as self-supporting. Protected employment, such |self-supporting. Protected employment, such as a sheltered workshop or enclave, |rather than useful occupation. | |
| | |as a sheltered workshop or enclave, shall not be considered|shall not be considered a useful occupation. | | |
| | |a useful occupation. | | | |
|3.541 |New Rule | |A. TO QUALIFY FOR AND-SO, THE CLIENT MUST MEET BOTH THE NON-FINANCIAL AND |Added sentence to clarify the program| |
| |Addition | |FINANCIAL ELIGIBILITY REQUIREMENTS AND HAVE A TOTAL DISABILITY AS DEFINED IN |requires both financial and | |
| | | |SECTION 3.540.1 AND PURSUANT TO SECTIONS 26-2-103(14)(A) AND 26-2-111(4)(A), |non-financial pieces of eligibility. | |
| | | |C.R.S. | | |
|3.541 |Clarification |A. To meet the disability eligibility requirement for |A. To meet the disability eligibility requirement for AND-CS, the client must be|All rules for the AND-CS program have|No |
| |Needed |AND-CS, the client must be approved for Supplemental |approved for Supplemental Security Income (SSI) due to a disability or |been moved to a new section specific | |
| | |Security Income (SSI) due to a disability or blindness. The|blindness. The county department shall verify SSI eligibility through SVES and |to that program. This was a request | |
| | |county department shall verify SSI eligibility through SVES|document in the statewide automated system case comments. |from stakeholders. | |
| | |and document in the statewide automated system case | | | |
| | |comments. | | | |
|3.541 |Clarification |B. To meet the disability requirement for AND-SO, the |B. 1. To meet the TOTAL disability requirement for AND-SO, the client shall be |Adjusting lettering due to |No |
| |Needed |client shall be certified by a medical professional as |certified by a medical professional as defined by Section 3.541.1., under one of|strikethrough in previous letter. | |
| | |defined by Section 3.541.1, under one of the following |the following categories: |Eliminating language found in | |
| | |categories:1. Disabled due to substance abuse, as outlined |1. Disabled due to substance abuse, as outlined in Section 3.541.3; or, |incorporation by reference. Using | |
| | |in Section 3.541.3; or,2. Totally disabled, as outlined in |2. Totally disabled, as outlined in Section 3.541.BC; or, |total disability definition. | |
| | |Section 3.541, C; or,3. With a medical disability that |3. With a medical disability that prevents the client from working in his OR | | |
| | |prevents the client from working in his/her usual |/her usual occupation and when the disability is combined with additional | | |
| | |occupation and when the disability is combined with |functional deficits related to certain social factors, the client's residual | | |
| | |additional functional deficits related to certain social |functional capacity to work in any type of employment is severely disabling, as | | |
| | |factors, the client's residual functional capacity to work |outlined in Section 3.541.C-ED-G. | | |
| | |in any type of employment is severely disabling, as |C. 2. To be determined totally disabled tThe client shall MUST meet the criteria| | |
| | |outlined in Section 3.541, D-F. |below ANDor have A other PHYSICAL OR MENTAL IMPAIRMENT THAT IS disabling AS | | |
| | | |conditions identified by the Social Security Administration (SSA): IN THE | | |
| | | |LISTING OF IMPAIRMENTS AND CONSISTENT WITH FEDERAL REGULATIONS FOUND AT 20 CFR, | | |
| | | |APPENDIX 1 TO SUBPART P OF PART 404 (SEPTEMBER 24, 2019), WHICH ARE HEREIN | | |
| | | |INCORPORATED BY REFERENCE. THIS RULE DOES NOT CONTAIN ANY LATER AMENDMENTS OR | | |
| | | |EDITIONS. THESE REGULATIONS ARE AVAILABLE AT NO COST AT . | | |
| | | |THESE REGULATIONS ARE ALSO AVAILABLE FOR PUBLIC INSPECTION AND COPYING AT THE | | |
| | | |COLORADO DEPARTMENT OF HUMAN SERVICES, DIRECTOR OF THE EMPLOYMENT AND BENEFITS | | |
| | | |DIVISION, 1575 SHERMAN STREET, DENVER, COLORADO, 80203, OR AT ANY STATE | | |
| | | |PUBLICATIONS LIBRARY DURING REGULAR BUSINESS HOURS. | | |
| | | |3. THE TOTAL DISABILITY MUST BE EXPECTED TO LAST SIX (6) MONTHS OR LONGER. | | |
| | | |1. Be blind or have a physical or mental impairment that is severely disabling. | | |
| | | |These conditions are generally permanent, fully debilitating, and may be | | |
| | | |expected to result in death. These impairments include: | | |
| | | |a. Respiratory disorders, such as cystic fibrosis, chronic persistent lung | | |
| | | |infections, or chronic pulmonary insufficiency; | | |
| | | |b. Cardiovascular disorders, such as chronic heart failure despite medication, | | |
| | | |congenital heart disease, or recurrent arrhythmias not related to a reversible | | |
| | | |cause; | | |
| | | |c. Digestive disorders, such as liver dysfunction or gastrointestinal | | |
| | | |hemorrhage; | | |
| | | |d. Genitourinary disorders, such as chronic renal failure resulting in chronic | | |
| | | |hemodialysis; | | |
| | | |e. Hematological disorders, such as sickle-cell disease, hemophilia, or aplastic| | |
| | | |anemia; | | |
| | | |f. Congenital disorders, such as fragile X syndrome or phenylketonuria (PKU); | | |
| | | |g. Neurological disorders, such as multiple sclerosis, muscular dystrophy, head | | |
| | | |trauma, or cerebral palsy; | | |
| | | |h. Disorders of speech or other senses, such as blindness, tinnitus in | | |
| | | |combination with progressive hearing loss, or loss of speech; | | |
| | | |i. Musculoskeletal disorders, such as a gross anatomical deformity, spinal | | |
| | | |stenosis or other spinal disorder resulting in nerve root compression, or | | |
| | | |amputation of both hands; | | |
| | | |j. Mental or cognitive disorders, such as schizophrenia, affective disorders, | | |
| | | |personality disorders, intellectual and developmental disabilities, or substance| | |
| | | |abuse to the extent that the disorder results in at least two of the following | | |
| | | |activities: | | |
| | | |1) Marked restriction of activities of daily living; or, | | |
| | | |2) Marked difficulties in maintaining social functioning; or, | | |
| | | |3) Marked difficulties in maintaining concentration, persistence, or pace; or, | | |
| | | |4) Repeated episodes of decompensation, each of extended duration. | | |
| | | |2. Have an impairment or blindness that is expected to last twelve (12) months | | |
| | | |or more; and, | | |
| | | |3. Must be completely unable to participate in a substantial gainful activity. | | |
| | | |Substantial gainful activity (SGA) means a level of work activity and earnings | | |
| | | |that is both substantial and gainful. The activity involves performance of | | |
| | | |significant physical or mental activities, or a combination of both. For a work | | |
| | | |activity to be considered substantial it does not need to equal full time. If | | |
| | | |impairment is anything other than blindness, earnings averaging over the current| | |
| | | |AND grant standard a month generally demonstrates a SGA. Gainful work activity | | |
| | | |is: | | |
| | | |a. Work performed for pay or profit; or, | | |
| | | |b. Work generally performed for pay or profit; or, | | |
| | | |c. Work intended for profit, whether or not a profit is realized. | | |
|3.541 |Clarification |E. To determine if the client's residual functional |BE. To determine if the client's DISABILITY residual functional capacity would |Adjusting lettering due to |No |
| |Needed |capacity would preclude him/her from employment, or from |preclude him/her from employment, or from learning skills necessary for |strikethrough in previous letter. | |
| | |learning skills necessary for employment, the county |employment, the county department shall REVIEW AND document other medical data. | | |
| | |department shall document other medical data and functional|and functional strengths and deficits, as follows: | | |
| | |strengths and deficits, as follows:1. Review medical |1. THE COUNTY DEPARTMENT SHALL RReview STATE PRESCRIBED medical CERTIFICATION | | |
| | |records from licensed medical personnel; and,2. Review |FORM(S) AND/OR ANY MEDICAID DISABILITY DETERMINATION records from licensed | | |
| | |disability assessments performed by other disability |medical personnel; and, | | |
| | |specialists; and,3. Shall weigh more heavily:a. A medical |2. Review disability assessments performed by other disability specialists; and,| | |
| | |certification form completed by the client's usual doctor |3. THE COUNTY DEPARTMENT SShall weigh more heavily: A DISABILITY DETERMINATION | | |
| | |than a form completed by a doctor who has had no previous |COMPLETED THROUGH A MEDICAID DISABILITY DETERMINATION PROCESS THAN A MEDICAL | | |
| | |history with the client, unless the doctor with no known |CERTIFICATION FORM COMPLETED BY A MEDICAL PROVIDER. | | |
| | |history is a specialist in the field of medicine pertaining|A. A medical certification form completed by the client's usual doctor than a | | |
| | |to the client's disability, if there is more than one form |form completed by a doctor who has had no previous history with the client, | | |
| | |provided by the applicant.b. A disability determination |unless the doctor with no known history is a specialist in the field of medicine| | |
| | |completed through a Medicaid disability determination |pertaining to the client's disability, if there is more than one form provided | | |
| | |process than a medical certification form completed by a |by the applicant. | | |
| | |medical provider. |B. A disability determination completed through a Medicaid disability | | |
| | | |determination process than a medical certification form completed by a medical | | |
| | | |provider. | | |
|3.541 |Clarification |F. The county department shall review all documentation |C.F. The county department shall review all documentation collected to determine|Adjusting lettering due to |No |
| |Needed |collected to determine if certain social factors combined |if THE CLIENT IS ELIGIBLE FOR AND-SO certain social factors combined with a |strikethrough in previous letter. | |
| | |with a medical disability reasonably prevent the client |medical disability reasonably prevent the client from working or from learning | | |
| | |from working or from learning new skills. |new skills. | | |
|3.541.1 |Clarification |A. Medical certification shall be completed on the State |A. Medical certification shall be completed on the State Department's prescribed|Technical clean-up. |No |
| |Needed |Department's prescribed medical report form.1. The county |medical CERTIFICATION report form. | | |
| | |department shall provide the form to the client or the |1. The county department shall provide the form to the client or the medical | | |
| | |medical provider at the time of application or interview |provider at the time of application or interview and PRIOR TO THE at each | | |
| | |and at each re-examination date. The client shall arrange |re-examination DUE date. The client shall arrange for the medical exam with an | | |
| | |for the medical exam with an appropriate medical provider |appropriate medical provider of his OR /her choosing. | | |
| | |of his/her choosing.a. It is the county department's |a. It is the county department's responsibility to provide the medical form to | | |
| | |responsibility to provide the medical form to the client or|the client or the client's provider of choice within ten (10) calendar days of | | |
| | |the client's provider of choice within ten (10) calendar |application. | | |
| | |days of application.b. If the client fails to make |b. If the client fails to make arrangement for or submit to the required medical| | |
| | |arrangement for or submit to the required medical |examination within thirty (30) calendar days following the interview, the client| | |
| | |examination within thirty (30) calendar days following the |has failed to comply with the requirements for eligibility and the CLIENT’S | | |
| | |interview, the client has failed to comply with the |PARTICIPATION IN THE program will be denied or discontinued FOLLOWING THE | | |
| | |requirements for eligibility and the program will be denied|POLICIES OUTLINED IN SECTION 3.554. The county department shall provide a notice| | |
| | |or discontinued. The county department shall provide a |of adverse action to the client. | | |
| | |notice of adverse action to the client.c. If the client |c. If the client requests a second opinion, the subsequent medical examination | | |
| | |requests a second opinion, the subsequent medical |shall be at the client's expense. The county department shall not be obligated | | |
| | |examination shall be at the client's expense. The county |to pay for more than one medical exam per client per application or medical | | |
| | |department shall not be obligated to pay for more than one |certification period. | | |
| | |medical exam per client per application or medical |d. If the county department requests a second opinion, the subsequent medical | | |
| | |certification period.d. If the county department requests a|examination shall be at the county department's expense. | | |
| | |second opinion, the subsequent medical examination shall be|e. The county department shall review the medical certification form for | | |
| | |at the county department's expense.e. The county department|completeness and to determine whether the information submitted is in conflict | | |
| | |shall review the medical certification form for |with other medical data, records, documentation, and information and/or | | |
| | |completeness and to determine whether the information |observations received from the client, family, friends, professionals, community| | |
| | |submitted is in conflict with other medical data, records, |members, or the county department. The county department shall: | | |
| | |documentation, and information and/or observations received|1) Ensure any incomplete forms are returned to the provider to be completed; | | |
| | |from the client, family, friends, professionals, community |and, | | |
| | |members, or the county department. The county department |2) Consult and verify with the provider any questionable or contradictory | | |
| | |shall:1) Ensure any incomplete forms are returned to the |information. | | |
| | |provider to be completed; and,2) Consult and verify with |2. The medical certification shall be completed and signed by a MEDICAL PROVIDER| | |
| | |the provider any questionable or contradictory information.|AS DEFINED IN SECTION 3.540.1 Colorado licensed physician, psychiatrist, | | |
| | |2. The medical certification shall be completed and signed |licensed psychologist, licensed clinical social worker, licensed professional | | |
| | |by a Colorado licensed physician, psychiatrist, licensed |counselor, physician's assistant, an advanced practice nurse, or a registered | | |
| | |psychologist, licensed clinical social worker, licensed |nurse. The physician may be a general practitioner or a specialist. Medical | | |
| | |professional counselor, physician's assistant, an advanced |certification for blindness shall be completed only by an ophthalmologist | | |
| | |practice nurse, or a registered nurse. The physician may be|licensed in Colorado. | | |
| | |a general practitioner or a specialist. Medical |a. The client shall be allowed to choose a medical provider licensed in a | | |
| | |certification for blindness shall be completed only by an |bordering state when the nearest Colorado provider is more than one hour from | | |
| | |ophthalmologist licensed in Colorado.a. The client shall be|the client's home. | | |
| | |allowed to choose a medical provider licensed in a |b. No other health care or counseling professionals shall be allowed to complete| | |
| | |bordering state when the nearest Colorado provider is more |the medical form.THE MEDICAL CERTIFICATION MUST BE DATED NO EARLIER THAN NINETY | | |
| | |than one hour from the client's home.b. No other health |(90) DAYS BEFORE THE APPLICATION OR RECERTIFICATION. | | |
| | |care or counseling professionals shall be allowed to |3. The medical certification form shall contain the disability limitations, | | |
| | |complete the medical form.3. The medical certification form|including the length and scope of the disability, if any; and, | | |
| | |shall contain the disability limitations, including the |4. The medical re-examination date shall be based upon the date of the | | |
| | |length and scope of the disability, if any; and,4. The |APPLICATION OR REDETERMINATION initial exam and the length of the disability, as| | |
| | |medical re-examination date shall be based upon the date of|documented by the medical provider, but shall not exceed twelve (12) months. | | |
| | |the initial exam and the length of the disability, as |However, if the client has been determined disabled by the State disability | | |
| | |documented by the medical provider, but shall not exceed |review contractor, the medical re-examination date shall be established by the | | |
| | |twelve (12) months. However, if the client has been |review contractor. | | |
| | |determined disabled by the State disability review | | | |
| | |contractor, the medical re-examination date shall be | | | |
| | |established by the review contractor. | | | |
|3.541.1 |Clarification |B. The county department shall authorize payment for |B. THE MEDICAL EXAMINATION DETERMINING THE CLIENT’S DISABILITY AND COMPLETION OF|Clarified that Medicaid should be | No |
| |Needed |examinations for AND-SO medical certification |THE MEDICAL CERTIFICATION FORM SHALL BE COMPLETED BY A MEDICAL PROVIDER THAT |used for provider reimbursement and | |
| | |examinations.1. Fees and costs shall be reimbursed to the |ACCEPTS MEDICAID WHENEVER POSSIBLE WHEN THE CLIENT IS RECEIVING MEDICAID. IF THE|then county funds. | |
| | |county department using the 80% state share, 20% county |CLIENT’S PRIMARY MEDICAL PROVIDER DOES NOT ACCEPT MEDICAID OR THE CLIENT IS NOT | | |
| | |share reimbursement methodology.2. The county department |RECEIVING MEDICAID, TThe county department shall authorize payment for | | |
| | |shall set the provider fee and shall make such payments in |examinations for AND-SO medical certification examinations. | | |
| | |a timely manner.3. Providers shall accept fees for services|1. Fees and costs shall be reimbursed to the county department using the 80% | | |
| | |as negotiated as payment in full. No client shall be |state share, 20% county share reimbursement methodology DESCRIBED IN SECTION | | |
| | |assessed any additional or supplementary fee.4. Providers |26-1-122(3)(B), C.R.S. | | |
| | |may be excluded from completing medical certification |2. The county department shall set the provider fee and shall make such payments| | |
| | |examinations if there is adequate documentation that the |in a timely manner. | | |
| | |provider:a. Is not completing a thorough examination on |3. Providers shall accept fees for services as negotiated as payment in full. No| | |
| | |which to base his/her decision; or,b. Falsified a medical |client shall be assessed any additional or supplementary fee. | | |
| | |certification form. |4. Providers may be excluded from completing medical certification examinations | | |
| | | |if there is adequate documentation that the provider: | | |
| | | |a. Is not completing a thorough examination on which to base his OR /her | | |
| | | |decision; or, | | |
| | | |b. Falsified a medical certification form. | | |
|3.541.1 |Clarification |C. A determination of medical eligibility shall be |C. A determination of medical eligibility shall be completed by each medical |Clarified what needs to occur when a | No |
| |Needed |completed by each medical re-examination date. The county |re-examination date. The county department shall be allowed to request the |re-examination is due. | |
| | |department shall be allowed to request the client submit a |client submit a medical re-examination at the time of financial redetermination | | |
| | |medical re-examination at the time of financial |or when the county has information that the client's medical condition may have | | |
| | |redetermination or when the county has information that the|changed. | | |
| | |client's medical condition may have changed.1. At the time |1. PRIOR TO THE At the time of medical re-examination DUE DATE, the county | | |
| | |of medical re-examination the county department shall |department shall SEND A NEW MEDICAL CERTIFICATION FORM obtain a release of | | |
| | |obtain a release of information from the client and send |information from the client and send the prior medical certification forms to | | |
| | |the prior medical certification forms to the client or the |the client or the medical provider. | | |
| | |medical provider.2. The provider shall be required to |2. The provider shall be required to indicate on the form whether there has been| | |
| | |indicate on the form whether there has been any improvement|any improvement in the client's medical condition since the last medical | | |
| | |in the client's medical condition since the last medical |certification. | | |
| | |certification.3. If the client fails to make arrangement |3. If the client fails to make arrangement for or submit the required medical | | |
| | |for or submit the required medical re-examination within |re-examination BY THE REDETERMINATION DUE DATE within ten (10) calendar days of | | |
| | |ten (10) calendar days of the request, the county |the request, the county department shall terminate assistance FOLLOWING THE | | |
| | |department shall terminate assistance and provide notice of|POLICIES OUTLINED IN SECTION 3.554and provide notice of adverse action to the | | |
| | |adverse action to the client. |client. | | |
|3.541.2 |Clarification |A. The county department shall deny or discontinue AND |A. FOLLOWING THE POLICIES OUTLINED IN SECTION 3.554, The county department shall|Deleted definitions, no need to | No |
| |Needed |assistance when:1. There was an administrative or |deny or discontinue AND-SO assistance when: |differentiate error types. | |
| | |disability determination error in the prior disability |1. There was an administrative or disability determination error in the prior | | |
| | |determination. The county department shall gather more |disability determination. The county department shall gather more information on| | |
| | |information on the discrepancies before taking a negative |the discrepancies before taking a negative action on the case.; or, | | |
| | |action on the case.; or,2. There has been improvement in |2. There has been improvement in the client's medical condition and the client | | |
| | |the client's medical condition and the client is no longer |is no longer TOTALLY disabled, as outlined DEFINED in Section 3.540.1. | | |
| | |disabled, as outlined in Section 3.541. Improvement may be |Improvement may be demonstrated by: | | |
| | |demonstrated by:a. Observations, symptoms, or other |a. Observations, symptoms, or other findings which demonstrate positive changes | | |
| | |findings which demonstrate positive changes in the client's|in the client's medical condition; or, | | |
| | |medical condition; or,b. Observations, symptoms, or other |b. Observations, symptoms, or other findings which demonstrate that the effect | | |
| | |findings which demonstrate that the effect of the medical |of the medical impairment(s) on the client has decreased. | | |
| | |impairment(s) on the client has decreased.c. New medical |c. New medical evidence which shows that while the client's underlying condition| | |
| | |evidence which shows that while the client's underlying |may not have changed, advances in medical therapy or technology have reduced or | | |
| | |condition may not have changed, advances in medical therapy|eliminated the adverse effect of the condition on the client; or, | | |
| | |or technology have reduced or eliminated the adverse effect|d. New or improved diagnostic techniques or other medical evaluations show that | | |
| | |of the condition on the client; or,d. New or improved |the client's previously determined medical condition is not as serious as | | |
| | |diagnostic techniques or other medical evaluations show |previously indicated; or, | | |
| | |that the client's previously determined medical condition |e. There has been a change in prognosis; or, | | |
| | |is not as serious as previously indicated; or,e. There has |f. The client has compensated or adjusted to the medical condition which now | | |
| | |been a change in prognosis; or,f. The client has |enables the client to engage in SGA a useful occupation; or, | | |
| | |compensated or adjusted to the medical condition which now |g. The client's medical condition is correctable and the client refuses, without| | |
| | |enables the client to engage in a useful occupation; or,g. |good cause, to obtain prescribed medical treatment to correct the condition. | | |
| | |The client's medical condition is correctable and the |Good cause may include, but is not limited to: | | |
| | |client refuses, without good cause, to obtain prescribed |1) Treatment is contrary to the established teachings of the client's religion, | | |
| | |medical treatment to correct the condition. Good cause may |provided the client can establish he OR SHE observes his OR /her religion; or, | | |
| | |include, but is not limited to:1) Treatment is contrary to |2) Surgery has previously been performed with unsuccessful results and the same | | |
| | |the established teachings of the client's religion, |surgery is again being recommended for the same impairment; or, | | |
| | |provided the client can establish he observes his/her |3) The treatment because of its magnitude (e.g., open heart surgery or organ | | |
| | |religion; or,2) Surgery has previously been performed with |transplant that has less than a 50% chance of improving the client's condition) | | |
| | |unsuccessful results and the same surgery is again being |or unusual nature (e.g., experimental procedures) is very risky; or, | | |
| | |recommended for the same impairment; or,3) The treatment |4) The cost of treatment is prohibitive or cannot be obtained; or, | | |
| | |because of its magnitude (e.g., open heart surgery or organ|3. There has been improvement in the client's residual functional capacity and | | |
| | |transplant that has less than a 50% chance of improving the|the client is not TOTALLY disabled, as outlined DEFINED in Section 3.540.1. | | |
| | |client's condition) or unusual nature (e.g., experimental |Improvement may be demonstrated by: | | |
| | |procedures) is very risky; or,4) The cost of treatment is |a. Observations, symptoms, or other findings which demonstrate positive changes | | |
| | |prohibitive or cannot be obtained; or, |in the client's residual functional capacity; or, | | |
| | | |b. Observations, symptoms, or other findings which demonstrate that the effect | | |
| | | |of the social factors impacting residual functional capacity on the client has | | |
| | | |decreased; or, | | |
| | | |c. New evidence shows that while the client's underlying condition may not have | | |
| | | |changed, the client's vocational abilities and/or residual functional capacity | | |
| | | |has so improved that the client is able to engage in SGA a useful occupation; | | |
| | | |or, | | |
| | | |d. Vocational opportunities for which the client has competence have become | | |
| | | |available in the community; or, | | |
| | | |e. The client has compensated or adjusted to the social factors impacting | | |
| | | |residual functional capacity and the client is able to engage in SGA a useful | | |
| | | |occupation; or, | | |
| | | |f. Residual functional capacity is not a barrier to employment in some type of | | |
| | | |employment that exists in the community. | | |
|3.541.2 |Clarification |B. If the county department has documented evidence that a |B. If the county department has documented evidence that a client is working AND|Modified to just reflect earnings | No |
| |Needed |client is working more than five (5) hours per week as an |RECEIVING more than five (5) hours per week EARNINGS EXCEEDING THE AND-SO GRANT |can't exceed the grant standard. | |
| | |employee, engaged in self-employment with earnings |STANDARD AFTER APPLICABLE DISREGARDS as an employee, engaged in self-employment | | |
| | |exceeding the grant standard, or donating services or work |with earnings exceeding the grant standard, or donating services or work hours | | |
| | |hours without pay as defined in Section 3.520.784, the |without pay as defined in Section 3.520.784, the county department shall deny or| | |
| | |county department shall deny or discontinue the client from|discontinue the client from AND-SO GRANT PAYMENTS benefits FOLLOWING THE | | |
| | |benefits. |POLICIES OUTLINED IN SECTION 3.554. | | |
|3.541.3 |Clarification |For the purpose of AND-SO, when the client's primary |For the purpose of AND-SO, when the client's primary diagnosis is alcoholism or |Added reference to statute. | |
| |Needed |diagnosis is alcoholism or controlled substance addiction, |controlled substance addiction, the following criteria shall apply PURSUANT TO | | |
| | |the following criteria shall apply: |SECTION 26-2-111(4)(E), C.R.S.: | | |
|3.541.3 |Clarification |B. The client shall agree to treatment for addiction to be |B. The client shall agree to treatment for addiction to be eligible for AND-SO. |Clarified that treatment agencies are| |
| |Needed |eligible for AND-SO. Upon consent, the county department |Upon consent, the county department shall refer the client to aN designated |licensed by OBH. | |
| | |shall refer the client to a designated assessment/treatment|assessment/treatment agency of LICENSED BY the STATE DEPARTMENT’S Office of | | |
| | |agency of the Office of Behavioral Health. |Behavioral Health. | | |
|3.541.3 |Clarification |C. The client shall agree to a defined treatment program by|C. The client shall agree to a defined treatment program by the designated |Clarified that treatment agencies are| |
| |Needed |the designated agency. |LICENSED agency. |licensed by OBH. | |
|3.541.3 |Clarification |D. If the client fails to comply with treatment, the |D. If the client fails to comply with treatment, the following steps shall be |Clarifying the discontinuation | No |
| |Needed |following steps shall be followed: |followed: |timeframe. | |
| | |1. The treatment center shall contact the county department|1. The treatment center shall contact the county department within twenty-four | | |
| | |within twenty-four (24) hours of the client's termination |(24) hours of the client's termination from treatment; and, | | |
| | |from treatment; and, |2. The county department shall discontinue the client's State AND-SO assistance | | |
| | |2. The county department shall discontinue the client's |immediately upon termination from treatment EFFECTIVE THE FOLLOWING MONTH WITH | | |
| | |State AND-SO assistance immediately upon termination from |TIMELY NOTICE PROVIDED. | | |
| | |treatment. | | | |
|3.541.3 |Clarification |E. The client shall submit to random testing to ensure the |E. The client shall submit to random testing BY THE DESIGNATED AGENCY to ensure |Adding who is responsible for random | No |
| |Needed |client remains free of alcohol/controlled substance(s). |the client remains free of alcohol/controlled substance(s). |testing. | |
|3.541.3 |Clarification |F. Any time a client tests positive for alcohol or |F. Any time a client tests positive for alcohol or controlled substance(s), the |Clarifying the discontinuation | No |
| |Needed |controlled substance(s), the client shall be warned by the |client shall be warned by the treatment center in writing. A COPY OF THE |timeframe. | |
| | |treatment center in writing. Written warnings shall have a |WWritten warnings shall BE have a copy placed in the client's file and noted as | | |
| | |copy placed in the client's file and noted as either mailed|either mailed or hand delivered. If a client tests positive for alcohol or | | |
| | |or hand delivered. If a client tests positive for alcohol |controlled substance(s) twice in any three-month period, the county department | | |
| | |or controlled substance(s) twice in any three-month period,|shall be notified and the client shall be terminated from AND-SO IMMEDIATELY | | |
| | |the county department shall be notified and the client |EFFECTIVE THE FOLLOWING MONTH WITH TIMELY NOTICE PROVIDED using the five (5) day| | |
| | |shall be terminated from AND-SO using the five (5) day |notice for non-compliance. | | |
| | |notice for non-compliance. | | | |
|3.542 |Clarification |3.542 DETERMINATION |3.542 DETERMINATION OF ELIGIBILITY |Renaming section for clarity | |
| |Needed | | | | |
|3.542 |Clarification |A. The county department shall enter all client, resource, |A. The county department shall enter all client, resource, and income |Moved with technical cleanup to the | No |
| |Needed |and income information into the statewide automated system.|information into the statewide automated system. |"Application Processing" section. | |
| | |1. The county department shall determine eligibility. |1. The county department shall determine eligibility. |Struck through to eliminate | |
| | |2. If the client is missing any verification, the statewide|2. If the client is missing any verification, the statewide automated system or |redundancy. | |
| | |automated system or the county department shall send a |the county department shall send a check list of required verifications to the | | |
| | |check list of required verifications to the client. The |client. The verification check list shall include: | | |
| | |verification check list shall include: |a. A specific list of verifications necessary to determine eligibility; | | |
| | |a. A specific list of verifications necessary to determine |b. The due date for when the verifications must be returned, which shall be ten | | |
| | |eligibility; |(10) calendar days from the date of the verification checklist; and, | | |
| | |b. The due date for when the verifications must be |c. Notification that if the client fails to return the verifications by the due | | |
| | |returned; and, |date, the county department shall process the application without those | | |
| | |c. Notification that if the client fails to return the |verifications, which may lead to a denial of benefits. | | |
| | |verifications by the due date, the county department shall | | | |
| | |process the application without those verifications, which | | | |
| | |may lead to a denial of benefits. | | | |
|3.542 |Clarification |B. The client shall be advised that a collateral contact or|B. The client shall be advised that a collateral contact or home visit may be |Moved with technical cleanup to the | No |
| |Needed |home visit may be used to confirm questionable evidence, to|used to confirm questionable evidence, to investigate potential fraud, or when |"Application Processing" section. | |
| | |investigate potential fraud, or when documentary evidence |documentary evidence is insufficient to make a determination of eligibility or |Struck through to eliminate | |
| | |is insufficient to make a determination of eligibility or |benefit level or cannot otherwise be obtained.1. A collateral contact is a |redundancy. | |
| | |benefit level or cannot otherwise be obtained.1. A |verbal or written confirmation of a client's circumstances by a person outside | | |
| | |collateral contact is a verbal or written confirmation of a|of the household. The county department shall:a. Request the name of an | | |
| | |client's circumstances by a person outside of the |appropriate collateral contact from the client; or,b. Independently determine an| | |
| | |household. The county department shall:a. Request the name |appropriate collateral contact; or,c. Substitute a home visit when an | | |
| | |of an appropriate collateral contact from the client; or,b.|appropriate collateral contact cannot be identified.2. An application may be | | |
| | |Independently determine an appropriate collateral contact; |denied if a collateral contact refuses to provide documentation of essential | | |
| | |or,c. Substitute a home visit when an appropriate |verifications and the applicant is unwilling to cooperate in obtaining such | | |
| | |collateral contact cannot be identified.2. An application |information personally.a. Authorization of the release of such information alone| | |
| | |may be denied if a collateral contact refuses to provide |does not constitute cooperation if the county department requests further | | |
| | |documentation of essential verifications and the applicant |assistance from the applicant. Documentation of lack of cooperation must be | | |
| | |is unwilling to cooperate in obtaining such information |entered in the case record.b. However, if the applicant is willing to cooperate | | |
| | |personally.a. Authorization of the release of such |but unable to obtain the information, no denial or delayed action shall be | | |
| | |information alone does not constitute cooperation if the |taken. The county shall assist the participant in gaining the information | | |
| | |county department requests further assistance from the |required to make a determination of eligibility.3. Client confidentiality shall | | |
| | |applicant. Documentation of lack of cooperation must be |be maintained to the greatest extent possible when using a collateral contact | | |
| | |entered in the case record.b. However, if the applicant is |for verification. | | |
| | |willing to cooperate but unable to obtain the information, | | | |
| | |no denial or delayed action shall be taken. The county | | | |
| | |shall assist the participant in gaining the information | | | |
| | |required to make a determination of eligibility.3. Client | | | |
| | |confidentiality shall be maintained to the greatest extent | | | |
| | |possible when using a collateral contact for verification. | | | |
|3.542 |Clarification |C. Each verification document shall be date-stamped with |C. Each verification document shall be date-stamped with the date it was |Moved with technical cleanup to the | No |
| |Needed |the date it was received in the county department office. |received in the county department office. |"Application Processing" section. | |
| | | | |Struck through to eliminate | |
| | | | |redundancy. | |
|3.542 |Clarification |D. Upon timely receipt of the required verifications, the |D. Upon timely receipt of the required verifications, the county department |Moved with technical cleanup to the | No |
| |Needed |county department shall enter verifications into the |shall enter verifications into the statewide automated system. When all |"Application Processing" section. | |
| | |statewide automated system. When all verifications have |verifications have been entered, the county department shall review the results,|Struck through to eliminate | |
| | |been entered, the county department shall review the |verify accuracy, and determine eligibility. If a client fails to return |redundancy. | |
| | |results, verify accuracy, and determine eligibility. If a |verifications, the case will be denied. | | |
| | |client fails to return verifications, the case will be | | | |
| | |denied. | | | |
|3.542 |Clarification |E. If a client returns the required verifications late, the|E. If a client returns the required verifications late, the county department |Moved with technical cleanup to the | No |
| |Needed |county department shall enter verifications into the |shall enter verifications into the statewide automated system. When all |"Application Processing" section. | |
| | |statewide automated system. When all verifications have |verifications have been entered, the county department shall review the results,|Struck through to eliminate | |
| | |been entered, the county department shall review the |verify accuracy, determine if good cause exists, and determine eligibility. If |redundancy. | |
| | |results, verify accuracy, determine if good cause exists, |the client does not have good cause and informs the county department that | | |
| | |and determine eligibility. If the client does not have good|he/she is requesting benefits, the client shall be required to reapply for | | |
| | |cause and informs the county department that he/she is |benefits. | | |
| | |requesting benefits, the client shall be required to | | | |
| | |reapply for benefits. | | | |
|3.542 |Clarification |F. If a client believes that an income or resource has been|F. If a client believes that an income or resource has been attributed |Moved with technical cleanup to the | No |
| |Needed |attributed incorrectly, the client shall provide |incorrectly, the client shall provide documentation that the value used for the |"Application Processing" section. | |
| | |documentation that the value used for the computation was |computation was incorrect. If such documentation confirms an incorrect |Struck through to eliminate | |
| | |incorrect. If such documentation confirms an incorrect |computation has been made, the county department shall correct the case. |redundancy. | |
| | |computation has been made, the county department shall | | | |
| | |correct the case. | | | |
|3.542 |Clarification |G. The county department shall send the client a notice |G. The county department shall send the client a notice explaining the |Moved with technical cleanup to the | No |
| |Needed |explaining the eligibility determination results and the |eligibility determination results and the client's appeal rights as outlined in |"Application Processing" section. | |
| | |client's appeal rights as outlined in Section 3.850, et |Section 3.850, et seq. (9 C.C.R. 2503-8). |Struck through to eliminate | |
| | |seq. (9 C.C.R. 2503-8). | |redundancy. | |
|3.542 |Clarification |H. The client shall have the right to decide how to spend |H. The client shall have the right to decide how to spend his/her AND-SO |Moved with technical cleanup to the | No |
| |Needed |his/her AND benefit. |benefit. |"Application Processing" section. | |
| | | | |Struck through to eliminate | |
| | | | |redundancy. | |
|3.542 |Clarification |I. The county department shall promptly act to make changes|I. The county department shall promptly act to make changes in food assistance |Removing prescriptive language about | No |
| |Needed |in food assistance eligibility and other public assistance |eligibility and other public assistance benefits as necessary in all instances |other HLPGs. | |
| | |benefits as necessary in all instances where a client or |where a client or mass change in AND-SO eligibility or payment occurs. | | |
| | |mass change in AND eligibility or payment occurs. | | | |
|3.542 |Clarification |J. Eligibility shall begin with the date of application or |BJ. Eligibility shall begin with the date of application or the date the client |Adjusting lettering due to | No |
| |Needed |the date the client meets all eligibility requirements, |meets all eligibility requirements, whichever is later. In the case of AND-SO, |strikethrough in previous letter. | |
| | |whichever is later. In the case of AND-SO, if the client is|if the client is delayed in completing the paperwork and appointment process for| | |
| | |delayed in completing thepaperwork and appointment process |SSI and/or the medical exam through no fault of their own or if he/she is | | |
| | |for SSI and/or the medical exam through no fault of |working with a Disability Benefits Guide, the date of application shall be used | | |
| | |theirown or if he/she is working with a Disability Benefits|as the date of eligibility. | | |
| | |Guide, the date of application shall be usedas the date of | | | |
| | |eligibility. | | | |
|3.542 |Clarification |K. If a client is terminated from SSI, the client shall |K. If a client is terminated from SSI, the client shall lose eligibility for the|Moved with technical cleanup to the | No |
| |Needed |lose eligibility for the AND-CS program. The client may |AND-CS program. The client may apply for AND-SO. |"Application Processing" section. | |
| | |apply for AND-SO. | |Struck through to eliminate | |
| | | | |redundancy. | |
|3.543 |Clarification |3.543 GRANT DETERMINATION |3.543 GRANT PAYMENT DETERMINATION |Re-named section for clarity | |
| |Needed | | | | |
|3.543 |Clarification |A. AND grants shall be calculated on an individual basis |A. AND-SO grants PAYMENTS shall be calculated on an individual basis with just |Clarified that this is for the State | No |
| |Needed |with just one client per case. |one client per case. |only program. | |
|3.543 |Clarification |B. When a client has been found eligible based upon |B. When a client has been found eligible based upon eligibility rules as |Removed unnecessary cross references.| No |
| |Needed |eligibility rules as outlined in Sections 3.520.6 and |outlined in Sections 3.520.6 and 3.520.71, 3.520.72, and 3.520.73, the amount of| | |
| | |3.520.71, 3.520.72, and 3.520.73, the amount of the |the client's authorized AND-SO GRANT PAYMENT benefit shall be determined by | | |
| | |client's authorized AND benefit shall be determined by |deducting the client's total countable income from the AND-SO grant standard. | | |
| | |deducting the client's total countable income from the AND |1. If determined eligible on the first of the month, the client shall receive | | |
| | |grant standard. |his OR /her authorized GRANT PAYMENT benefit in the initial and subsequent | | |
| | |1. If determined eligible on the first of the month, the |months. | | |
| | |client shall receive his/her authorized benefit in the |2. If determined eligible on any other day of the month, the client's first | | |
| | |initial and subsequent months. |month GRANT PAYMENT benefit shall be prorated according to the number of days | | |
| | |2. If determined eligible on any other day of the month, |remaining in the month; the client shall receive their FULL authorized GRANT | | |
| | |the client's first month benefit shall be prorated |PAYMENT benefit in subsequent months. | | |
| | |according to the number of days remaining in the month; the| | | |
| | |client shall receive their authorized benefit in subsequent| | | |
| | |months. | | | |
|3.543 |Clarification |C. If found eligible, the client's eligibility date shall |C. If found eligible, the client's eligibility date shall be determined as |Moved with technical cleanup to the | No |
| |Needed |be determined as follows:1. If the client returns all |follows:1. If the client returns all verifications within the sixty (60) day |"Application Processing" section. | |
| | |verifications within the sixty (60) day processing time |processing time frame, the eligibility date shall be the application date.2. If |Struck through to eliminate | |
| | |frame, the eligibility date shall be the application |the client returns all verifications after the sixty (60) day processing time |redundancy. | |
| | |date.2. If the client returns all verifications after the |frame, but within 90 days of the original application date, the eligibility date| | |
| | |sixty (60) day processing time frame, but within 90 days of|shall be the date the verifications were returned.3. If the client returns all | | |
| | |the original application date, the eligibility date shall |verifications after ninety (90) days from the original application date, the | | |
| | |be the date the verifications were returned.3. If the |client shall be required to re-apply for benefits. | | |
| | |client returns all verifications after ninety (90) days | | | |
| | |from the original application date, the client shall be | | | |
| | |required to re-apply for benefits. | | | |
|3.543 |Clarification |D. If a client is actively attempting to sell, liquidate, |D. If a client is actively attempting to sell, liquidate, or legally acquire a |Moved with technical cleanup to the | No |
| |Needed |or legally acquire a resource or secure available income, |resource or secure available income, the county department shall not delay |"Application Processing" section. | |
| | |the county department shall not delay action on an |action on an application. |Struck through to eliminate | |
| | |application. |1. AND-SO shall be continued without adjustment until the resource or income is |redundancy. | |
| | |1. AND shall be continued without adjustment until the |available. The county department is urged to monitor the attempts to access the | | |
| | |resource or income is available. The county department is |resource or income. | | |
| | |urged to monitor the attempts to access the resource or |2. If the client refuses or fails to make a reasonable effort to secure a | | |
| | |income. |potential resource or income, such resource or income shall be considered as if | | |
| | |2. If the client refuses or fails to make a reasonable |available, unless the client can show good cause. Timely and adequate notice | | |
| | |effort to secure a potential resource or income, such |shall be given regarding a proposed action to deny, reduce, or terminate | | |
| | |resource or income shall be considered as if available, |assistance. | | |
| | |unless the client can show good cause. Timely and adequate |3. If upon receipt of the prior notice, the client secures the potential | | |
| | |notice shall be given regarding a proposed action to deny, |resource or income prior to the effective action date, the proposed action to | | |
| | |reduce, or terminate assistance. |deny, reduce, or terminate assistance shall be withdrawn, and the case shall be | | |
| | |3. If upon receipt of the prior notice, the client secures |corrected. Benefits may still be denied, reduced, or discontinued due to a | | |
| | |the potential resource or income prior to the effective |change in income or resources. | | |
| | |action date, the proposed action to deny, reduce, or | | | |
| | |terminate assistance shall be withdrawn, and the case shall| | | |
| | |be corrected. Benefits may still be denied, reduced, or | | | |
| | |discontinued due to a change in income or resources. | | | |
|3.543 |Clarification |E. Except as specified below, the AND benefit shall be made|CE. Except as specified below, the AND-SO benefit shall be made directly to the |Clarified who a payment may be made | No |
| |Needed |directly to the client. |client. THE AND-SO GRANT PAYMENT SHALL BE MADE VIA ELECTRONIC BENEFITS TRANSFER,|to. | |
| | | |DIRECT DEPOSIT, OR WARRANT TO THE CLIENT, TO A FACILITY, OR TO A LEGALLY | | |
| | | |DESIGNATED PERSON, SUCH AS A REPRESENTATIVE PAYEE, FIDUCIARY, OR CONSERVATOR. | | |
|3.543 |Clarification |F. When the client lives in a facility or has a payee, |F. When the client lives in a facility or has a payee, legal fiduciary, or |Combined into previous letter. | No |
| |Needed |legal fiduciary, or authorized representative, the payment |authorized representative, the payment shall be made to the payee, fiduciary, | | |
| | |shall be made to the payee, fiduciary, authorized |authorized representative, or facility on behalf of the client. | | |
| | |representative, or facility on behalf of the client. | | | |
|3.543 |Clarification |G. The client shall be eligible only for a monthly personal|DG. The client shall be eligible only for a monthly Ppersonal Nneeds Aallowance |Added Adult Financial Approved | No |
| |Needed |needs allowance when program requirements are met and the |when program requirements are met and the client is a resident of a facility at |Setting. | |
| | |client is a resident of a facility at least thirty (30) |least thirty (30) consecutive days, as follows: | | |
| | |consecutive days, as follows: |1. In a general medical and surgical hospital; | | |
| | |1. In a general medical and surgical hospital; |2. In a nursing home, assisted living residence, or, intermediate care facility,| | |
| | |2. In a nursing home, assisted living residence, or, |group home, host home, or other long-term care facility, OR ADULT FINANCIAL | | |
| | |intermediate care facility, group home, host home, or other|APPROVED SETTING. | | |
| | |long-term care facility. | | | |
|3.543 |Clarification |H. The following persons are not eligible for a personal |EH. The following persons are not eligible for a Ppersonal Nneeds Aallowance or |Adjusting lettering due to | No |
| |Needed |needs allowance or AND benefit: |AND-SO GRANT PAYMENTS benefit: |strikethrough in previous letter. | |
| | |1. Inmates in a penal institution; or, |1. Inmates in a penal institution; or, | | |
| | |2. Residents in an unlicensed private or uncertified public|2. Residents in an unlicensed private or uncertified public facility. | | |
| | |facility. | | | |
|3.543 |Clarification |I. For every full calendar month that the client is a |FI. For every full calendar month that the client is a resident in an approved |Adjusting lettering due to | No |
| |Needed |resident in an approved facility, the AND personal needs |facility, the AND-SO Ppersonal Nneeds Aallowance maximum shall be seventy nine |strikethrough in previous letter. | |
| | |allowance maximum shall be seventy seven dollars ($77) |dollars ($79) effective October 1, 2016. | | |
| | |effective January 1, 2015. | | | |
|3.543 |Clarification |J. If the Social Security Administration (SSA) is |J. If the Social Security Administration (SSA) is recovering any portion of the |No longer relevant to this section. | No |
| |Needed |recovering any portion of the client's SSI payment due to |client's SSI payment due to an overpayment of benefits, AND-CS shall be | | |
| | |an overpayment of benefits, AND-CS shall be calculated |calculated based on the gross SSI payment and not the received amount. | | |
| | |based on the gross SSI payment and not the received amount.| | | |
|3.544 |New Rule | |DISREGARDS SHALL BE APPLIED BEFORE CALCULATING A CLIENT’S TOTAL COUNTABLE |Added introduction to explain the use| |
| |Addition | |INCOME. IF A CLIENT'S TOTAL COUNTABLE INCOME EQUALS OR EXCEEDS THE AND-SO GRANT |of net income per statute. | |
| | | |STANDARD AFTER THE DISREGARDS ARE APPLIED, HE OR SHE SHALL BE DENIED FOLLOWING | | |
| | | |THE POLICIES OUTLINED IN SECTION 3.554. | | |
|3.544 |Clarification |A. The earned and unearned income for an AND-SO client |A. The earned and unearned income for an AND-SO client shall be counted dollar |Allowing for same earned and unearned| No |
| |Needed |shall be counted dollar for dollar, with no disregards. |for dollar, with no disregards. |income disregards as SSI. | |
| | | |A. IF THE CLIENT HAS EARNED INCOME, APPLY THE FOLLOWING INCOME DISREGARDS: | | |
| | | |1. DEDUCT $65 FROM THE GROSS EARNED INCOME; AND, | | |
| | | |2. DIVIDE THE REMAINDER BY TWO (2). | | |
| | | |3. THE RESULT IS THE COUNTABLE EARNED INCOME. | | |
|3.544 |Restructured and| |B. IF THE CLIENT HAS UNEARNED INCOME, APPLY THE FOLLOWING INCOME DISREGARDS: |Allowing for same earned and unearned| |
| |renumbered | |1. DETERMINE THE CLIENT'S GROSS UNEARNED INCOME FROM ALL SOURCES. |income disregards as SSI. | |
| | | |2. DEDUCT $20.00. IF THE CLIENT IS MARRIED, THE $20.00 DISREGARD SHALL BE SPLIT | | |
| | | |BETWEEN THE CLIENT AND THE SPOUSE SO THAT NO MORE THAN A $20.00 DISREGARD IS | | |
| | | |APPLIED. | | |
| | | |3. THE RESULT IS COUNTABLE UNEARNED INCOME. | | |
|3.544 |Restructured and| |C. SUBTRACT THE COUNTABLE EARNED AND COUNTABLE UNEARNED INCOME FROM THE AND-SO |Allowing for same earned and unearned| |
| |renumbered | |GRANT STANDARD TO DETERMINE THE GRANT PAYMENT AMOUNT. |income disregards as SSI. | |
|3.544 |Clarification |B. A portion of the earned income of the AND-SO client's |DB. A portion of the earned income of the AND-SO client's spouse shall be deemed|Allowing for same earned and unearned| No |
| |Needed |spouse shall be deemed to the client, as follows:1. |to the client, as follows: |income disregards as SSI. | |
| | |Determine the spouse's monthly gross earnings.2. Deduct |1. Determine the spouse's monthly gross earnings. | | |
| | |$20.00.3. From the remainder, deduct fifty percent (50%) |2. Deduct $20.00. | | |
| | |but no more than $30.00.4. From the remainder, subtract |3. From the remainder, deduct fifty percent (50%) but no more than $30.00. | | |
| | |federal and state income tax, Medicare withholdings, and |4. From the remainder, subtract federal and state income tax, Medicare | | |
| | |Social Security withholdings.5. From the remainder, deduct |withholdings, and Social Security withholdings. | | |
| | |$30.00 or the actual documented expenses of employment as |5. From the remainder, deduct $30.00 or the actual documented expenses of | | |
| | |allowed under Internal Revenue Services (IRS) deductions, |employment as allowed under Internal Revenue Services (IRS) deductions, | | |
| | |whichever is greater.6. The remainder is the amount of |whichever is greater. | | |
| | |income deemed to the client. |6. The remainder is the amount of income deemed to the client. | | |
| | | |1. DEDUCT SIXTY FIVE DOLLARS ($65) FROM THE SPOUSE'S GROSS EARNED INCOME; AND, | | |
| | | |2. DIVIDE THE REMAINDER BY TWO (2); AND, | | |
| | | |3. THE RESULT IS THE AMOUNT OF EARNED INCOME DEEMED TO THE CLIENT. | | |
| | | |4. THE DEEMED EARNED INCOME SHALL BE CONSIDERED INCOME TO THE CLIENT AND SHALL | | |
| | | |BE DEDUCTED, TOGETHER WITH ANY OTHER INCOME, FROM THE GRANT OF THE CLIENT. | | |
| | | |5. WAGES BEING GARNISHED BY THE COURT ARE COUNTABLE EARNED INCOME. | | |
|3.544 |Clarification |C. A portion of the unearned income of the AND-SO client's |EC. A portion of the unearned income of the AND-SO client's spouse shall be |Allowing for same earned and unearned| No |
| |Needed |spouse shall be deemed to the client, as follows: |deemed to the client, as follows: |income disregards as SSI. | |
| | |1. Determine the spouse's unearned monthly gross income. |1. Determine the spouse's unearned monthly gross income. | | |
| | |2. Deduct $20.00. |2. Deduct $20.00 UNLESS THE CLIENT ALSO HAS UNEARNED INCOME. THE $20.00 | | |
| | |3. The remainder is deemed to the client. |DISREGARD SHALL BE SPLIT BETWEEN THE CLIENT AND THE CLIENT’S SPOUSE SO THAT NO | | |
| | | |MORE THAN A $20.00 DISREGARD IS APPLIED. | | |
| | | |3. The RESULTremainder is deemed to the client. | | |
| |New Rule |NEW |F. IF A CLIENT’S SPOUSE IS RECEIVING ADULT FINANCIAL GRANT PAYMENTS, SSI |Added to be consistent with OAP | No |
| |Addition | |BENEFITS, OR MEDICAID ASSISTANCE AND HAS INCOME NO GREATER THAN THE SSI LIMIT, |section. | |
| | | |THEIR INCOME SHALL NOT BE CONSIDERED AS AVAILABLE TO THE CLIENT AND SHALL NOT BE| | |
| | | |DEEMED. IF A CLIENT’S SPOUSE IS INSTITUTIONALIZED AND THE CLIENT HAS RETAINED | | |
| | | |THE MINIMUM MONTHLY MAINTENANCE NEEDS ALLOWANCE (MMMNA), THE MMMNA SHALL BE | | |
| | | |DEDUCTED FROM THE INSTITUTIONALIZED SPOUSE’S TOTAL INCOME. | | |
| |New Rule |NEW |G. A SPONSOR'S INCOME CAN ONLY BE DEEMED TO THE NON-CITIZEN CLIENT HE OR SHE |Added to be consistent with OAP | No |
| |Addition | |SPONSORS. THE AMOUNT OF EARNED AND UNEARNED INCOME TO DEEM FROM A SPONSOR(S) TO |section. | |
| | | |A NON-CITIZEN CLIENT IS CALCULATED AS FOLLOWS: | | |
| | | |1. THE TOTAL GROSS EARNED AND UNEARNED INCOME OF THE SPONSOR ARE ADDED TOGETHER.| | |
| | | |2. THE FOLLOWING DEDUCTIONS ARE SUBTRACTED FROM THE TOTAL INCOME OF THE SPONSOR:| | |
| | | |A. A DEDUCTION FOR THE SPONSOR EQUAL TO THE CURRENT SSI BENEFIT STANDARD FOR AN | | |
| | | |INDIVIDUAL, AS DEFINED IN SECTION 3.510; PLUS | | |
| | | |B. A DEDUCTION FOR THE SPONSOR'S SPOUSE LIVING IN THE SAME HOUSEHOLD WITH THE | | |
| | | |SPONSOR, EQUAL TO ONE-HALF THE CURRENT SSI BENEFIT STANDARD FOR AN INDIVIDUAL, | | |
| | | |AS DEFINED IN SECTION 3.510; OR A DEDUCTION FOR THE SPONSOR'S SPOUSE, WHO IS | | |
| | | |ALSO A CO-SPONSOR OF THE NON-CITIZEN, EQUAL TO THE CURRENT SSI BENEFIT STANDARD | | |
| | | |FOR AN INDIVIDUAL; PLUS | | |
| | | |C. A DEDUCTION EQUAL TO ONE-HALF THE SSI BENEFIT STANDARD FOR AN INDIVIDUAL, AS | | |
| | | |DEFINED IN SECTION 3.510, FOR EACH PERSON WHO IS A DEPENDENT OF THE SPONSOR | | |
| | | |(OTHER THAN THE NON-CITIZEN CLIENT AND THE NON-CITIZEN CLIENT'S SPOUSE). | | |
| | | |3. THE DIFFERENCE BETWEEN THE TOTAL INCOME AND THE TOTAL DEDUCTIONS IS DEEMED AS| | |
| | | |UNEARNED INCOME TO THE NON-CITIZEN CLIENT. THIS DEEMED INCOME IS ADDED TO THE | | |
| | | |NON-CITIZEN CLIENT'S OWN INCOME TO DETERMINE THE TOTAL COUNTABLE INCOME. | | |
| | | |4. THE NON-CITIZEN CLIENT'S COUNTABLE INCOME IS COMPARED TO THE INCOME STANDARD | | |
| | | |OF THE ADULT FINANCIAL PROGRAM FOR WHICH THE NON-CITIZEN CLIENT IS APPLYING TO | | |
| | | |DETERMINE ELIGIBILITY AND/OR THE GRANT PAYMENT AMOUNT. | | |
| | | |5. IF MORE THAN ONE NON-CITIZEN CLIENT HAS THE SAME SPONSOR, ALL OF THE | | |
| | | |SPONSOR'S INCOME IS DEEMED TO EACH NON-CITIZEN CLIENT. DO NOT DIVIDE THE | | |
| | | |SPONSOR'S INCOME AMONG THE NON-CITIZEN CLIENTS. | | |
| |New Rule |NEW |H. THE COUNTY DEPARTMENT SHALL DETERMINE ALL COUNTABLE EARNED AND UNEARNED |Added to be consistent with OAP | No |
| |Addition | |INCOME AVAILABLE FROM THE CLIENT, THE SPOUSE, AND THE SPONSOR(S). THE TOTAL |section. | |
| | | |SHALL BE DEDUCTED FROM THE AND-SO GRANT TO DETERMINE THE CLIENT'S GRANT PAYMENT | | |
| | | |AMOUNT. | | |
|3.545 |Clarification |A. A portion of the earned income of an AND-CS client's |A. A portion of the earned income of an AND-CS client's spouse shall be deemed |All rules for the AND-CS program have| No |
| |Needed |spouse shall be deemed to the client, as follows:1. |to the client, as follows:1. Determine the spouse's monthly gross income.2. |been moved to a new section specific | |
| | |Determine the spouse's monthly gross income.2. Deduct |Deduct $65.00.3. Divide the remainder in half.4. The result is the amount deemed|to that program. This was a request | |
| | |$65.00.3. Divide the remainder in half.4. The result is the|to the client. |from stakeholders. | |
| | |amount deemed to the client. | | | |
|3.545 |Clarification |B. A portion of the unearned income for an AND-CS client |B. A portion of the unearned income for an AND-CS client who receives SSI and |All rules for the AND-CS program have| No |
| |Needed |who receives SSI and other unearned income shall be |other unearned income shall be disregarded and shall not be countable income, as|been moved to a new section specific | |
| | |disregarded and shall not be countable income, as follows: |follows: |to that program. This was a request | |
| | |1. Determine the client's unearned income from all sources |1. Determine the client's unearned income from all sources except SSI. |from stakeholders. | |
| | |except SSI. |2. Deduct $20.00. If the client is married, the $20.00 disregard shall be split | | |
| | |2. Deduct $20.00. If the client is married, the $20.00 |between the client and the spouse so that no more than a $20.00 disregard is | | |
| | |disregard shall be split between the client and the spouse |applied. | | |
| | |so that no more than a $20.00 disregard is applied. |3. The remainder is countable unearned income. | | |
| | |3. The remainder is countable unearned income. |4. If the client's unearned income is less than $20, the difference between the | | |
| | |4. If the client's unearned income is less than $20, the |gross unearned income and the $20 deduction shall be applied to the earned | | |
| | |difference between the gross unearned income and the $20 |income calculation, if applicable. | | |
| | |deduction shall be applied to the earned income | | | |
| | |calculation, if applicable. | | | |
|3.545 |Clarification |C. A portion of the unearned income for AND-CS client's |C. A portion of the unearned income for AND-CS client's spouse shall be deemed |All rules for the AND-CS program have| No |
| |Needed |spouse shall be deemed to the client, as follows: |to the client, as follows: |been moved to a new section specific | |
| | |1. Determine the spouse's monthly gross unearned income. |1. Determine the spouse's monthly gross unearned income. |to that program. This was a request | |
| | |2. Deduct any remaining unearned income disregard remaining|2. Deduct any remaining unearned income disregard remaining from the client or |from stakeholders. | |
| | |from the client or $20.00, whichever is less. A couple |$20.00, whichever is less. A couple shall be allowed a combined $20.00 | | |
| | |shall be allowed a combined $20.00 disregard, which is |disregard, which is split between the client and the spouse. | | |
| | |split between the client and the spouse. |3. The remainder is countable unearned income and is deemed to the client. | | |
| | |3. The remainder is countable unearned income and is deemed| | | |
| | |to the client. | | | |
|3.545 |Clarification |D. An AND-CS client who does not receive another source of |D. An AND-CS client who does not receive another source of unearned income other|All rules for the AND-CS program have| No |
| |Needed |unearned income other than SSI such as an Adult Foster Care|than SSI such as an Adult Foster Care allowance does not receive the $20.00 |been moved to a new section specific | |
| | |allowance does not receive the $20.00 unearned income |unearned income disregard. |to that program. This was a request | |
| | |disregard. | |from stakeholders. | |
|3.545 |Clarification |E. When the AND-CS client is an unemancipated child under |E. When the AND-CS client is an unemancipated child under eighteen (18) years of|All rules for the AND-CS program have| No |
| |Needed |eighteen (18) years of age, the earned and unearned income |age, the earned and unearned income of the child and the child's parents shall |been moved to a new section specific | |
| | |of the child and the child's parents shall be subject to |be subject to disregards and deeming, as outlined above. The parents' income |to that program. This was a request | |
| | |disregards and deeming, as outlined above. The parents' |shall be deemed using the same calculations as a spouse. |from stakeholders. | |
| | |income shall be deemed using the same calculations as a | | | |
| | |spouse. | | | |
|3.545 |Clarification |F. If a spouse or parent is receiving assistance under |F. If a spouse or parent is receiving assistance under another category of |All rules for the AND-CS program have| No |
| |Needed |another category of public assistance, SSI benefits, or |public assistance, SSI benefits, or medical assistance, the income from those |been moved to a new section specific | |
| | |medical assistance, the income from those benefits shall |benefits shall not be considered as available to the client. |to that program. This was a request | |
| | |not be considered as available to the client. | |from stakeholders. | |
|3.545 |Clarification |G. A sponsor's income can only be deemed towards the |G. A sponsor's income can only be deemed towards the non-citizen they sponsor. |All rules for the AND-CS program have| No |
| |Needed |non-citizen they sponsor. To determine the amount of earned|To determine the amount of earned and unearned income to deem from a sponsor(s) |been moved to a new section specific | |
| | |and unearned income to deem from a sponsor(s) to a client, |to a client, calculate, as follows:1. The total earned and unearned income of |to that program. This was a request | |
| | |calculate, as follows:1. The total earned and unearned |the sponsor are added together.2. The following deductions are subtracted from |from stakeholders. | |
| | |income of the sponsor are added together.2. The following |the total income of the sponsor:a. A deduction for the sponsor equal to the | | |
| | |deductions are subtracted from the total income of the |current SSI benefit standard for an individual for the month in which | | |
| | |sponsor:a. A deduction for the sponsor equal to the current|eligibility is being determined; plusb. A deduction for the sponsor's spouse | | |
| | |SSI benefit standard for an individual for the month in |living in the same household with the sponsor, equal to one-half the current SSI| | |
| | |which eligibility is being determined; plusb. A deduction |benefit standard for an individual; or a deduction for the sponsor's spouse, who| | |
| | |for the sponsor's spouse living in the same household with |is also a co-sponsor of the non-citizen, equal to the current SSI benefit | | |
| | |the sponsor, equal to one-half the current SSI benefit |standard for an individual; plusc. A deduction equal to one-half the SSI benefit| | |
| | |standard for an individual; or a deduction for the |standard for an individual for each person who is a dependent of the sponsor | | |
| | |sponsor's spouse, who is also a co-sponsor of the |(other than the non-citizen and the non-citizen's spouse).3. The difference | | |
| | |non-citizen, equal to the current SSI benefit standard for |between the total income and the total deductions is deemed as unearned income | | |
| | |an individual; plusc. A deduction equal to one-half the SSI|to the non-citizen. This deemed income is added to the non-citizen's own income | | |
| | |benefit standard for an individual for each person who is a|to determine the total countable income.4. Compare the non-citizen's countable | | |
| | |dependent of the sponsor (other than the non-citizen and |income to the income standard of the Adult Financial program for which the | | |
| | |the non-citizen's spouse).3. The difference between the |non-citizen is applying to determine eligibility and/or the benefit amount.5. If| | |
| | |total income and the total deductions is deemed as unearned|more than one non-citizen has the same sponsor, deem all of the sponsor's income| | |
| | |income to the non-citizen. This deemed income is added to |to each non-citizen. Do not divide the sponsor's income among the non-citizens. | | |
| | |the non-citizen's own income to determine the total | | | |
| | |countable income.4. Compare the non-citizen's countable | | | |
| | |income to the income standard of the Adult Financial | | | |
| | |program for which the non-citizen is applying to determine | | | |
| | |eligibility and/or the benefit amount.5. If more than one | | | |
| | |non-citizen has the same sponsor, deem all of the sponsor's| | | |
| | |income to each non-citizen. Do not divide the sponsor's | | | |
| | |income among the non-citizens. | | | |
|3.545 |Clarification |H. The county department shall determine all countable |H. The county department shall determine all countable earned and unearned |All rules for the AND-CS program have| No |
| |Needed |earned and unearned income available from the client, the |income available from the client, the spouse, and the sponsor(s). The total |been moved to a new section specific | |
| | |spouse, and the sponsor(s). The total shall be deducted |shall be deducted from the AND grant to determine the client's benefit amount. |to that program. This was a request | |
| | |from the AND grant to determine the client's benefit | |from stakeholders. | |
| | |amount. | | | |
|3.546- new |Clarification |A. AND-SO payments made while an SSI claim is pending, in |A. AND-SO payments made while an SSI claim is pending, in suspense, terminated, |Clarified process of when an IM-14 | No |
|Number 3.545 |Needed |suspense, terminated, or in appeal shall be classified as |or in appeal shall be classified as interim assistance. At the time of |must be completed. | |
| | |interim assistance. At the time of application, the SSI |application, the SSI payment procedure shall be explained to the client. | | |
| | |payment procedure shall be explained to the client.1. All |1. All AND-SO payments made to the client are recoverable upon approval for SSI | | |
| | |AND-SO payments made to the client are recoverable upon |benefits. IF THE FIRST RETROACTIVE SSI PAYMENT IS SENT TO THE CLIENT, RATHER | | |
| | |approval for SSI benefits.2. As a condition of eligibility |THAN THE COUNTY DEPARTMENT, HE OR SHE IS REQUIRED TO REPAY ANY AND-SO GRANT | | |
| | |for AND-SO the client shall be required to sign the |PAYMENTS FROM SUCH LUMP SUM FOR MONTHS HE OR SHE WAS DETERMINED ELIGIBLE FOR | | |
| | |“Authorization for Reimbursement of Interim Assistance” |SSI. | | |
| | |(IM-14) annually allowing recovery of the funds from the |2. As a condition of eligibility for AND-SO the client shall be required to sign| | |
| | |first retroactive SSI payment.3. The client shall be |the “Authorization for Reimbursement of Interim Assistance” (IM-14), AS DEFINED | | |
| | |required to give signed authorization for recovery directly|IN SECTION 3.510, AT APPLICATION AND AT LEAST annually allowing recovery of the | | |
| | |from the client in the event that the first retroactive SSI|funds from the first retroactive SSI payment. THIS FORM MUST ALSO BE COMPLETED | | |
| | |payment is sent to the client rather than to the county |AT EVERY REDETERMINATION AND WHENEVER THE CLIENT’S CASE IS TRANSFERRED TO | | |
| | |department.4. The authorization shall be effective for a |ANOTHER COUNTY. THE FORM MUST INCLUDE THE SELECTION OF ONE PAYMENT DESIGNATION; | | |
| | |maximum of one (1) year from the date it was signed by the |CLIENT’S SIGNATURE AND DATE; A COUNTY REPRESENTATIVE’S SIGNATURE AND DATE, WHICH| | |
| | |client. The county department shall ensure that a new |SHALL NOT PREDATE THE CLIENT’S SIGNATURE AND DATE; AND ALL REQUIREMENTS FOR THE | | |
| | |“Authorization for Reimbursement of Interim Assistance” |INTERIM ASSISTANCE AGREEMENT INCLUDING THE APPLICABLE COUNTY SOCIAL SECURITY | | |
| | |(IM-14) is signed prior to the expiration of the previous |GRANT REIMBURSEMENT (GR) CODE AS DESCRIBED IN THE SSA INTERIM ASSISTANCE | | |
| | |IM-14 form. |REIMBURSEMENT STATE HANDBOOK, SECTION 4 (NOVEMBER 30, 2018) WHICH IS HEREIN | | |
| | | |INCORPORATED BY REFERENCE. THIS RULE DOES NOT CONTAIN ANY LATER AMENDMENTS OR | | |
| | | |EDITIONS. THIS HANDBOOK IS AVAILABLE FOR NO COST AT | | |
| | | |. THIS HANDBOOK IS ALSO | | |
| | | |AVAILABLE FOR PUBLIC INSPECTION AND COPYING AT THE COLORADO DEPARTMENT OF HUMAN | | |
| | | |SERVICES, DIRECTOR OF THE EMPLOYMENT AND BENEFITS DIVISION, 1575 SHERMAN STREET,| | |
| | | |DENVER, COLORADO, 80203, OR AT ANY STATE PUBLICATIONS LIBRARY DURING REGULAR | | |
| | | |BUSINESS HOURS. | | |
| | | |A. THE COUNTY SHALL NOTIFY THE SSA WITHIN 30 CALENDAR DAYS OF OBTAINING A VALID | | |
| | | |IM-14, AS DEFINED IN SECTION 3.510, IF THE NOTIFICATION EXCEEDS 30 CALENDAR | | |
| | | |DAYS, THE COUNTY DEPARTMENT SHALL BE REQUIRED TO OBTAIN A NEW VALID IM-14 FROM | | |
| | | |THE CLIENT. | | |
| | | |B. THE COUNTY DEPARTMENT SHALL BE REQUIRED TO REVIEW THE “IAR TRANSACTIONS | | |
| | | |REJECTED BY SSA REPORT” IN THE STATEWIDE AUTOMATED SYSTEM, COGNOS REPORT | | |
| | | |PLATFORM, AND SHALL TAKE ALL NECESSARY ACTIONS TO RESOLVE ANY DISCREPANCIES | | |
| | | |WITHIN THIRTY (30) CALENDAR DAYS OF THE ORIGINAL TRANSMISSION DATE. | | |
| | | |3. The client shall be required to give signed authorization for recovery | | |
| | | |directly from the client in the event that the first retroactive SSI payment is | | |
| | | |sent to the client rather than to the county department. | | |
| | | |4. The authorization shall be effective for a maximum of one (1) year from the | | |
| | | |date it was signed by the client. The county department shall ensure that a new | | |
| | | |“Authorization for Reimbursement of Interim Assistance” (IM-14) is signed prior | | |
| | | |to the expiration of the previous IM-14 form. | | |
|3.546- new |Clarification |B. Within ten (10) working days of receipt of the initial |B. Within ten (10) working days of receipt of the REIMBURSEMENT FROM SSA initial|Additional process added to | No |
|Number 3.545 |Needed |SSI retroactive payment, the county department shall |SSI retroactive payment, the county department shall complete and send to the |incorporate over collection of IAR | |
| | |complete and send to the client the apportionment notice to|client the apportionment notice (IM-19), AS DEFINED IN SECTION 3.510, to include|funds. | |
| | |include the amount of the interim assistance payments made,|the amount of the interim assistance payments made, by month, for all counties | | |
| | |by month, for all counties that provided AND-SO payments to|that provided AND-SO payments to the client. IF THE COUNTY DEPARTMENT RECOVERS | | |
| | |the client. |EXCESS IAR FUNDS FROM THE INITIAL SSI RETROACTIVE PAYMENT, THE COUNTY MUST | | |
| | | |REIMBURSE THE SOCIAL SECURITY ADMINISTRATION UTILIZING THE STATE PRESCRIBED | | |
| | | |FORM, WITHIN THREE (3) BUSINESS DAYS OF THE MAILING OF THE IM-19. | | |
|3.546- new | New number and |C. The accounting of payments made shall be entered in the |C. The accounting of payments made shall be entered in the federal SSA eIAR data| Added clarifying language | No |
|Number 3.545 |clarification |federal SSA eIAR data system. SSA shall process the |system. THE FEDERAL SSA EIAR DATA SYSTEM RECORDS THE ACCOUNTING OF PAYMENTS | | |
| |needed |information and make a payment to the county department. |MADE. AFTER PROCESSING THIS INFORMATION, IT ISSUES PAYMENTS TO THE COUNTY | | |
| | |SSA distributes the remainder, if any, to the client. |DEPARTMENT AND DISTRIBUTES THE REMAINDER, IF ANY. SSA shall process the | | |
| | |Recoveries directly from a retroactive SSI payment can only|information and make a payment to the county department. SSA distributes the | | |
| | |be made from the first such payment. |remainder, if any, to the client. Recoveries directly from a retroactive SSI | | |
| | | |payment can only be made from the first such payment. | | |
|3.546- new | |D. When the SSI payment is received by the client, the | D. When the SSI payment is received by the client, the county department shall |No language change, renumbering | No |
|Number 3.545 | |county department shall consider the payment as income in |consider the payment as income in the month received. |only. | |
| | |the month received. | | | |
|3.546- new | |E. In the event that a client receives the initial |E. In the event that a client receives the initial retroactive SSI payment | Technical cleanup | No |
|Number 3.545 | |retroactive SSI payment directly, the county department |directly, the county department shall establish a recovery from the client. | | |
| | |shall establish a recovery from the client. |1. The county department may agree to recover interim payments by periodic | | |
| | |1. The county department may agree to recover interim |payments or through a lump sum recovery. | | |
| | |payments by periodic payments or through a lump sum |2. Any such recovery(ies) made shall be coded as Interim Assistance | | |
| | |recovery. |Reimbursement (IAR) Recovery(ies). | | |
| | |2. Any such recovery(ies) made shall be coded as Interim |3. Any amount recovered in the same month as the month in which the retroactive | | |
| | |Assistance Reimbursement (IAR) Recovery(ies). |payment was received shall not be counted as income. | | |
| | |3. Any amount recovered in the same month as the month in | | | |
| | |which the retroactive payment was received shall not be | | | |
| | |counted as income. | | | |
|3.546- new | |F. The county department shall not pay any portion of its |F. The county department shall not pay any portion of its share of the federal | Technical cleanup | No |
|Number 3.545 | |share of the federal SSI lump sum payment to the client or |SSI lump sum payment to the client or to any third party for legal, | | |
| | |to any third party for legal, professional, or other fees |professional, or other fees incurred by the client in securing SSI benefits. All| | |
| | |incurred by the client in securing SSI benefits. All of the|of the IAR payment shall be used to reimburse the AND-SO program for GRANT | | |
| | |IAR payment shall be used to reimburse the AND-SO program |PAYMENTS benefits paid to the client as interim assistance in accordance with | | |
| | |for benefits paid to the client as interim assistance in |the agreement between the Colorado Department of Human Services and the Social | | |
| | |accordance with the agreement between the Colorado |Security Administration. The client is not required to obtain legal or other | | |
| | |Department of Human Services and the Social Security |third party representation in order to apply for and/or obtain SSI benefits, and| | |
| | |Administration. The client is not required to obtain legal |the client is solely responsible for any fees incurred in this process. | | |
| | |or other third party representation in order to apply for | | | |
| | |and/or obtain SSI benefits, and the client is solely | | | |
| | |responsible for any fees incurred in this process. | | | |
|3.546- new | |G. If an SSI client's SSI payment is suspended or |G. If an SSI client's SSI payment is suspended or terminated, the client may | Technical cleanup | No |
|Number 3.545 | |terminated, the client may apply for AND-SO and complete |apply for AND-SO and complete the “Authorization for Reimbursement of Interim | | |
| | |the “Authorization for Reimbursement of Interim Assistance”|Assistance” (IM-14), AS DEFINED IN SECTION 3.510. | | |
| | |(IM-14). | | | |
|3.546- new |Clarification |H. The county department that filed the original |H. The county department that filed the original “Authorization for |Struck unnecessary word. | No |
|Number 3.545 |Needed |“Authorization for Reimbursement of Interim Assistance” |Reimbursement of Interim Assistance” (IM-14), AS DEFINED IN SECTION 3.510, for | | |
| | |(IM-14) for an AND-SO client shall be the County of Record.|an AND-SO client shall be the County of Record. The County of Record acting as | | |
| | |The County of Record acting as an agent of the state shall:|an agent of the state shall: | | |
| | |1. Collect and apportion all AND-SO payments for all county|1. Collect and apportion all AND-SO GRANT payments for all county departments | | |
| | |departments that may have provided AND-SO benefits; and, |that may have provided AND-SO GRANT PAYMENTSbenefits; and, | | |
| | |2. Account for all AND-SO payments to the Social Security |2. Account for all AND-SO payments to the Social Security Administration (SSA) | | |
| | |Administration (SSA) timely; and, |timely; and, | | |
| | |3. Make an accounting in the statewide automated system for|3. Make an accounting in the statewide automated system for any reimbursement | | |
| | |any reimbursement received. Non-system determined claims |received. Non-system determined claims (NSDC) shall not be entered for IARs | | |
| | |(NSDC) shall not be entered for IARs without State |without State Department approval. | | |
| | |Department approval. | | | |
|3.546- new |New Rule |NEW |I. THE COUNTY DEPARTMENT SHALL MAINTAIN RECORDS OF THE IAR CASE FOR FOUR (4) |Added for federal auditing purposes | No |
|Number 3.545 |Addition | |YEARS FROM THE END OF THE FEDERAL FISCAL YEAR IN WHICH THE IAR WAS PROCESSED. | | |
|3.545 |New Rule | |J. THE COUNTY DEPARTMENT SHALL COMPLY WITH OTHER REGULATIONS THAT THE STATE |Added based on language in SSA | |
| |Addition | |DEPARTMENT FINDS NECESSARY TO ADMINISTER THE INTERIM ASSISTANCE PROVISIONS. |regulations. | |
|3.546 |New Rule |NEW |THE AID TO THE NEEDY DISABLED-COLORADO SUPPLEMENT (AND-CS) PROGRAM PROVIDES A |All rules for the AND-CS program have| No |
| |Addition | |SUPPLEMENTAL PAYMENT FOR CLIENT'S AGE ZERO (0) TO FIFTY-NINE (59) WHO ARE |been moved to a new section specific | |
| | | |RECEIVING SSI DUE TO A DISABILITY OR BLINDNESS, BUT ARE NOT RECEIVING THE FULL |to that program. This was a request | |
| | | |SSI BENEFIT STANDARD, AS DEFINED IN SECTION 3.510. |from stakeholders. | |
| | | |A. THE TOTAL AND-CS GRANT STANDARD IS $783.00, EFFECTIVE JANUARY 1, 2020. | | |
|3.546 |New Rule |NEW |B. THE GRANT STANDARD FOR AND-CS SHALL BE ADJUSTED AS NEEDED TO REMAIN WITHIN |All rules for the AND-CS program have| No |
| |Addition | |AVAILABLE APPROPRIATIONS. APPEALS SHALL NOT BE ALLOWED FOR GRANT STANDARD |been moved to a new section specific | |
| | | |ADJUSTMENTS NECESSARY TO STAY WITHIN AVAILABLE APPROPRIATIONS. |to that program. This was a request | |
| | | | |from stakeholders. | |
|3.546 |New Rule |NEW |C. IN ADDITION TO THE REGULAR MONTHLY AND-CS GRANT PAYMENTS, SUPPLEMENTAL |All rules for the AND-CS program have| No |
| |Addition | |PAYMENTS NECESSARY TO COMPLY WITH THE FEDERAL MOE REQUIREMENTS, AS INCORPORATED |been moved to a new section specific | |
| | | |BY REFERENCE IN SECTION 3.531.D, MAY BE PROVIDED. THESE PAYMENTS ARE SUPPLEMENTS|to that program. This was a request | |
| | | |TO REGULAR GRANT PAYMENTS, ARE NOT ENTITLEMENTS, AND DO NOT AFFECT GRANT |from stakeholders. | |
| | | |STANDARDS. APPEALS SHALL NOT BE ALLOWED FOR MOE PAYMENT ADJUSTMENTS. | | |
|3.546 |New Rule |NEW |D. EFFECTIVE JANUARY 1, 2020, THE MAXIMUM ISM AMOUNT FOR SHELTER COSTS IS |All rules for the AND-CS program have| No |
| |Addition | |$281.00. |been moved to a new section specific | |
| | | | |to that program. This was a request | |
| | | | |from stakeholders. | |
|3.547 |New Rule |NEW |A. TO MEET THE DISABILITY ELIGIBILITY REQUIREMENT FOR AND-CS, THE CLIENT MUST BE|All rules for the AND-CS program have| No |
| |Addition | |APPROVED FOR SSI DUE TO A DISABILITY OR BLINDNESS. THE COUNTY DEPARTMENT SHALL |been moved to a new section specific | |
| | | |VERIFY SSI ELIGIBILITY THROUGH SVES OR SDX AND DOCUMENT IN THE STATEWIDE |to that program. This was a request | |
| | | |AUTOMATED SYSTEM CASE COMMENTS. |from stakeholders. | |
|3.547 |New Rule |NEW |B. THE COUNTY DEPARTMENT SHALL ENTER ALL CLIENT, RESOURCE, AND INCOME |All rules for the AND-CS program have| No |
| |Addition | |INFORMATION INTO THE STATEWIDE AUTOMATED SYSTEM. |been moved to a new section specific | |
| | | | |to that program. This was a request | |
| | | | |from stakeholders. | |
|3.547 |New Rule |NEW |C. THE CLIENT SHALL HAVE THE RIGHT TO DECIDE HOW TO SPEND HIS OR HER AND-CS |All rules for the AND-CS program have| No |
| |Addition | |GRANT PAYMENT. |been moved to a new section specific | |
| | | | |to that program. This was a request | |
| | | | |from stakeholders. | |
|3.547 |New Rule |NEW |D. IF A CLIENT IS TERMINATED FROM SSI, THE CLIENT SHALL LOSE ELIGIBILITY FOR THE|All rules for the AND-CS program have| No |
| |Addition | |AND-CS PROGRAM. |been moved to a new section specific | |
| | | | |to that program. This was a request | |
| | | | |from stakeholders. | |
|3.548 |New Rule |NEW |A. AND-CS GRANTS SHALL BE CALCULATED ON AN INDIVIDUAL BASIS WITH JUST ONE CLIENT|All rules for the AND-CS program have| No |
| |Addition | |PER CASE. |been moved to a new section specific | |
| | | | |to that program. This was a request | |
| | | | |from stakeholders. | |
|3.548 |New Rule |NEW |B. WHEN A CLIENT HAS BEEN FOUND ELIGIBLE THE AMOUNT OF THE CLIENT'S AUTHORIZED |All rules for the AND-CS program have| No |
| |Addition | |AND-CS GRANT PAYMENT SHALL BE DETERMINED BY DEDUCTING THE CLIENT'S TOTAL |been moved to a new section specific | |
| | | |COUNTABLE INCOME FROM THE AND-CS GRANT STANDARD. |to that program. This was a request | |
| | | |1. IF DETERMINED ELIGIBLE ON THE FIRST OF THE MONTH, THE CLIENT SHALL RECEIVE |from stakeholders. | |
| | | |HIS OR HER AUTHORIZED GRANT PAYMENT IN THE INITIAL AND SUBSEQUENT MONTHS. | | |
| | | |2. IF DETERMINED ELIGIBLE ON ANY OTHER DAY OF THE MONTH, THE CLIENT'S FIRST | | |
| | | |MONTH GRANT PAYMENT SHALL BE PRORATED ACCORDING TO THE NUMBER OF DAYS REMAINING | | |
| | | |IN THE MONTH; THE CLIENT SHALL RECEIVE THEIR AUTHORIZED GRANT PAYMENT IN | | |
| | | |SUBSEQUENT MONTHS. | | |
|3.548 |New Rule |NEW |C. THE AND-CS GRANT PAYMENT SHALL BE MADE VIA ELECTRONIC BENEFITS TRANSFER, |All rules for the AND-CS program have| No |
| |Addition | |DIRECT DEPOSIT, OR WARRANT TO THE CLIENT, TO A FACILITY, OR TO A LEGALLY |been moved to a new section specific | |
| | | |DESIGNATED PERSON, SUCH AS A REPRESENTATIVE PAYEE, FIDUCIARY, OR CONSERVATOR. |to that program. This was a request | |
| | | | |from stakeholders. | |
|3.548 |New Rule |NEW |D. THE CLIENT SHALL ONLY BE ELIGIBLE FOR A MONTHLY PERSONAL NEEDS ALLOWANCE |All rules for the AND-CS program have| No |
| |Addition | |(PNA) WHEN PROGRAM REQUIREMENTS ARE MET AND THE CLIENT IS A RESIDENT OF A |been moved to a new section specific | |
| | | |FACILITY FOR AT LEAST THIRTY (30) CONSECUTIVE DAYS, AS FOLLOWS: |to that program. This was a request | |
| | | |1. IN A GENERAL MEDICAL AND SURGICAL HOSPITAL; |from stakeholders. | |
| | | |2. IN A NURSING HOME, ASSISTED LIVING RESIDENCE, OR, INTERMEDIATE CARE FACILITY,| | |
| | | |GROUP HOME, HOST HOME, OTHER LONG-TERM CARE FACILITY, OR ADULT FINANCIAL | | |
| | | |APPROVED SETTING. | | |
|3.548 |New Rule |NEW |E. THE FOLLOWING PERSONS ARE NOT ELIGIBLE FOR A PNA OR AND-CS GRANT PAYMENTS: |All rules for the AND-CS program have| No |
| |Addition | |1. INMATES IN A PENAL INSTITUTION; OR, |been moved to a new section specific | |
| | | |2. RESIDENTS IN AN UNLICENSED PRIVATE OR UNCERTIFIED PUBLIC FACILITY. |to that program. This was a request | |
| | | | |from stakeholders. | |
|3.548 |New Rule |NEW |F. THE AND-CS PERSONAL NEEDS ALLOWANCE MAXIMUM SHALL BE SEVENTY-NINE DOLLARS |All rules for the AND-CS program have| No |
| |Addition | |($79) EFFECTIVE OCTOBER 1, 2016. THE AND-CS GRANT SHALL NOT BE REDUCED UNTIL THE|been moved to a new section specific | |
| | | |MONTH FOLLOWING THE FIRST FULL CALENDAR MONTH THAT THE CLIENT IS A RESIDENT IN |to that program. This was a request | |
| | | |AN APPROVED FACILITY. |from stakeholders. | |
|3.548 |New Rule |NEW |G. IF THE SOCIAL SECURITY ADMINISTRATION (SSA) IS RECOVERING ANY PORTION OF THE |All rules for the AND-CS program have| No |
| |Addition | |CLIENT'S SSI PAYMENT DUE TO AN OVERPAYMENT OF BENEFITS, AND-CS SHALL BE |been moved to a new section specific | |
| | | |CALCULATED BASED ON THE GROSS SSI PAYMENT AND NOT THE RECEIVED AMOUNT. |to that program. This was a request | |
| | | | |from stakeholders. | |
|3.549 |New Rule |NEW |A. IF THE CLIENT HAS INCOME, APPLY THE FOLLOWING INCOME DISREGARDS: |All rules for the AND-CS program have| No |
| |Addition | |1. TO DETERMINE COUNTABLE EARNED INCOME: |been moved to a new section specific | |
| | | |A. DEDUCT $65 FROM THE MONTHLY GROSS INCOME; AND, |to that program. This was a request | |
| | | |B. DIVIDE THE REMAINDER BY TWO (2). |from stakeholders. | |
| | | |C. THE RESULT IS THE COUNTABLE EARNED INCOME. | | |
| | | |2. TO DETERMINE COUNTABLE UNEARNED INCOME: | | |
| | | |A. DETERMINE THE CLIENT'S UNEARNED INCOME FROM ALL SOURCES. | | |
| | | |B. SUBTRACT ANY AMOUNT RECEIVED FROM SSI. | | |
| | | |C. DEDUCT $20 FROM THE REMAINDER. | | |
| | | |1. IF THE CLIENT IS MARRIED, THE $20 DISREGARD SHALL BE SPLIT BETWEEN THE CLIENT| | |
| | | |AND THE SPOUSE SO THAT NO MORE THAN A $20.00 DISREGARD IS APPLIED FOR THE | | |
| | | |MARRIED COUPLE. | | |
| | | |2. A CLIENT WHO RECEIVES SSI ONLY, AND DOES NOT RECEIVE ANY OTHER UNEARNED | | |
| | | |INCOME, DOES NOT RECEIVE AN UNEARNED INCOME DISREGARD. | | |
| | | |D. ADD THE FULL SSI INCOME BACK TO THE REMAINDER. | | |
| | | |E. THE RESULT IS THE COUNTABLE UNEARNED INCOME. | | |
| | | |F. IF THE CLIENT'S UNEARNED INCOME IS LESS THAN $20.00, THE DIFFERENCE BETWEEN | | |
| | | |THE GROSS UNEARNED INCOME AND THE $20.00 DEDUCTION SHALL BE APPLIED TO THE | | |
| | | |EARNED INCOME CALCULATION, IF APPLICABLE. | | |
|3.549 |New Rule |NEW |B. SUBTRACT THE COUNTABLE EARNED AND COUNTABLE UNEARNED INCOME FROM THE AND-CS |All rules for the AND-CS program have| No |
| |Addition | |GRANT STANDARD TO DETERMINE THE GRANT PAYMENT AMOUNT. |been moved to a new section specific | |
| | | | |to that program. This was a request | |
| | | | |from stakeholders. | |
|3.549 |New Rule |NEW |C. A PORTION OF THE EARNED INCOME OF AN AND-CS CLIENT'S SPOUSE SHALL BE DEEMED |All rules for the AND-CS program have| No |
| |Addition | |TO THE CLIENT, AS FOLLOWS: |been moved to a new section specific | |
| | | |1. DETERMINE THE SPOUSE'S MONTHLY GROSS INCOME. |to that program. This was a request | |
| | | |2. DEDUCT $65.00 FROM THE MONTHLY GROSS INCOME; AND, |from stakeholders. | |
| | | |3. DIVIDE THE REMAINDER BY TWO (2). | | |
| | | |4. THE RESULT IS THE AMOUNT DEEMED TO THE CLIENT. | | |
|3.549 |New Rule |NEW |D. A PORTION OF THE UNEARNED INCOME FOR THE AND-CS CLIENT'S SPOUSE SHALL BE |All rules for the AND-CS program have| No |
| |Addition | |DEEMED TO THE CLIENT, AS FOLLOWS: |been moved to a new section specific | |
| | | |1. DETERMINE THE SPOUSE'S MONTHLY GROSS UNEARNED INCOME. |to that program. This was a request | |
| | | |2. DEDUCT ANY REMAINING UNEARNED INCOME DISREGARD REMAINING FROM THE CLIENT OR |from stakeholders. | |
| | | |$20.00, WHICHEVER IS LESS. A COUPLE SHALL BE ALLOWED A COMBINED $20.00 | | |
| | | |DISREGARD, WHICH IS SPLIT BETWEEN THE CLIENT AND THE SPOUSE. | | |
| | | |3. THE RESULT IS COUNTABLE UNEARNED INCOME AND IS DEEMED TO THE CLIENT. | | |
|3.549 |New Rule |NEW |E. WHEN THE AND-CS CLIENT IS AN UNEMANCIPATED CHILD UNDER EIGHTEEN (18) YEARS OF|All rules for the AND-CS program have| No |
| |Addition | |AGE, THE EARNED AND UNEARNED INCOME OF THE CHILD AND THE CHILD'S PARENTS SHALL |been moved to a new section specific | |
| | | |BE SUBJECT TO DISREGARDS AND DEEMING, AS OUTLINED ABOVE. THE PARENTS' INCOME |to that program. This was a request | |
| | | |SHALL BE DEEMED USING THE SAME CALCULATIONS AS A SPOUSE. |from stakeholders. | |
|3.549 |New Rule |NEW |F. IF A SPOUSE OR PARENT IS RECEIVING ADULT FINANCIAL GRANT PAYMENTS, SSI |All rules for the AND-CS program have| No |
| |Addition | |BENEFITS, OR MEDICAID ASSISTANCE AND HAS INCOME NO GREATER THAN THE SSI LIMIT, |been moved to a new section specific | |
| | | |THEIR INCOME SHALL NOT BE CONSIDERED AS AVAILABLE TO THE AND-CS CLIENT AND SHALL|to that program. This was a request | |
| | | |NOT BE DEEMED. IF A SPOUSE IS INSTITUTIONALIZED AND THE CLIENT HAS RETAINED THE |from stakeholders. | |
| | | |MMMNA, THE MMMNA SHALL BE DEDUCTED FROM THE INSTITUTIONALIZED SPOUSE’S TOTAL | | |
| | | |INCOME. | | |
|3.549 |New Rule |NEW |G. A SPONSOR'S INCOME CAN ONLY BE DEEMED TOWARDS THE NON-CITIZEN CLIENT HE OR |All rules for the AND-CS program have| No |
| |Addition | |SHE SPONSORS. THE AMOUNT OF EARNED AND UNEARNED INCOME TO DEEM FROM A SPONSOR(S)|been moved to a new section specific | |
| | | |TO A CLIENT IS CALCULATED AS FOLLOWS: |to that program. This was a request | |
| | | |1. THE TOTAL GROSS EARNED AND UNEARNED INCOME OF THE SPONSOR ARE ADDED TOGETHER.|from stakeholders. | |
| | | |2. THE FOLLOWING DEDUCTIONS ARE SUBTRACTED FROM THE TOTAL INCOME OF THE SPONSOR:| | |
| | | |A. A DEDUCTION FOR THE SPONSOR EQUAL TO THE CURRENT SSI BENEFIT STANDARD, AS | | |
| | | |DEFINED IN SECTION 3.510, FOR AN INDIVIDUAL FOR THE MONTH IN WHICH ELIGIBILITY | | |
| | | |IS BEING DETERMINED; PLUS | | |
| | | |B. A DEDUCTION FOR THE SPONSOR'S SPOUSE LIVING IN THE SAME HOUSEHOLD WITH THE | | |
| | | |SPONSOR, EQUAL TO ONE-HALF THE CURRENT SSI BENEFIT STANDARD, AS DEFINED IN | | |
| | | |SECTION 3.510, FOR AN INDIVIDUAL; OR A DEDUCTION FOR THE SPONSOR'S SPOUSE, WHO | | |
| | | |IS ALSO A CO-SPONSOR OF THE NON-CITIZEN CLIENT, EQUAL TO THE CURRENT SSI BENEFIT| | |
| | | |STANDARD FOR AN INDIVIDUAL; PLUS | | |
| | | |C. A DEDUCTION EQUAL TO ONE-HALF THE SSI BENEFIT STANDARD, AS DEFINED IN SECTION| | |
| | | |3.510, FOR AN INDIVIDUAL FOR EACH PERSON WHO IS A DEPENDENT OF THE SPONSOR | | |
| | | |(OTHER THAN THE NON-CITIZEN CLIENT AND THE NON-CITIZEN CLIENT'S SPOUSE). | | |
| | | |3. THE DIFFERENCE BETWEEN THE TOTAL INCOME AND THE TOTAL DEDUCTIONS IS DEEMED AS| | |
| | | |UNEARNED INCOME TO THE NON-CITIZEN CLIENT. THIS DEEMED INCOME IS ADDED TO THE | | |
| | | |NON-CITIZEN CLIENT'S OWN INCOME TO DETERMINE THE TOTAL COUNTABLE INCOME. | | |
| | | |4. COMPARE THE NON-CITIZEN CLIENT'S COUNTABLE INCOME TO THE INCOME STANDARD OF | | |
| | | |THE ADULT FINANCIAL PROGRAM FOR WHICH THE NON-CITIZEN CLIENT IS APPLYING TO | | |
| | | |DETERMINE ELIGIBILITY AND/OR THE GRANT PAYMENT AMOUNT. | | |
| | | |5. IF MORE THAN ONE NON-CITIZEN CLIENT HAS THE SAME SPONSOR, ALL OF THE | | |
| | | |SPONSOR'S INCOME IS DEEMED TO EACH NON-CITIZEN CLIENT. DO NOT DIVIDE THE | | |
| | | |SPONSOR'S INCOME AMONG THE NON-CITIZEN CLIENTS. | | |
|3.549 |New Rule |NEW |H. THE COUNTY DEPARTMENT SHALL DETERMINE ALL COUNTABLE EARNED AND UNEARNED |All rules for the AND-CS program have| No |
| |Addition | |INCOME AVAILABLE FROM THE CLIENT, THE SPOUSE/PARENTS, AND THE SPONSOR(S). THE |been moved to a new section specific | |
| | | |TOTAL SHALL BE DEDUCTED FROM THE AND-CS GRANT STANDARD TO DETERMINE THE CLIENT'S|to that program. This was a request | |
| | | |GRANT PAYMENT AMOUNT. |from stakeholders. | |
|3.550 |Clarification |A. A redetermination of eligibility shall mean a case |A. A redetermination of eligibility shall mean a case review/determination of |Clarified the expected RRR frequency | No |
| |Needed |review/determination of necessary information and |necessary information and verifications to determine ongoing eligibility every |for AND. | |
| | |verifications to determine ongoing eligibility every twelve|twelve (12) to twenty-four (24) months for OAP and AT LEAST every twelve (12) | | |
| | |(12) to twenty-four (24) months for OAP and every twelve |months for AND. The eligibility period for OAP shall be determined by the | | |
| | |(12) months for AND. The eligibility period for OAP shall |statewide automated system based on the following factors: | | |
| | |be determined by the statewide automated system based on |1. OAP cases shall be redetermined, at a minimum, every twenty-four (24) months | | |
| | |the following factors:1. OAP cases shall be redetermined, |when: | | |
| | |at a minimum, every twenty-four (24) months when:a. There |a. There is no earned income; and, | | |
| | |is no earned income; and,b. The value of the client's |b. The value of the client's countable resources are at least two hundred | | |
| | |countable resources are at least two hundred dollars ($200)|dollars ($200) under the client's resource limit, as defined in Section | | |
| | |under the client's resource limit, as defined in Section |3.520.72.A. | | |
| | |3.520.72, A.2. All other OAP cases shall be redetermined |2. All other OAP cases shall be redetermined every twelve (12) months, at a | | |
| | |every twelve (12) months, at a minimum. |minimum. | | |
|3.550 |Clarification |B. Clients shall file their redetermination with the county|B. Clients shall file their redetermination with the county DEPARTMENT by the |Extended the amount of time a county | No |
| |Needed |by the fifteenth (15th) of the month as specified in the |fifteenth (15th) of the month as specified in the redetermination packet. |will have to process RRRs that are | |
| | |redetermination packet. |1. A client's failure to file a RRR REDETERMINATION timely may delay the |turned in late by the client. | |
| | |1. A client's failure to file a RRR timely may delay the |determination of benefits AND GRANT PAYMENTS. | | |
| | |determination of benefits. |2. THE COUNTY DEPARTMENT MUST MAKE AN ELIGIBILITY DECISION ON CComplete, | | |
| | |2. Complete forms received timely must be acted upon by the|TIMELY-RECEIVED forms ON OR BEFORE received timely must be acted upon by the | | |
| | |county department by the last day of the month. |county department by the last day of the month IN WHICH THE FORMS WERE DUE. | | |
| | |3. Complete forms received between the 16th and the last |3. Complete forms received between the 16th and the last day of the month the | | |
| | |day of the month the redetermination is due must be |redetermination is due must be approved or denied as soon as possible. but no | | |
| | |approved or denied as soon as possible but no later than |later than the tenth (10th) calendar day in the following month. THE COUNTY | | |
| | |the tenth (10th) calendar day in the following month. |DEPARTMENT WILL HAVE TEN (10) DAYS TO ACT ON SUCH REDETERMINATIONS, TO INCLUDE | | |
| | | |SCHEDULING AND CONDUCTING THE INTERVIEW AND REQUESTING ANY NECESSARY | | |
| | | |VERIFICATION. THE COUNTY MUST MAKE AN ELIGIBILITY DECISION ON REDETERMINATION | | |
| | | |FORMS RECEIVED BETWEEN THE 16TH AND LAST DAY OF THE MONTH WITHIN THIRTY (30) | | |
| | | |DAYS FROM RECEIPT OF SUCH REDETERMINATION. | | |
|3.550 |Clarification |C. The county department shall schedule an interview with |C. The county department shall schedule AND CONDUCT an interview with the client|Updated interview requirements. | No |
| |Needed |the client at each redetermination.1. The interview shall |at each redetermination. | | |
| | |be an in-person interview if the county department has not |1. THE CLIENT SHALL BE OFFERED The interview shall be an in-person interview if | | |
| | |had an in-person interview with the client within three (3)|the county department has not had an in-person interview with the client within | | |
| | |years of the RRR due date.a. Exception to this rule is |three (3) years of the RRR due date. | | |
| | |allowed if there is good cause, as outlined in Section |a. Exception to this rule is allowed if there is good cause, as outlined in | | |
| | |3.520.4, C; or,b. If the client resides in a long-term care|Section 3.510 3.520.4, C; or, | | |
| | |facility and the county department is able to verify |b. If the client resides in a long-term care facility and the county department | | |
| | |information through the facility administration; or,c. Has |is able to verify information through the facility administration; or, | | |
| | |regular monitoring (to include face-to-face visits) by a |c. Has regular monitoring (to include face-to-face visits) by a Single Entry | | |
| | |Single Entry Point case manager.2. The interview may be a |Point case manager. | | |
| | |phone interview if the county department has had an |2. IF THE CLIENT DOES NOT ELECT AN IN-PERSON INTERVIEW, THE COUNTY SHALL | | |
| | |in-person interview with the client within the past three |SCHEDULE A PHONE INTERVIEW. The interview may be a phone interview if the county| | |
| | |years.3. When a redetermination interview is scheduled, the|department has had an in-person interview with the client within the past three | | |
| | |client shall be notified at least ten (10) calendar days in|years. | | |
| | |advance, in writing, of:a. The date and time for the |3. THE CLIENT SHALL BE PROVIDED WRITTEN NOTICE AT LEAST FOUR (4) DAYS IN ADVANCE| | |
| | |interview;b. Any documentation that may be needed |OF THE SCHEDULED INTERVIEW. THE CLIENT MAY PROVIDE A WRITTEN OR VERBAL WAIVER | | |
| | |including, but not limited to:1) Non-financial eligibility |THAT WRITTEN NOTICE OF THE SCHEDULED INTERVIEW IS NOT NECESSARY WHEN THE COUNTY | | |
| | |requirements, as outlined in Section 3.520.6; and,2) |DEPARTMENT IS ABLE TO CONDUCT THE INTERVIEW DURING REDETERMINATION PROCESSING. | | |
| | |Resources, as outlined in Section 3.520.72; and,3) Income, |When a redetermination interview is scheduled, the client shall be notified at | | |
| | |as outlined in Section 3.520.78.c. The opportunity to |least ten (10) calendar days in advance, in writing, of: WRITTEN NOTICE SHALL | | |
| | |reschedule the appointment or make other arrangements in |INCLUDE: | | |
| | |the event of good cause.4. When the client does not keep |a. The date and time for the interview; | | |
| | |the appointment and does not request an alternate time or |b. IDENTIFICATION OF AAny documentation that may be needed; AND including, but | | |
| | |arrangement, benefits will be discontinued. |not limited to: | | |
| | | |1) Non-financial eligibility requirements, as outlined in Section 3.520.6; and, | | |
| | | |2) Resources, as outlined in Section 3.520.72; and, | | |
| | | |3) Income, as outlined in Section 3.520.78. | | |
| | | |c. The opportunity to reschedule the appointment or make other arrangements in | | |
| | | |the event of good cause. | | |
| | | |4. When the client does not keep the INTERVIEW appointment and does not request | | |
| | | |an alternate time or arrangement, AS DESCRIBED IN SECTION 3.520.4.C, GRANT | | |
| | | |PAYMENTSbenefits will be discontinued FOLLOWING THE POLICIES OUTLINED IN SECTION| | |
| | | |3.554. | | |
|3.550 |Clarification |D. To redetermine eligibility a case review must be |D. To redetermine eligibility a case review must be conducted and necessary |Changed requirement to verify all | No |
| |Needed |conducted and necessary verification must be received to |verification must be received to determine ongoing eligibility. |resources at every RRR to only verify| |
| | |determine ongoing eligibility.1. If the client is approved |1. If the client is approved and is receiving SSI benefits and has no other |those things that have changed. | |
| | |and is receiving SSI benefits and has no other earned or |earned or unearned income, the income and resources received through the federal| | |
| | |unearned income, the income and resources received through |State Data Exchange (SDX) OR THE FEDERAL STATE VERIFICATION ELIGIBILITY SYSTEM | | |
| | |the federal State Data Exchange (SDX) interface shall be |(SVES) interface shall be considered verified upon receipt. | | |
| | |considered verified upon receipt.a. The county department |a. The county department shall verify REVIEW non-financial eligibility AND | | |
| | |shall verify non-financial eligibility; and,b. If the |VERIFY ANY CHANGES; and, | | |
| | |county department has obtained or received information |b. If the county department has obtained or received information related to | | |
| | |related to income, resources, or non-financial eligibility |income, resources, or non-financial eligibility requirements that is contrary to| | |
| | |requirements that is contrary to the SDX interface, the |the SDX OR SVES interfaceS, the county department shall independently verify the| | |
| | |county department shall independently verify the |information; and, | | |
| | |information; and,c. The county department shall forward |c. The county department shall forward such contrary information to the local | | |
| | |such contrary information to the local Social Security |Social Security Administration office. | | |
| | |Administration office.2. During the redetermination |2. During the redetermination process AND PRIOR TO ELIGIBILITY DETERMINATION, | | |
| | |process, the county worker shall:a. Conduct an interview;b.|the county worker shall: | | |
| | |Explain the purpose of the interview and the use of the |a. Conduct an interview; | | |
| | |information supplied by the client on the redetermination |b. Explain the purpose of the interview and the use of the information supplied | | |
| | |form and any additional required forms;c. Inform the client|by the client on the redetermination form and any additional required forms; | | |
| | |in writing that Social Security Numbers will be used to |c. Inform the client in writing that Social Security Numbers will be used to | | |
| | |request and exchange information with other agencies as |request and exchange information with other agencies as part of the eligibility | | |
| | |part of the eligibility process, including the Department |process, including the Department of Labor and Employment (state wage and | | |
| | |of Labor and Employment (state wage and unemployment data),|unemployment data), AND THE Social Security Administration, and Internal Revenue| | |
| | |Social Security Administration, and Internal Revenue |Service; | | |
| | |Service;d. Have the client complete the forms or complete |d. Have the client complete the form(s) or PROVIDE ASSISTANCE TO THE CLIENT IN | | |
| | |the form on behalf of the client;e. Explain the appeal |COMPLETING complete the form(S) on behalf of the client; | | |
| | |rights to the client as outlined in Section 3.850, et seq. |e. Explain the appeal rights to the client as outlined in Section 3.587 3.850, | | |
| | |(9 C.C.R. 2503-8);f. Witness the signature of the client |et seq. (9 C.C.R. 2503-8); | | |
| | |and sign as a person who helped complete the forms, when |f. Witness the signature of the client and sign as a person who helped complete | | |
| | |applicable;g. Review documents, verifications, and any |the form(S), when applicable; | | |
| | |other information supplied by the client with the client in|g. Review documents, verifications, and any other information supplied by the | | |
| | |order to obtain clarification if needed.h. Request updated |client with the client in order to obtain clarification if needed;. | | |
| | |verifications for all income, resources, and non-financial |h. Request updated verifications for all income, resources, and non-financial | | |
| | |eligibility requirements, to include, but not limited to:1)|eligibility requirements WHICH HAVE CHANGED. THIS MAY to include, but IS not | | |
| | |Newly declared, such as a new vehicle;2) Previously |limited to: | | |
| | |declared, such as a change in marital status;3) Changes |1) Newly declared, such as a new vehicle; | | |
| | |from the previous RRR, such as closure of a bank account; |2) Previously declared, such as a change in marital status; AND, | | |
| | |and,4) Changes in value, such as an increase in the cash |3) Changes from the previous RRR REDETERMINATION, such as closure of a bank | | |
| | |surrender value of life insurance policies. |account.; and, | | |
| | | |4) Changes in value, such as an increase in the cash surrender value of life | | |
| | | |insurance policies. | | |
|3.550 |Clarification |E. Any time while receiving Adult Financial program |E. Any time while receiving Adult Financial program GRANT PAYMENTSbenefits, if |Replaces intermittent redetermination| No |
| |Needed |benefits, if there is questionable information regarding |there is questionable information regarding the circumstances of a household OR |with request for contact to better | |
| | |the circumstances of a household, the county worker can |THE COUNTY DEPARTMENT RECEIVES INFORMATION ABOUT CHANGES IN A HOUSEHOLD’S |align with Food Assistance. | |
| | |request a redetermination. The county department shall |CIRCUMSTANCES BUT CANNOT DETERMINE THE EFFECT OF THOSE CHANGES ON GRANT | | |
| | |generate an intermittent redetermination when:1. It |PAYMENTS, the county worker can request a CONTACT redetermination. THE COUNTY | | |
| | |receives information that would contradict eligibility or |DEPARTMENT SHALL SEND A REQUEST FOR CONTACT NOTICE REQUESTING THE CLIENT ATTEND | | |
| | |that is questionable; or,2. It suspects possible fraud; |AN INTERVIEW APPOINTMENT. THE INTERVIEW SHOULD BE IN-PERSON UNLESS GOOD CAUSE | | |
| | |or,3. It receives direction to do so from the State |APPLIES WHICH WOULD ALLOW FOR A PHONE INTERVIEW IN LIEU OF THE IN-PERSON | | |
| | |Department; or,4. Otherwise reasonable under the prudent |INTERVIEW. IF THE CLIENT DOES NOT ATTEND THE INTERVIEW APPOINTMENT OR REQUEST AN| | |
| | |person principle. |ALTERNATE TIME OR ARRANGEMENT, AS SPECIFIED IN SECTION 3.520.4.C., THE CASE | | |
| | | |SHALL BE DISCONTINUED. The county department shall MAKE A REQUEST FOR CONTACT | | |
| | | |generate an intermittent redetermination when: | | |
| | | |1. It receives information that would contradict eligibility or that is | | |
| | | |questionable; or, | | |
| | | |2. It suspects possible fraud; or, | | |
| | | |3. It receives direction to do so from the State Department; or, | | |
| | | |4. IT IS OOtherwise reasonable TO DO SO under the prudent person principle. | | |
|3.550 |Clarification |F. Forms that the client is required to complete shall be |F. Forms that the client is required to complete shall be mailed to the client |Minor grammar fix. | No |
| |Needed |mailed to the client at least thirty (30) calendar days |at least thirty (30) calendar days prior to the first of the month in which the | | |
| | |prior to the first of the month in which the eligibility |eligibility redetermination is due. This is considered the prior notice period. | | |
| | |redetermination is due. This is considered the prior notice|A review of the case record will indicate the forms required based on individual| | |
| | |period. A review of the case record will indicate the forms|case circumstances. The following procedures relate to Mmail-out | | |
| | |required based on individual case circumstances. The |redeterminations SHALL BE CONDUCTED AS FOLLOWS: | | |
| | |following procedures relate to mail-out redeterminations:1.|1. A redetermination form shall be mailed to the client; | | |
| | |A redetermination form shall be mailed to the client;2. |2. Form(s) shall be completed, signed by the client, and returned to the county | | |
| | |Forms shall be completed, signed by the client, and |department no later than redetermination due date; and, | | |
| | |returned to the county department no later than |3. When the client is unable to complete the form(s) due to physical, mental, or| | |
| | |redetermination due date; and,3. When the client is unable |emotional disabilities, and has no one to help, the county department shall | | |
| | |to complete the forms due to physical, mental, or emotional|assist the client to complete the form(s), unless there is another available | | |
| | |disabilities, and has no one to help, the county department|legal or other resource that is willing and able to assist the client. | | |
| | |shall assist the client to complete the forms, unless there|4. When the client is unable to complete the redetermination packet in a timely | | |
| | |is another available legal or other resource that is |manner due to good cause, the county department shall extend the due date up to | | |
| | |willing and able to assist the client.4. When the client is|thirty (30) calendar days. The assistance or referral action of the county | | |
| | |unable to complete the redetermination packet in a timely |department shall be recorded in the case record. | | |
| | |manner due to good cause, the county department shall | | | |
| | |extend the due date up to thirty (30) calendar days. The | | | |
| | |assistance or referral action of the county department | | | |
| | |shall be recorded in the case record. | | | |
|3.550 |Clarification |G. When the county department receives the completed RRR |G. When the county department receives the completed RRR REDETERMINATION packet,|Additional clarification for county | No |
| |Needed |packet, it shall:1. Date stamp the redetermination forms |it shall: |processing of the RRR. | |
| | |and corresponding verification.2. Thoroughly review the RRR|1. Date stamp the redetermination form(s) and corresponding verification. | | |
| | |packet for completeness, accuracy, and consistency. All |2. Thoroughly review the RRR REDETERMINATION packet for completeness, accuracy, | | |
| | |factors shall be evaluated as to their effect on |and consistency. All factors shall be evaluated as to their effect on | | |
| | |eligibility and payment.a. If the client failed to sign the|eligibility and payment. | | |
| | |RRR, the RRR packet shall be returned to the client for |a. If the client failed to sign the RRR REDETERMINATION PACKET, the RRR | | |
| | |signature with instructions to return the signed packet |REDETERMINATION packet shall be returned to the client for signature with | | |
| | |before the end of the client's eligibility period.b. If the|instructions to return the signed packet before the end of the client's | | |
| | |RRR is incomplete, the county department shall ask for all |eligibility period. AN UNSIGNED REDETERMINATION PACKET SHALL BE CONSIDERED | | |
| | |necessary verification.3. Review the RRR packet for changes|INCOMPLETE AND SHALL NOT BE PROCESSED BY THE COUNTY DEPARTMENT. | | |
| | |to:a. Non-financial eligibility requirements, as outlined |b. If the RRR REDETERMINATION PACKET is incomplete, the county department shall | | |
| | |in Section 3.520.6; and,b. Resources, as outlined in |ask ADDITIONAL CLARIFYING QUESTIONS AND REQUEST for all necessary verification. | | |
| | |Section 3.520.72; and,c. Income, as outlined in Section |3. Review the RRR REDETERMINATION packet for changes to: | | |
| | |3.520.78.4. Document verifications in the case file. The |a. Non-financial eligibility requirements, as outlined in Section 3.520.6; and, | | |
| | |case file shall be used as a checklist in the |b. Resources, as outlined in Section 3.520.72; and, | | |
| | |redetermination process, and shall be used to keep track of|c. Income, as outlined in Section 3.520.78. | | |
| | |matters requiring further action. When additional |4. Document verifications in the case file, UTILIZING THE PROCESS DESCRIBED IN | | |
| | |information is needed:a. Due to incomplete forms or lack of|SECTION 3.520.4.D. The case file shall be used as a checklist in the | | |
| | |verification, a notice shall be mailed to the client. The |redetermination process, and shall be used to keep track of matters requiring | | |
| | |notice shall specify the items that are required for a |further action. When additional information is needed: | | |
| | |redetermination to be completed in order to determine |a. Due to incomplete form(s) or lack of verification, a notice shall be mailed | | |
| | |eligibility and/or payment;b. Due to inaccurate or |to the client. The notice shall specify the items that are required for a | | |
| | |inconsistent data, the client may be contacted by telephone|redetermination to be completed in order to determine eligibility and/or | | |
| | |or be requested to make an office visit, to secure the |payment; | | |
| | |proper information.c. Complete forms must be acted upon |b. Due to inaccurate or inconsistent data, the client may be contacted by | | |
| | |promptly by the county. |telephone or be requested to make an office visit, to secure the proper | | |
| | | |information. COLLATERAL CONTACTS AND INTERFACES SHALL BE USED TO GATHER | | |
| | | |INFORMATION WHENEVER POSSIBLE. | | |
| | | |c. Complete forms must be acted upon promptly by the county. | | |
|3.550 |Clarification |H. If the redetermination form is received by the first |H. If the redetermination form is TIMELY RECEIVED BUT IS received by the first |Clarified what needs to be done of | No |
| |Needed |filing deadline, but it is incomplete, a correction notice |filing deadline, but it is incomplete, a correction notice shall be sent to the |the RRR is incomplete. | |
| | |shall be sent to the client advising the client that the |client advising the client that the redetermination form is incomplete and must | | |
| | |redetermination form is incomplete and must be corrected by|be corrected by the LAST DAY OF THE MONTH IN WHICH THE FORMS WERE DUE correction| | |
| | |the correction deadline to avoid termination and/or the |deadline to avoid termination and/or the county department shall work with the | | |
| | |county department shall work with the client to complete |client to complete the form. | | |
| | |the form. | | | |
|3.550 |Clarification |I. When the information provided on the redetermination |I. When the information provided on the redetermination form, or otherwise |Removed unnecessary word. | No |
| |Needed |form, or otherwise provided by the client, is the basis for|provided by the client, is the basis for reduction in the amount of assistance | | |
| | |reduction in the amount of assistance or in termination of |or in termination of assistance FOLLOW THE POLICIES OUTLINED IN SECTION 3.554., | | |
| | |assistance, such actions shall be taken after adequate |such actions shall be taken after adequate notice is given. | | |
| | |notice is given. | | | |
|3.551 |Clarification |When a client fails to return his/her redetermination |When a client fails to return his OR /her redetermination packet BY prior to the|Describes county requirements for | No |
| |Needed |packet prior to the last day of the month of the expiring |last day of the month of the expiring eligibility period, the client's case |processing an RRR returned within 30 | |
| | |eligibility period, the client's case shall be |shall be discontinued FOLLOWING THE POLICIES OUTLINED IN SECTION 3.554. |days after discontinuation. | |
| | |discontinued. | | | |
|3.551 |Clarification |A. If the client returns the redetermination packet within |A. If the client returns the redetermination packet within thirty (30) calendar |Describes county requirements for | |
| |Needed |thirty (30) calendar days after discontinuation, the |days after discontinuation, the following processing requirements shall be |processing an RRR returned within 30 | |
| | |following processing requirements shall be implemented: |implemented: |days after discontinuation. | |
| | |1. If the client has good cause, the client's benefits |1. If the client has good cause, the client's GRANT PAYMENTSbenefits shall be | | |
| | |shall be reinstated. There shall be no break in the |reinstated. There shall be no break in the client's GRANT PAYMENTSbenefit. THE | | |
| | |client's benefit. |COUNTY DEPARTMENT WILL HAVE TEN (10) DAYS TO ACT ON SUCH REDETERMINATIONS, TO | | |
| | |2. If the client does not have good cause, the county |INCLUDE SCHEDULING AND CONDUCTING THE INTERVIEW AND REQUESTING ANY NECESSARY | | |
| | |department shall use the redetermination packet as a new |VERIFICATION. THE COUNTY MUST MAKE AN ELIGIBILITY DECISION ON REDETERMINATION | | |
| | |application. The date of the new application shall be the |FORMS RECEIVED WITHIN THIRTY (30) CALENDAR DAYS AFTER DISCONTINUATION WITHIN | | |
| | |date the county department received the redetermination |THIRTY (30) DAYS FROM RECEIPT OF SUCH REDETERMINATION. | | |
| | |packet. There shall be a break in the client's benefit. |2. If the client does not have good cause, the county department shall use the | | |
| | | |redetermination packet as a new application. The date of the new application | | |
| | | |shall be the date the county department received the redetermination packet. | | |
| | | |There shall be a break in the client's GRANT PAYMENTSbenefit. | | |
|3.551 |Clarification |B. If the client returns the redetermination packet |B. If the client returns the redetermination packet thirty-one (31) or more days|Updated language to grant payment to | |
| |Needed |thirty-one (31) or more days after the discontinuation, the|after the discontinuation, the county department shall require the client to |be consistent throughout rule. | |
| | |county department shall require the client to complete a |complete a new application. This will result in a break in the client's GRANT | | |
| | |new application. This will result in a break in the |PAYMENTSbenefit. | | |
| | |client's benefit. | | | |
|3.552 |New Rule |NEW |A. WHEN A CLIENT IS CERTIFIED FOR ADULT FINANCIAL GRANT PAYMENTS, A |New section of rule added to describe| No |
| |Addition | |CERTIFICATION PERIOD IS ASSIGNED. DURING THE CERTIFICATION PERIOD, THE CLIENT IS|requirements for reporting changes | |
| | | |REQUIRED TO REPORT AND PROVIDE VERIFICATION OF CHANGES APPLICABLE TO |and the corresponding county actions.| |
| | | |ELIGIBILITY. EXAMPLES OF CHANGES INCLUDE, BUT ARE NOT LIMITED TO, INCOME, | | |
| | | |MARITAL STATUS, HOUSEHOLD COMPOSITION, SHELTER COSTS, RESOURCES, AND CITIZENSHIP| | |
| | | |STATUS. IF A CLIENT DOES NOT REPORT CHANGES AS REQUIRED AND AS A RESULT IS | | |
| | | |OVERPAID GRANT PAYMENTS, THE CLIENT WILL BE HELD LIABLE FOR REPAYING ANY GRANT | | |
| | | |PAYMENTS HE OR SHE WAS NOT ELIGIBLE TO RECEIVE. | | |
|3.552 |New Rule |NEW |B. SOME CHANGES MAY BE REPORTED DIRECTLY TO THE COUNTY DEPARTMENT THROUGH |New section of rule added to describe| No |
| |Addition | |INTERFACES. UNLESS OTHERWISE SPECIFIED IN SECTION 3.520.5, INFORMATION THAT IS |requirements for reporting changes | |
| | | |RECEIVED THROUGH INTERFACES IS CONSIDERED VERIFIED UPON RECEIPT AND IS NOT |and the corresponding county actions.| |
| | | |SUBJECT TO ADDITIONAL VERIFICATION BY THE CLIENT. THE DATE OF THE CHANGE FOR | | |
| | | |THIS INFORMATION SHALL BE CONSIDERED THE DATE THE INFORMATION IS REPORTED TO THE| | |
| | | |COUNTY THROUGH AN INTERFACE. THE COUNTY DEPARTMENT SHALL ACT ON THESE CHANGES | | |
| | | |WITHIN TEN (10) CALENDAR DAYS OF THE DATE OF THE CHANGE, UNLESS OTHERWISE | | |
| | | |PRESCRIBED IN SECTION 3.520.5. | | |
|3.552 |New Rule |NEW |C. CLIENTS SHALL BE REQUIRED TO REPORT AND PROVIDE VERIFICATION OF CHANGES IN |New section of rule added to describe| No |
| |Addition | |CIRCUMSTANCES BY THE 10TH OF THE MONTH FOLLOWING THE MONTH IN WHICH THE CHANGE |requirements for reporting changes | |
| | | |OCCURRED. THE COUNTY DEPARTMENT HAS UP TO TEN (10) CALENDAR DAYS TO ACT ON THE |and the corresponding county actions.| |
| | | |INFORMATION FROM THE DATE THE CHANGE IS REPORTED AND VERIFIED, AS OUTLINED IN | | |
| | | |SECTION 3.553. | | |
|3.552 |New Rule |NEW |D. THE CLIENT SHALL BE ALLOWED TO REPORT CHANGES IN PERSON, BY TELEPHONE, IN |New section of rule added to describe| No |
| |Addition | |WRITING, OR ELECTRONICALLY. CHANGES REPORTED BY THE CLIENT BY TELEPHONE, |requirements for reporting changes | |
| | | |ELECTRONICALLY, OR IN PERSON SHALL BE ACTED UPON IN THE SAME MANNER AS THOSE |and the corresponding county actions.| |
| | | |REPORTED IN WRITING. IF REPORTING BY MAIL, CLIENTS WILL HAVE MET THE REPORTING | | |
| | | |REQUIREMENT PROVIDED THE ENVELOPE IS POSTMARKED BY THE 10TH OF THE MONTH | | |
| | | |FOLLOWING THE MONTH IN WHICH THE CHANGE OCCURRED. | | |
|3.552 |New Rule |NEW |E. IF ADDITIONAL VERIFICATION IS REQUIRED TO PROCESS THE REPORTED CHANGE, THE |New section of rule added to describe| No |
| |Addition | |CLIENT SHALL BE NOTIFIED OF THE VERIFICATION NEEDED AND THE DEADLINE FOR |requirements for reporting changes | |
| | | |SUBMITTING REQUIRED VERIFICATION TO THE COUNTY DEPARTMENT, UTILIZING THE PROCESS|and the corresponding county actions.| |
| | | |DESCRIBED IN SECTION 3.520.4.D. THE NOTICE SHALL INFORM THE CLIENT THAT THE | | |
| | | |CHANGE MUST BE VERIFIED PRIOR TO ACTION BEING TAKEN BY THE COUNTY DEPARTMENT IF | | |
| | | |GRANT PAYMENTS ARE TO BE INCREASED. | | |
|3.552 |New Rule |NEW |F. WHEN A CHANGE IN CLIENT CIRCUMSTANCES OCCURS AND THE COUNTY DEPARTMENT HAS |New section of rule added to describe| No |
| |Addition | |DETERMINED THAT A CLIENT HAS FAILED TO COOPERATE IN PROVIDING VERIFICATION |requirements for reporting changes | |
| | | |NECESSARY TO DETERMINE ELIGIBILITY. THE CLIENT'S ELIGIBILITY SHALL BE TERMINATED|and the corresponding county actions.| |
| | | |FOLLOWING WRITTEN TIMELY NOTICE. CLIENTS EXPERIENCING DIFFICULTY IN OBTAINING | | |
| | | |NECESSARY VERIFICATION SHALL BE ASSISTED BY THE COUNTY DEPARTMENT EITHER IN | | |
| | | |OBTAINING THE DOCUMENTARY EVIDENCE OR BY MAKING A COLLATERAL CONTACT. THE COUNTY| | |
| | | |DEPARTMENT MUST ENSURE THAT THE CLIENT WAS NOTIFIED OF THE NEEDED VERIFICATION | | |
| | | |AND AT LEAST ELEVEN (11) CALENDAR DAYS WAS ALLOWED TO OBTAIN THE VERIFICATION. | | |
|3.553 |New Rule |NEW |A. A CHANGE SHALL BE CONSIDERED TO BE REPORTED AS OF THE DATE THE COUNTY |New section of rule added to describe| No |
| |Addition | |DEPARTMENT IS NOTIFIED OF THE CHANGE. A CHANGE SHALL BE CONSIDERED VERIFIED AS |requirements for reporting changes | |
| | | |OF THE DATE THE COUNTY DEPARTMENT RECEIVES VERIFICATION OF THE CHANGE. IF A |and the corresponding county actions.| |
| | | |CHANGE IS REPORTED AND VERIFIED BY THE TENTH (10TH) OF THE MONTH FOLLOWING THE | | |
| | | |DATE OF THE CHANGE, THE CHANGE SHALL BE CONSIDERED TIMELY REPORTED BY THE | | |
| | | |CLIENT. | | |
|3.553 |New Rule |NEW |B. THE COUNTY DEPARTMENT SHALL PROCESS THE CHANGE WITHIN TEN (10) CALENDAR DAYS |New section of rule added to describe| No |
| |Addition | |FROM THE DATE THE CHANGE WAS VERIFIED, TO BE CONSIDERED TIMELY PROCESSED BY THE |requirements for reporting changes | |
| | | |COUNTY DEPARTMENT. CHANGES REPORTED BY CLIENTS SHALL BE DOCUMENTED IN THE CASE |and the corresponding county actions.| |
| | | |RECORD TO INDICATE THE CHANGE, THE DATE THE CHANGE WAS REPORTED, AND THE DATE | | |
| | | |THE CHANGE WAS VERIFIED. IF THE CHANGE CAUSES A CHANGE TO THE CLIENT’S GRANT, A | | |
| | | |NOTICE OF ACTION FORM SHALL BE ISSUED TO INFORM THE CLIENT OF THE CHANGE. | | |
|3.553 |New Rule |NEW |C. CHANGES SHALL BE ACTED UPON AS FOLLOWS: |New section of rule added to describe| No |
| |Addition | |1. CHANGES THAT RESULT IN AN INCREASE IN GRANT PAYMENTS SHALL TAKE EFFECT THE |requirements for reporting changes | |
| | | |MONTH FOLLOWING THE MONTH THE CHANGE WAS VERIFIED BY THE CLIENT. DUE TO THE TIME|and the corresponding county actions.| |
| | | |REQUIRED FOR PROCESSING BY THE COUNTY DEPARTMENT, RECEIPT OF ANY INCREASE IN | | |
| | | |GRANT PAYMENTS MAY BE DELAYED BEYOND THE MONTH FOLLOWING THE MONTH OF THE | | |
| | | |CHANGE. | | |
| | | |2. CHANGES THAT RESULT IN A DECREASE IN GRANT PAYMENTS OR TOTAL INELIGIBILITY | | |
| | | |SHALL AFFECT A CASE FOLLOWING THE POLICIES OUTLINED IN SECTION 3.554. | | |
|3.553 |New Rule |NEW |D. IF GRANT PAYMENTS ARE OVER-PAID BECAUSE A CLIENT FAILS TO TIMELY REPORT |New section of rule added to describe| No |
| |Addition | |AND/OR TIMELY VERIFY CHANGES IN CIRCUMSTANCES OR INCOME AS REQUIRED, A CLAIM |requirements for reporting changes | |
| | | |SHALL BE ESTABLISHED AND A NOTICE OF OVERPAYMENT AND A PUBLIC ASSISTANCE |and the corresponding county actions.| |
| | | |REPAYMENT AGREEMENT FORM REFERENCED IN SECTION 3.582.B.4. WILL BE MAILED. IF THE| | |
| | | |OVER-PAYMENT IS DISCOVERED WITHIN THE CERTIFICATION PERIOD, THE CLIENT MUST BE | | |
| | | |GIVEN WRITTEN TIMELY NOTICE IF GRANT PAYMENTS ARE TO BE REDUCED. | | |
|3.554 |New Rule |NEW |A. THE COUNTY DEPARTMENT AND/OR THE SINGLE ENTRY POINT (SEP) SHALL NOTIFY A |New section of rule added to describe| No |
| |Addition | |CLIENT OF ANY CHANGE FROM HIS OR HER PRIOR GRANT PAYMENT AMOUNT, THE REASON FOR |requirements for reporting changes | |
| | | |THE ACTION, AND THE DATE THE ACTION BECOMES EFFECTIVE IN WRITING. |and the corresponding county actions.| |
|3.554 |New Rule |NEW |B. CLIENTS SHALL RECEIVE WRITTEN TIMELY NOTICE, GIVING AT LEAST ELEVEN (11) |New section of rule added to describe| No |
| |Addition | |CALENDAR DAYS ADVANCE NOTICE BEFORE ANY ADVERSE ACTION, SUCH AS A GRANT PAYMENT |requirements for reporting changes | |
| | | |REDUCTION, SUSPENSION, TERMINATION OR DENIAL, BECOMES EFFECTIVE DURING THE |and the corresponding county actions.| |
| | | |CERTIFICATION PERIOD, EXCEPT AS SPECIFIED IN SECTION 3.554.C. THE NOTICE SHALL | | |
| | | |EXPLAIN THE REASON FOR THE PROPOSED ACTION AND THE DATE THE ACTION BECOMES | | |
| | | |EFFECTIVE. | | |
| | | |1. WHEN ACTING ON A CHANGE IN ACCORDANCE WITH SECTION 3.553, IF THE ELEVEN (11) | | |
| | | |CALENDAR DAY TIMELY NOTICE PERIOD CAN BE GIVEN WITHIN THE MONTH THE WRITTEN | | |
| | | |TIMELY NOTICE IS SENT, THE CHANGE WILL BECOME EFFECTIVE THE FIRST DAY OF THE | | |
| | | |FOLLOWING MONTH. | | |
| | | |2. IF THE 11 CALENDAR DAY TIMELY NOTICE PERIOD CONCLUDES IN THE FOLLOWING MONTH,| | |
| | | |THE CHANGE SHALL BECOME EFFECTIVE THE FIRST DAY OF THE MONTH AFTER WHICH THE | | |
| | | |TIMELY NOTICE PERIOD CONCLUDED. | | |
| | | |3. IF THE TIMELY NOTICE PERIOD ENDS ON A WEEKEND OR HOLIDAY AND A REQUEST FOR A | | |
| | | |STATE LEVEL FAIR HEARING AND CONTINUATION OF GRANT PAYMENTS IS RECEIVED THE | | |
| | | |FIRST BUSINESS DAY AFTER THE TIMELY NOTICE PERIOD, THE REQUEST SHALL BE | | |
| | | |CONSIDERED TIMELY RECEIVED. | | |
|3.554 |New Rule |NEW |C. ADEQUATE NOTICE, NOT TIMELY NOTICE, IS REQUIRED IN THE FOLLOWING SITUATIONS: |New section of rule added to describe| No |
| |Addition | |1. WHEN FACTS INDICATE AN OVERPAYMENT BECAUSE OF PROBABLE FRAUD OR AN |requirements for reporting changes | |
| | | |INTENTIONAL PROGRAM VIOLATION AND SUCH FACTS HAVE BEEN VERIFIED TO THE EXTENT |and the corresponding county actions.| |
| | | |POSSIBLE, PRIOR NOTICE SHALL BE MAILED AT LEAST FIVE (5) CALENDAR DAYS BEFORE | | |
| | | |THE PROPOSED EFFECTIVE DATE. | | |
| | | |2. THE COUNTY DEPARTMENT HAS DETERMINED THAT THE STATE PRESCRIBED MEDICAL | | |
| | | |CERTIFICATION HAS EXPIRED. | | |
| | | |3. THE COUNTY DEPARTMENT AND/OR SEP HAS DETERMINED THAT THE CLIENT HAS STOPPED | | |
| | | |RECEIVING HOME CARE ALLOWANCE (HCA) AND IS NOW RECEIVING HOME AND COMMUNITY | | |
| | | |BASED SERVICES (HCBS). | | |
| | | |4. THE CLIENT HAS DIED. | | |
| | | |5. THE CLIENT HAS PROVIDED A CLEAR STATEMENT WHICH STATES THAT HE OR SHE NO | | |
| | | |LONGER WISHES TO RECEIVE ASSISTANCE/SERVICES. | | |
| | | |6. THE CLIENT BEGINS RECEIVING SSI OR SSDI. A CLAIM TO RECOVER THE AND-SO OR | | |
| | | |COLORADO SUPPLEMENT GRANT PAYMENTS THAT ARE ISSUED IN THE SAME MONTH THAT THE | | |
| | | |SSI OR SSDI BENEFITS ARE RECEIVED SHALL BE CREATED AND THE CLIENT SHALL BE | | |
| | | |LIABLE TO REPAY THE AND-SO OR COLORADO SUPPLEMENT GRANT PAYMENTS THAT WERE | | |
| | | |ISSUED. | | |
| | | |7. AT APPLICATION OR REDETERMINATION, WHEN A CERTIFICATION PERIOD HAS NOT YET | | |
| | | |BEEN SET. | | |
|3.554 |New Rule |NEW |D. IF THE CHANGE IN CIRCUMSTANCES REQUIRES A REDUCTION OR TERMINATION OF GRANT |New section of rule added to describe| No |
| |Addition | |PAYMENTS, THE FOLLOWING ACTION WILL BE REQUIRED: |requirements for reporting changes | |
| | | |1. SEND A WRITTEN TIMELY NOTICE. |and the corresponding county actions.| |
| | | |2. IF A CLIENT REQUESTS A COUNTY CONFERENCE, CONDUCT THE COUNTY CONFERENCE AS | | |
| | | |SPECIFIED IN SECTION 3.586. IF A CLIENT IS DISSATISFIED WITH THE RESULTS OF THE | | |
| | | |COUNTY CONFERENCE AND REQUESTS A STATE LEVEL FAIR HEARING BEFORE AN | | |
| | | |ADMINISTRATIVE LAW JUDGE, SUCH A REQUEST SHALL BE IN ACCORDANCE WITH SECTION | | |
| | | |3.587. | | |
| | | |IF A CLIENT DOES NOT REQUEST A COUNTY CONFERENCE AND ONLY REQUESTS A STATE LEVEL| | |
| | | |FAIR HEARING ANY TIME PRIOR TO THE EFFECTIVE DATE OF THE TIMELY NOTICE, AND THE | | |
| | | |CERTIFICATION PERIOD HAS NOT EXPIRED, THE CLIENT'S GRANT PAYMENTS SHALL BE | | |
| | | |CONTINUED ON THE BASIS AUTHORIZED IMMEDIATELY PRIOR TO THE TIMELY NOTICE. | | |
| | | |CONTINUED GRANT PAYMENTS SHALL NOT BE ISSUED FOR A PERIOD BEYOND THE END OF THE | | |
| | | |CURRENT CERTIFICATION PERIOD. GRANT PAYMENTS SHALL BE CONTINUED UNTIL A FINAL | | |
| | | |DECISION HAS BEEN MADE BY THE OFFICE OF APPEALS OR UNTIL THE CERTIFICATION | | |
| | | |PERIOD ENDS, WHICHEVER OCCURS FIRST. THE COUNTY DEPARTMENT SHALL EXPLAIN TO THE | | |
| | | |CLIENT THAT REPAYMENT WILL BE REQUIRED FOR THE AMOUNT OF ANY GRANT PAYMENTS | | |
| | | |DETERMINED BY THE HEARING OFFICER TO HAVE BEEN OVER-PAID OR THE CONTINUED GRANT | | |
| | | |PAYMENTS TO WHICH THE CLIENT WAS NOT ELIGIBLE TO RECEIVE. | | |
| | | |3. IF THE CERTIFICATION PERIOD EXPIRES BEFORE THE HEARING PROCESS IS COMPLETED, | | |
| | | |THE CLIENT MAY REAPPLY FOR BENEFITS. | | |
| | | |4. IF THE CLIENT DOES NOT APPEAL THE TIMELY NOTICE TO DECREASE OR TERMINATE | | |
| | | |GRANT PAYMENTS WITHIN THE TIMELY NOTICE PERIOD, THE CHANGES SHALL BE MADE IN | | |
| | | |ACCORDANCE WITH TIMEFRAMES OUTLINED IN SECTION 3.553, C. | | |
|3.560 |Clarification |A. If the client's eligibility has been discontinued and |A. If the client's eligibility has been discontinued and he OR /she reports a |Technical cleanup |No |
| |Needed |he/she reports a change of address after the |change of address after the discontinuation, the client shall be required to | | |
| | |discontinuation, the client shall be required to complete a|complete a new application for benefits in the new county department of | | |
| | |new application for benefits in the new county department |residence. This will result in a break in the client's GRANT PAYMENTSbenefits. | | |
| | |of residence. This will result in a break in the client's | | | |
| | |benefits. | | | |
|3.560 |Clarification |B. If the client notifies a county department of a change |B. If the client notifies a county department of a change in address while the |Included verification request as part| No |
| |Needed |in address while the client's case is approved, the |client's case is approved, the following steps shall be completed: |of the transfer process. | |
| | |following steps shall be completed:1. The case transfer |1. The case transfer shall be completed OR ADDITIONAL VERIFICATION SHALL BE | | |
| | |shall be completed within three (3) working days if no |REQUESTED within three (3) working days if no additional verification is needed.| | |
| | |additional verification is needed.2. Prior to transferring |VERIFICATION WILL BE ACTED ON BY THE TRANSFERRING COUNTY PRIOR TO TRANSFERRING | | |
| | |an ongoing case to the new county department, the |IN ACCORDANCE WITH TIMELINESS REQUIREMENTS OUTLINED IN SECTION 3.553. | | |
| | |originating county department shall update the case to |2. Prior to transferring an ongoing case to the new county department, the | | |
| | |address any unresolved IEVS, discrepancies, claims, and any|originating county department shall update the case to address any unresolved | | |
| | |unworked case changes.3. The new county department may |IEVS, discrepancies, claims, and any unworked case changes. | | |
| | |choose to pull a case from the originating county |3. The new county department may choose to pull a case from the originating | | |
| | |department.a. If the new county department chooses to pull |county department. | | |
| | |the case, it is responsible for addressing any unresolved |a. If the new county department chooses to pull the case, it is responsible for | | |
| | |IEVS, notifying the originating county department that the |addressing any unresolved IEVS, notifying the originating county department that| | |
| | |case has been transferred, and requesting from the |the case has been transferred, and requesting from the originating county | | |
| | |originating county department any unworked changes so the |department any unworked changes so the new county department can process the | | |
| | |new county department can process the changes.b. The |changes. | | |
| | |originating county department shall be responsible for |b. The originating county department shall be responsible for researching and | | |
| | |researching and documenting any discrepancies and claims. |documenting any discrepancies and claims. | | |
|3.560 |Clarification |C. If the client notifies the county department of a change|C. If the client notifies the county department of a change of address during |Changed RRR to Redetermination. | No |
| |Needed |of address during his/her RRR certification period, the |his OR /her RRR REDETERMINATION certification period, the following apply: | | |
| | |following apply:1. The county department receiving the |1. The county department receiving the change of address notice shall: | | |
| | |change of address notice shall:a. Notify the client of the |a. Notify the client of the RRR REDETERMINATION due date and the affected | | |
| | |RRR due date and the affected benefit month; and,b. |benefit month; and, | | |
| | |Determine whether the client has received the RRR packet.1)|b. Determine whether the client has received the RRR REDETERMINATION packet. | | |
| | |If yes, the client shall be instructed to complete and |1) If yes, the client shall be instructed to complete and return the RRR | | |
| | |return the RRR packet to the new county department.2) If |REDETERMINATION packet to the new county department. | | |
| | |no, the new county department shall mail an RRR packet to |2) If no, the new county department shall mail an RRR REDETERMINATION packet to | | |
| | |the client's new address, ask the client to come to the |the client's new address, ask the client to come to the office to complete an | | |
| | |office to complete an RRR, or ask the client to complete |RRR REDETERMINATION, or ask the client to complete the RRR REDETERMINATION | | |
| | |the RRR through the online application process.2. If a |through the online application process. | | |
| | |client submits their RRR packet to the originating county |2. If a client submits their RRR REDETERMINATION packet to the originating | | |
| | |department prior to the end of the eligibility period and |county department prior to the end of the eligibility period and subsequently | | |
| | |subsequently submits a new application in the client's new |submits a new application in the client's new county department of residence | | |
| | |county department of residence before the RRR is processed,|before the RRR REDETERMINATION is processed, the date of the RRR REDETERMINATION| | |
| | |the date of the RRR shall be the date of application. The |shall be the date of application. The new county department may process the RRR | | |
| | |new county department may process the RRR at the same time |REDETERMINATION at the same time the new application is processed. | | |
| | |the new application is processed.3. When the client's RRR |3. When the client's RRR REDETERMINATION packet has been mailed and then the | | |
| | |packet has been mailed and then the client reports a change|client reports a change in address, the following shall apply: | | |
| | |in address, the following shall apply:a. If the client |a. If the client reports the change of address and returns the RRR | | |
| | |reports the change of address and returns the RRR packet to|REDETERMINATION packet to the originating county department, the originating | | |
| | |the originating county department, the originating county |county department shall process the RRR REDETERMINATION and then transfer the | | |
| | |department shall process the RRR and then transfer the case|case to the new county department. | | |
| | |to the new county department.b. If the client reports the |b. If the client reports the change of address to the new county department | | |
| | |change of address to the new county department prior to |prior to returning his OR /her RRR REDETERMINATION packet to the originating | | |
| | |returning his/her RRR packet to the originating county |county department, the originating county department shall instruct the client | | |
| | |department, the originating county department shall |to return their RRR REDETERMINATION to the new county department for processing.| | |
| | |instruct the client to return their RRR to the new county |c. If the client reports the change of address to the new county department | | |
| | |department for processing.c. If the client reports the |after returning his OR /her RRR REDETERMINATION packet to the original county | | |
| | |change of address to the new county department after |department, the RRR REDETERMINATION shall be processed by the original county | | |
| | |returning his/her RRR packet to the original county |department and then transferred to the new county department. | | |
| | |department, the RRR shall be processed by the original |4. When the client's RRR REDETERMINATION packet has not been mailed and the | | |
| | |county department and then transferred to the new county |client reports the change in address during the recertification timeframe, the | | |
| | |department. 4. When the client's RRR packet has not been |county department receiving the change of address shall: | | |
| | |mailed and the client reports the change in address during |a. Update the client's address in the statewide automated system to ensure the | | |
| | |the recertification timeframe, the county department |RRR REDETERMINATION is mailed to the client's new address when it is generated | | |
| | |receiving the change of address shall:a. Update the |by the statewide automated system; | | |
| | |client's address in the statewide automated system to |b. Inform the client that his OR /her case shall be transferred to the new | | |
| | |ensure the RRR is mailed to the client's new address when |county department; and, | | |
| | |it is generated by the statewide automated system;b. Inform|c. Provide the client with the name and address of the new county department | | |
| | |the client that his/her case shall be transferred to the |office; and, | | |
| | |new county department; and,c. Provide the client with the |d. The originating county department shall transfer the case. | | |
| | |name and address of the new county department office; | | | |
| | |and,d. The originating county department shall transfer the| | | |
| | |case. | | | |
|3.560 |Clarification |D. For AND-SO cases, if the medical certification form is |D. For AND-SO cases, if the medical certification form is expiring within thirty|Unnecessary as the Med-9 form is now | No |
| |Needed |expiring within thirty (30) calendar days of the reported |(30) calendar days of the reported change of address, the originating county |automated in CBMS and is sent out as | |
| | |change of address, the originating county department is |department is strongly encouraged to send the medical certification form to the |part of the Redetermination packet. | |
| | |strongly encouraged to send the medical certification form |client immediately. | | |
| | |to the client immediately. |1. If the form is returned to the originating county department, the originating| | |
| | |1. If the form is returned to the originating county |county department shall process the medical RRR. | | |
| | |department, the originating county department shall process|2. If the form is returned to the new county department, the new county | | |
| | |the medical RRR. |department shall process the medical RRR. | | |
| | |2. If the form is returned to the new county department, |3. If the form was not provided to the client at the time of the reported change| | |
| | |the new county department shall process the medical RRR. |of address, the new county department shall provide the client with the form and| | |
| | |3. If the form was not provided to the client at the time |process the medical RRR. | | |
| | |of the reported change of address, the new county | | | |
| | |department shall provide the client with the form and | | | |
| | |process the medical RRR. | | | |
|3.570 |Clarification | |HOME CARE ALLOWANCE, SPECIAL POPULATIONS HOME CARE ALLOWANCE, ADULT FOSTER CARE,| | No |
| |Needed | |AND BURIAL | | |
|3.570.11 |Clarification |A. Home Care Allowance (HCA) is a special cash payment made|A. Home Care Allowance (HCA) is a special cash payment made to a client, FIVE |Modified ages according to evidenced | No |
| |Needed |to a client for the purpose of securing in-home, personal |(5) YEARS OF AGE OR OLDER for the purpose of securing in-home, personal care |based research indicating age | |
| | |care services.1. HCA is a non-entitlement program; and,2. |services. |appropriate activities where parental| |
| | |Cannot be received while receiving Home and Community Based|1. HCA is a non-entitlement program; and, |assistance is to be expected. Removed| |
| | |Services or Adult Foster Care; and,3. HCA is designed to |2. HCA CCannot be received while receiving Home and Community Based Services or |reference to Adult Foster Care. | |
| | |serve clients with the lowest functional abilities and the |Adult Foster Care; and, | | |
| | |greatest need for paid care. |3. HCA is designed to serve clients with the lowest functional abilities and the| | |
| | | |greatest need for paid care. | | |
|3.570.11 |Clarification |C. The tier grant standard maximums shall be lower for |C. The tier grant standard maximums shall be lower for certain clients who have |Removed incorrect reference. | No |
| |Needed |certain clients who have income greater than program |income greater than program limits, as defined in Section 3.570.13, B, or for | | |
| | |limits, as defined in Section 3.570.13, B, or for clients |clients with special circumstances, as defined in Section 3.570.13, D. | | |
| | |with special circumstances, as defined in Section 3.570.13,| | | |
| | |D. | | | |
|3.570.11 |Clarification |F. In addition to the regular monthly HCA grant payments, |F. In addition to the regular monthly HCA grant payments, supplemental payments |Technical addition to incorporation | |
| |Needed |supplemental payments necessary to comply with the federal |necessary to comply with the federal Maintenance of Effort (MOE) requirements, |by reference found in prior rule. | |
| | |Maintenance of Effort (MOE) requirements may be provided. |AS INCORPORATED IN SECTION 3.531.D., may be provided. These payments are | | |
| | |These payments are supplements to regular grant payments, |supplements to regular grant payments, are not entitlements, and do not affect | | |
| | |are not entitlements, and do not affect grant standards. |grant standards. Appeals shall not be allowed for MOE payment adjustments. | | |
| | |Appeals shall not be allowed for MOE payment adjustments. | | | |
|3.570.12 |Clarification |“Activities of daily living” (ADL) means physical |“Activities of daily living” (ADL) means physical transfers, bladder care, bowel|Minor grammar change |No |
| |Needed |transfers, bladder care, bowel care, mobility, dressing, |care, mobility, dressing, bathing, hygiene, and eating. | | |
| | |bathing, hygiene, and eating. | | | |
|3.570.12 |Clarification |“Authorized representative” means an individual designated |“Authorized representative” means an individual OR ORGANIZATION designated by |Updated to reflect an organization | No |
| |Needed |by the client, or by the parent or guardian of the client, |the client, or by the parent or guardian of the client, if appropriate, to |can also be designated. | |
| | |if appropriate, to assist in acquiring or utilizing Home |assist in acquiring or utilizing Home Care Allowance (HCA). The extent of the | | |
| | |Care Allowance (HCA). The extent of the authorized |authorized representative's involvement shall be determined upon designation. | | |
| | |representative's involvement shall be determined upon | | | |
| | |designation. | | | |
|3.570.12 |Clarification |“BUS” means the Benefits Utilization System, the data |“BUS” means the Benefits Utilization System, the data system used to document |Removed HCPF automated system no | No |
| |Needed |system used to document case management activities for Home|case management activities for Home Care Allowance (HCA) clients. |longer in use. | |
| | |Care Allowance (HCA) clients. | | | |
|3.570.12 |Eliminate Rule |“Client” means a current or past applicant or a current or |“Client” means a current or past applicant or a current or past recipient of |Eliminate definition already in 3.510| |
| | |past recipient of benefits under the HCA program. |benefits under the HCA program. | | |
| | | | | | |
|3.570.12 |Eliminate Rule |“County department” means the county department of |“County department” means the county department of human/social services. |Eliminate redundant definition. | |
| | |human/social services. | | | |
|3.570.12 |Clarification |“Functional assessment” means the comprehensive evaluation |“Functional assessment” means the comprehensive evaluation of the client's |Technical cleanup | |
| |Needed |of the client's ability to manage his/her activities of |ability to manage his OR /her activities of daily living and to determine the | | |
| | |daily living and to determine the level of assistance the |level of assistance the client requires to complete his OR /her activities of | | |
| | |client requires to complete his/her activities of daily |daily living. | | |
| | |living. | | | |
|3.570.12 |Clarification |“Home” means a non-facility residence. |“Home” means a non-facility residence. A HOME CANNOT INCLUDE A HOMELESS SHELTER |Clarified that services cannot be | No |
| |Needed | |OR OTHER TEMPORARY SETTING. |provided in a homeless shelter or | |
| | | | |temporary setting. | |
|3.570.12 |New Rule |NEW |“NON-SKILLED CARE” MEANS CARE PROVIDED BY LICENSED AND UNLICENSED NON-MEDICAL |Definition added for non-skilled | No |
| |Addition | |PERSONNEL, INCLUDING CAREGIVERS WHO ASSIST OR HELP THE INDIVIDUAL WITH DAILY |care. | |
| | | |TASKS SUCH AS BATHING, EATING, CLEANING THE HOME, AND PREPARING MEALS. | | |
|3.570.12 | |“Ongoing case management” means the evaluation of the |“Ongoing case management” means the evaluation of the effectiveness and |Modified to be consistent with other | No |
| | |effectiveness and appropriateness of services, on an |appropriateness of services, on an ongoing basis, through contacts with the |sections. | |
| | |ongoing basis, through contacts with the client, |client, appropriate collaterals CONTACTS, and service providers. | | |
| | |appropriate collaterals, and service providers. | | | |
|3.570.12 |Clarification |“Single Entry Point (“SEP”) agency” means the agency |“Single Entry Point (“SEP”) agency” means the agency selected by HCPF the |Technical cleanup | |
| |Needed |selected by the Colorado Department of Health Care Policy |Colorado Department of Health Care Policy and Financing to provide case | | |
| | |and Financing to provide case management functions for |management functions for persons in need of long term care services within | | |
| | |persons in need of long term care services within specific |specific demographic areas, pursuant to Section 25.5-6-106, C.R.S. | | |
| | |demographic areas, pursuant to Section 25.5-6-106, C.R.S. | | | |
|3.570.12 |Clarification |“Skilled personal care” means some exceptions to personal |“Skilled personal care” means some exceptions to personal care for activities of|Technical cleanup | |
| |Needed |care for activities of daily living that, because of the |daily living that, because of the severe or complex nature of the client's need,| | |
| | |severe or complex nature of the client's need, requires a |requires a person with specialized training and skill to complete the task. | | |
| | |person with specialized training and skill to complete the |Skilled personal care is not a paid service of the Home Care Allowance (HCA) | | |
| | |task. Skilled personal care is not a paid service of the |program. See Section 8.489.30 (10 C.C.R. 2505-10) of the HCPF Colorado | | |
| | |Home Care Allowance (HCA) program. See Section 8.489.30 (10|Department of Health Care Policy and Financing's rules for the definitions of | | |
| | |C.C.R. 2505-10) of the Colorado Department of Health Care |personal care and the skilled exceptions to personal care. | | |
| | |Policy and Financing's rules for the definitions of | | | |
| | |personal care and the skilled exceptions to personal care. | | | |
|3.570.12 |Eliminate |“State Department” means the Colorado Department of Human |“State Department” means the Colorado Department of Human Services. |Technical cleanup | |
| |duplicate rule |Services. | | | |
|3.570.13 |Clarification |B. To be financially eligible, the client shall: |B. To be financially eligible, the client shall: |Removed payment requirement as SSI | No |
| |Needed |1. Be approved for Supplemental Security Income (SSI) |1. Be approved for Supplemental Security Income (SSI) benefits and be receiving |approval is sufficient to receive | |
| | |benefits and be receiving at least one dollar ($1) SSI |at least one dollar ($1) SSI payment; or, |HCA. | |
| | |payment; or, |2. Meet all eligibility criteria required for Aid to the Needy Disabled – State | | |
| | |2. Meet all eligibility criteria required for Aid to the |Only (AND-SO) program; or, | | |
| | |Needy Disabled – State Only (AND-SO) program; or, |3. Have been receiving both Old Age Pension (OAP) GRANT PAYMENTSbenefits and HCA| | |
| | |3. Have been receiving both Old Age Pension (OAP) benefits |as of December 31, 2013 and remain continuously eligible for both benefits. | | |
| | |and HCA as of December 31, 2013 and remain continuously | | | |
| | |eligible for both benefits. | | | |
|3.570.13 |Clarification |C. To be functionally eligible, the client shall have an |C. To be functionally eligible, the client shall have an HCA eligible functional|Technical clean up. | |
| |Needed |HCA eligible functional assessment score. The functional |assessment score. The functional assessment score is calculated by determining | | |
| | |assessment score is calculated by determining the client's |the client's functional capacity score and need for paid care score, as follows:| | |
| | |functional capacity score and need for paid care score, as |1. Functional Capacity: determined by assessing the client's ability to complete| | |
| | |follows: |all activities of daily living (ADLs) and applying a score to his OR /her | | |
| | |1. Functional Capacity: determined by assessing the |ability to complete the ADLs using the functional impairment scale; and, | | |
| | |client's ability to complete all activities of daily living|2. Need for Paid Care: determined by identifying the unmet need for paid care | | |
| | |(ADLs) and applying a score to his /her ability to complete|and applying a score to the unmet need using the need for paid care scale, as | | |
| | |the ADLs using the functional impairment scale; and, |outlined in Section 3.570.14; and, | | |
| | |2. Need for Paid Care: determined by identifying the unmet |3. Combining the functional capacity score and the need for paid care score to | | |
| | |need for paid care and applying a score to the unmet need |determine whether the client meets the minimum scores for eligibility and, if | | |
| | |using the need for paid care scale, as outlined in Section |eligible, the tier of GRANT PAYMENTSbenefits to be approved, as follows: | | |
| | |3.570.14; and, |TIER | | |
| | |3. Combining the functional capacity score and the need for|CAPACITY SCORE | | |
| | |paid care score to determine whether the client meets the |NEED FOR PAID CARE SCORE | | |
| | |minimum scores for eligibility and, if eligible, the tier | | | |
| | |of benefits to be approved, as follows: |1 | | |
| | |TIER |21 or Higher | | |
| | |CAPACITY SCORE |1 to 23 | | |
| | |NEED FOR PAID CARE SCORE | | | |
| | | |2 | | |
| | |1 |21 or Higher | | |
| | |21 or Higher |24 to 37 | | |
| | |1 to 23 | | | |
| | | |3 | | |
| | |2 |21 or Higher | | |
| | |21 or Higher |38 to 51 | | |
| | |24 to 37 | | | |
| | | | | | |
| | |3 | | | |
| | |21 or Higher | | | |
| | |38 to 51 | | | |
| | | | | | |
|3.570.13 |Clarification |F. If financially and functionally eligible for HCA, |F. If financially and functionally eligible for HCA, payment of the HCA |Clarified effective start date of HCA| No |
| |Needed |payment of the HCA authorized grant shall begin on the |authorized grant PAYMENT shall begin on the first day of the month following the|payment. | |
| | |first day of the month following the month in which the HCA|month in which the HCA is approved OR THE PAYMENT EFFECTIVE DATE FROM THE STATE | | |
| | |is approved. There shall be no retroactive HCA payments. |APPROVED FORM COMPLETED BY THE SEP, WHICHEVER DATE IS LATER. There shall be no | | |
| | | |retroactive HCA payments. | | |
|3.570.13 |New Rule |NEW |G. IF A CLIENT IS ASSESSED AND DOES NOT MEET THE FUNCTIONAL ASSESSMENT SCORING |Requires additional referrals are | No |
| |Addition | |REQUIREMENTS, THE COUNTY DEPARTMENT AND SEP SHALL REFER THE CLIENT TO OTHER |made if the client is not eligible | |
| | | |AGENCIES OR SERVICES AVAILABLE IN THE COMMUNITY, SUCH AS AREA AGENCIES ON AGING |for HCA. | |
| | | |(AAA), AGING AND DISABILITY RESOURCES FOR COLORADO (ADRC), CENTERS FOR | | |
| | | |INDEPENDENT LIVING, AND/OR OTHER LOCAL COMMUNITY RESOURCES TO HELP WITH ANY | | |
| | | |IDENTIFIED NEEDS. | | |
|3.570.14 |Clarification |B. In order to be eligible for the Home Care Allowance |B. In order to be eligible for the Home Care Allowance program, each client |Clarified the type of supervision or | No |
| |Needed |program, each client shall score a minimum of twenty one |shall score a minimum of twenty one (21) points when assessed for the ability to|assistance needed for the low score. | |
| | |(21) points when assessed for the ability to complete the |complete the activities of daily living (ADLs) using the following functional | | |
| | |activities of daily living (ADLs) using the following |impairment scale: | | |
| | |functional impairment scale:1. Independent: score zero (0) |1. Independent: score zero (0) if the client is physically able to perform all | | |
| | |if the client is physically able to perform all essential |essential components of the ADL, with or without an assistive device. | | |
| | |components of the ADL, with or without an assistive |2. Low: score one (1) if the client REQUIRES OCCASIONAL OR INTERMITTENT | | |
| | |device.2. Low: score one (1) if the client is able to |SUPERVISION OR STAND-BY ASSISTANCE IN A LIMITED NUMBER OF THE COMPONENTS OF THE | | |
| | |perform all essential components of the function, but |ACTIVITY SUCH AS HE OR SHE is able to perform all essential components of the | | |
| | |impairment of function exists even with an assistive |function, but impairment of function exists even with an assistive device. The | | |
| | |device. The client requires occasional or intermittent |client requires occasional or intermittent supervision or physical assistance in| | |
| | |supervision or physical assistance in a limited number of |a limited number of the components of the activity. | | |
| | |the components of the activity.a. Occasional or |a. Occasional or intermittent means the client does not need assistance daily, | | |
| | |intermittent means the client does not need assistance |but may need assistance a few times a month or up to two (2) times per week. | | |
| | |daily, but may need assistance a few times a month or up to|b. Supervision or assistance means verbal prompting, cueing, and reminders, and | | |
| | |two (2) times per week.b. Supervision or assistance means |means stand-by assistance or monitoring to help the client if he OR /she needs | | |
| | |verbal prompting, cueing, and reminders, and means stand-by|physical assistance up to two (2) times per week. | | |
| | |assistance or monitoring to help the client if he/she needs|C. STAND-BY ASSISTANCE MEANS ASSISTANCE OR MONITORING TO HELP THE CLIENT IF HE | | |
| | |physical assistance up to two (2) times per week.3. |OR SHE NEEDS PHYSICAL ASSISTANCE UP TO TWO (2) TIMES PER WEEK. | | |
| | |Moderate: score two (2) if the client is unable to perform |3. Moderate: score two (2) if the client is unable to perform the majority of | | |
| | |the majority of the essential components of the function |the essential components of the function even with an assistive device, and the | | |
| | |even with an assistive device, and the client requires |client requires hands-on and frequent assistance to accomplish the activity. | | |
| | |hands-on and frequent assistance to accomplish the |a. Frequent means the client needs assistance at least three (3) times per week | | |
| | |activity.a. Frequent means the client needs assistance at |and up to daily. | | |
| | |least three (3) times per week and up to daily.b. Hands-on |b. Hands-on assistance means the care provider must physically assist the client| | |
| | |assistance means the care provider must physically assist |in completing the task. | | |
| | |the client in completing the task.4. Severe: score three |4. Severe: score three (3) if the client is totally unable to perform the | | |
| | |(3) if the client is totally unable to perform the function|function and requires someone to perform the task, or the client requires | | |
| | |and requires someone to perform the task, or the client |constant supervision for the task. | | |
| | |requires constant supervision for the task. | | | |
|3.570.14 |Clarification |D. For children age zero (0) through eighteen (18) years, |D. For children age FIVE (5) zero (0) through eighteen (18) years, functional |Modified ages according to evidenced | No |
| |Needed |functional capacity and need for paid care shall be scored |capacity and need for paid care shall be scored according to age appropriate |based research indicating age | |
| | |according to age appropriate criteria. |criteria. CHILDREN UNDER THE AGE OF 5 SHALL NOT BE SCORED AND ARE NOT ELIGIBLE |appropriate activities where parental| |
| | | |TO RECEIVE HOME CARE ALLOWANCE. |assistance is to be expected. | |
|3.570.15 |Clarification |A. Activities of daily living (ADLs) shall be scored using |A. Activities of daily living (ADLs) shall be scored using the functional |Minor technical clean up. | |
| |Needed |the functional capacity impairment scale and the need for |capacity impairment scale and the need for paid care scale. | | |
| | |paid care scale. | | | |
|3.570.15 |Clarification |B. The activities of daily living are:1. Critical ADLsa. |B. The activities of daily living are: |Modified ages according to evidenced | No |
| |Needed |Transfers: the ability to move between surfaces, such as |1. Critical ADLs |based research indicating age | |
| | |getting in and out of bed; transferring from a bed to a |a. Transfers: the ability to move between surfaces, such as getting in and out |appropriate activities where parental| |
| | |chair, wheelchair, or walker; moving from a chair or |of bed; transferring from a bed to a chair, wheelchair, or walker; moving from a|assistance is to be expected. | |
| | |wheelchair to a walker or to a standing position; and the |chair or wheelchair to a walker or to a standing position; and the ability to | | |
| | |ability to use assistive devices, including prosthetics. A |use assistive devices, including prosthetics. A child age 0 to 48 months shall | | |
| | |child age 0 to 48 months shall not be scored for any |not be scored for any transfers, including positioning. A child age 0 to 60 | | |
| | |transfers, including positioning. A child age 0 to 60 |months shall not be scored for car seat, highchair, or crib transfers. | | |
| | |months shall not be scored for car seat, highchair, or crib|b. Bladder care: the extent to which the client has control of his OR /her | | |
| | |transfers.b. Bladder care: the extent to which the client |bladder functions and the ability of the client to accomplish the tasks of | | |
| | |has control of his/her bladder functions and the ability of|toileting, including catheterizing, getting on and off the toilet, changing | | |
| | |the client to accomplish the tasks of toileting, including |incontinence products, and cleaning him/herself. A child age 0 to 36 months | | |
| | |catheterizing, getting on and off the toilet, changing |shall not be scored for bladder incontinence or care. | | |
| | |incontinence products, and cleaning him/herself. A child |c. Bowel care: the extent to which the client has control of his OR /her bowel | | |
| | |age 0 to 36 months shall not be scored for bladder |functions and the ability of the client to accomplish the tasks of toileting, | | |
| | |incontinence or care.c. Bowel care: the extent to which the|including getting on and off the toilet, changing incontinence products, and | | |
| | |client has control of his/her bowel functions and the |cleaning him/herself. A child age 0 to 36 months shall not be scored for bowel | | |
| | |ability of the client to accomplish the tasks of toileting,|incontinence or care. | | |
| | |including getting on and off the toilet, changing |2. Basic ADLs | | |
| | |incontinence products, and cleaning him/herself. A child |a. Mobility: the ability of the client to ambulate around the home and around | | |
| | |age 0 to 36 months shall not be scored for bowel |essential places outside the home, with or without assistive devices. A child | | |
| | |incontinence or care. |age 0 to 36 months shall not be scored for mobility. | | |
| | | |b. Dressing: the ability of the client to accomplish all phases of the | | |
| | | |activities of dressing and undressing, including getting, putting on, fastening,| | |
| | | |and taking off all items of clothing, braces, and artificial limbs. A child age | | |
| | | |0 to 60 months shall not be scored for dressing. | | |
| | | |c. Bathing: the ability of the client to safely accomplish the task of washing | | |
| | | |body parts including getting into bathing waters, with or without assistive | | |
| | | |devices or whether the client requires stand by or hands-on assistance from | | |
| | | |another person. A child age 0 to 60 months shall not be scored for bathing. | | |
| | | |d. Hygiene: the ability of the client to maintain personal hygiene other than | | |
| | | |bathing, including combing hair, brushing teeth, and clipping nails. A child age| | |
| | | |0 to 60 months shall not be scored for hygiene. | | |
| | | |e. Eating: the ability to cut food into manageable size pieces, chew, and | | |
| | | |swallow food, with or without assistive devices. A child age 0 to 48 months | | |
| | | |shall not be scored for eating. | | |
| | | |3. Instrumental ADLs | | |
| | | |a. Meals: the ability to safely prepare food to meet the basic nutritional | | |
| | | |requirements of the client, including cutting food, transferring food to cooking| | |
| | | |vessels and/or dishes, utilizing utensils, using a stove or microwave, and | | |
| | | |implementing special dietary needs. A child age 50 to 1814 years shall not be | | |
| | | |scored for meals. | | |
| | | |b. Housekeeping: the ability to maintain the interior of the client's residence | | |
| | | |for the purpose of health and safety, such as wiping surfaces, cleaning floors, | | |
| | | |making a bed, and cleaning dishes. A child age 50 to 1812 years shall not be | | |
| | | |scored for housekeeping. | | |
| | | |c. Laundry: the ability to gather and wash soiled clothing and linens; use | | |
| | | |washing machines and dryers; hang, fold, and put away clean clothing and linens.| | |
| | | |A child age 50 to 1812 years shall not be scored for laundry. | | |
| | | |d. Shopping: the ability to purchase goods that are necessary for health and | | |
| | | |safety. Activities include the ability to make needs known, to make a list, | | |
| | | |reach for the needed items at the store, ability to estimate or determine the | | |
| | | |cost of the item, and to move items into the home and put them away. A child age| | |
| | | |50 to 1815 years shall not be scored for shopping. | | |
| | | |4. Supportive ADLs | | |
| | | |a. Medicine: the ability to manage medications, including knowing the name of | | |
| | | |the medication, knowing the amount, frequency, and how to take the medicine, | | |
| | | |understanding the reason for taking it, and understanding possible side effects.| | |
| | | |A child age 50 to 14 years shall not be scored for medicine. | | |
| | | |b. Appointment: the ability to schedule or make an appointment for essential | | |
| | | |activities, such as doctor visits, meetings with caseworkers, and | | |
| | | |transportation. A child age 50 to 1816 years shall not be scored for | | |
| | | |appointments. | | |
| | | |c. Money: the ability to manage money, such as balancing a check book, writing | | |
| | | |checks or paying a bill electronically, and ability to understand financial | | |
| | | |decisions. A child age 50 to 1816 years shall not be scored for money. | | |
| | | |d. Access: the ability to access resources or services in the community, such as| | |
| | | |locating the resource/service and completing the process necessary to receive | | |
| | | |the resource or service. A child age 50 to 1816 years shall not be scored for | | |
| | | |access. | | |
| | | |e. Telephone: the ability to use the telephone to communicate essential needs, | | |
| | | |such as answering the phone in a reasonable time, speaking clearly and loudly | | |
| | | |enough to be understood, dialing the phone, initiating a conversation, hearing | | |
| | | |the caller, and placing a call in an emergency. A child age 50 to 12 years shall| | |
| | | |not be scored for telephone. | | |
|3.570.16 |Clarification |B. The SEP shall develop a care plan on the State |B. The SEP shall develop a care plan on the State Department prescribed form |Added "and" to letter 'a'. | No |
| |Needed |Department prescribed form within ten (10) working days |within ten (10) working days after program eligibility has been determined and | | |
| | |after program eligibility has been determined and prior to |prior to the arrangement for services. |Modified to reflect provider | |
| | |the arrangement for services.1. The care plan shall be:a. |1. The care plan shall be: |selection is the client's | |
| | |Signed by the client, SEP, and the service provider;b. |a. Signed by the client, SEP, and the service provider; AND, |responsibility. | |
| | |Reviewed and updated at least once every twelve months; |b. Reviewed and updated at least once every twelve months; and, | | |
| | |and,c. Reviewed sooner if there is a change in the client's|c. Reviewed sooner if there is a change in the client's needs; and, |Added discussion about other waivers | |
| | |needs; and,d. Provided to all parties. |d. Provided to all parties. |or services. | |
| | | |2. Care planning shall include, but not be limited to, the following tasks: | | |
| | | |a. IdentifyING and documentING care plan goals and client choices. | | |
| | | |b. IdentifyING and documentING services, including type, duration and frequency.| | |
| | | |c. ArrangINGe for services through a service provider, family member, or other | | |
| | | |provider of the client's choosing. | | |
| | | |1) Providers shall be at least eighteen (18) years of age or older and have the | | |
| | | |ability to provide appropriate services. The SEP shall assist the client in | | |
| | | |finding an appropriate service provider, if needed. | | |
| | | |2) The SEP shall negotiate with the client and care provider to arrive at the | | |
| | | |total number of paid care hours to be provided monthly. | | |
| | | |3) The HCA payments shall be made directly to the client or authorized | | |
| | | |representative who shall pay the provider the agreed upon, authorized amount | | |
| | | |monthly. | | |
| | | |4) No portion of the authorized HCA amount shall be withheld by the client for | | |
| | | |personal use. The entire HCA authorized amount shall be spent for HCA allowable | | |
| | | |services. | | |
| | | |d. CoordinatINGe service delivery, negotiatINGe with the service provider and | | |
| | | |the client regarding service provision, and formalizINGe the provider agreement.| | |
| | | |e. CompletINGe program requirements for the authorization of services. | | |
| | | |f. ReferRING the client to community resources, as needed, and attemptING to | | |
| | | |develop resources for the client if a resource is not available within the | | |
| | | |client's community. | | |
| | | |g. ExplainING the complaint procedures to the client, as listed on the care plan| | |
| | | |document. | | |
| | | |h. ExplainING the client's right to appeal any decision. | | |
| | | |3. The SEP shall meet the client's needs, with consideration of the client's | | |
| | | |choices, using the most cost effective methods available. | | |
| | | |a. When services are available to the client at no cost from family, friends, | | |
| | | |volunteers, or others, these services shall be utilized before the purchase of | | |
| | | |services, providing these services adequately meet the client's needs. | | |
| | | |b. When public dollars must be used to purchase services, the SEP shall ASSIST | | |
| | | |THE CLIENT IN COMPARING THE COST encourage the client to select the lowest cost | | |
| | | |provider of serviceS when quality of service is comparable. | | |
| | | |c. The SEP shall ENSUREassure there is no duplication in services provided by | | |
| | | |any other public or privately funded services. | | |
| | | |D. THE SEP SHALL DISCUSS WITH THE CLIENT IF OTHER WAIVERS AND/OR SERVICES ARE | | |
| | | |MORE APPROPRIATE OR BENEFICIAL TO THE CLIENT AND ASSESS AS NEEDED. | | |
|3.570.16 |Clarification |C. The SEP shall provide ongoing case management, as |C. The SEP shall provide ongoing case management, as follows: |Minor language and statutory citation| No |
| |Needed |follows: |1. MonitorING the quality of care provided to THE clients. |changes. | |
| | |1. Monitor the quality of care provided to clients. |2. ContactING service providers concerning service coordination, effectiveness, | | |
| | |2. Contact service providers concerning service |and appropriateness. | | |
| | |coordination, effectiveness, and appropriateness. |3. ReviewING the client's assessment, care plan, and service agreements to | | |
| | |3. Review the client's assessment, care plan, and service |include changes in client functioning, service effectiveness, appropriateness, | | |
| | |agreements to include changes in client functioning, |and cost-effectiveness that may require a reassessment or a change in the care | | |
| | |service effectiveness, appropriateness, and |plan. | | |
| | |cost-effectiveness that may require a reassessment or a |4. MakINGe changes in care plans as appropriate to client needs and/or referRING| | |
| | |change in the care plan. |the client to community resources, if appropriate. | | |
| | |4. Make changes in care plans as appropriate to client |5. ProvidINGe conflict resolution and/or crisis intervention, as needed. | | |
| | |needs and/or refer the client to community resources, if |6. IdentifyING, AND contactING appropriate individuals, and resolvINGe any | | |
| | |appropriate. |problems or complaints raised by the client or others regarding service | | |
| | |5. Provide conflict resolution and/or crisis intervention, |delivery. | | |
| | |as needed. |7. NotifyING the appropriate law enforcement and/or CHILD/Adult Protective | | |
| | |6. Identify, contact appropriate individuals, and resolve |Services agency of suspected abuse, neglect or exploitation, as required by | | |
| | |any problems or complaints raised by the client or others |SECTIONS 18-6.5-101108, 19-3-304 and 26-3.1-102, C.R.S. | | |
| | |regarding service delivery. | | | |
| | |7. Notify the appropriate law enforcement and/or Adult | | | |
| | |Protective Services agency of suspected abuse, neglect or | | | |
| | |exploitation, as required by 18-6.5-101 and 26-3.1-102, | | | |
| | |C.R.S. | | | |
|3.570.16 |Clarification |D. The SEP shall complete a review of the client's current |D. The SEP shall complete a review of the client's current assessment or |Revision for consistency of the term | |
| |Needed |assessment or reassessment and the care plan with the |reassessment and the care plan with the client six months following the |face to face. | |
| | |client six months following the assessment or reassessment.|assessment or reassessment. | | |
| | |1. The review shall be conducted by telephone, at the |1. The review shall be conducted by telephone, at the client's place of | | |
| | |client's place of residence, at the place of service, or |residence, at the place of service, or other appropriate setting as determined | | |
| | |other appropriate setting as determined by the client's |by the client's needs. | | |
| | |needs. |2. AN IN-PERSON face-to-face home visit shall be completed when significant | | |
| | |2. A face-to-face home visit shall be completed when |changes in the client's condition are identified. | | |
| | |significant changes in the client's condition are | | | |
| | |identified. | | | |
|3.570.16 |Clarification |E. The SEP shall complete a face-to-face functional |E. The SEP shall complete AN IN-PERSONface-to-face functional reassessment |Revision for consistency of the term | |
| |Needed |reassessment within twelve (12) months of the initial |within twelve (12) months of the initial functional assessment and every twelve |face to face. | |
| | |functional assessment and every twelve months thereafter. A|months thereafter. A reassessment shall be completed sooner if the client's | | |
| | |reassessment shall be completed sooner if the client's |condition changes. | | |
| | |condition changes. | | | |
|3.570.16 |Clarification |F. Reassessment shall include the following tasks: |F. Reassessment shall include the following tasks: |Added discussion about other waivers | No |
| |Needed |1. Review the care plan, service agreement, and provider |1. ReviewING the care plan, service agreement, and provider contract or |or services. | |
| | |contract or agreement. |agreement. | | |
| | |2. Evaluate service effectiveness, quality of care, and |2. EvaluatINGe service effectiveness, quality of care, and appropriateness of | | |
| | |appropriateness of services. |services. | | |
| | |3. Verify continuing financial and program eligibility. |3. VerifyING continuing financial and program eligibility. | | |
| | |4. Annually, or more often if indicated, complete a new |4. Annually, or more often if indicated, completINGe a new care plan and service| | |
| | |care plan and service agreement. |agreement. | | |
| | |5. Refer the client to community resources, as needed. |5. ReferRING the client to community resources, as needed.; AND | | |
| | |6. Determine continued appropriateness of placement. |6. Determine continued appropriateness of placement. DISCUSSING WITH THE CLIENT | | |
| | | |IF A HCPF WAIVER AND/OR SERVICE IS MORE APPROPRIATE OR BENEFICIAL AND ASSESS AS | | |
| | | |NEEDED. | | |
|3.570.16 |Clarification |G. The SEP shall update the information provided at the |G. The SEP shall update the information provided at the previous assessment or |Removed BUS language. | No |
| |Needed |previous assessment or reassessment, utilizing the State |reassessment, utilizing the State Department prescribed FORM functional | | |
| | |Department prescribed functional assessment tool and the |assessment tool and the HCPF PRESCRIBED SYSTEM Benefits Utilization System. When| | |
| | |Benefits Utilization System. When a new functional |a new functional assessment is completed a copy shall be sent to the county | | |
| | |assessment is completed a copy shall be sent to the county |department within ten (10) working days of the reassessment. | | |
| | |department within ten (10) working days of the | | | |
| | |reassessment. | | | |
|3.570.17 |Clarification |A. The responsibility of the SEP is to determine the |A. The responsibility of the SEP is to determine the functional eligibility of |Clarified noticing requirements for | No |
| |Needed |functional eligibility of the client. The SEP shall deny or|the client. The SEP shall deny or discontinue the client from the HCA program if|denials. Clarified that notification| |
| | |discontinue the client from the HCA program if he/she is |he OR /she is determined functionally ineligible AND PROVIDE TIMELY OR ADEQUATE |of the selected provider is the | |
| | |determined functionally ineligible.1. The client shall be |NOTICE AS REQUIRED BY SECTION 3.554. |client's responsibility. | |
| | |informed of his/her appeal rights in accordance with rules |1. The client shall be informed of his OR /her appeal rights in accordance with | | |
| | |under Section 3.850, et seq.2. The client shall be provided|rules under Section 3.850, et seq AS OUTLINED IN SECTION 3.587. | | |
| | |appropriate referrals to other community resources within |2. The client shall be provided appropriate referrals to other community | | |
| | |one (1) working day of discontinuation or denial.3. The SEP|resources within one (1) working day of discontinuation or denial. | | |
| | |shall notify all providers on the care plan within one (1) |3. IF THE DISCONTINUATION OR DENIAL IS DUE TO FUNCTIONAL ELIGIBILITY, The SEP | | |
| | |working day of discontinuation.4. The SEP shall notify the |shall notify THE CLIENT THAT HE OR SHE MUST NOTIFY THE providers on the care | | |
| | |county department within one (1) working day of |plan within one (1) working day of RECEIVING NOTICE FROM THE COUNTY | | |
| | |discontinuation.5. The SEP shall prepare for and defend at |DEPARTMENTdiscontinuation. | | |
| | |the hearing any appeal related to functional denial or |4. IF THE DISCONTINUATION OR DENIAL IS DUE TO FINANCIAL ELIGIBILITY, THE SEP | | |
| | |discontinuation. The SEP may request assistance and/or |SHALL NOTIFY THE CLIENT THAT HE OR SHE MUST NOTIFY ALL PROVIDERS ON THE CARE | | |
| | |testimony from the county department. |PLAN WITHIN ONE (1) WORKING DAY OF RECEIVING NOTICE FROM THE COUNTY DEPARTMENT. | | |
| | | |54. The SEP shall notify the county department within FIVE (5) one (1) working | | |
| | | |dayS of discontinuation. | | |
| | | |65. The SEP shall prepare for and defend at the STATE LEVEL FAIR hearing any | | |
| | | |appeal related to functional denial or discontinuation. The SEP may request | | |
| | | |assistance and/or testimony from the county department. | | |
|3.570.17 |Clarification |B. The responsibility of the county department is to |B. The responsibility of the county department is to determine the financial |Removed unnecessary process | No |
| |Needed |determine the financial eligibility of the client. The |eligibility of the client. The county department shall deny or discontinue the |information as it is not the county | |
| | |county department shall deny or discontinue the client from|client from the HCA program if he OR /she is determined financially ineligible |department's responsibility to notify| |
| | |the HCA program if he/she is determined financially |AND PROVIDE TIMELY OR ADEQUATE NOTICE AS REQUIRED BY SECTION 3.554. |providers. | |
| | |ineligible.1. The client shall be informed of his/her |1. The client shall be informed of his OR /her appeal rights in accordance with | | |
| | |appeal rights in accordance with rules under Section 3.850,|rules under Section 3.850, et seq AS OUTLINED IN SECTION 3.587. | | |
| | |et seq.2. The client shall be provided appropriate |2. The client shall be provided appropriate referrals to other community | | |
| | |referrals to other community resources within one (1) |resources within one (1) working day of discontinuation or denial. | | |
| | |working day of discontinuation or denial.3. The county |3. The county department shall notify all providers on the care plan within one | | |
| | |department shall notify all providers on the care plan |(1) working day of discontinuation. | | |
| | |within one (1) working day of discontinuation.4. The county|34. The county department shall notify the SEP within FIVE (5) one (1) working | | |
| | |department shall notify the SEP within one (1) working day |dayS of discontinuation. | | |
| | |of discontinuation.5. The county department shall prepare |45. The county department shall prepare for and defend at the STATE LEVEL FAIR | | |
| | |for and defend at the hearing any appeal related to |hearing any appeal related to financial denial or discontinuation. The county | | |
| | |financial denial or discontinuation. The county department |department may request assistance and/or testimony from the SEP. | | |
| | |may request assistance and/or testimony from the SEP. | | | |
|3.570.17 |Clarification |C. Denial and/or discontinuation from the HCA program shall|C. FOLLOWING THE NOTICE PROCEDURES OUTLINED IN SECTION 3.554, DDenial and/or |Added missing word. | No |
| |Needed |occur for the following reasons:1. Financial and Functional|discontinuation from the HCA program shall occur for the following reasons: | | |
| | |Eligibility: The SEP or county department shall deny or |1. Financial and Functional Eligibility: The SEP or county department shall deny| | |
| | |discontinue a client if the client is not financially |or discontinue a client if the client is not financially eligible and/or is not | | |
| | |eligible and/or is not functionally eligible for HCA.2. |functionally eligible for HCA. | | |
| | |Level of Care: The SEP shall deny or discontinue when the |2. Level of Care: The SEP shall deny or discontinue when the client: | | |
| | |client:a. Does not meet functional capacity score minimum |a. Does not meet functional capacity score minimum requirements; or, | | |
| | |requirements; or,b. Does not meet need for paid care score |b. Does not meet need for paid care score criteria. | | |
| | |criteria.3. Receipt of Services: The SEP or county |3. Receipt of Services: The SEP or county department shall deny or discontinue | | |
| | |department shall deny or discontinue when the client:a. Has|when the client: | | |
| | |not received services for one month;b. Has twice refused to|a. Has not received services for one month; | | |
| | |schedule an appointment for an initial assessment, six |b. Has twice refused to schedule an appointment for an initial assessment, six | | |
| | |(6)-month review, or reassessment within a thirty (30) day |(6)-month review, or reassessment within a thirty (30) consecutive DAY period; | | |
| | |consecutive period;c. Has failed to keep three (3) |c. Has failed to keep three (3) scheduled appointments within a thirty (30) | | |
| | |scheduled appointments within a thirty (30) consecutive day|consecutive day period; | | |
| | |period;d. Has refused to schedule an appointment for a |d. Has refused to schedule an appointment for a required visit after the | | |
| | |required visit after the client's case has been transferred|client's case has been transferred to a new SEP or county department; | | |
| | |to a new SEP or county department;e. Refuses to use the HCA|e. Refuses to use the HCA payment to pay for services or uses the payment for | | |
| | |payment to pay for services or uses the payment for |services not identified in the service agreement; or, | | |
| | |services not identified in the service agreement; or,f. |f. Refuses to sign the intake form, care plan, or other documents and forms | | |
| | |Refuses to sign the intake form, care plan, or other |required to receive services. | | |
| | |documents and forms required to receive services. |4. Facility Status: The SEP or county department shall deny or discontinue when | | |
| | | |the client: | | |
| | | |a. Is a resident of a nursing facility, hospital, or any other long-term care | | |
| | | |facility; or, | | |
| | | |b. Enters a hospital or other long-term care facility for treatment, | | |
| | | |hospitalization, or rehabilitation that continues for thirty (30) CALENDAR days | | |
| | | |or more. | | |
| | | |5. Service Limitations Related to Safety: The SEP or county department shall | | |
| | | |deny or discontinue when the client cannot be safely served given the type | | |
| | | |and/or amount of services available. Evidence of safety concerns include, but | | |
| | | |are not limited to: | | |
| | | |a. The results of an Adult Protective Services assessment that substantiates | | |
| | | |ongoing risk. | | |
| | | |b. A statement from the client's physician attesting to diminished cognitive | | |
| | | |capacity, debilitating mental health concerns, or ongoing risk. | | |
| | | |c. Lack of available and/or appropriate service providers. | | |
| | | |d. A functional assessment score indicating a level of need for services in | | |
| | | |excess of those available under the HCA program. | | |
| | | |e. Other available information or evidence that will support the determination | | |
| | | |that the client's safety is at risk. | | |
| | | |6. Service Limitations Related to Cost Effectiveness: The SEP or county | | |
| | | |department shall deny or discontinue when other more cost effective alternatives| | |
| | | |are available to meet the client's needs. | | |
| | | |7. Living Arrangements: The SEP or county department shall deny or discontinue | | |
| | | |when the client is residing anywhere other than his OR /her home. | | |
| | | |a. The SEP may continue to authorize services while a resident is on medical or | | |
| | | |non-medical leave. | | |
| | | |b. Combined leave shall not exceed a total of forty-two (42) days in a twelve | | |
| | | |(12) month period beginning with the date the client was approved for the HCA | | |
| | | |program. | | |
| | | |8. Move Out of State: The SEP or county department shall deny or discontinue | | |
| | | |when the client has moved out of state. | | |
| | | |a. Discontinuation shall be effective the day after the date of the move. | | |
| | | |b. Clients who leave the state on a temporary basis with the intent to return to| | |
| | | |Colorado within thirty (30) calendar days shall not be discontinued. If the | | |
| | | |client fails to return to Colorado the client shall be discontinued on day | | |
| | | |thirty one (31). | | |
| | | |9. Voluntary Withdrawal from the Program: The SEP or county shall deny or | | |
| | | |discontinue when the client requests withdrawal from the HCA program. | | |
| | | |10. Death: The SEP or county shall discontinue the HCA program effective the day| | |
| | | |after the client's date of death. No notice of discontinuation shall be sent. | | |
|3.570.17 |Clarification |D. The SEP shall complete the following procedures to |D. The SEP shall complete the following procedures to transfer an HCA client to |Identified it is the SEP’s | |
| |Needed |transfer an HCA client to a new county department: |a new county department: |responsibility to transfer the case | |
| | |1. Notify the county department of the client's plans to |1. THE SEP SHALL NNotify the county department of the client's plans to relocate| | |
| | |relocate to another county and the date of transfer. |to another county and the date of transfer. | | |
| | |2. If the client's current service providers do not provide|2. If the client's current service providers do not provide services in the area| | |
| | |services in the area where the client is relocating, make |where the client is relocating, THE SEP SHALL make arrangements, in consultation| | |
| | |arrangements, in consultation with the client, for new |with the client, for new service providers. | | |
| | |service providers. | | | |
|3.570.17 |Clarification |E. The SEP shall complete the following procedures to |E. The SEP shall complete the following procedures to transfer an HCA client to |Ensures the consistent use of the | |
| |Needed |transfer an HCA client to a new SEP: |a new SEP: |term face to face | |
| | |1. The transferring SEP shall contact the receiving SEP by |1. The transferring SEP shall contact the receiving SEP by telephone or email to| | |
| | |telephone or email to give notification that the client is |give notification that the client is planning to transfer, to negotiate a | | |
| | |planning to transfer, to negotiate a transfer date, and to |transfer date, and to provide information. | | |
| | |provide information. |2. The transferring SEP shall forward copies of the client's case records, | | |
| | |2. The transferring SEP shall forward copies of the |including forms required for the HCA program, to the receiving SEP prior to the | | |
| | |client's case records, including forms required for the HCA|relocation, if possible, but in no case later than five (5) working days after | | |
| | |program, to the receiving SEP prior to the relocation, if |the client's relocation. | | |
| | |possible, but in no case later than five (5) working days |3. The receiving SEP shall complete aN IN-PERSONface-to-face meeting with the | | |
| | |after the client's relocation. |client and an assessment and case summary update within ten (10) working days | | |
| | |3. The receiving SEP shall complete a face-to-face meeting |after notification of the client's relocation. | | |
| | |with the client and an assessment and case summary update |4. The receiving SEP shall review the care plan and the assessment tool, revise | | |
| | |within ten (10) working days after notification of the |as necessary, and coordinate services and providers. | | |
| | |client's relocation. | | | |
| | |4. The receiving SEP shall review the care plan and the | | | |
| | |assessment tool, revise as necessary, and coordinate | | | |
| | |services and providers. | | | |
|3.570.18 |Clarification |A. The county department shall:1. Ensure all requirements |A. The county department shall: |Added appropriate rule cross | No |
| |Needed |of the county department are implemented, as appropriate |1. Ensure all requirements of the county department are implemented, as |references and removed unnecessary | |
| | |for the HCA program, related to:a. General county |appropriate for the HCA program, related to: |language. | |
| | |requirements, as outlined in Section 3.520; and,b. |a. General county requirements, as outlined in Section 3.520; and, | | |
| | |Documentation, as outlined in Section 3.520.2; and,c. |b. OLD AGE PENSION Documentation, as outlined in Section 3.530 3.520.2; and, | | |
| | |Program review and oversight, as outlined in Section |c. AID TO THE NEEDY DISABLED STATE ONLY AND COLORADO SUPPLEMENTProgram review | | |
| | |3.520.3; and,d. Application processing, as outlined in |and oversight, as outlined in Section 3.540 AND 3.546.3.520.3; and, | | |
| | |Section 3.520.4.2. The county department shall determine |d. FINANCIAL REDETERMINATION Application processing, as outlined in Section | | |
| | |financial eligibility for HCA in the statewide automated |3.550 3.520.4. | | |
| | |system and update any changes in the case record.3. The |2. The county department shall Ddetermine financial eligibility for HCA in the | | |
| | |county department shall notify the SEP in writing:a. Within|statewide automated system and update any changes in the case record. | | |
| | |five (5) working days of determining HCA eligibility.b. |3. The county department shall Nnotify the SEP in writing: | | |
| | |Within five (5) working days after the eligibility worker |a. Within five (5) working days of determining HCA eligibility. | | |
| | |determines that the client is no longer financially |b. Within five (5) working days after the eligibility worker determines that the| | |
| | |eligible for HCA.c. Within one (1) working day when the |client is no longer financially eligible for HCA. | | |
| | |client has filed a written appeal with the county |c. Within one (1) working day when the client has filed a written appeal with | | |
| | |department.d. Within one (1) working day when the client |the county department. | | |
| | |has withdrawn the appeal or a final agency decision has |d. Within one (1) working day when the client has withdrawn the appeal or a | | |
| | |been entered.4. The county department shall respond to |final agency decision has been entered. | | |
| | |requests for information from the SEP within ten (10) |4. The county department shall Rrespond to requests for information from the SEP| | |
| | |working days. |within ten (10) working days. | | |
|3.570.18 |Clarification |B. The SEP shall:1. Provide intake, screening, and referral|B. The SEP shall: |Removed unnecessary language. | No |
| |Needed |activities, as follows:a. Determine of the appropriateness |1. Provide intake, screening, and referral activities, as follows: | | |
| | |of a referral for a client assessment.1) If appropriate, |a. Determine of the appropriateness of a referral for a client assessment. | | |
| | |complete intake activities within two (2) working days of |1) If appropriate, complete intake activities within two (2) working days of the| | |
| | |the referral.2) Obtain the client's or client's authorized |referral. | | |
| | |representative's signature on the intake form.3) Complete |2) Obtain the client's or client's authorized representative's signature on the | | |
| | |the HCA functional assessment within thirty (30) calendar |intake form. | | |
| | |days of referral.b. Provide the client information and |3) Complete the HCA functional assessment within thirty (30) calendar days of | | |
| | |referral to other agencies, as needed.2. The SEP shall |referral. | | |
| | |identify potential payment source(s), including the |b. Provide the client information and referral to other agencies, as needed. | | |
| | |availability of private funding:a. Refer the client to the |2. The SEP shall Iidentify potential payment source(s), including the | | |
| | |county department to complete an application; or,b. Refer |availability of private funding: | | |
| | |the client to another community resource that can assist in|a. Refer the client to the county department to complete an application; or, | | |
| | |completing the application; or,c. Verify the client's |b. Refer the client to another community resource that can assist in completing | | |
| | |ability to private pay for services.3. The SEP shall |the application; or, | | |
| | |complete a functional assessment when the county department|c. Verify the client's ability to private pay for services. | | |
| | |provides written notification that the client has requested|3. The SEP shall Ccomplete a functional assessment when the county department | | |
| | |HCA and is receiving or has submitted an application for |provides written notification that the client has requested HCA and is receiving| | |
| | |Old Age Pension (OAP), Aid to the Needy Disabled Colorado |or has submitted an application for Old Age Pension (OAP), Aid to the Needy | | |
| | |Supplement (AND-CS), Aid to the Needy Disabled State Only |Disabled Colorado Supplement (AND-CS), Aid to the Needy Disabled State Only | | |
| | |(AND-SO), or the client is receiving Supplemental Security |(AND-SO), or the client is receiving Supplemental Security Income (SSI). | | |
| | |Income (SSI).a. If the client is being discharged from a |a. If the client is being discharged from a hospital or nursing facility, the | | |
| | |hospital or nursing facility, the SEP shall complete the |SEP shall complete the functional assessment regardless of whether AN the | | |
| | |functional assessment regardless of whether the Medicaid |Medicaid application date FOR STATE ASSISTANCE OR MEDICAID has been provided by | | |
| | |application date has been provided by the county |the county department. | | |
| | |department.b. The SEP shall complete the functional |b. The SEP shall complete the functional assessment within two (2) working days | | |
| | |assessment within two (2) working days after notification |after notification when a client is being transferred from a hospital to the HCA| | |
| | |when a client is being transferred from a hospital to the |program. | | |
| | |HCA program.c. The SEP shall complete the functional |c. The SEP shall complete the functional assessment within five (5) working days| | |
| | |assessment within five (5) working days after notification |after notification when a client who is being transferred from a nursing | | |
| | |when a client who is being transferred from a nursing |facility to the HCA program. | | |
| | |facility to the HCA program.d. The SEP shall complete the |d. The SEP shall complete the functional assessment within ten (10) working days| | |
| | |functional assessment within ten (10) working days after |after notification for all other clients. However, the SEP shall have a | | |
| | |notification for all other clients. However, the SEP shall |procedure for prioritizing urgent referrals. | | |
| | |have a procedure for prioritizing urgent referrals. |4. The SEP shall Ddocument all case information. | | |
| | | |a. Documentation of contacts and case management activities shall be entered | | |
| | | |into the HCPF PRESCRIBED SYSTEM Benefits Utilization System (BUS) within five | | |
| | | |(5) working days of the contact or activity. | | |
| | | |b. All information related to intake, assessment, and care planning shall be | | |
| | | |thoroughly documented within ten (10) working days of the intake, assessment or | | |
| | | |care planning using State Department prescribed forms and the HCPF PRESCRIBED | | |
| | | |SYSTEM BUS. | | |
| | | |c. Additional documentation that cannot be entered into the HCPF PRESCRIBED | | |
| | | |SYSTEM BUS shall be maintained in the case file. | | |
| | | |5. The SEP shall Nnotify clients of their program status using the State | | |
| | | |Department prescribed form at the time of initial eligibility, when there is a | | |
| | | |significant change in the client's payment or services, when an adverse action | | |
| | | |is taken, or at the time of discontinuation. | | |
| | | |6. The SEP shall Nnotify the county department in writing: | | |
| | | |a. Within five (5) working days of determining HCA functional eligibility. | | |
| | | |b. Within five (5) working days after the SEP determines that the client is no | | |
| | | |longer functionally eligible for HCA. | | |
| | | |c. Within one (1) working day when the client has filed a written appeal with | | |
| | | |the SEP. | | |
| | | |d. Within one (1) working day when the client has withdrawn the appeal or a | | |
| | | |final agency decision has been entered. | | |
| | | |7. The SEP shall Rrespond to requests for information from the county department| | |
| | | |within ten (10) working days. | | |
| | | |8. The SEP shall Nnotify the client, at the time of his or her application and | | |
| | | |at the time of reassessment or discontinuation of the right to request a STATE | | |
| | | |LEVEL fair hearing before an Administrative Law Judge AS OUTLINED IN SECTION | | |
| | | |3.587, in accordance with Section 3.850 (9 C.C.R. 2503-8), and to appeal adverse| | |
| | | |actions of the SEP or county department. | | |
| | | |9. The SEP shall Iinform the client's Adult Protective Services caseworker, if | | |
| | | |applicable, of the client's status. The case manager shall participate in mutual| | |
| | | |staffing of the client's case. | | |
| | | |10. The SEP shall IMMEDIATELY report to the Colorado Department of Public Health| | |
| | | |and Environment any congregate facility, with three (3) or more residents, that | | |
| | | |is not licensed. | | |
| | | |11. The SEP shall Iimmediately report to the county department any information | | |
| | | |that indicates an overpayment, incorrect payment, or misuse of any HCA benefit, | | |
| | | |and shall cooperate with the county department in any subsequent recovery | | |
| | | |process. | | |
| | | |12. The SEP shall Bbe subject to routine quality control, program monitoring, | | |
| | | |and contract management to minimally include: | | |
| | | |a. Targeted review of the HCPF PRESCRIBED SYSTEM BUS documentation; | | |
| | | |b. Case file review; | | |
| | | |c. Targeted program review conducted via phone, email, or survey; | | |
| | | |d. Onsite program review; | | |
| | | |e. A performance improvement plan to correct areas of identified non-compliance;| | |
| | | |and, | | |
| | | |f. Contract sanctions when the SEP fails to implement a performance improvement | | |
| | | |plan. | | |
|3.570.21 |Program Deletion|A. Special Populations Home Care Allowance (SP-HCA) is a |A. Special Populations Home Care Allowance (SP-HCA) is a special cash payment |Program sunset due to implementation | No |
| | |special cash payment made to a client for the purpose of |made to a client for the purpose of securing in-home, personal care services. |of CDASS program in the SLS waiver. | |
| | |securing in-home, personal care services. |1. SP-HCA is a non-entitlement program; and, | | |
| | |1. SP-HCA is a non-entitlement program; and, |2. Cannot be received while receiving benefits from a Home and Community Based | | |
| | |2. Cannot be received while receiving benefits from a Home |Services waiver other than Supportive Living Services (HCBS-SLS) or Children's | | |
| | |and Community Based Services waiver other than Supportive |Extensive Supports (HCBS-CES); and, | | |
| | |Living Services (HCBS-SLS) or Children's Extensive Supports|3. Is for clients that received Home Care Allowance (HCA) and HCBS-SLS or | | |
| | |(HCBS-CES); and, |HCBS-CES services for at least one month between September 2011 and December | | |
| | |3. Is for clients that received Home Care Allowance (HCA) |2011. | | |
| | |and HCBS-SLS or HCBS-CES services for at least one month | | | |
| | |between September 2011 and December 2011. | | | |
|3.570.21 |Program Deletion|B. Effective September 1, 2018, the SP-HCA grant standard |B. Effective September 1, 2018, the SP-HCA grant standard maximums are as |Program sunset due to implementation | No |
| | |maximums are as follows: |follows: |of CDASS program in the SLS waiver. | |
| | |1. Tier 1 - $330.00 |1. Tier 1 - $330.00 | | |
| | |2. Tier 2 - $472.00 |2. Tier 2 - $472.00 | | |
| | |3. Tier 3 - $605.00 |3. Tier 3 - $605.00 | | |
|3.570.21 |Program Deletion|C. The SP-HCA grant is not taxable income to the client. |C. The SP-HCA grant is not taxable income to the client. The payment made to the|Program sunset due to implementation | No |
| | |The payment made to the care provider using the SP-HCA |care provider using the SP-HCA grant received by the client is income to the |of CDASS program in the SLS waiver. | |
| | |grant received by the client is income to the care provider|care provider and subject to taxation under State and Federal laws. | | |
| | |and subject to taxation under State and Federal laws. | | | |
|3.570.21 |Program Deletion|D. The SP-HCA grant standards shall be adjusted to stay |D. The SP-HCA grant standards shall be adjusted to stay within available |Program sunset due to implementation | No |
| | |within available appropriations. Appeals shall not be |appropriations. Appeals shall not be granted for these adjustments. |of CDASS program in the SLS waiver. | |
| | |granted for these adjustments. | | | |
|3.570.21 |Program Deletion|E. In addition to the regular monthly SP-HCA grant |E. In addition to the regular monthly SP-HCA grant payments, supplemental |Program sunset due to implementation | No |
| | |payments, supplemental payments necessary to comply with |payments necessary to comply with the federal Maintenance of Effort (MOE) |of CDASS program in the SLS waiver. | |
| | |the federal Maintenance of Effort (MOE) requirements may be|requirements may be provided. These payments are supplements to regular grant | | |
| | |provided. These payments are supplements to regular grant |payments, are not entitlements, and do not affect grant standards. Appeals shall| | |
| | |payments, are not entitlements, and do not affect grant |not be allowed for MOE payment adjustments. | | |
| | |standards. Appeals shall not be allowed for MOE payment | | | |
| | |adjustments. | | | |
|3.570.22 |Program Deletion|“Activities of daily living” means physical transfers, |“Activities of daily living” means physical transfers, bladder care, bowel care,|Program sunset due to implementation | No |
| | |bladder care, bowel care, mobility, dressing, bathing, |mobility, dressing, bathing, hygiene, and eating. |of CDASS program in the SLS waiver. | |
| | |hygiene, and eating. | | | |
|3.570.22 |Program Deletion|“Authorized representative” means an individual designated |“Authorized representative” means an individual designated by the client, or by |Program sunset due to implementation | No |
| | |by the client, or by the parent or guardian of the client, |the parent or guardian of the client, if appropriate, to assist in acquiring or |of CDASS program in the SLS waiver. | |
| | |if appropriate, to assist in acquiring or utilizing Special|utilizing Special Populations Home Care Allowance (SP-HCA). The extent of the | | |
| | |Populations Home Care Allowance (SP-HCA). The extent of the|authorized representative's involvement shall be determined upon designation. | | |
| | |authorized representative's involvement shall be determined| | | |
| | |upon designation. | | | |
|3.570.22 |Program Deletion|“BUS” means the Benefits Utilization System, the data |“BUS” means the Benefits Utilization System, the data system used to document |Program sunset due to implementation | No |
| | |system used to document case management activities for |case management activities for Special Populations Home Care Allowance (SP-HCA) |of CDASS program in the SLS waiver. | |
| | |Special Populations Home Care Allowance (SP-HCA) clients. |clients. | | |
|3.570.22 |Program Deletion|“Care planning” means identifying client goals and choices |“Care planning” means identifying client goals and choices for the care needed, |Program sunset due to implementation | No |
| | |for the care needed, services needed, appropriate service |services needed, appropriate service providers, and knowledge of the client and |of CDASS program in the SLS waiver. | |
| | |providers, and knowledge of the client and of community |of community resources. The care plan shall be documented on the State | | |
| | |resources. The care plan shall be documented on the State |prescribed care plan tool. | | |
| | |prescribed care plan tool. | | | |
|3.570.22 |Program Deletion|“Case management” means the assessment of a client's |“Case management” means the assessment of a client's long-term care needs, |Program sunset due to implementation | No |
| | |long-term care needs, development and implementation of a |development and implementation of a care plan, coordination and monitoring of |of CDASS program in the SLS waiver. | |
| | |care plan, coordination and monitoring of the long-term |the long-term care service delivery, evaluation of service effectiveness, and | | |
| | |care service delivery, evaluation of service effectiveness,|periodic reassessment of client needs. | | |
| | |and periodic reassessment of client needs. | | | |
|3.570.22 |Program Deletion|“Client” means any person identified by the State |“Client” means any person identified by the State Department as meeting the |Program sunset due to implementation | No |
| | |Department as meeting the minimal eligibility criteria to |minimal eligibility criteria to apply for a Special Populations Home Care |of CDASS program in the SLS waiver. | |
| | |apply for a Special Populations Home Care Allowance |Allowance (SP-HCA) program grant as outlined at Section 3.570.23, or any person | | |
| | |(SP-HCA) program grant as outlined at Section 3.570.23, or |approved for a SP-HCA program grant. | | |
| | |any person approved for a SP-HCA program grant. | | | |
|3.570.22 |Program Deletion|“Functional Assessment” means a comprehensive evaluation by|“Functional Assessment” means a comprehensive evaluation by the case manager |Program sunset due to implementation | No |
| | |the case manager with the client and appropriate |with the client and appropriate collaterals (such as family members, friends |of CDASS program in the SLS waiver. | |
| | |collaterals (such as family members, friends and/or |and/or caregivers) to determine the client's level of functioning, service | | |
| | |caregivers) to determine the client's level of functioning,|needs, available resources, and necessity for paid care. | | |
| | |service needs, available resources, and necessity for paid | | | |
| | |care. | | | |
|3.570.22 |Program Deletion|“Home” means a non-facility residence. |“Home” means a non-facility residence. |Program sunset due to implementation | No |
| | | | |of CDASS program in the SLS waiver. | |
|3.570.22 |Program Deletion|“Medical leave” means the absence of the client from their |“Medical leave” means the absence of the client from their home for more than |Program sunset due to implementation | No |
| | |home for more than twenty-four (24) hours due to admittance|twenty-four (24) hours due to admittance to a hospital or other facility, upon |of CDASS program in the SLS waiver. | |
| | |to a hospital or other facility, upon physician's order |physician's order with the presumption on the part of the physician that the | | |
| | |with the presumption on the part of the physician that the |client will be returning to their home. Medical leave may be planned or | | |
| | |client will be returning to their home. Medical leave may |unplanned. | | |
| | |be planned or unplanned. | | | |
|3.570.22 |Program Deletion|“Non-medical leave” means the absence of the client from |“Non-medical leave” means the absence of the client from their home for more |Program sunset due to implementation | No |
| | |their home for more than twenty-four (24) hours for |than twenty-four (24) hours for non-medical reasons that are not part of a |of CDASS program in the SLS waiver. | |
| | |non-medical reasons that are not part of a client's care |client's care plan. Non-medical leave may be planned or unplanned. | | |
| | |plan. Non-medical leave may be planned or unplanned. | | | |
|3.570.22 |Program Deletion|“Ongoing case management” means the evaluation of the |“Ongoing case management” means the evaluation of the effectiveness and |Program sunset due to implementation | No |
| | |effectiveness and appropriateness of services, on an |appropriateness of services, on an ongoing basis, through contacts with the |of CDASS program in the SLS waiver. | |
| | |ongoing basis, through contacts with the client, |client, appropriate collaterals, and service providers. | | |
| | |appropriate collaterals, and service providers. | | | |
|3.570.22 |Program Deletion|“Reassessment” means a comprehensive re-evaluation by the |“Reassessment” means a comprehensive re-evaluation by the case manager with the |Program sunset due to implementation | No |
| | |case manager with the client and appropriate collaterals |client and appropriate collaterals (such as family members, friends and/or |of CDASS program in the SLS waiver. | |
| | |(such as family members, friends and/or caregivers) to |caregivers) to determine the client's level of functioning, service needs, | | |
| | |determine the client's level of functioning, service needs,|available resources, potential funding resources, and necessity for paid care. | | |
| | |available resources, potential funding resources, and |The reassessment of functional needs shall be documented on the State prescribed| | |
| | |necessity for paid care. The reassessment of functional |assessment tool. | | |
| | |needs shall be documented on the State prescribed | | | |
| | |assessment tool. | | | |
|3.570.22 |Program Deletion|“Service Plan Authorization Limit” (SPAL) means an annual |“Service Plan Authorization Limit” (SPAL) means an annual upper payment limit of|Program sunset due to implementation | No |
| | |upper payment limit of total funds available to purchase |total funds available to purchase services to meet the client's ongoing needs. |of CDASS program in the SLS waiver. | |
| | |services to meet the client's ongoing needs. Purchase of |Purchase of services not subject to the SPAL are in accordance with the Colorado| | |
| | |services not subject to the SPAL are in accordance with the|Department of Health Care Policy and Financing rules in Section 8.500.102, B (10| | |
| | |Colorado Department of Health Care Policy and Financing |C.C.R. 2505-10). A specific limit is assigned to each of the six (6) support | | |
| | |rules in Section 8.500.102, B (10 C.C.R. 2505-10). A |levels in the HCBS-SLS waiver. The SPAL is determined by the Department based on| | |
| | |specific limit is assigned to each of the six (6) support |the annual appropriation for the HCBS-SLS waiver, the number of clients in each | | |
| | |levels in the HCBS-SLS waiver. The SPAL is determined by |level, and projected utilization. | | |
| | |the Department based on the annual appropriation for the | | | |
| | |HCBS-SLS waiver, the number of clients in each level, and | | | |
| | |projected utilization. | | | |
|3.570.22 |Program Deletion|“Spending Limitation” means an annual maximum limit of |“Spending Limitation” means an annual maximum limit of funds available to |Program sunset due to implementation | No |
| | |funds available to purchase services to meet the client's |purchase services to meet the client's needs under the Home and Community Based |of CDASS program in the SLS waiver. | |
| | |needs under the Home and Community Based Services |Services Children's Extensive Support (HCBS-CES) waiver. | | |
| | |Children's Extensive Support (HCBS-CES) waiver. | | | |
|3.570.22 |Program Deletion|“Single Entry Point (“SEP”) agency” means the agency |“Single Entry Point (“SEP”) agency” means the agency selected by the Colorado |Program sunset due to implementation | No |
| | |selected by the Colorado Department of Health Care Policy |Department of Health Care Policy and Financing to provide case management |of CDASS program in the SLS waiver. | |
| | |and Financing to provide case management functions for |functions for persons in need of long term care services within specific | | |
| | |persons in need of long term care services within specific |demographic areas, pursuant to Section 25.5-6-106, C.R.S. | | |
| | |demographic areas, pursuant to Section 25.5-6-106, C.R.S. | | | |
|3.570.22 |Program Deletion|“Skilled personal care” means some exceptions to personal |“Skilled personal care” means some exceptions to personal care for activities of|Program sunset due to implementation | No |
| | |care for activities of daily living that, because of the |daily living that, because of the severe or complex nature of the client's need,|of CDASS program in the SLS waiver. | |
| | |severe or complex nature of the client's need, requires a |requires a person with specialized training and skill to complete the task. | | |
| | |person with specialized training and skill to complete the |Skilled personal care is not a paid service of the Special Populations Home Care| | |
| | |task. Skilled personal care is not a paid service of the |Allowance (SP-HCA) program. See the Colorado Department of Health Care Policy | | |
| | |Special Populations Home Care Allowance (SP-HCA) program. |and Financing rules in Section 8.489.30 (10 C.C.R. 2505-10) for the definitions | | |
| | |See the Colorado Department of Health Care Policy and |of personal care and the skilled exceptions to personal care. | | |
| | |Financing rules in Section 8.489.30 (10 C.C.R. 2505-10) for| | | |
| | |the definitions of personal care and the skilled exceptions| | | |
| | |to personal care. | | | |
|3.570.22 |Program Deletion|“State Department” means the Colorado Department of Human |“State Department” means the Colorado Department of Human Services (CDHS). |Program sunset due to implementation | No |
| | |Services (CDHS). | |of CDASS program in the SLS waiver. | |
|3.570.23 |Program Deletion|A. Eligibility for SP-HCA shall be based on financial need,|A. Eligibility for SP-HCA shall be based on financial need, the client's |Program sunset due to implementation | No |
| | |the client's functional needs, and SP-HCA special |functional needs, and SP-HCA special eligibility criteria. The client shall meet|of CDASS program in the SLS waiver. | |
| | |eligibility criteria. The client shall meet eligibility for|eligibility for financial, functional, and special requirements to be approved | | |
| | |financial, functional, and special requirements to be |for an SP-HCA payment. | | |
| | |approved for an SP-HCA payment. | | | |
|3.570.23 |Program Deletion|B. The State Department shall identify persons eligible to |B. The State Department shall identify persons eligible to apply for SP-HCA as |Program sunset due to implementation | No |
| | |apply for SP-HCA as potential clients through a review of |potential clients through a review of the statewide automated system for |of CDASS program in the SLS waiver. | |
| | |the statewide automated system for eligibility |eligibility determination, the data system for the Division for Developmental | | |
| | |determination, the data system for the Division for |Disabilities, and review of the Single Entry Point (SEP) case file. Persons | | |
| | |Developmental Disabilities, and review of the Single Entry |identified as potential clients for a SP-HCA grant minimally shall have been:1. | | |
| | |Point (SEP) case file. Persons identified as potential |Approved for Supplemental Security Income (SSI) benefits and been receiving at | | |
| | |clients for a SP-HCA grant minimally shall have been:1. |least a one dollar ($1.00) SSI payment at least one month between September 2011| | |
| | |Approved for Supplemental Security Income (SSI) benefits |and December 2011; or,2. Eligible for a Home Care Allowance (HCA) grant under | | |
| | |and been receiving at least a one dollar ($1.00) SSI |criteria for the Old Age Pension (OAP) or Aid to the Needy Disabled/Aid to the | | |
| | |payment at least one month between September 2011 and |Blind – State Only (AND/AB-SO) programs as outlined in Sections 3.500 (9 C.C.R. | | |
| | |December 2011; or,2. Eligible for a Home Care Allowance |2503-5), et seq., at least one month between September 2011 and December 2011; | | |
| | |(HCA) grant under criteria for the Old Age Pension (OAP) or|and,3. Receiving a Home Care Allowance (HCA) grant at least one month between | | |
| | |Aid to the Needy Disabled/Aid to the Blind – State Only |September 2011 and December 2011; and,4. Receiving Home and Community Based | | |
| | |(AND/AB-SO) programs as outlined in Sections 3.500 (9 |Services Supported Living Services (HCBS-SLS) or Home and Community Based | | |
| | |C.C.R. 2503-5), et seq., at least one month between |Services Children's Extensive Support (HCBS-CES) services at least one month | | |
| | |September 2011 and December 2011; and,3. Receiving a Home |between September 2011 and December 2011; and,5. One thousand dollars ($1,000) | | |
| | |Care Allowance (HCA) grant at least one month between |or less from the maximum Service Plan Authorization Limit (SPAL) or Spending | | |
| | |September 2011 and December 2011; and,4. Receiving Home and|Limitation for his/her functional level of need within the HCBS-SLS or HCBS-CES | | |
| | |Community Based Services Supported Living Services |waiver between September 2011 and December 2011. | | |
| | |(HCBS-SLS) or Home and Community Based Services Children's | | | |
| | |Extensive Support (HCBS-CES) services at least one month | | | |
| | |between September 2011 and December 2011; and,5. One | | | |
| | |thousand dollars ($1,000) or less from the maximum Service | | | |
| | |Plan Authorization Limit (SPAL) or Spending Limitation for | | | |
| | |his/her functional level of need within the HCBS-SLS or | | | |
| | |HCBS-CES waiver between September 2011 and December 2011. | | | |
|3.570.23 |Program Deletion|C. Persons identified by the State Department in March 2012|C. Persons identified by the State Department in March 2012 as potential clients|Program sunset due to implementation | No |
| | |as potential clients as outlined in Section 3.570.23, B, |as outlined in Section 3.570.23, B, shall be provided a one-time-only |of CDASS program in the SLS waiver. | |
| | |shall be provided a one-time-only opportunity to apply for |opportunity to apply for SP-HCA.1. The application process to determine | | |
| | |SP-HCA.1. The application process to determine eligibility |eligibility for the SP-HCA grant shall be initiated no later than March 23, | | |
| | |for the SP-HCA grant shall be initiated no later than March|2012.2. An application packet for SP-HCA shall be sent to the identified | | |
| | |23, 2012.2. An application packet for SP-HCA shall be sent |clients. The application packet shall include:a. A cover letter outlining the | | |
| | |to the identified clients. The application packet shall |SP-HCA grant, the application process, and other necessary information; and,b. | | |
| | |include:a. A cover letter outlining the SP-HCA grant, the |The application; and,c. Any other forms or documents deemed necessary by the | | |
| | |application process, and other necessary information; |State Department to determine eligibility and process grant payments.3. No | | |
| | |and,b. The application; and,c. Any other forms or documents|additional persons shall be identified as potential clients after March 2012. | | |
| | |deemed necessary by the State Department to determine |Appeals shall not be granted to persons wishing to apply for SP-HCA who were not| | |
| | |eligibility and process grant payments.3. No additional |identified as potential clients at the inception of the SP-HCA program in March | | |
| | |persons shall be identified as potential clients after |2012. | | |
| | |March 2012. Appeals shall not be granted to persons wishing| | | |
| | |to apply for SP-HCA who were not identified as potential | | | |
| | |clients at the inception of the SP-HCA program in March | | | |
| | |2012. | | | |
|3.570.23 |Program Deletion|D. Persons identified by the State Department as potential |D. Persons identified by the State Department as potential clients who wish to |Program sunset due to implementation | No |
| | |clients who wish to apply for an SP-HCA grant shall return |apply for an SP-HCA grant shall return the application packet and all supporting|of CDASS program in the SLS waiver. | |
| | |the application packet and all supporting documentation so |documentation so it arrives in the State Department office no later than June 1,| | |
| | |it arrives in the State Department office no later than |2012. | | |
| | |June 1, 2012. |1. Applications may be returned via email, fax, or mail service. | | |
| | |1. Applications may be returned via email, fax, or mail |2. Clients whose application is received in the State Department office after | | |
| | |service. |June 1, 2012 shall be determined permanently ineligible for SP-HCA. An appeal of| | |
| | |2. Clients whose application is received in the State |this decision must be filed no later than thirty (30) calendar days after the | | |
| | |Department office after June 1, 2012 shall be determined |denial. | | |
| | |permanently ineligible for SP-HCA. An appeal of this | | | |
| | |decision must be filed no later than thirty (30) calendar | | | |
| | |days after the denial. | | | |
|3.570.23 |Program Deletion|E. Each application that was returned timely shall be |E. Each application that was returned timely shall be reviewed within forty five|Program sunset due to implementation | No |
| | |reviewed within forty five (45) calendar days of receipt of|(45) calendar days of receipt of the application to determine eligibility and |of CDASS program in the SLS waiver. | |
| | |the application to determine eligibility and grant award, |grant award, to include:1. Completeness of the application.a. Incomplete and/or | | |
| | |to include:1. Completeness of the application.a. Incomplete|unsigned applications shall be returned to the client immediately.b. If an | | |
| | |and/or unsigned applications shall be returned to the |incomplete application is received between April 15 and June 1, 2012, the State | | |
| | |client immediately.b. If an incomplete application is |Department may grant a waiver, at its discretion, for the client to return the | | |
| | |received between April 15 and June 1, 2012, the State |completed application after the June 1, 2012 program deadline for application.2.| | |
| | |Department may grant a waiver, at its discretion, for the |Financial eligibility determination.a. A client receiving at least one dollar | | |
| | |client to return the completed application after the June |($1.00) in SSI benefits shall be determined financially eligible.b. A client not| | |
| | |1, 2012 program deadline for application.2. Financial |receiving at least $1.00 in SSI benefits shall meet eligibility under either the| | |
| | |eligibility determination.a. A client receiving at least |Old Age Pension (OAP) or Aid to the Needy Disabled-State Only (AND-SO) program | | |
| | |one dollar ($1.00) in SSI benefits shall be determined |requirements, as outlined in Sections 3.530 and 3.540 to be determined | | |
| | |financially eligible.b. A client not receiving at least |financially eligible.1) A secondary application to collect income and resource | | |
| | |$1.00 in SSI benefits shall meet eligibility under either |information shall be sent to the client immediately.2) The client shall return | | |
| | |the Old Age Pension (OAP) or Aid to the Needy |the completed secondary application along with all verifications of income and | | |
| | |Disabled-State Only (AND-SO) program requirements, as |resources within twenty (20) working days.3) A phone interview shall be | | |
| | |outlined in Sections 3.530 and 3.540 to be determined |scheduled with the client or authorized representative to review the secondary | | |
| | |financially eligible.1) A secondary application to collect |application and verifications.4) If the client or authorized representative | | |
| | |income and resource information shall be sent to the client|refuses to consent to the interview, fails to return the secondary application, | | |
| | |immediately.2) The client shall return the completed |or fails to provide required verification the client shall be permanently | | |
| | |secondary application along with all verifications of |ineligible for the SP-HCA program. An appeal of this decision must be filed no | | |
| | |income and resources within twenty (20) working days.3) A |later than thirty (30) calendar days after the denial. | | |
| | |phone interview shall be scheduled with the client or | | | |
| | |authorized representative to review the secondary | | | |
| | |application and verifications.4) If the client or | | | |
| | |authorized representative refuses to consent to the | | | |
| | |interview, fails to return the secondary application, or | | | |
| | |fails to provide required verification the client shall be | | | |
| | |permanently ineligible for the SP-HCA program. An appeal of| | | |
| | |this decision must be filed no later than thirty (30) | | | |
| | |calendar days after the denial. | | | |
|3.570.23 |Program Deletion|E.3. Functional eligibility determination.a. If the |E.3. Functional eligibility determination.a. If the client's most recent |Program sunset due to implementation | No |
| | |client's most recent functional assessment (FA), care plan |functional assessment (FA), care plan (CP), and provider agreement (PA) were |of CDASS program in the SLS waiver. | |
| | |(CP), and provider agreement (PA) were completed ten (10) |completed ten (10) or more months prior to the application date, the State | | |
| | |or more months prior to the application date, the State |Department shall refer the client to the appropriate SEP for a new FA, CP, and | | |
| | |Department shall refer the client to the appropriate SEP |PA prior to determining eligibility.1) The SEP shall complete the FA, CP, and PA| | |
| | |for a new FA, CP, and PA prior to determining |no later than fifteen (15) working days from the date of referral by the State | | |
| | |eligibility.1) The SEP shall complete the FA, CP, and PA no|Department.2) The SEP shall email the State Department with the completed FA, | | |
| | |later than fifteen (15) working days from the date of |CP, and PA within one (1) working day of completion.b. If the client's most | | |
| | |referral by the State Department.2) The SEP shall email the|recent FA, CP, and PA were completed less than ten (10) months prior to the | | |
| | |State Department with the completed FA, CP, and PA within |application date, the State Department shall review for functional | | |
| | |one (1) working day of completion.b. If the client's most |eligibility.c. To be functionally eligible, the client shall have an SP-HCA | | |
| | |recent FA, CP, and PA were completed less than ten (10) |eligible functional assessment score as outlined in Section 3.570.24. The | | |
| | |months prior to the application date, the State Department |functional assessment score is calculated by determining the client's functional| | |
| | |shall review for functional eligibility.c. To be |capacity score and need for paid care score, as follows:1) Functional Capacity: | | |
| | |functionally eligible, the client shall have an SP-HCA |determined by assessing the client's ability to complete all activities of daily| | |
| | |eligible functional assessment score as outlined in Section|living (ADLs) and applying a score to their ability to complete the ADLs using | | |
| | |3.570.24. The functional assessment score is calculated by |the functional impairment scale, as outlined in Section 3.570.24; and,2) Need | | |
| | |determining the client's functional capacity score and need|for Paid Care: determined by identifying the unmet need for paid care and | | |
| | |for paid care score, as follows:1) Functional Capacity: |applying a score to the unmet need using the need for paid care scale as | | |
| | |determined by assessing the client's ability to complete |outlined in Section 3.570.24; and,3) Combining the functional capacity score and| | |
| | |all activities of daily living (ADLs) and applying a score |the need for paid care score to determine whether the client meets the minimum | | |
| | |to their ability to complete the ADLs using the functional |scores for eligibility and, if eligible, the tier of benefits to be approved, as| | |
| | |impairment scale, as outlined in Section 3.570.24; and,2) |follows:TIER CAPACITY SCORE NEED FOR PAID CARE | | |
| | |Need for Paid Care: determined by identifying the unmet |SCORE1 21 or Higher 1 to 232 | | |
| | |need for paid care and applying a score to the unmet need |21 or Higher 24 to 373 21 or Higher| | |
| | |using the need for paid care scale as outlined in Section |38 to 51 | | |
| | |3.570.24; and,3) Combining the functional capacity score | | | |
| | |and the need for paid care score to determine whether the | | | |
| | |client meets the minimum scores for eligibility and, if | | | |
| | |eligible, the tier of benefits to be approved, as | | | |
| | |follows:TIER CAPACITY SCORE | | | |
| | |NEED FOR PAID CARE SCORE1 21 or Higher | | | |
| | |1 to 232 21 or Higher | | | |
| | |24 to 373 21 or Higher | | | |
| | |38 to 51 | | | |
|3.570.23 |Program Deletion|E.3.d. The SEP shall not approve the maximum authorized |E.3.d. The SEP shall not approve the maximum authorized SP-HCA amount for the |Program sunset due to implementation | No |
| | |SP-HCA amount for the tier if:1) The client's needs can be |tier if:1) The client's needs can be fully or partially met through other paid |of CDASS program in the SLS waiver. | |
| | |fully or partially met through other paid or unpaid sources|or unpaid sources (excluding family and friends); or,2) The SP-HCA provider is | | |
| | |(excluding family and friends); or,2) The SP-HCA provider |able to provide the authorized services for less than the maximum authorized | | |
| | |is able to provide the authorized services for less than |amount, or,3) The client is unwilling or unable to use the maximum authorized | | |
| | |the maximum authorized amount, or,3) The client is |amount.e. Each client who meets the minimum functional assessment scoring | | |
| | |unwilling or unable to use the maximum authorized amount.e.|requirements for the SP-HCA program shall be functionally eligible for an SP-HCA| | |
| | |Each client who meets the minimum functional assessment |grant.1) The authorization by the SEP shall be forwarded to the State Department| | |
| | |scoring requirements for the SP-HCA program shall be |to determine financial eligibility and SP-HCA special eligibility, as outlined | | |
| | |functionally eligible for an SP-HCA grant.1) The |in Sections 3.570.23, E, 2 and 3.570.23, E, 4.2) Clients shall not be approved | | |
| | |authorization by the SEP shall be forwarded to the State |for SP-HCA if financially ineligible and/or do not meet SP-HCA special | | |
| | |Department to determine financial eligibility and SP-HCA |eligibility criteria, even if the client is functionally eligible.3) Clients | | |
| | |special eligibility, as outlined in Sections 3.570.23, E, 2|shall not be approved for SP-HCA if functionally ineligible, even if the client | | |
| | |and 3.570.23, E, 4.2) Clients shall not be approved for |is financially eligible and/or meets SP-HCA special eligibility criteria. | | |
| | |SP-HCA if financially ineligible and/or do not meet SP-HCA | | | |
| | |special eligibility criteria, even if the client is | | | |
| | |functionally eligible.3) Clients shall not be approved for | | | |
| | |SP-HCA if functionally ineligible, even if the client is | | | |
| | |financially eligible and/or meets SP-HCA special | | | |
| | |eligibility criteria. | | | |
|3.570.23 |Program Deletion|E.4. SP-HCA special eligibility criteria. |E.4. SP-HCA special eligibility criteria. |Program sunset due to implementation | No |
| | |a. A client must have received a Home Care Allowance (HCA) |a. A client must have received a Home Care Allowance (HCA) program payment at |of CDASS program in the SLS waiver. | |
| | |program payment at least one month between September 2011 |least one month between September 2011 and December 2011. | | |
| | |and December 2011. |b. A client must have received HCBS-SLS or HCBS-CES waiver services at least one| | |
| | |b. A client must have received HCBS-SLS or HCBS-CES waiver |month between September 2011 and December 2011. | | |
| | |services at least one month between September 2011 and |c. A client must have been $1,000 or less from his/her SPAL in HCBS-SLS or | | |
| | |December 2011. |Spending Limitation in HCBS-CES at least one month between September 2011 and | | |
| | |c. A client must have been $1,000 or less from his/her SPAL|December 2011. | | |
| | |in HCBS-SLS or Spending Limitation in HCBS-CES at least one|d. All applications will be reviewed for eligibility retroactive to January | | |
| | |month between September 2011 and December 2011. |2012, provided the client was still a resident of Colorado on January 1, 2012. | | |
| | |d. All applications will be reviewed for eligibility | | | |
| | |retroactive to January 2012, provided the client was still | | | |
| | |a resident of Colorado on January 1, 2012. | | | |
|3.570.23 |Program Deletion|F. All eligible clients shall be approved for an SP-HCA |F. All eligible clients shall be approved for an SP-HCA program grant.1. The |Program sunset due to implementation | No |
| | |program grant.1. The SP-HCA program approval shall be |SP-HCA program approval shall be retroactive to January 2012 for all months that|of CDASS program in the SLS waiver. | |
| | |retroactive to January 2012 for all months that the client |the client is eligible.2. The client's grant amount shall be based on the SP-HCA| | |
| | |is eligible.2. The client's grant amount shall be based on |tier of payment as determined by the functional assessment conducted by the | | |
| | |the SP-HCA tier of payment as determined by the functional |SEP.3. Grants shall be for one full month and shall not be prorated based on a | | |
| | |assessment conducted by the SEP.3. Grants shall be for one |partial month of services. | | |
| | |full month and shall not be prorated based on a partial | | | |
| | |month of services. | | | |
|3.570.23 |Program Deletion|G. Notice shall be provided to the client of approval for |G. Notice shall be provided to the client of approval for or denial of an SP-HCA|Program sunset due to implementation | No |
| | |or denial of an SP-HCA grant no later than ten (10) working|grant no later than ten (10) working days after completing the eligibility |of CDASS program in the SLS waiver. | |
| | |days after completing the eligibility determination. |determination. | | |
| | |1. The notice shall contain the eligibility result and |1. The notice shall contain the eligibility result and appropriate rule | | |
| | |appropriate rule citations; and, |citations; and, | | |
| | |2. The date when the grant will be effective, if approved; |2. The date when the grant will be effective, if approved; or, | | |
| | |or, |3. The date and reason for denial and the appeal process, if denied. | | |
| | |3. The date and reason for denial and the appeal process, | | | |
| | |if denied. | | | |
|3.570.23 |Program Deletion|H. Monthly payments shall be processed on the 20th of the |H. Monthly payments shall be processed on the 20th of the month. |Program sunset due to implementation | No |
| | |month. |1. The client or authorized representative shall report any changes related to |of CDASS program in the SLS waiver. | |
| | |1. The client or authorized representative shall report any|income, resources, functional assessment, HCBS waiver status, or any other | | |
| | |changes related to income, resources, functional |change that might affect eligibility to the State Department or SEP within five | | |
| | |assessment, HCBS waiver status, or any other change that |(5) working days of the change. | | |
| | |might affect eligibility to the State Department or SEP |2. Failure to report a change shall be grounds for discontinuation from the | | |
| | |within five (5) working days of the change. |program and any payments made after the change shall be subject to recovery | | |
| | |2. Failure to report a change shall be grounds for |and/or fraud investigation and possible prosecution, as outlined in Section | | |
| | |discontinuation from the program and any payments made |3.800, et seq. (9 C.C.R. 2503-8). | | |
| | |after the change shall be subject to recovery and/or fraud | | | |
| | |investigation and possible prosecution, as outlined in | | | |
| | |Section 3.800, et seq. (9 C.C.R. 2503-8). | | | |
|3.570.23 |Program Deletion|I. Ongoing review of the client's eligibility beginning |I. Ongoing review of the client's eligibility beginning February 2012 and |Program sunset due to implementation | No |
| | |February 2012 and thereafter shall be conducted in |thereafter shall be conducted in coordination with the SEP, Division for |of CDASS program in the SLS waiver. | |
| | |coordination with the SEP, Division for Developmental |Developmental Disabilities, and State Department. To remain eligible for a | | |
| | |Disabilities, and State Department. To remain eligible for |SP-HCA grant, the client shall continually:1. Be approved for Supplemental | | |
| | |a SP-HCA grant, the client shall continually:1. Be approved|Security Income (SSI) benefits and be receiving at least a one dollar ($1.00) | | |
| | |for Supplemental Security Income (SSI) benefits and be |SSI monthly payment; or, meet all eligibility criteria for the Aid to the Needy | | |
| | |receiving at least a one dollar ($1.00) SSI monthly |Disabled – State Only (AND-SO) programs; or, were receiving both Old Age Pension| | |
| | |payment; or, meet all eligibility criteria for the Aid to |(OAP) benefits and SP-HCA as of December 31, 2013 and remain continuously | | |
| | |the Needy Disabled – State Only (AND-SO) programs; or, were|eligible for both benefits; and,2. Be receiving HCBS-SLS or HCBS-CES services | | |
| | |receiving both Old Age Pension (OAP) benefits and SP-HCA as|and SP-HCA; and,3. Remain one thousand dollars ($1,000) or less from the maximum| | |
| | |of December 31, 2013 and remain continuously eligible for |SPAL or Spending Limitation for his/her functional level of need within the | | |
| | |both benefits; and,2. Be receiving HCBS-SLS or HCBS-CES |HCBS-SLS or HCBS-CES waiver; and,4. Meet the SP-HCA eligible functional capacity| | |
| | |services and SP-HCA; and,3. Remain one thousand dollars |score and need for paid care score as outlined in Section 3.570.24. | | |
| | |($1,000) or less from the maximum SPAL or Spending | | | |
| | |Limitation for his/her functional level of need within the | | | |
| | |HCBS-SLS or HCBS-CES waiver; and,4. Meet the SP-HCA | | | |
| | |eligible functional capacity score and need for paid care | | | |
| | |score as outlined in Section 3.570.24. | | | |
|3.570.23 |Program Deletion|J. Annual reassessment and redetermination shall be |J. Annual reassessment and redetermination shall be conducted. |Program sunset due to implementation | No |
| | |conducted. |1. A new functional assessment shall be conducted by the SEP. |of CDASS program in the SLS waiver. | |
| | |1. A new functional assessment shall be conducted by the |2. A new financial and SP-HCA eligibility determination shall be conducted. | | |
| | |SEP. |3. The client or authorized representative shall compete and timely return the | | |
| | |2. A new financial and SP-HCA eligibility determination |redetermination application and any other required documentation required to | | |
| | |shall be conducted. |process the redetermination. | | |
| | |3. The client or authorized representative shall compete |4. Notice of continued eligibility and grant amount shall be provided, if the | | |
| | |and timely return the redetermination application and any |client is determined eligible for SP-HCA. | | |
| | |other required documentation required to process the | | | |
| | |redetermination. | | | |
| | |4. Notice of continued eligibility and grant amount shall | | | |
| | |be provided, if the client is determined eligible for | | | |
| | |SP-HCA. | | | |
|3.570.23 |Program Deletion|K. If during ongoing review or at the time of annual |K. If during ongoing review or at the time of annual redetermination the client |Program sunset due to implementation | No |
| | |redetermination the client is no longer eligible for |is no longer eligible for SP-HCA, notice of discontinuation and appeal rights, |of CDASS program in the SLS waiver. | |
| | |SP-HCA, notice of discontinuation and appeal rights, as |as outlined in Section 3.850, et seq. (9 C.C.R. 2503-8) shall be provided within| | |
| | |outlined in Section 3.850, et seq. (9 C.C.R. 2503-8) shall |ten (10) working days.1. The notice shall include the reason for the | | |
| | |be provided within ten (10) working days.1. The notice |discontinuation, the appropriate rule citations, and information on the appeal | | |
| | |shall include the reason for the discontinuation, the |process.2. The appeal process shall be as outlined in Section 3.850, with the | | |
| | |appropriate rule citations, and information on the appeal |following exceptions:a. Requirements of the county department shall be changed | | |
| | |process.2. The appeal process shall be as outlined in |to requirements of the State Department and/or SEP and requests for a county | | |
| | |Section 3.850, with the following exceptions:a. |level conference shall be a State Department level conference.b. Appeals shall | | |
| | |Requirements of the county department shall be changed to |be granted for specific SP-HCA requirements only within thirty (30) days of | | |
| | |requirements of the State Department and/or SEP and |denial or discontinuation. | | |
| | |requests for a county level conference shall be a State | | | |
| | |Department level conference.b. Appeals shall be granted for| | | |
| | |specific SP-HCA requirements only within thirty (30) days | | | |
| | |of denial or discontinuation. | | | |
|3.570.23 |Program Deletion|L. No hardship exceptions shall apply to SP-HCA grants. |L. No hardship exceptions shall apply to SP-HCA grants. |Program sunset due to implementation | No |
| | | | |of CDASS program in the SLS waiver. | |
|3.570.24 |Program Deletion|A. The need for skilled personal care shall not be included|A. The need for skilled personal care shall not be included in the scoring of |Program sunset due to implementation | No |
| | |in the scoring of the need for paid care. |the need for paid care. |of CDASS program in the SLS waiver. | |
|3.570.24 |Program Deletion|B. The Single Entry Point (SEP) agency shall complete a |B. The Single Entry Point (SEP) agency shall complete a functional assessment |Program sunset due to implementation | No |
| | |functional assessment for each client as follows:1. Upon |for each client as follows:1. Upon referral by the State Department to determine|of CDASS program in the SLS waiver. | |
| | |referral by the State Department to determine initial |initial eligibility for the SP-HCA program; or,2. Immediately whenever the SEP, | | |
| | |eligibility for the SP-HCA program; or,2. Immediately |during ordinary case management services and in his/her professional opinion, | | |
| | |whenever the SEP, during ordinary case management services |identifies a significant change in the client's ability to perform activities of| | |
| | |and in his/her professional opinion, identifies a |daily living; or,3. Immediately whenever the client or authorized representative| | |
| | |significant change in the client's ability to perform |reports a significant change in the client's ability to perform activities of | | |
| | |activities of daily living; or,3. Immediately whenever the |daily living; or,4. Annually, at a minimum. The annual functional assessment | | |
| | |client or authorized representative reports a significant |shall be completed no earlier than forty-five (45) calendar days prior to and no| | |
| | |change in the client's ability to perform activities of |later than the client's reassessment due date. The assessment shall include, but| | |
| | |daily living; or,4. Annually, at a minimum. The annual |may not be limited to:a. A new functional assessment during a face-to-face visit| | |
| | |functional assessment shall be completed no earlier than |at the client's place of residence;b. Evaluation of the appropriateness of | | |
| | |forty-five (45) calendar days prior to and no later than |services, service effectiveness, and quality of care over the past year; and,c. | | |
| | |the client's reassessment due date. The assessment shall |Completion of an updated care plan and provider agreement. | | |
| | |include, but may not be limited to:a. A new functional | | | |
| | |assessment during a face-to-face visit at the client's | | | |
| | |place of residence;b. Evaluation of the appropriateness of | | | |
| | |services, service effectiveness, and quality of care over | | | |
| | |the past year; and,c. Completion of an updated care plan | | | |
| | |and provider agreement. | | | |
|3.570.24 |Program Deletion|C. In order to be eligible for the SP-HCA program, each |C. In order to be eligible for the SP-HCA program, each client shall score a |Program sunset due to implementation | No |
| | |client shall score a minimum of twenty-one (21) points when|minimum of twenty-one (21) points when assessed for the ability to complete the |of CDASS program in the SLS waiver. | |
| | |assessed for the ability to complete the activities of |activities of daily living (ADL) using the following functional impairment | | |
| | |daily living (ADL) using the following functional |scale:1. Independent: score zero (0) if the client is physically able to perform| | |
| | |impairment scale:1. Independent: score zero (0) if the |all essential components of the ADL, with or without an assistive device.2. Low:| | |
| | |client is physically able to perform all essential |score one (1) if the client is able to perform all essential components of the | | |
| | |components of the ADL, with or without an assistive |function, but impairment of function exists even with an assistive device, or | | |
| | |device.2. Low: score one (1) if the client is able to |the client requires occasional or intermittent supervision or physical | | |
| | |perform all essential components of the function, but |assistance in a limited number of the components of the activity.a. Occasional | | |
| | |impairment of function exists even with an assistive |or intermittent means the client does not need assistance daily, but may need | | |
| | |device, or the client requires occasional or intermittent |assistance a few times a month or up to two (2) times per week.b. Supervision or| | |
| | |supervision or physical assistance in a limited number of |assistance means verbal prompting, cueing, and reminders, and means stand-by | | |
| | |the components of the activity.a. Occasional or |assistance or monitoring to help the client if he/she needs physical assistance | | |
| | |intermittent means the client does not need assistance |up to two (2) times per week.3. Moderate: score two (2) if the client is unable | | |
| | |daily, but may need assistance a few times a month or up to|to perform the majority of the essential components of the function even with an| | |
| | |two (2) times per week.b. Supervision or assistance means |assistive device, and the client requires hands-on and frequent assistance to | | |
| | |verbal prompting, cueing, and reminders, and means stand-by|accomplish the activity.a. Frequent means the client needs assistance at least | | |
| | |assistance or monitoring to help the client if he/she needs|three (3) times per week and up to daily.b. Hands-on assistance means the care | | |
| | |physical assistance up to two (2) times per week.3. |provider must physically assist the client in completing the task.4. Severe: | | |
| | |Moderate: score two (2) if the client is unable to perform |score three (3) if the client is totally unable to perform the function and | | |
| | |the majority of the essential components of the function |requires someone to perform the task, or the client requires constant | | |
| | |even with an assistive device, and the client requires |supervision for the task. | | |
| | |hands-on and frequent assistance to accomplish the | | | |
| | |activity.a. Frequent means the client needs assistance at | | | |
| | |least three (3) times per week and up to daily.b. Hands-on | | | |
| | |assistance means the care provider must physically assist | | | |
| | |the client in completing the task.4. Severe: score three | | | |
| | |(3) if the client is totally unable to perform the function| | | |
| | |and requires someone to perform the task, or the client | | | |
| | |requires constant supervision for the task. | | | |
|3.570.24 |Program Deletion|D. The need for paid care score shall be based on the |D. The need for paid care score shall be based on the frequency of the client's |Program sunset due to implementation | No |
| | |frequency of the client's unmet need for paid care and |unmet need for paid care and shall be modified by the following factors:1. Need |of CDASS program in the SLS waiver. | |
| | |shall be modified by the following factors:1. Need for paid|for paid care shall be scored as zero (0) when those services are provided | | |
| | |care shall be scored as zero (0) when those services are |through another program, agency, or individual.2. For clients living with | | |
| | |provided through another program, agency, or individual.2. |others, the need for paid care shall be scored only on the client's needs that | | |
| | |For clients living with others, the need for paid care |are greater than and differentiated from typical household routine and the | | |
| | |shall be scored only on the client's needs that are greater|typical expectation of assistance by family members living in the home.3. Need | | |
| | |than and differentiated from typical household routine and |for paid care shall be scored only on the client's needs that are greater than | | |
| | |the typical expectation of assistance by family members |and differentiated from services received through the Medicaid Home and | | |
| | |living in the home.3. Need for paid care shall be scored |Community Based Services Supportive Living Services (HCBS-SLS) or Children's | | |
| | |only on the client's needs that are greater than and |Extensive Support (HCBS-CES) waiver. | | |
| | |differentiated from services received through the Medicaid | | | |
| | |Home and Community Based Services Supportive Living | | | |
| | |Services (HCBS-SLS) or Children's Extensive Support | | | |
| | |(HCBS-CES) waiver. | | | |
|3.570.24 |Program Deletion|E. For children age zero (0) through eighteen (18) years, |E. For children age zero (0) through eighteen (18) years, functional capacity |Program sunset due to implementation | No |
| | |functional capacity and need for paid care shall be scored |and need for paid care shall be scored according to age appropriate criteria. |of CDASS program in the SLS waiver. | |
| | |according to age appropriate criteria. | | | |
|3.570.24 |Program Deletion|F. The need for paid care scale is as follows: |F. The need for paid care scale is as follows: |Program sunset due to implementation | No |
| | |SCORE FREQUENCY DEFINITION OF FREQUENCY |SCORE FREQUENCY DEFINITION OF FREQUENCY |of CDASS program in the SLS waiver. | |
| | |0 None Client's |0 None Client's needs are met. No | | |
| | |needs are met. No need for paid care. |need for paid care. | | |
| | |1 Weekly Client |1 Weekly Client needs paid care up to and| | |
| | |needs paid care up to and including once a week. |including once a week. | | |
| | |2 Daily Client |2 Daily Client needs paid care more | | |
| | |needs paid care more than once a week and up to once a day,|than once a week and up to once a day, seven days a week. | | |
| | |seven days a week. |3 Twice Daily Client needs paid care two or more | | |
| | |3 Twice Daily Client needs |times per day at least five days per week. | | |
| | |paid care two or more times per day at least five days per | | | |
| | |week. | | | |
|3.570.24 |Program Deletion|G. The functional assessment shall be scored on the State |G. The functional assessment shall be scored on the State Department prescribed |Program sunset due to implementation | No |
| | |Department prescribed form, which shall list each activity |form, which shall list each activity of daily living, the functional capacity |of CDASS program in the SLS waiver. | |
| | |of daily living, the functional capacity score, and the |score, and the need for paid care score for each ADL. | | |
| | |need for paid care score for each ADL. | | | |
|3.570.25 |Program Deletion|A. Activities of daily living (ADLs) shall be scored using |A. Activities of daily living (ADLs) shall be scored using the functional |Program sunset due to implementation | No |
| | |the functional capacity impairment scale and the need for |capacity impairment scale and the need for paid care scale outlined in Section |of CDASS program in the SLS waiver. | |
| | |paid care scale outlined in Section 3.570.24. |3.570.24. | | |
|3.570.25 |Program Deletion|B. The activities of daily living are: |B. The activities of daily living are: |Program sunset due to implementation | No |
| | |1. Critical ADLs |1. Critical ADLs |of CDASS program in the SLS waiver. | |
| | |a. Transfers: the ability to move between surfaces, such as|a. Transfers: the ability to move between surfaces, such as getting in and out | | |
| | |getting in and out of bed; transferring from a bed to a |of bed; transferring from a bed to a chair, wheelchair, or walker; moving from a| | |
| | |chair, wheelchair, or walker; moving from a chair or |chair or wheelchair to a walker or to a standing position; and the ability to | | |
| | |wheelchair to a walker or to a standing position; and the |use assistive devices, including prosthetics. A child age 0 to 48 months shall | | |
| | |ability to use assistive devices, including prosthetics. A |not be scored for any transfers, including positioning. A child age 0 to 60 | | |
| | |child age 0 to 48 months shall not be scored for any |months shall not be scored for car seat, highchair, or crib transfers. | | |
| | |transfers, including positioning. A child age 0 to 60 |b. Bladder care: the extent to which the client has control of his/her bladder | | |
| | |months shall not be scored for car seat, highchair, or crib|functions and the ability of the client to accomplish the tasks of toileting, | | |
| | |transfers. |including catheterizing, getting on and off the toilet, changing incontinence | | |
| | |b. Bladder care: the extent to which the client has control|products, and cleaning him/herself. A child age 0 to 36 months shall not be | | |
| | |of his/her bladder functions and the ability of the client |scored for bladder incontinence or care. | | |
| | |to accomplish the tasks of toileting, including |c. Bowel care: the extent to which the client has control of his/her bowel | | |
| | |catheterizing, getting on and off the toilet, changing |functions and the ability of the client to accomplish the tasks of toileting, | | |
| | |incontinence products, and cleaning him/herself. A child |including getting on and off the toilet, changing incontinence products, and | | |
| | |age 0 to 36 months shall not be scored for bladder |cleaning him/herself. A child age 0 to 36 months shall not be scored for bowel | | |
| | |incontinence or care. |incontinence or care. | | |
| | |c. Bowel care: the extent to which the client has control | | | |
| | |of his/her bowel functions and the ability of the client to| | | |
| | |accomplish the tasks of toileting, including getting on and| | | |
| | |off the toilet, changing incontinence products, and | | | |
| | |cleaning him/herself. A child age 0 to 36 months shall not | | | |
| | |be scored for bowel incontinence or care. | | | |
|3.570.25 |Program Deletion|B.2. Basic ADLsa. Mobility: the ability of the client to |B.2. Basic ADLsa. Mobility: the ability of the client to ambulate around the |Program sunset due to implementation | No |
| | |ambulate around the home and around essential places |home and around essential places outside the home, with or without assistive |of CDASS program in the SLS waiver. | |
| | |outside the home, with or without assistive devices. A |devices. A child age 0 to 36 months shall not be scored for mobility.b. | | |
| | |child age 0 to 36 months shall not be scored for |Dressing: the ability of the client to accomplish all phases of the activities | | |
| | |mobility.b. Dressing: the ability of the client to |of dressing and undressing, including getting, putting on, fastening, and taking| | |
| | |accomplish all phases of the activities of dressing and |off all items of clothing, braces, and artificial limbs. A child age 0 to 60 | | |
| | |undressing, including getting, putting on, fastening, and |months shall not be scored for dressing.c. Bathing: the ability of the client to| | |
| | |taking off all items of clothing, braces, and artificial |safely accomplish the task of washing body parts including getting into bathing | | |
| | |limbs. A child age 0 to 60 months shall not be scored for |waters, with or without assistive devices or whether the client requires stand | | |
| | |dressing.c. Bathing: the ability of the client to safely |by or hands-on assistance from another person. A child age 0 to 60 months shall | | |
| | |accomplish the task of washing body parts including getting|not be scored for bathing.d. Hygiene: the ability of the client to maintain | | |
| | |into bathing waters, with or without assistive devices or |personal hygiene other than bathing, including combing hair, brushing teeth, and| | |
| | |whether the client requires stand by or hands-on assistance|clipping nails. A child age 0 to 60 months shall not be scored for hygiene.e. | | |
| | |from another person. A child age 0 to 60 months shall not |Eating: the ability to cut food into manageable size pieces, chew, and swallow | | |
| | |be scored for bathing.d. Hygiene: the ability of the client|food, with or without assistive devices. A child age 0 to 48 months shall not be| | |
| | |to maintain personal hygiene other than bathing, including |scored for eating. | | |
| | |combing hair, brushing teeth, and clipping nails. A child | | | |
| | |age 0 to 60 months shall not be scored for hygiene.e. | | | |
| | |Eating: the ability to cut food into manageable size | | | |
| | |pieces, chew, and swallow food, with or without assistive | | | |
| | |devices. A child age 0 to 48 months shall not be scored for| | | |
| | |eating. | | | |
|3.570.25 |Program Deletion|B.3. Instrumental ADLsa. Meals: the ability to safely |B.3. Instrumental ADLsa. Meals: the ability to safely prepare food to meet the |Program sunset due to implementation | No |
| | |prepare food to meet the basic nutritional requirements of |basic nutritional requirements of the individual, including cutting food, |of CDASS program in the SLS waiver. | |
| | |the individual, including cutting food, transferring food |transferring food to cooking vessels and/or dishes, utilizing utensils, using a | | |
| | |to cooking vessels and/or dishes, utilizing utensils, using|stove or microwave, and implementing special dietary needs. A child age 0 to 14 | | |
| | |a stove or microwave, and implementing special dietary |years shall not be scored for meals.b. Housekeeping: the ability to maintain the| | |
| | |needs. A child age 0 to 14 years shall not be scored for |interior of the client's residence for the purpose of health and safety, such as| | |
| | |meals.b. Housekeeping: the ability to maintain the interior|wiping surfaces, cleaning floors, making a bed, and cleaning dishes. A child age| | |
| | |of the client's residence for the purpose of health and |0 to 12 years shall not be scored for housekeeping.c. Laundry: the ability to | | |
| | |safety, such as wiping surfaces, cleaning floors, making a |gather and wash soiled clothing and linens; use washing machines and dryers; | | |
| | |bed, and cleaning dishes. A child age 0 to 12 years shall |hang, fold, and put away clean clothing and linens. A child age 0 to 12 years | | |
| | |not be scored for housekeeping.c. Laundry: the ability to |shall not be scored for laundry.d. Shopping: the ability to purchase goods that | | |
| | |gather and wash soiled clothing and linens; use washing |are necessary for health and safety. Activities include ability to make needs | | |
| | |machines and dryers; hang, fold, and put away clean |known, to make a list, reach for the needed items at the store, ability to | | |
| | |clothing and linens. A child age 0 to 12 years shall not be|estimate or determine the cost of the item, and to move items into the home and | | |
| | |scored for laundry.d. Shopping: the ability to purchase |put them away. A child age 0 to 15 years shall not be scored for shopping. | | |
| | |goods that are necessary for health and safety. Activities | | | |
| | |include ability to make needs known, to make a list, reach | | | |
| | |for the needed items at the store, ability to estimate or | | | |
| | |determine the cost of the item, and to move items into the | | | |
| | |home and put them away. A child age 0 to 15 years shall not| | | |
| | |be scored for shopping. | | | |
|3.570.25 |Program Deletion|B.4. Supportive ADLsa. Medicine: the ability to manage |B.4. Supportive ADLsa. Medicine: the ability to manage medications, including |Program sunset due to implementation | No |
| | |medications, including knowing the name of the medication, |knowing the name of the medication, knowing the amount, frequency, and how to |of CDASS program in the SLS waiver. | |
| | |knowing the amount, frequency, and how to take the |take the medicine, understanding the reason for taking it, and understanding | | |
| | |medicine, understanding the reason for taking it, and |possible side effects. A child age 0 to 14 years shall not be scored for | | |
| | |understanding possible side effects. A child age 0 to 14 |medicine.b. Appointment: the ability to schedule or make an appointment for | | |
| | |years shall not be scored for medicine.b. Appointment: the |essential activities, such as doctor visits, meetings with caseworkers, and | | |
| | |ability to schedule or make an appointment for essential |transportation. A child age 0 to 16 years shall not be scored for | | |
| | |activities, such as doctor visits, meetings with |appointments.c. Money: the ability to manage money, such as balancing a check | | |
| | |caseworkers, and transportation. A child age 0 to 16 years |book, writing checks or paying a bill electronically, and ability to understand | | |
| | |shall not be scored for appointments.c. Money: the ability |financial decisions. A child age 0 to 16 years shall not be scored for money.d. | | |
| | |to manage money, such as balancing a check book, writing |Access: the ability to access resources or services in the community, such as | | |
| | |checks or paying a bill electronically, and ability to |locating the resource/service and completing the process necessary to receive | | |
| | |understand financial decisions. A child age 0 to 16 years |the resource or service. A child age 0 to 16 years shall not be scored for | | |
| | |shall not be scored for money.d. Access: the ability to |access.e. Telephone: the ability to use the telephone to communicate essential | | |
| | |access resources or services in the community, such as |needs, such as answering the phone in a reasonable time, speaking clearly and | | |
| | |locating the resource/service and completing the process |loudly enough to be understood, dialing the phone, initiating a conversation, | | |
| | |necessary to receive the resource or service. A child age 0|hearing the caller, and placing a call in an emergency. A child age 0 to 12 | | |
| | |to 16 years shall not be scored for access.e. Telephone: |years shall not be scored for telephone. | | |
| | |the ability to use the telephone to communicate essential | | | |
| | |needs, such as answering the phone in a reasonable time, | | | |
| | |speaking clearly and loudly enough to be understood, | | | |
| | |dialing the phone, initiating a conversation, hearing the | | | |
| | |caller, and placing a call in an emergency. A child age 0 | | | |
| | |to 12 years shall not be scored for telephone. | | | |
|3.570.26 |Program Deletion|A. Special Populations Home Care Allowance may be used to |A. Special Populations Home Care Allowance may be used to purchase: |Program sunset due to implementation | No |
| | |purchase: |1. Non-skilled assistance with activities of daily living, as defined in Section|of CDASS program in the SLS waiver. | |
| | |1. Non-skilled assistance with activities of daily living, |3.570.25; and; | | |
| | |as defined in Section 3.570.25; and; |2. Electronic monitoring, such as an emergency alert button; and, | | |
| | |2. Electronic monitoring, such as an emergency alert |3. One-time deep cleaning if a referral is initiated by Adult Protective | | |
| | |button; and, |Services and determined necessary by the SEP. | | |
| | |3. One-time deep cleaning if a referral is initiated by | | | |
| | |Adult Protective Services and determined necessary by the | | | |
| | |SEP. | | | |
|3.570.26 |Program Deletion|B. The SEP shall develop a care plan on the State |B. The SEP shall develop a care plan on the State Department prescribed form |Program sunset due to implementation | No |
| | |Department prescribed form within ten (10) working days |within ten (10) working days after program eligibility has been determined and |of CDASS program in the SLS waiver. | |
| | |after program eligibility has been determined and prior to |prior to the arrangement for services.1. The care plan shall be:a. Signed by the| | |
| | |the arrangement for services.1. The care plan shall be:a. |client, SEP, and the service provider.b. Reviewed and updated at least once | | |
| | |Signed by the client, SEP, and the service provider.b. |every twelve (12) months; and,c. Reviewed sooner if there is a change in the | | |
| | |Reviewed and updated at least once every twelve (12) |client's needs; and,d. Provided to all parties.2. Care planning shall include, | | |
| | |months; and,c. Reviewed sooner if there is a change in the |but not be limited to, the following tasks:a. Identify and document care plan | | |
| | |client's needs; and,d. Provided to all parties.2. Care |goals and client choices.b. Identify and document services, including type, | | |
| | |planning shall include, but not be limited to, the |duration and frequency.c. Arrange for services through a service provider, | | |
| | |following tasks:a. Identify and document care plan goals |family member, or other provider of the client's choosing.1) Providers shall be | | |
| | |and client choices.b. Identify and document services, |at least eighteen (18) years of age or older and have the ability to provide | | |
| | |including type, duration and frequency.c. Arrange for |appropriate services. The SEP shall assist the client in finding an appropriate | | |
| | |services through a service provider, family member, or |service provider, if needed.2) The SEP shall negotiate with the client and care | | |
| | |other provider of the client's choosing.1) Providers shall |provider to arrive at the total number of paid care hours to be provided | | |
| | |be at least eighteen (18) years of age or older and have |monthly.3) The SP-HCA payments shall be made directly to the client or | | |
| | |the ability to provide appropriate services. The SEP shall |authorized representative who shall pay the provider the agreed upon, authorized| | |
| | |assist the client in finding an appropriate service |amount monthly.4) No portion of the authorized SP-HCA amount shall be withheld | | |
| | |provider, if needed.2) The SEP shall negotiate with the |by the client for personal use. The entire SP-HCA authorized amount shall be | | |
| | |client and care provider to arrive at the total number of |spent for SP-HCA allowable services.d. Coordinate service delivery, negotiate | | |
| | |paid care hours to be provided monthly.3) The SP-HCA |with the service provider and the client regarding service provision, and | | |
| | |payments shall be made directly to the client or authorized|formalize the provider agreement.e. Complete program requirements for the | | |
| | |representative who shall pay the provider the agreed upon, |authorization of services.f. Refer the client to community resources, as needed,| | |
| | |authorized amount monthly.4) No portion of the authorized |and attempt to develop resources for a client if a resource is not available | | |
| | |SP-HCA amount shall be withheld by the client for personal |within the client's community.g. Explain the complaint procedures to the client,| | |
| | |use. The entire SP-HCA authorized amount shall be spent for|as listed on the care plan document.h. Explain the client's right to appeal any | | |
| | |SP-HCA allowable services.d. Coordinate service delivery, |decision. | | |
| | |negotiate with the service provider and the client | | | |
| | |regarding service provision, and formalize the provider | | | |
| | |agreement.e. Complete program requirements for the | | | |
| | |authorization of services.f. Refer the client to community | | | |
| | |resources, as needed, and attempt to develop resources for | | | |
| | |a client if a resource is not available within the client's| | | |
| | |community.g. Explain the complaint procedures to the | | | |
| | |client, as listed on the care plan document.h. Explain the | | | |
| | |client's right to appeal any decision. | | | |
|3.570.26 |Program Deletion|B.3. The SEP shall meet the client's needs, with |B.3. The SEP shall meet the client's needs, with consideration of the client's |Program sunset due to implementation | No |
| | |consideration of the client's choices, using the most cost |choices, using the most cost effective methods available.a. When services are |of CDASS program in the SLS waiver. | |
| | |effective methods available.a. When services are available |available to the client at no cost from family, friends, volunteers, or others, | | |
| | |to the client at no cost from family, friends, volunteers, |these services shall be utilized before the purchase of services, providing | | |
| | |or others, these services shall be utilized before the |these services adequately meet the client's needs.b. When public dollars must be| | |
| | |purchase of services, providing these services adequately |used to purchase services, the SEP shall encourage the client to select the | | |
| | |meet the client's needs.b. When public dollars must be used|lowest cost provider of service when quality of service is comparable.c. The SEP| | |
| | |to purchase services, the SEP shall encourage the client to|shall assure there is no duplication in services provided by any other public or| | |
| | |select the lowest cost provider of service when quality of |privately funded services.4. The SEP shall notify the client in writing of the | | |
| | |service is comparable.c. The SEP shall assure there is no |outcome of the functional assessment no later than ten (10) working days from | | |
| | |duplication in services provided by any other public or |the date of the functional assessment. The notice shall contain:a. The | | |
| | |privately funded services.4. The SEP shall notify the |functional eligibility result and appropriate rule citations.b. The authorized | | |
| | |client in writing of the outcome of the functional |grant amount, if the functional assessment determines the client has a | | |
| | |assessment no later than ten (10) working days from the |functional need for paid care:1) The authorized grant amount shall be the tier | | |
| | |date of the functional assessment. The notice shall |grant standard based on the client's overall functional capacity and need for | | |
| | |contain:a. The functional eligibility result and |paid care score; or,2) An amount less than the tier grant standard based on the | | |
| | |appropriate rule citations.b. The authorized grant amount, |client's overall functional capacity score if the care provider has agreed to | | |
| | |if the functional assessment determines the client has a |provide all services outlined in the care plan for the lesser amount.c. The | | |
| | |functional need for paid care:1) The authorized grant |reason for denial and the appeal process, if denied. | | |
| | |amount shall be the tier grant standard based on the | | | |
| | |client's overall functional capacity and need for paid care| | | |
| | |score; or,2) An amount less than the tier grant standard | | | |
| | |based on the client's overall functional capacity score if | | | |
| | |the care provider has agreed to provide all services | | | |
| | |outlined in the care plan for the lesser amount.c. The | | | |
| | |reason for denial and the appeal process, if denied. | | | |
|3.570.26 |Program Deletion|C. The SEP shall provide ongoing case management, as |C. The SEP shall provide ongoing case management, as follows:1. Monitor the |Program sunset due to implementation | No |
| | |follows:1. Monitor the quality of care provided to |quality of care provided to clients.a. Contact service providers concerning |of CDASS program in the SLS waiver. | |
| | |clients.a. Contact service providers concerning service |service coordination, effectiveness and appropriateness.b. Review the client's | | |
| | |coordination, effectiveness and appropriateness.b. Review |assessment, care plan, and service agreements to include changes in client | | |
| | |the client's assessment, care plan, and service agreements |functioning, service effectiveness, appropriateness, and cost-effectiveness that| | |
| | |to include changes in client functioning, service |may require a reassessment or a change in the care plan.c. Make changes in | | |
| | |effectiveness, appropriateness, and cost-effectiveness that|service plans as appropriate to client needs and/or refer the client to | | |
| | |may require a reassessment or a change in the care plan.c. |community resources, if appropriate.d. Provide conflict resolution and/or crisis| | |
| | |Make changes in service plans as appropriate to client |intervention, as needed.e. Identify and contact appropriate individuals, and | | |
| | |needs and/or refer the client to community resources, if |resolve any problems or complaints raised by the client or others regarding | | |
| | |appropriate.d. Provide conflict resolution and/or crisis |service delivery.f. Notify the appropriate law enforcement and/or Adult | | |
| | |intervention, as needed.e. Identify and contact appropriate|Protective Services agency of suspected abuse, neglect, or exploitation, as | | |
| | |individuals, and resolve any problems or complaints raised |required by Sections 18-6.5-101 and 26-3.1-102, C.R.S. | | |
| | |by the client or others regarding service delivery.f. | | | |
| | |Notify the appropriate law enforcement and/or Adult | | | |
| | |Protective Services agency of suspected abuse, neglect, or | | | |
| | |exploitation, as required by Sections 18-6.5-101 and | | | |
| | |26-3.1-102, C.R.S. | | | |
|3.570.26 |Program Deletion|D. The SEP shall complete a review of the client's current |D. The SEP shall complete a review of the client's current assessment or |Program sunset due to implementation | No |
| | |assessment or reassessment and the care plan with the |reassessment and the care plan with the client six (6) months following the |of CDASS program in the SLS waiver. | |
| | |client six (6) months following the assessment or |assessment or reassessment. | | |
| | |reassessment. |1. The review shall be conducted by telephone, at the client's place of | | |
| | |1. The review shall be conducted by telephone, at the |residence, at the place of service, or in another appropriate setting as | | |
| | |client's place of residence, at the place of service, or in|determined by the client's needs. | | |
| | |another appropriate setting as determined by the client's |2. A face-to-face home visit shall be completed when significant changes in the | | |
| | |needs. |client's condition are identified. | | |
| | |2. A face-to-face home visit shall be completed when | | | |
| | |significant changes in the client's condition are | | | |
| | |identified. | | | |
|3.570.26 |Program Deletion|E. The SEP shall complete a face-to-face functional |E. The SEP shall complete a face-to-face functional reassessment within twelve |Program sunset due to implementation | No |
| | |reassessment within twelve (12) months of the initial |(12) months of the initial functional assessment and every 12 months thereafter.|of CDASS program in the SLS waiver. | |
| | |functional assessment and every 12 months thereafter. A |A reassessment shall be completed sooner if the client's condition changes. | | |
| | |reassessment shall be completed sooner if the client's | | | |
| | |condition changes. | | | |
|3.570.26 |Program Deletion|F. Reassessment shall include the following tasks:1. Review|F. Reassessment shall include the following tasks:1. Review the care plan, |Program sunset due to implementation | No |
| | |the care plan, service agreement, and provider contract or |service agreement, and provider contract or agreement.2. Evaluate service |of CDASS program in the SLS waiver. | |
| | |agreement.2. Evaluate service effectiveness, quality of |effectiveness, quality of care, and appropriateness of services.3. Verify | | |
| | |care, and appropriateness of services.3. Verify continuing |continuing functional and program eligibility.4. Annually, or more often if | | |
| | |functional and program eligibility.4. Annually, or more |indicated, complete a new care plan and service agreement.5. Refer the client to| | |
| | |often if indicated, complete a new care plan and service |community resources, as needed. | | |
| | |agreement.5. Refer the client to community resources, as | | | |
| | |needed. | | | |
|3.570.26 |Program Deletion|G. The SEP shall update the information provided at the |G. The SEP shall update the information provided at the previous assessment or |Program sunset due to implementation | No |
| | |previous assessment or reassessment, utilizing the State |reassessment, utilizing the State Department prescribed functional assessment |of CDASS program in the SLS waiver. | |
| | |Department prescribed functional assessment tool and the |tool and the BUS. When a new functional assessment is completed a copy shall be | | |
| | |BUS. When a new functional assessment is completed a copy |sent to the State Department within ten (10) working days of the reassessment. | | |
| | |shall be sent to the State Department within ten (10) | | | |
| | |working days of the reassessment. | | | |
|3.570.27 |Program Deletion|A. A client shall meet all eligibility requirements |A. A client shall meet all eligibility requirements outlined in Sections |Program sunset due to implementation | No |
| | |outlined in Sections 3.570.23 and 3.570.24 each month to |3.570.23 and 3.570.24 each month to continue to be eligible for the SP-HCA |of CDASS program in the SLS waiver. | |
| | |continue to be eligible for the SP-HCA program. |program. | | |
|3.570.27 |Program Deletion|B. Clients shall be denied or discontinued from the SP-HCA |B. Clients shall be denied or discontinued from the SP-HCA program if he/she is |Program sunset due to implementation | No |
| | |program if he/she is determined ineligible. The client |determined ineligible. The client shall be informed of the adverse action and |of CDASS program in the SLS waiver. | |
| | |shall be informed of the adverse action and appeal rights |appeal rights in accordance with rules under Sections 3.570.23, K, and 3.850. | | |
| | |in accordance with rules under Sections 3.570.23, K, and | | | |
| | |3.850. | | | |
|3.570.27 |Program Deletion|C. Clients that are denied and/or are discontinued from the|C. Clients that are denied and/or are discontinued from the SP-HCA program are |Program sunset due to implementation | No |
| | |SP-HCA program are permanently disqualified from the |permanently disqualified from the program and shall not be eligible to apply for|of CDASS program in the SLS waiver. | |
| | |program and shall not be eligible to apply for or be |or be approved for benefits in subsequent months or years.1. To ease the | | |
| | |approved for benefits in subsequent months or years.1. To |eligibility process for the SP-HCA program, the following provisions shall | | |
| | |ease the eligibility process for the SP-HCA program, the |apply:a. Clients originally approved for the SP-HCA program and then | | |
| | |following provisions shall apply:a. Clients originally |subsequently discontinued from SP-HCA on or before June 30, 2013, may reapply | | |
| | |approved for the SP-HCA program and then subsequently |for reinstatement of benefits.b. Application must be received no later than July| | |
| | |discontinued from SP-HCA on or before June 30, 2013, may |12, 2013, for reinstatement of benefits.c. The application shall be reviewed to | | |
| | |reapply for reinstatement of benefits.b. Application must |determine if between January 1, 2012 and June 30, 2013, the client again met | | |
| | |be received no later than July 12, 2013, for reinstatement |SP-HCA eligibility criteria following the most recent discontinuation.d. If the | | |
| | |of benefits.c. The application shall be reviewed to |client is determined to meet SP-HCA eligibility criteria again following the | | |
| | |determine if between January 1, 2012 and June 30, 2013, the|most recent discontinuation, but still on or before June 30, 2013, benefits | | |
| | |client again met SP-HCA eligibility criteria following the |shall be retroactive to the new eligibility date.2. Clients originally approved | | |
| | |most recent discontinuation.d. If the client is determined |for the SP-HCA program and then subsequently discontinued from SP-HCA on or | | |
| | |to meet SP-HCA eligibility criteria again following the |after July 1, 2013, shall be permanently discontinued from receiving SP-HCA | | |
| | |most recent discontinuation, but still on or before June |benefits. | | |
| | |30, 2013, benefits shall be retroactive to the new | | | |
| | |eligibility date.2. Clients originally approved for the | | | |
| | |SP-HCA program and then subsequently discontinued from | | | |
| | |SP-HCA on or after July 1, 2013, shall be permanently | | | |
| | |discontinued from receiving SP-HCA benefits. | | | |
|3.570.27 |Program Deletion|D. The SEP and/or CCB shall notify the State Department |D. The SEP and/or CCB shall notify the State Department when the agency has |Program sunset due to implementation | No |
| | |when the agency has knowledge that any of the following |knowledge that any of the following occurs. The State Department shall notify |of CDASS program in the SLS waiver. | |
| | |occurs. The State Department shall notify the client of |the client of discontinuation from SP-HCA when it has information from the SEP, | | |
| | |discontinuation from SP-HCA when it has information from |CCB, program data systems, or any other source that any of the following has | | |
| | |the SEP, CCB, program data systems, or any other source |occurred:1. The client no longer receives services under the HCBS-SLS or | | |
| | |that any of the following has occurred:1. The client no |HCBS-CES waiver.2. The client's needs changed and his/her level of service need | | |
| | |longer receives services under the HCBS-SLS or HCBS-CES |is no longer within one thousand dollars ($1,000) of the SPAL or Spending | | |
| | |waiver.2. The client's needs changed and his/her level of |Limitation for HCBS-SLS or HCBS-CES.3. The client no longer meets financial | | |
| | |service need is no longer within one thousand dollars |eligibility criteria.4. The client no longer meets the functional capacity and | | |
| | |($1,000) of the SPAL or Spending Limitation for HCBS-SLS or|need for paid care scores necessary to be approved for SP-HCA.5. The client has | | |
| | |HCBS-CES.3. The client no longer meets financial |not received services for thirty (30) or more consecutive days.6. The client or | | |
| | |eligibility criteria.4. The client no longer meets the |authorized representative has refused to schedule an appointment with the SEP, | | |
| | |functional capacity and need for paid care scores necessary|CCB, or State Department or refuses to allow for a home visit, an initial | | |
| | |to be approved for SP-HCA.5. The client has not received |assessment, six (6)-month review, reassessment, or other review.7. The client or| | |
| | |services for thirty (30) or more consecutive days.6. The |authorized representative has failed to keep two (2) scheduled appointments.8. | | |
| | |client or authorized representative has refused to schedule|The client or authorized representative refuses to sign the application, the | | |
| | |an appointment with the SEP, CCB, or State Department or |care plan, or other documents and forms required to receive services or in any | | |
| | |refuses to allow for a home visit, an initial assessment, |other way refuses to cooperate with the requirements of the SP-HCA program.9. | | |
| | |six (6)-month review, reassessment, or other review.7. The |The client or authorized representative refuses to use the SP-HCA grant to pay | | |
| | |client or authorized representative has failed to keep two |for services, uses the grant for services not identified in the care plan and | | |
| | |(2) scheduled appointments.8. The client or authorized |provider agreement, or uses the grant to purchase household expenses including, | | |
| | |representative refuses to sign the application, the care |but not limited to, shelter costs, utilities, food, toiletries, clothing, home | | |
| | |plan, or other documents and forms required to receive |furnishings or other items not authorized by the SP-HCA care plan.10. The client| | |
| | |services or in any other way refuses to cooperate with the |is a resident of a nursing facility, hospital, alternative care facility, group | | |
| | |requirements of the SP-HCA program.9. The client or |home, licensed or unlicensed long-term care facility. | | |
| | |authorized representative refuses to use the SP-HCA grant | | | |
| | |to pay for services, uses the grant for services not | | | |
| | |identified in the care plan and provider agreement, or uses| | | |
| | |the grant to purchase household expenses including, but not| | | |
| | |limited to, shelter costs, utilities, food, toiletries, | | | |
| | |clothing, home furnishings or other items not authorized by| | | |
| | |the SP-HCA care plan.10. The client is a resident of a | | | |
| | |nursing facility, hospital, alternative care facility, | | | |
| | |group home, licensed or unlicensed long-term care facility.| | | |
|3.570.27 |Program Deletion|D.11. The client enters a hospital or other long-term care |D.11. The client enters a hospital or other long-term care facility for |Program sunset due to implementation | No |
| | |facility for treatment or rehabilitation that continues for|treatment or rehabilitation that continues for thirty (30) or more consecutive |of CDASS program in the SLS waiver. | |
| | |thirty (30) or more consecutive days.a. SP-HCA benefits |days.a. SP-HCA benefits shall be temporarily discontinued while the client | | |
| | |shall be temporarily discontinued while the client remains |remains in the hospital or long-term care facility for treatment or | | |
| | |in the hospital or long-term care facility for treatment or|rehabilitation.b. SP-HCA benefits shall be permanently discontinued if the | | |
| | |rehabilitation.b. SP-HCA benefits shall be permanently |client remains in the hospital or long-term care facility for treatment or | | |
| | |discontinued if the client remains in the hospital or |rehabilitation for one hundred eighty (180) or more consecutive days.12. The | | |
| | |long-term care facility for treatment or rehabilitation for|client cannot be safely served given the type and/or amount of services | | |
| | |one hundred eighty (180) or more consecutive days.12. The |available. To support a denial or discontinuation for safety reasons related to | | |
| | |client cannot be safely served given the type and/or amount|service limitations, the SEP shall document the limitations and evidence of | | |
| | |of services available. To support a denial or |safety concerns, when available, including, but not limited to:a. The results of| | |
| | |discontinuation for safety reasons related to service |an adult protective services assessment;b. A statement from the client's | | |
| | |limitations, the SEP shall document the limitations and |physician attesting to diminished cognitive capacity, debilitating mental health| | |
| | |evidence of safety concerns, when available, including, but|concerns, or increased medical or physical care needs;c. Lack of available | | |
| | |not limited to:a. The results of an adult protective |services and/or providers;d. An assessment score indicating a level of need for | | |
| | |services assessment;b. A statement from the client's |services in excess of those available under the SP-HCA program; and/or,e. Other | | |
| | |physician attesting to diminished cognitive capacity, |available information or evidence that will support the determination that the | | |
| | |debilitating mental health concerns, or increased medical |client's safety is at risk.13. The level of service need is not cost effective | | |
| | |or physical care needs;c. Lack of available services and/or|under the SP-HCA program. To support a denial or discontinuation due to cost | | |
| | |providers;d. An assessment score indicating a level of need|effectiveness the SEP shall document the level of service need and more cost | | |
| | |for services in excess of those available under the SP-HCA |effective alternatives.14. The client has moved out of the state or country or | | |
| | |program; and/or,e. Other available information or evidence |has or been out of the state or country for more than thirty (30) consecutive | | |
| | |that will support the determination that the client's |days. Discontinuation shall be effective the day after the date of the move or | | |
| | |safety is at risk.13. The level of service need is not cost|on day thirty-one (31) of the absence from the state or country.15. The client | | |
| | |effective under the SP-HCA program. To support a denial or |or authorized representative requests withdrawal from the program.16. The client| | |
| | |discontinuation due to cost effectiveness the SEP shall |or authorized representative has failed to report a change in circumstances that| | |
| | |document the level of service need and more cost effective |potentially affects eligibility for SP-HCA.17. The client has died. | | |
| | |alternatives.14. The client has moved out of the state or |Discontinuation shall be effective the day after the client's death. No notice | | |
| | |country or has or been out of the state or country for more|of discontinuation shall be sent. | | |
| | |than thirty (30) consecutive days. Discontinuation shall be| | | |
| | |effective the day after the date of the move or on day | | | |
| | |thirty-one (31) of the absence from the state or | | | |
| | |country.15. The client or authorized representative | | | |
| | |requests withdrawal from the program.16. The client or | | | |
| | |authorized representative has failed to report a change in | | | |
| | |circumstances that potentially affects eligibility for | | | |
| | |SP-HCA.17. The client has died. Discontinuation shall be | | | |
| | |effective the day after the client's death. No notice of | | | |
| | |discontinuation shall be sent. | | | |
|3.570.27 |Program Deletion|E. The notice of adverse action shall include the reason |E. The notice of adverse action shall include the reason for denial or |Program sunset due to implementation | No |
| | |for denial or discontinuation, the appropriate rule cite, |discontinuation, the appropriate rule cite, and appeal rights as outlined in |of CDASS program in the SLS waiver. | |
| | |and appeal rights as outlined in Section 3.850, et seq. (9 |Section 3.850, et seq. (9 C.C.R. 2503-8). | | |
| | |C.C.R. 2503-8). | | | |
|3.570.27 |Program Deletion|F. In the event of denial or discontinuation, the SEP |F. In the event of denial or discontinuation, the SEP shall:1. Provide |Program sunset due to implementation | No |
| | |shall:1. Provide appropriate referrals to other community |appropriate referrals to other community resources, as needed, within one (1) |of CDASS program in the SLS waiver. | |
| | |resources, as needed, within one (1) working day of |working day of discontinuation.2. Notify all providers on the care plan within | | |
| | |discontinuation.2. Notify all providers on the care plan |one (1) working day of discontinuation.3. Notify the State Department within one| | |
| | |within one (1) working day of discontinuation.3. Notify the|(1) working day of discontinuation.4. Attend the appeal hearing to defend the | | |
| | |State Department within one (1) working day of |denial or discontinuation. | | |
| | |discontinuation.4. Attend the appeal hearing to defend the | | | |
| | |denial or discontinuation. | | | |
|3.570.28 |Program Deletion|A. The State Department shall: |A. The State Department shall: |Program sunset due to implementation | No |
| | |1. Determine eligibility for SP-HCA and update any changes |1. Determine eligibility for SP-HCA and update any changes in the case record. |of CDASS program in the SLS waiver. | |
| | |in the case record. |2. Notify the SEP in writing: | | |
| | |2. Notify the SEP in writing: |a. Within five (5) working days of determining SP-HCA eligibility. | | |
| | |a. Within five (5) working days of determining SP-HCA |b. Within five (5) working days after the State Department determines that the | | |
| | |eligibility. |client is no longer financially eligible for SP-HCA. | | |
| | |b. Within five (5) working days after the State Department |c. Within one (1) working day when the client has filed a written appeal with | | |
| | |determines that the client is no longer financially |the State Department. | | |
| | |eligible for SP-HCA. |d. Within one (1) working day when the client has withdrawn the appeal or a | | |
| | |c. Within one (1) working day when the client has filed a |final agency decision has been entered. | | |
| | |written appeal with the State Department. |3. Respond to requests for information from the SEP within ten (10) working | | |
| | |d. Within one (1) working day when the client has withdrawn|days. | | |
| | |the appeal or a final agency decision has been entered. | | | |
| | |3. Respond to requests for information from the SEP within | | | |
| | |ten (10) working days. | | | |
|3.570.28 |Program Deletion|B. The SEP shall:1. Provide intake, screening, and referral|B. The SEP shall:1. Provide intake, screening, and referral activities, as |Program sunset due to implementation | No |
| | |activities, as follows:a. Complete intake activities within|follows:a. Complete intake activities within two (2) working days of the |of CDASS program in the SLS waiver. | |
| | |two (2) working days of the referral.b. Obtain the client's|referral.b. Obtain the client's or client's authorized representative's | | |
| | |or client's authorized representative's signature on the |signature on the intake form.c. Complete the SP-HCA functional assessment within| | |
| | |intake form.c. Complete the SP-HCA functional assessment |thirty (30) calendar days of referral.d. Provide the client information and | | |
| | |within thirty (30) calendar days of referral.d. Provide the|referral to other agencies, as needed.2. Complete a functional assessment when | | |
| | |client information and referral to other agencies, as |the State Department provides written notification that the client has requested| | |
| | |needed.2. Complete a functional assessment when the State |SP-HCA and is receiving or has submitted an application for Old Age Pension | | |
| | |Department provides written notification that the client |(OAP), Aid to the Needy Disabled State Only (AND-SO), or the client is receiving| | |
| | |has requested SP-HCA and is receiving or has submitted an |Supplemental Security Income (SSI).a. If the client is being discharged from a | | |
| | |application for Old Age Pension (OAP), Aid to the Needy |hospital or nursing facility, the SEP shall complete the functional assessment | | |
| | |Disabled State Only (AND-SO), or the client is receiving |regardless of whether the Medicaid application date has been provided by the | | |
| | |Supplemental Security Income (SSI).a. If the client is |county department.b. The SEP shall complete the functional assessment within two| | |
| | |being discharged from a hospital or nursing facility, the |(2) working days after notification when a client is being transferred from a | | |
| | |SEP shall complete the functional assessment regardless of |hospital to the SP-HCA program.c. The SEP shall complete the functional | | |
| | |whether the Medicaid application date has been provided by |assessment within five (5) working days after notification when a client who is | | |
| | |the county department.b. The SEP shall complete the |being transferred from a nursing facility to the SP-HCA program.d. The SEP shall| | |
| | |functional assessment within two (2) working days after |complete the functional assessment within ten (10) working days after | | |
| | |notification when a client is being transferred from a |notification for all other clients. However, the SEP shall have a procedure for | | |
| | |hospital to the SP-HCA program.c. The SEP shall complete |prioritizing urgent referrals. | | |
| | |the functional assessment within five (5) working days | | | |
| | |after notification when a client who is being transferred | | | |
| | |from a nursing facility to the SP-HCA program.d. The SEP | | | |
| | |shall complete the functional assessment within ten (10) | | | |
| | |working days after notification for all other clients. | | | |
| | |However, the SEP shall have a procedure for prioritizing | | | |
| | |urgent referrals. | | | |
|3.570.28 |Program Deletion|B.3. Document all case information.a. Documentation of |B.3. Document all case information.a. Documentation of contacts and case |Program sunset due to implementation | No |
| | |contacts and case management activities shall be entered |management activities shall be entered into the BUS within five (5) working days|of CDASS program in the SLS waiver. | |
| | |into the BUS within five (5) working days of the contact or|of the contact or activity.b. All information related to intake, assessment, and| | |
| | |activity.b. All information related to intake, assessment, |care planning shall be thoroughly documented within ten (10) working days of the| | |
| | |and care planning shall be thoroughly documented within ten|intake, assessment or care planning using forms and the BUS.c. Additional | | |
| | |(10) working days of the intake, assessment or care |documentation that cannot be entered into the BUS shall be maintained in the | | |
| | |planning using forms and the BUS.c. Additional |case file.4. Notify clients of their program status using the State Department | | |
| | |documentation that cannot be entered into the BUS shall be |prescribed form at the time of initial eligibility, when there is a significant | | |
| | |maintained in the case file.4. Notify clients of their |change in the client's payment or services, when an adverse action is taken, or | | |
| | |program status using the State Department prescribed form |at the time of discontinuation.5. Notify the State Department in writing:a. | | |
| | |at the time of initial eligibility, when there is a |Within five (5) working days of determining SP-HCA functional eligibility.b. | | |
| | |significant change in the client's payment or services, |Within five (5) working days after the SEP determines that the client is no | | |
| | |when an adverse action is taken, or at the time of |longer functionally eligible for SP-HCA.c. Within one (1) working day when the | | |
| | |discontinuation.5. Notify the State Department in |client has filed a written appeal with the SEP.d. Within one (1) working day | | |
| | |writing:a. Within five (5) working days of determining |when the client has withdrawn the appeal or a final agency decision has been | | |
| | |SP-HCA functional eligibility.b. Within five (5) working |entered.6. Respond to requests for information from the State Department within | | |
| | |days after the SEP determines that the client is no longer |ten (10) working days. | | |
| | |functionally eligible for SP-HCA.c. Within one (1) working | | | |
| | |day when the client has filed a written appeal with the | | | |
| | |SEP.d. Within one (1) working day when the client has | | | |
| | |withdrawn the appeal or a final agency decision has been | | | |
| | |entered.6. Respond to requests for information from the | | | |
| | |State Department within ten (10) working days. | | | |
|3.570.28 |Program Deletion|B.7. Notify the client, at the time of his or her |B.7. Notify the client, at the time of his or her application and at the time of|Program sunset due to implementation | No |
| | |application and at the time of reassessment or |reassessment or discontinuation of the right to request a fair hearing before an|of CDASS program in the SLS waiver. | |
| | |discontinuation of the right to request a fair hearing |Administrative Law Judge in accordance with Section 3.850, and to appeal adverse| | |
| | |before an Administrative Law Judge in accordance with |actions of the SEP or State Department.8. Inform the client's Adult Protective | | |
| | |Section 3.850, and to appeal adverse actions of the SEP or |Services caseworker, if applicable, of the client's status. The case manager | | |
| | |State Department.8. Inform the client's Adult Protective |shall participate in mutual staffing of the client's case.9. Report to the | | |
| | |Services caseworker, if applicable, of the client's status.|Colorado Department of Public Health and Environment any congregate facility, | | |
| | |The case manager shall participate in mutual staffing of |with three (3) or more residents that is not licensed.10. Report immediately to | | |
| | |the client's case.9. Report to the Colorado Department of |the State Department any information that indicates an overpayment, incorrect | | |
| | |Public Health and Environment any congregate facility, with|payment, or misuse of any SP-HCA benefit, and shall cooperate with the county | | |
| | |three (3) or more residents that is not licensed.10. Report|department in any subsequent recovery process.11. Be subject to routine quality | | |
| | |immediately to the State Department any information that |control, program monitoring, and contract management to minimally include:a. | | |
| | |indicates an overpayment, incorrect payment, or misuse of |Targeted review of the BUS documentation; and,b. Case file review; and,c. | | |
| | |any SP-HCA benefit, and shall cooperate with the county |Targeted program review conducted via phone, email, or survey; and,d. Onsite | | |
| | |department in any subsequent recovery process.11. Be |program review; and,e. A performance improvement plan to correct areas of | | |
| | |subject to routine quality control, program monitoring, and|identified non-compliance; and,f. Contract sanctions when the SEP fails to | | |
| | |contract management to minimally include:a. Targeted review|implement a performance improvement plan. | | |
| | |of the BUS documentation; and,b. Case file review; and,c. | | | |
| | |Targeted program review conducted via phone, email, or | | | |
| | |survey; and,d. Onsite program review; and,e. A performance | | | |
| | |improvement plan to correct areas of identified | | | |
| | |non-compliance; and,f. Contract sanctions when the SEP | | | |
| | |fails to implement a performance improvement plan. | | | |
|3.570.4 |Rule Reordering |NEW | BURIAL ASSISTANCE PROGRAM | | No |
|3.570.41 |Rule Reordering |NEW |BURIAL BENEFITS ARE AVAILABLE TO ELIGIBLE CLIENTS TO COVER REASONABLE AND |No substantive change-just reordered.| No |
| | | |NECESSARY COSTS FOR BURIAL SERVICES. | | |
|3.570.42 |Rule Reordering |NEW |“BURIAL BENEFIT” MEANS THE STATE DEPARTMENT PROGRAM TO PAY ALL OR A PORTION OF |No substantive change-just reordered.| No |
| | | |THE COST OF FUNERAL, BURIAL, OR CREMATION SERVICES FOR CERTAIN DECEASED CLIENTS.| | |
| |Rule Reordering |NEW |“BURIAL FUNDS” MEANS THE FUNDS AUTHORIZED BY THE COUNTY DEPARTMENT UNDER THE |No substantive change-just reordered.| No |
| | | |BURIAL BENEFIT. | | |
| |Rule Reordering |NEW |“BURIAL PLOT” MEANS THE CLIENT'S FINAL RESTING PLACE, WHETHER A CEMETERY PLOT, |No substantive change-just reordered.| No |
| | | |VAULT, OR CREMATORIUM NICHE. | | |
| |Rule Reordering |NEW |“BURIAL SERVICES” MEANS THOSE SERVICES PROVIDED AS PART OF FUNERAL, BURIAL, OR |No substantive change-just reordered.| No |
| | | |CREMATION SERVICES, INCLUDING: | | |
| | | |A. TRANSPORTATION OF THE BODY FROM THE PLACE OF DEATH TO A FUNERAL HOME OR OTHER| | |
| | | |STORAGE FACILITY, AND/OR FROM THE FUNERAL HOME TO THE FUNERAL/MEMORIAL SITE, | | |
| | | |AND/OR TO THE BURIAL PLOT; | | |
| | | |B. STORAGE OF THE BODY PRIOR TO FINAL DISPOSITION AND/OR STORAGE OF THE CREMATED| | |
| | | |REMAINS FOR NO MORE THAN ONE HUNDRED TWENTY (120) DAYS, IN THOSE CASES WHERE THE| | |
| | | |REMAINS ARE NOT BURIED AND ARE NOT CLAIMED BY THE CLIENT'S FAMILY OR FRIENDS; | | |
| | | |C. EMBALMING, WHERE NECESSARY FOR PRESERVATION OF THE BODY AND/OR PREPARATION OF| | |
| | | |THE BODY FOR THE CASKET OR FOR CREMATION; | | |
| | | |D. PURCHASE OF A CASKET OR OF AN URN OR OTHER RECEPTACLE FOR THE CREMATED | | |
| | | |REMAINS; | | |
| | | |E. PURCHASE OF A GRAVESITE, VAULT, VAULT LINER, OR CREMATORIUM NICHE; | | |
| | | |F. PURCHASE AND PLACEMENT OF THE GRAVE MARKER AND/OR OF PERPETUAL CARE OF THE | | |
| | | |GRAVESITE, VAULT, OR CREMATORIUM NICHE; | | |
| | | |G. FUNERAL OR MEMORIAL SERVICE; | | |
| | | |H. CREMATION OF THE BODY; | | |
| | | |I. BURIAL OR INTERNMENT OF THE BODY OR CREMATED REMAINS IN A BURIAL PLOT, VAULT,| | |
| | | |OR CREMATORIUM NICHE; | | |
| | | |J. ANY OTHER ITEMS THAT ARE INCIDENTAL TO BURIAL SERVICES. | | |
| |Rule Reordering |NEW |“CONTRIBUTIONS” MEANS ANY MONETARY PAYMENT OR DONATION MADE DIRECTLY TO THE |Change to definition to exclude small| No |
| | | |SERVICE PROVIDER(S) BY A NON-RESPONSIBLE PERSON TO DEFRAY THE EXPENSES OF A |donations. | |
| | | |deceased public assistance or medical assistance recipient’s funeral, cremAtion,| | |
| | | |or burial, or any combination thereof. | | |
| |Rule Reordering |NEW |“LEGALLY RESPONSIBLE PERSON(S)” MEANS A PERSON WHO IS THE DECEDENT’S SPOUSE OR |No substantive change-just reordered.| No |
| | | |THE DECEDENT’S PARENT IF THE DECEDENT IS AN UNEMANCIPATED MINOR WHO IS UNDER THE| | |
| | | |AGE OF EIGHTEEN; AND BEARS LEGAL RESPONSIBILITY FOR THE CHARGES ASSOCIATED WITH | | |
| | | |THE DECEDENT’S FUNERAL, CREAMATION, OR BURIAL EXPENSES. | | |
| |Rule Reordering |NEW |“NONRESPONSIBLE PERSON” MEANS ONE OF THE FOLLOWING WHO MAKES A CONTRIBUTION TO |New definition to align with Statute | No |
| | | |THE CHARGES FOR BURIAL SERVICES: |to identify individuals who are not | |
| | | |A RELATIVE OF THE DECEDENT WHO IS NOT A LEGALLY RESPONSIBLE PERSON; OR, |responsible for burial contributions.| |
| | | |ANY OTHER PERSON OR PARTY. | | |
|3.570.43 |Rule Reordering |NEW |A. A BURIAL BENEFIT SHALL BE AVAILABLE TO COVER ALL OR PART OF REASONABLE AND |Added Home Care Allowance as HCA-SSI | No |
| | | |NECESSARY COSTS FOR BURIAL SERVICES WHEN: |recipients are also eligible for | |
| | | |1. A DECEASED CLIENT WAS RECEIVING OLD AGE PENSION (OAP), AID TO THE NEEDY |burial assistance. | |
| | | |DISABLED (AND-SO OR AND-CS), HOME CARE ALLOWANCE, AND/OR COLORADO MEDICAID | | |
| | | |ASSISTANCE AT THE TIME OF DEATH; AND, | | |
| | | |2. THE DECEASED CLIENT'S ESTATE IS INSUFFICIENT TO PAY ALL OR PART OF THE BURIAL| | |
| | | |SERVICES; AND, | | |
| | | |3. THE RESOURCES OF THE LEGALLY RESPONSIBLE PERSON(S) FOR THE SUPPORT OF THE | | |
| | | |DECEASED CLIENT ARE INSUFFICIENT, EVEN WITH CONTRIBUTIONS FROM THE CLIENT'S | | |
| | | |ESTATE, TO ENABLE THE LEGALLY RESPONSIBLE PERSON(S) TO PAY ALL OR PART OF SUCH | | |
| | | |EXPENSES; AND, | | |
| | | |4. THE TOTAL COST FOR ALL BURIAL SERVICES DOES NOT TOTAL MORE THAN TWO THOUSAND | | |
| | | |FIVE HUNDRED DOLLARS ($2,500), EXCEPT THAT THE COST OF A BURIAL PLOT SHALL NOT | | |
| | | |BE INCLUDED IN THE $2,500 MAXIMUM COST LIMIT WHEN: | | |
| | | |A. THE CLIENT HAS A PREPAID BURIAL PLOT VALUED AT TWO THOUSAND DOLLARS ($2,000) | | |
| | | |OR LESS AT THE TIME OF PURCHASE; OR, | | |
| | | |B. A BURIAL PLOT WAS PURCHASED BY SOMEONE OTHER THAN THE DECEASED CLIENT AND | | |
| | | |DONATED TO THE DECEASED CLIENT; AND, | | |
| |Rule Reordering |NEW |B. THE TOTAL BURIAL BENEFIT SHALL NOT EXCEED THE CURRENT BURIAL BENEFIT RATE. |Eliminating two separate maximum | No |
| | | |1. EFFECTIVE MARCH 1, 2020, THE BURIAL BENEFIT SHALL NOT EXCEED ONE THOUSAND |benefit limits (previously $1,500 or | |
| | | |FIVE HUNDRED DOLLARS ($1,500). |$1,000 depending on HLPG). | |
| | | |2. THE REIMBURSEMENT RATE SHALL BE ADJUSTED BY THE STATE DEPARTMENT AS NEEDED TO| | |
| | | |STAY WITHIN THE AVAILABLE APPROPRIATIONS. THERE SHALL BE NO APPEAL GRANTED FOR | | |
| | | |THIS ADJUSTMENT. | | |
| |Rule Reordering |NEW |C. WHEN ASSISTANCE FOR FUNERAL, BURIAL, OR CREMATION SERVICES IS REQUESTED |Modified application timeframe to | No |
| | | |WITHIN THIRTY (30) DAYS FROM THE DATE OF DEATH ON BEHALF OF A DECEASED CLIENT AS|within 30 days from date of death | |
| | | |DESCRIBED IN SECTION 3.570.43.A, BY ANY INTERESTED PARTY; AN APPLICATION |(unless good cause is provided). | |
| | | |REQUESTING A BURIAL BENEFIT SHALL BE COMPLETED AND SUBMITTED TO THE COUNTY | | |
| | | |DEPARTMENT FOR ELIGIBILITY DETERMINATION. REQUESTS MADE AFTER 30 DAYS SHALL BE | | |
| | | |EVALUATED BY THE COUNTY DEPARTMENT AND AN EXTENSION MAY BE GIVEN IF GOOD CAUSE | | |
| | | |EXISTS, NOT TO EXCEED ONE (1) YEAR FROM THE DATE OF DEATH. GOOD CAUSE SHALL | | |
| | | |EXIST FOR ANY APPLICATION FILED WITHIN ONE YEAR OF THE DATE OF DEATH OF THE | | |
| | | |CLIENT, IF THE CLIENT’S DATE OF DEATH PRECEDED THE EFFECTIVE DATE OF THIS RULE. | | |
| | | |THE CLIENT'S FAMILY OR FRIENDS, OR THE COUNTY DEPARTMENT WHEN THERE ARE NO KNOWN| | |
| | | |FAMILY OR FRIENDS, SHALL MAKE ARRANGEMENTS FOR DISPOSITION OF THE CLIENT'S BODY | | |
| | | |IN A REASONABLE, DIGNIFIED MANNER WHICH APPROXIMATES THE WISHES AND THE | | |
| | | |RELIGIOUS AND CULTURAL PREFERENCES OF THE CLIENT OR FAMILY, TO THE EXTENT | | |
| | | |POSSIBLE WITHIN THE BURIAL BENEFIT RULES AND BURIAL GRANT PAYMENT FUNDS. | | |
| | | |1. THE COUNTY DEPARTMENT SHALL ENSURE THAT A CHOICE OF DISPOSITION BY THE CLIENT| | |
| | | |IS MADE IN WRITING. THE CHOICE OF DISPOSITION MAY BE MADE ON THE CLIENT'S MOST | | |
| | | |RECENT APPLICATION FOR BENEFITS, IN THE CLIENT'S WILL, OR BY ANY OTHER DOCUMENT | | |
| | | |WHICH THE COUNTY DEPARTMENT DEEMS CREDIBLE. IF THERE ARE CONFLICTING DOCUMENTS | | |
| | | |EXPRESSING THE CLIENT’S CHOICE OF DISPOSITION, THE COUNTY DEPARTMENT SHALL | | |
| | | |UTILIZE THE MOST RECENT DOCUMENT CONTAINING THE CLIENT’S CHOICE. IF THE CLIENT | | |
| | | |HAS NOT EXPRESSED A CHOICE OF DISPOSITION, THE CLIENT’S DISPOSITION SHALL BE | | |
| | | |DETERMINED RESPECTIVELY BY THE CLIENT’S SPOUSE, ADULT CHILDREN, PARENTS, OR | | |
| | | |SIBLINGS. | | |
| | | |2. THE COUNTY DEPARTMENT SHALL COORDINATE WITH THE CLIENT'S FAMILY OR INTERESTED| | |
| | | |PARTIES TO EXPLAIN THE BURIAL BENEFIT RULES, INCLUDING: | | |
| | | |A. OPTIONS IN THE EVENT THE CLIENT'S OR FAMILY'S BURIAL PREFERENCES CANNOT BE | | |
| | | |MET WITHIN THE LIMITATIONS OF THE BURIAL RULES OR BURIAL GRANT PAYMENT MAXIMUM; | | |
| | | |AND, | | |
| | | |B. IF THE FAMILY'S BURIAL PREFERENCE IS IN OPPOSITION TO THE CLIENT'S | | |
| | | |PREFERENCE, AS NOTED ON THE CLIENT'S MOST RECENT APPLICATION FOR BENEFITS OR | | |
| | | |OTHER DOCUMENTATION, THE BURIAL GRANT PAYMENT SHALL BE USED TO MEET THE CLIENT'S| | |
| | | |PREFERENCE, UNLESS ALL OPTIONS FOR MEETING THAT PREFERENCE HAVE BEEN EXHAUSTED | | |
| | | |WITHIN THE LIMITATIONS OF THE BURIAL GRANT PAYMENT; AND, | | |
| | | |C. THE LEGALLY RESPONSIBLE PERSON'S RESPONSIBILITY TO PAY THE COST OF BURIAL | | |
| | | |SERVICES THAT EXCEED THE APPROVED BURIAL GRANT PAYMENT; AND, | | |
| | | |D. THAT VOLUNTARY CONTRIBUTIONS FROM FAMILY, FRIENDS, OR OTHER INTERESTED | | |
| | | |PARTIES, MAY BE USED TO COVER SOME OR ALL OF THE LEGALLY RESPONSIBLE PERSON'S | | |
| | | |COSTS THAT EXCEED THE APPROVED BURIAL GRANT PAYMENT UP TO THE MAXIMUM COST | | |
| | | |LIMIT. | | |
| | | |3. THE COUNTY DEPARTMENT SHALL USE THE FOLLOWING PROCEDURES WHEN THE DECEASED | | |
| | | |CLIENT'S BURIAL PREFERENCES ARE UNKNOWN AND A FAMILY MEMBER CANNOT BE LOCATED: | | |
| | | |A. IF A FAMILY MEMBER HAS NOT BEEN LOCATED WITHIN TWENTY-FOUR HOURS AFTER THE | | |
| | | |CLIENT DIES, THE COUNTY DEPARTMENT SHALL HAVE THE BODY REFRIGERATED OR EMBALMED.| | |
| | | | | | |
| | | |B. IF A FAMILY MEMBER HAS NOT BEEN LOCATED WITHIN SEVEN (7) DAYS, THE COUNTY | | |
| | | |DEPARTMENT SHALL MAKE THE DETERMINATION TO BURY OR CREMATE THE BODY BASED ON THE| | |
| | | |BEST OPTION AVAILABLE. | | |
| | | |C. THE COUNTY DEPARTMENT SHALL COMPLETE AND SEND WRITTEN AUTHORIZATION TO THE | | |
| | | |APPROPRIATE FUNERAL HOME OR CREMATORIUM. | | |
| |Rule Reordering | |D. THE COUNTY DEPARTMENT SHALL REDUCE THE BURIAL GRANT PAYMENT BY APPLYING THE |Modified to reflect that resources | No |
| | | |FOLLOWING MONIES TOWARD THE FULL BURIAL COSTS IN THE ORDER LISTED: |should be subtracted if readily | |
| | | |1. FIRST, SUBTRACT MONIES DUE FROM ANY INSURANCE POLICY OF THE DECEASED CLIENT |accessible. | |
| | | |TO A LEGALLY RESPONSIBLE PERSON OR ANY OTHER PERSON WHO MAKES A CONTRIBUTION TO | | |
| | | |BURIAL SERVICES AND IS NAMED AS BENEFICIARY OR A JOINT BENEFICIARY; THEN IF | | |
| | | |COSTS REMAIN, | | |
| | | |2. SUBTRACT THE VALUE OF THE DECEASED CLIENT'S ESTATE AS OF THE DATE OF DEATH | | |
| | | |THAT ARE AVAILABLE, INCLUDING ANY CASH OR PROPERTY OF ANY KIND WHICH THE | | |
| | | |DECEASED CLIENT OWNED OR PROPORTIONATE SHARE OF RESOURCES HELD IN JOINT | | |
| | | |OWNERSHIP AT THE TIME OF DEATH; THEN IF COSTS REMAIN, | | |
| | | |3. SUBTRACT MONIES FROM THE LEGALLY RESPONSIBLE PERSON(S) FOR THE CLIENT, AS | | |
| | | |FOLLOWS: | | |
| | | |A. SOCIAL SECURITY LUMP SUM DEATH BENEFITS PAYABLE TO A LEGALLY RESPONSIBLE | | |
| | | |PERSON SHALL BE EXEMPT. | | |
| | | |B. IF THE LEGALLY RESPONSIBLE PERSON(S) HAS RESOURCES BELOW THE SSI RESOURCE | | |
| | | |LIMIT OF $2,000 FOR AN INDIVIDUAL OR $3,000 FOR A COUPLE ANY RESOURCES WOULD NOT| | |
| | | |BE USED TO REDUCE THE BURIAL GRANT PAYMENT. THESE LIMITS ARE CONSISTENT WITH THE| | |
| | | |PROVISIONS OF FEDERAL REGULATIONS FOUND AT 20 CFR 416.1205 (2019), WHICH ARE | | |
| | | |HEREIN INCORPORATED BY REFERENCE. THIS RULE DOES NOT CONTAIN ANY LATER | | |
| | | |AMENDMENTS OR EDITIONS. THESE REGULATIONS ARE AVAILABLE FOR NO COST AT | | |
| | | |. THESE REGULATIONS ARE ALSO AVAILABLE FOR PUBLIC | | |
| | | |INSPECTION AND COPYING AT THE COLORADO DEPARTMENT OF HUMAN SERVICES, DIRECTOR OF| | |
| | | |THE EMPLOYMENT AND BENEFITS DIVISION, 1575 SHERMAN STREET, DENVER, COLORADO, | | |
| | | |80203, OR AT ANY STATE PUBLICATIONS LIBRARY DURING REGULAR BUSINESS HOURS. | | |
| | | |1) IF THE LEGALLY RESPONSIBLE PERSON IS THE WIDOW(ER), THE INDIVIDUAL RESOURCE | | |
| | | |LIMIT SHALL APPLY. | | |
| | | |2) THE LEGALLY RESPONSIBLE PERSON(S) MAY VOLUNTARILY CONTRIBUTE MONIES TOWARD | | |
| | | |THE COST OF THE BURIAL SERVICES. | | |
| | | |C. IF THE LEGALLY RESPONSIBLE PERSON(S) HAS RESOURCES OVER THE SSI LIMIT, THE | | |
| | | |AMOUNT OF RESOURCES OVER THE LIMIT SHALL BE USED TO REDUCE THE BURIAL GRANT | | |
| | | |PAYMENT; THEN IF COSTS REMAIN, | | |
| | | |4. THE COUNTY DEPARTMENT SHALL ISSUE A WRITTEN AUTHORIZATION FOR THE AMOUNT OF | | |
| | | |THE BURIAL GRANT PAYMENT, UP TO THE BURIAL GRANT PAYMENT LIMIT, AS SET FORTH IN | | |
| | | |SECTION 3.570.43.B.1. | | |
| |Rule Reordering | |E. ONCE THE APPLICATION AND CHOICE OF BURIAL SERVICES IS DETERMINED, THE FAMILY |No substantive change-just reordered.| No |
| | | |OR COUNTY DEPARTMENT SHALL CONTACT THE APPROPRIATE PROVIDER(S) TO OBTAIN A | | |
| | | |WRITTEN ESTIMATE OF THE PROVIDER'S PROPOSED CHARGES FOR BURIAL SERVICES. IF MORE| | |
| | | |THAN ONE PROVIDER IS INVOLVED, A SEPARATE WRITTEN ESTIMATE FROM EACH PROVIDER | | |
| | | |SHALL BE OBTAINED. | | |
| |Rule Reordering | |F. ONCE THE PROPOSAL(S) FROM THE PROVIDER(S) IS RECEIVED, THE COUNTY DEPARTMENT |Change to the amount of time the | No |
| | | |SHALL DETERMINE IF A BURIAL GRANT PAYMENT IS APPROPRIATE. |provider has to resubmit a new | |
| | | |1. IF THE COMBINED CHARGES FROM THE PROVIDER(S) EXCEED TWO THOUSAND FIVE HUNDRED|written estimate from 30 days to 10 | |
| | | |DOLLARS ($2,500), NO BURIAL GRANT PAYMENT SHALL BE PAID. |days. | |
| | | |2. THE COUNTY DEPARTMENT SHALL ALLOW THE PROVIDER(S) TO RESUBMIT A WRITTEN | | |
| | | |ESTIMATE WITHIN TEN (10) CALENDAR DAYS OF NOTIFICATION THAT THE CHARGES EXCEEDED| | |
| | | |THE BURIAL GRANT PAYMENT MAXIMUM. | | |
| |Rule Reordering | |G. ALL PAYMENTS FROM A DECEDENT'S ESTATE, PAYMENTS FROM LEGALLY RESPONSIBLE |New rule to align with Statute to | No |
| | | |PERSONS, AND CONTRIBUTIONS FROM ANY OTHER PERSON PERSONS WHO MAKE A CONTRIBUTION|reflect that payments from estate , | |
| | | |TO BURIAL SERVICES SHALL BE PAID DIRECTLY TO THE PROVIDER(S) OF SERVICES. AFTER |responsible persons, and voluntary | |
| | | |THE PROVISION OF ALL SERVICES, THE PROVIDERS SHALL BILL THE COUNTY DEPARTMENT |contributions go directly to the | |
| | | |DIRECTLY FOR REIMBURSEMENT FOR APPROPRIATE COSTS THAT HAVE NOT BEEN COVERED BY |provider of services. After these | |
| | | |THE RESOURCES FROM OR CONTRIBUTIONS MADE BY THE DECEDENT'S ESTATE, LEGALLY |deductions have been made, the | |
| | | |RESPONSIBLE PERSONS, OR ANY OTHER PERSON PERSONS WHO MAKE A CONTRIBUTION TO |remainder is billed to the county | |
| | | |BURIAL SERVICES. THE COUNTY DEPARTMENT SHALL REIMBURSE THE APPROPRIATE PROVIDERS|department. | |
| | | |DIRECTLY, BASED UPON THE STATEMENT OF AGREEMENT. | | |
| |Rule Reordering | |H. THE COUNTY DEPARTMENT OF RESIDENCE OF THE DECEASED CLIENT SHALL AUTHORIZE THE|Added processing timeframe for the | No |
| | | |APPROVED BURIAL GRANT PAYMENT THROUGH THE STATEWIDE AUTOMATED SYSTEM. THE BURIAL|county department. | |
| | | |GRANT PAYMENT SHALL BE PAID DIRECTLY TO THE PROVIDER(S). THE BURIAL APPLICATION | | |
| | | |MUST BE PROCESSED AS SOON AS POSSIBLE BUT NO LATER THAN THIRTY (30) DAYS FROM | | |
| | | |SUBMISSION. | | |
| |Rule Reordering | |I. THE COUNTY DEPARTMENT SHALL HAVE A STATEMENT OF AGREEMENT BETWEEN THE |No substantive change-just reordered.| No |
| | | |PROVIDERS, WHICH ENSURES THAT THE DISTRIBUTION OF BURIAL GRANT PAYMENT IS | | |
| | | |PROPORTIONAL TO BURIAL SERVICES PROVIDED OR AS THE PROVIDERS OTHERWISE | | |
| | | |DETERMINE. THE AGREEMENT SHALL BE SIGNED BY ALL PROVIDER(S) AND SHALL BE | | |
| | | |APPROVED AND SIGNED BY THE COUNTY DEPARTMENT BEFORE THE BURIAL GRANT PAYMENT IS | | |
| | | |AUTHORIZED IN THE STATEWIDE AUTOMATED SYSTEM. | | |
| |Rule Reordering | |J. THE COUNTY DEPARTMENT WILL SEEK RECOVERY OF RESOURCES IF: |New rule to specify when recovery may| No |
| | | |1. THE RESOURCE WAS REPORTED TO THE FUNERAL DIRECTOR AFTER THE DEADLINE DATE, |be pursued. | |
| | | |AND THE FUNERAL DIRECTOR DOES NOT COLLECT FROM THEM. | | |
| | | |2. THE RESOURCE BECOMES AVAILABLE ONLY AFTER THE COUNTY DEPARTMENT HAS PAID FOR | | |
| | | |BURIAL SERVICES. | | |
|3.581 |Program Deletion|A. The AFC program provides twenty-four (24) hour care and |A. The AFC program provides twenty-four (24) hour care and supervision for frail|Program deletion due to no | No |
| | |supervision for frail elderly or physically or emotionally |elderly or physically or emotionally disabled adults, age eighteen (18) or |utilization in the last four years. | |
| | |disabled adults, age eighteen (18) or older, who do not |older, who do not require twenty-four (24) hour medical care but who cannot |No longer included in appropriation | |
| | |require twenty-four (24) hour medical care but who cannot |return to their home and need twenty-four (24) hour non-medical supervision. |by General Assembly. | |
| | |return to their home and need twenty-four (24) hour | | | |
| | |non-medical supervision. | | | |
|3.581 |Program Deletion|B. Effective January 1, 2019, the maximum AFC grant |B. Effective January 1, 2019, the maximum AFC grant standard is $1,403.00, |Program deletion due to no | No |
| | |standard is $1,403.00, determined as follows: |determined as follows: |utilization in the last four years. | |
| | |1. Deduct the client's income, from the AFC grant standard;|1. Deduct the client's income, from the AFC grant standard; and, |No longer included in appropriation | |
| | |and, |2. Deduct the client's OAP or AND-CS grant and any Supplemental Security Income |by General Assembly. | |
| | |2. Deduct the client's OAP or AND-CS grant and any |(SSI) benefits; and, | | |
| | |Supplemental Security Income (SSI) benefits; and, |3. The remainder is the AFC benefit. | | |
| | |3. The remainder is the AFC benefit. | | | |
|3.581 |Program Deletion|C. The AFC maximum grant standard shall be adjusted to stay|C. The AFC maximum grant standard shall be adjusted to stay within available |Program deletion due to no | No |
| | |within available appropriations. Appeals shall not be |appropriations. Appeals shall not be granted for these adjustments. |utilization in the last four years. | |
| | |granted for these adjustments. | |No longer included in appropriation | |
| | | | |by General Assembly. | |
|3.581 |Program Deletion|D. The AFC grant is not taxable income to the client. |D. The AFC grant is not taxable income to the client. |Program deletion due to no | No |
| | | | |utilization in the last four years. | |
| | | | |No longer included in appropriation | |
| | | | |by General Assembly. | |
|3.581 |Program Deletion|E. In addition to the regular monthly AFC grant payments, |E. In addition to the regular monthly AFC grant payments, supplemental payments |Program deletion due to no | No |
| | |supplemental payments necessary to comply with the federal |necessary to comply with the federal Maintenance of Effort (MOE) requirements |utilization in the last four years. | |
| | |Maintenance of Effort (MOE) requirements may be provided. |may be provided. These payments are supplements to regular grant payments, are |No longer included in appropriation | |
| | |These payments are supplements to regular grant payments, |not entitlements, and do not affect grant standards. Appeals shall not be |by General Assembly. | |
| | |are not entitlements, and do not affect grant standards. |allowed for MOE payment adjustments. | | |
| | |Appeals shall not be allowed for MOE payment adjustments. | | | |
|3.582 |Program Deletion|“Adult Foster Care (AFC) Facility” means a Colorado |“Adult Foster Care (AFC) Facility” means a Colorado Department of Public Health |Program deletion due to no | No |
| | |Department of Public Health and Environment (CDPHE) |and Environment (CDPHE) licensed assisted living residence (ALR) that shall |utilization in the last four years. | |
| | |licensed assisted living residence (ALR) that shall |provide: |No longer included in appropriation | |
| | |provide: |A. Twenty-four hour residential care for no more than sixteen (16) residents; |by General Assembly. | |
| | |A. Twenty-four hour residential care for no more than |B. An environment that is sanitary and safe from physical harm; | | |
| | |sixteen (16) residents; |C. Adequate sleeping and living areas; and, | | |
| | |B. An environment that is sanitary and safe from physical |D. Appropriate AFC services. | | |
| | |harm; | | | |
| | |C. Adequate sleeping and living areas; and, | | | |
| | |D. Appropriate AFC services. | | | |
|3.582 |Program Deletion|“Adult Foster Care (AFC) Services” means services provided |“Adult Foster Care (AFC) Services” means services provided for each AFC client |Program deletion due to no | No |
| | |for each AFC client including, but not limited to:A. |including, but not limited to:A. Availability of three (3) balanced meals per |utilization in the last four years. | |
| | |Availability of three (3) balanced meals per day with |day with provision for special diets when those diets have been prescribed as |No longer included in appropriation | |
| | |provision for special diets when those diets have been |part of a medical plan;B. Assistance with transportation;C. Protective |by General Assembly. | |
| | |prescribed as part of a medical plan;B. Assistance with |oversight;D. Assistance with basic personal tasks, such as bathing, hair care, | | |
| | |transportation;C. Protective oversight;D. Assistance with |and dressing;E. Supervision of self-administration of medications;F. | | |
| | |basic personal tasks, such as bathing, hair care, and |Housekeeping services such as changing of bed linen, cleaning of living areas, | | |
| | |dressing;E. Supervision of self-administration of |and rearrangement of furniture as needed to promote freer mobility;G. Laundering| | |
| | |medications;F. Housekeeping services such as changing of |of resident's clothing and bedding; and,H. Opportunities for structured | | |
| | |bed linen, cleaning of living areas, and rearrangement of |recreational activities and socializing. | | |
| | |furniture as needed to promote freer mobility;G. Laundering| | | |
| | |of resident's clothing and bedding; and,H. Opportunities | | | |
| | |for structured recreational activities and socializing. | | | |
|3.582 |Program Deletion|“Appropriateness of placement” means the determination of |“Appropriateness of placement” means the determination of whether a client would|Program deletion due to no | No |
| | |whether a client would be appropriate for an AFC facility |be appropriate for an AFC facility and/or the AFC program. |utilization in the last four years. | |
| | |and/or the AFC program. | |No longer included in appropriation | |
| | | | |by General Assembly. | |
|3.582 |Program Deletion|“BUS” means the Benefits Utilization System used to |“BUS” means the Benefits Utilization System used to document case management |Program deletion due to no | No |
| | |document case management services conducted by the Single |services conducted by the Single Entry Point agencies. |utilization in the last four years. | |
| | |Entry Point agencies. | |No longer included in appropriation | |
| | | | |by General Assembly. | |
|3.582 |Program Deletion|“Client” means a current or past applicant or a current or |“Client” means a current or past applicant or a current or past recipient of |Program deletion due to no | No |
| | |past recipient of benefits under the AFC program. |benefits under the AFC program. |utilization in the last four years. | |
| | | | |No longer included in appropriation | |
| | | | |by General Assembly. | |
|3.582 |Program Deletion|“County department” means the county department of |“County department” means the county department of human/social services. |Program deletion due to no | No |
| | |human/social services. | |utilization in the last four years. | |
| | | | |No longer included in appropriation | |
| | | | |by General Assembly. | |
|3.582 |Program Deletion|“Medical leave” means the absence of the client from the |“Medical leave” means the absence of the client from the Adult Foster Care (AFC)|Program deletion due to no | No |
| | |Adult Foster Care (AFC) facility for more than twenty-four |facility for more than twenty-four (24) hours due to admittance to a hospital or|utilization in the last four years. | |
| | |(24) hours due to admittance to a hospital or other |other facility, upon physician's order with the presumption on the part of the |No longer included in appropriation | |
| | |facility, upon physician's order with the presumption on |physician that the client will be returning to the AFC facility. Medical leave |by General Assembly. | |
| | |the part of the physician that the client will be returning|may be planned or unplanned. | | |
| | |to the AFC facility. Medical leave may be planned or | | | |
| | |unplanned. | | | |
|3.582 |Program Deletion|“Non-medical leave” means the absence of the client from |“Non-medical leave” means the absence of the client from the Adult Foster Care |Program deletion due to no | No |
| | |the Adult Foster Care (AFC) facility for more than |(AFC) facility for more than twenty-four (24) hours for non-medical reasons that|utilization in the last four years. | |
| | |twenty-four (24) hours for non-medical reasons that are not|are not part of a client's care plan. Non-medical leave may be planned or |No longer included in appropriation | |
| | |part of a client's care plan. Non-medical leave may be |unplanned. |by General Assembly. | |
| | |planned or unplanned. | | | |
|3.582 |Program Deletion|“Operator” means any person who owns an Adult Foster Care |“Operator” means any person who owns an Adult Foster Care (AFC) facility or an |Program deletion due to no | No |
| | |(AFC) facility or an individual with authority delegated by|individual with authority delegated by the owner who manages, controls, or |utilization in the last four years. | |
| | |the owner who manages, controls, or performs the day-to-day|performs the day-to-day tasks for operating an AFC facility. |No longer included in appropriation | |
| | |tasks for operating an AFC facility. | |by General Assembly. | |
|3.582 |Program Deletion|“Protective Oversight” means guidance of an Adult Foster |“Protective Oversight” means guidance of an Adult Foster Care (AFC) client, as |Program deletion due to no | No |
| | |Care (AFC) client, as required by the needs of the client |required by the needs of the client or as reasonably requested by the client, |utilization in the last four years. | |
| | |or as reasonably requested by the client, including the |including the following: |No longer included in appropriation | |
| | |following: |A. Knowing the client's general whereabouts, although the client may travel |by General Assembly. | |
| | |A. Knowing the client's general whereabouts, although the |independently in the community; | | |
| | |client may travel independently in the community; |B. Monitoring the activities of the client while on the premises to ensure the | | |
| | |B. Monitoring the activities of the client while on the |health, safety, and well-being of the client, including monitoring of prescribed| | |
| | |premises to ensure the health, safety, and well-being of |medications; | | |
| | |the client, including monitoring of prescribed medications;|C. Reminding the client to carry out activities of daily living; and, | | |
| | |C. Reminding the client to carry out activities of daily |D. Reminding the client of any important activities, including appointments. | | |
| | |living; and, | | | |
| | |D. Reminding the client of any important activities, | | | |
| | |including appointments. | | | |
|3.582 |Program Deletion|“Single Entry Point (“SEP”) agency” means the agency |“Single Entry Point (“SEP”) agency” means the agency selected by the Colorado |Program deletion due to no | No |
| | |selected by the Colorado Department of Health Care Policy |Department of Health Care Policy and Financing (HCPF) to provide case management|utilization in the last four years. | |
| | |and Financing (HCPF) to provide case management services |services for persons in need of long term care services within specific |No longer included in appropriation | |
| | |for persons in need of long term care services within |demographic areas, pursuant to Section 25.5-6-106, C.R.S. |by General Assembly. | |
| | |specific demographic areas, pursuant to Section 25.5-6-106,| | | |
| | |C.R.S. | | | |
|3.582 |Program Deletion|“Staff” means a paid employee of the Adult Foster Care |“Staff” means a paid employee of the Adult Foster Care (AFC) facility. |Program deletion due to no | No |
| | |(AFC) facility. | |utilization in the last four years. | |
| | | | |No longer included in appropriation | |
| | | | |by General Assembly. | |
|3.582 |Program Deletion|“Substance Abuse” means the use of alcohol or drugs or any |“Substance Abuse” means the use of alcohol or drugs or any other mind or mood |Program deletion due to no | No |
| | |other mind or mood altering material in a manner that |altering material in a manner that deviates from standard medical practice in |utilization in the last four years. | |
| | |deviates from standard medical practice in the community, |the community, which acts to the detriment of the individual clients or the |No longer included in appropriation | |
| | |which acts to the detriment of the individual clients or |public. |by General Assembly. | |
| | |the public. | | | |
|3.582 |Program Deletion|“Universal Precautions” refers to a system of infection |“Universal Precautions” refers to a system of infection control, which assumes |Program deletion due to no | No |
| | |control, which assumes that every direct contact with body |that every direct contact with body fluids is potentially infectious including |utilization in the last four years. | |
| | |fluids is potentially infectious including skin, eye, |skin, eye, mucous membrane, blood, blood-tinged body fluids, or other |No longer included in appropriation | |
| | |mucous membrane, blood, blood-tinged body fluids, or other |potentially infectious materials. |by General Assembly. | |
| | |potentially infectious materials. | | | |
|3.583 |Program Deletion|A. The AFC program provides twenty-four (24) hour care and |A. The AFC program provides twenty-four (24) hour care and supervision for |Program deletion due to no | No |
| | |supervision for clients who are: |clients who are: |utilization in the last four years. | |
| | |1. Frail elderly or physically or emotionally disabled |1. Frail elderly or physically or emotionally disabled adults age eighteen (18) |No longer included in appropriation | |
| | |adults age eighteen (18) or older who do not require |or older who do not require twenty-four (24) hour medical care but who cannot |by General Assembly. | |
| | |twenty-four (24) hour medical care but who cannot return to|return to their home and need twenty-four (24) hour non-medical supervision; | | |
| | |their home and need twenty-four (24) hour non-medical |and, | | |
| | |supervision; and, |2. Living in a non-medical facility of no more than sixteen (16) clients that is| | |
| | |2. Living in a non-medical facility of no more than sixteen|licensed by the Colorado Department of Public Health And Environment (CDPHE); | | |
| | |(16) clients that is licensed by the Colorado Department of|and, | | |
| | |Public Health And Environment (CDPHE); and, |3. Receiving or eligible to receive Old Age Pension (OAP), Aid to the Needy | | |
| | |3. Receiving or eligible to receive Old Age Pension (OAP), |Disabled-Colorado Supplement (AND-CS), or Supplemental Security Income (SSI). | | |
| | |Aid to the Needy Disabled-Colorado Supplement (AND-CS), or | | | |
| | |Supplemental Security Income (SSI). | | | |
|3.583 |Program Deletion|B. AFC shall not be available to persons: |B. AFC shall not be available to persons: |Program deletion due to no | No |
| | |1. Receiving home care allowance; or, |1. Receiving home care allowance; or, |utilization in the last four years. | |
| | |2. With a developmental disability, as defined in |2. With a developmental disability, as defined in 27-10.5-102, C.R.S.; or, |No longer included in appropriation | |
| | |27-10.5-102, C.R.S.; or, |3. Receiving or eligible to receive behavioral or mental health services |by General Assembly. | |
| | |3. Receiving or eligible to receive behavioral or mental |pursuant to any provision in Title 27, C.R.S. | | |
| | |health services pursuant to any provision in Title 27, | | | |
| | |C.R.S. | | | |
|3.583 |Program Deletion|C. Eligibility for the Adult Foster Care program shall be |C. Eligibility for the Adult Foster Care program shall be based on:1. Financial |Program deletion due to no | No |
| | |based on:1. Financial eligibility; and,2. Functional |eligibility; and,2. Functional eligibility that includes the client's functional|utilization in the last four years. | |
| | |eligibility that includes the client's functional |assessment, the client's need for twenty-four (24) hour supervision and |No longer included in appropriation | |
| | |assessment, the client's need for twenty-four (24) hour |assistance, and the client's appropriateness for the AFC program. |by General Assembly. | |
| | |supervision and assistance, and the client's | | | |
| | |appropriateness for the AFC program. | | | |
|3.583 |Program Deletion|D. The county department shall determine financial |D. The county department shall determine financial eligibility for AFC. |Program deletion due to no | No |
| | |eligibility for AFC. |1. The client's application shall be processed to determine eligibility for OAP |utilization in the last four years. | |
| | |1. The client's application shall be processed to determine|or AND-CS, or the county department shall determine whether the client is |No longer included in appropriation | |
| | |eligibility for OAP or AND-CS, or the county department |receiving SSI benefits. |by General Assembly. | |
| | |shall determine whether the client is receiving SSI |2. If approved for OAP or AND-CS or the client is receiving SSI, deduct the | | |
| | |benefits. |client's income and the OAP or AND-CS grant standard from the AFC maximum grant | | |
| | |2. If approved for OAP or AND-CS or the client is receiving|standard to determine the client's AFC benefit. | | |
| | |SSI, deduct the client's income and the OAP or AND-CS grant|3. If a client is receiving or eligible to receive Home Care Allowance (HCA) or | | |
| | |standard from the AFC maximum grant standard to determine |a Home and Community Based Services (HCBS) waiver that provides services for any| | |
| | |the client's AFC benefit. |person receiving or eligible to receive services pursuant to any provision in | | |
| | |3. If a client is receiving or eligible to receive Home |Title 27, C.R.S., eligibility for AFC cannot begin until the first day of the | | |
| | |Care Allowance (HCA) or a Home and Community Based Services|month following the discontinuation of HCA OR HCBS. | | |
| | |(HCBS) waiver that provides services for any person |4. The AFC benefit shall be paid to the client. The client shall: | | |
| | |receiving or eligible to receive services pursuant to any |a. Keep $79.00 of the payment for personal needs; and, | | |
| | |provision in Title 27, C.R.S., eligibility for AFC cannot |b. Use the remainder of the AFC payment to pay a portion of the fee charged by | | |
| | |begin until the first day of the month following the |the AFC provider; and, | | |
| | |discontinuation of HCA OR HCBS. |c. Pay the remainder of the AFC charges using his/her income from OAP, AND/CS, | | |
| | |4. The AFC benefit shall be paid to the client. The client |or SSI. | | |
| | |shall: |5. AFC facilities shall charge a standard rate of payment for all AFC clients. | | |
| | |a. Keep $77.00 of the payment for personal needs; and, |a. The AFC rate charged by the AFC facility shall be no greater than the current| | |
| | |b. Use the remainder of the AFC payment to pay a portion of|maximum AFC grant standard less seventy seven dollars ($79), effective October | | |
| | |the fee charged by the AFC provider; and, |1, 2016, for the client's personal needs. | | |
| | |c. Pay the remainder of the AFC charges using his/her |b. AFC facilities shall charge private pay clients an amount at least equal to | | |
| | |income from OAP, AND/CS, or SSI. |that charged to clients receiving an AFC benefit. | | |
| | |5. AFC facilities shall charge a standard rate of payment | | | |
| | |for all AFC clients. | | | |
| | |a. The AFC rate charged by the AFC facility shall be no | | | |
| | |greater than the current maximum AFC grant standard less | | | |
| | |seventy seven dollars ($77), effective January 1, 2015, for| | | |
| | |the client's personal needs. | | | |
| | |b. AFC facilities shall charge private pay clients an | | | |
| | |amount at least equal to that charged to clients receiving | | | |
| | |an AFC benefit. | | | |
|3.583 |Program Deletion|E. The Single Entry Point (SEP) shall determine functional |E. The Single Entry Point (SEP) shall determine functional eligibility.To be |Program deletion due to no | No |
| | |eligibility.To be functionally eligible, the client shall |functionally eligible, the client shall have an AFC eligible functional |utilization in the last four years. | |
| | |have an AFC eligible functional assessment score as |assessment score as outlined in Section 3.584. The functional assessment score |No longer included in appropriation | |
| | |outlined in Section 3.584. The functional assessment score |is calculated by determining the client's functional capacity score and need for|by General Assembly. | |
| | |is calculated by determining the client's functional |paid care score, as follows:1. Functional Capacity: determined by assessing the | | |
| | |capacity score and need for paid care score, as follows:1. |client's ability to complete all activities of daily living (ADLs) and applying | | |
| | |Functional Capacity: determined by assessing the client's |a score to his/her ability to complete the ADLs using the functional impairment | | |
| | |ability to complete all activities of daily living (ADLs) |scale; and,2. Determining the client's appropriateness of placement in an AFC | | |
| | |and applying a score to his/her ability to complete the |facility. | | |
| | |ADLs using the functional impairment scale; and,2. | | | |
| | |Determining the client's appropriateness of placement in an| | | |
| | |AFC facility. | | | |
|3.583 |Program Deletion|F. When the client is determined functionally eligible for |F. When the client is determined functionally eligible for the AFC program, the |Program deletion due to no | No |
| | |the AFC program, the Single Entry Point (SEP) shall notify |Single Entry Point (SEP) shall notify the county department. The county |utilization in the last four years. | |
| | |the county department. The county department shall notify |department shall notify the SEP when the client has been determined financially |No longer included in appropriation | |
| | |the SEP when the client has been determined financially |eligible for the AFC program. |by General Assembly. | |
| | |eligible for the AFC program. | | | |
|3.583 |Program Deletion|G. The AFC payment effective date shall be the date that |G. The AFC payment effective date shall be the date that the client was admitted|Program deletion due to no | No |
| | |the client was admitted to the AFC facility or the date |to the AFC facility or the date he/she is determined to be financially eligible,|utilization in the last four years. | |
| | |he/she is determined to be financially eligible, whichever |whichever is later. If the client is receiving or eligible to receive Home and |No longer included in appropriation | |
| | |is later. If the client is receiving or eligible to receive|Community Based Services (HCBS) pursuant to any provision in Title 27, C.R.S, |by General Assembly. | |
| | |Home and Community Based Services (HCBS) pursuant to any |the effective date is the first day of the month following the discontinuation | | |
| | |provision in Title 27, C.R.S, the effective date is the |of HCBS. | | |
| | |first day of the month following the discontinuation of | | | |
| | |HCBS. | | | |
|3.584 |Program Deletion|A. The need for skilled personal care shall not be included|A. The need for skilled personal care shall not be included in the scoring of |Program deletion due to no | No |
| | |in the scoring of the functional capacity or need for paid |the functional capacity or need for paid care. Skilled personal care is not a |utilization in the last four years. | |
| | |care. Skilled personal care is not a paid service of the |paid service of the AFC program. |No longer included in appropriation | |
| | |AFC program. | |by General Assembly. | |
|3.584 |Program Deletion|B. In order to be eligible for the AFC, each client shall |B. In order to be eligible for the AFC, each client shall score a minimum of ten|Program deletion due to no | No |
| | |score a minimum of ten (10) points when assessed for the |(10) points when assessed for the ability to complete the activities of daily |utilization in the last four years. | |
| | |ability to complete the activities of daily living (ADL) |living (ADL) using the following functional capacity impairment scale:1. |No longer included in appropriation | |
| | |using the following functional capacity impairment scale:1.|Independent: score zero (0) if the client is physically able to perform all |by General Assembly. | |
| | |Independent: score zero (0) if the client is physically |essential components of the ADL, with or without an assistive device.2. Low: | | |
| | |able to perform all essential components of the ADL, with |score one (1) if the client is able to perform all essential components of the | | |
| | |or without an assistive device.2. Low: score one (1) if the|function, but impairment of function exists even with an assistive device. The | | |
| | |client is able to perform all essential components of the |client requires occasional or intermittent supervision or physical assistance in| | |
| | |function, but impairment of function exists even with an |a limited number of the components of the activity.a. Occasional or intermittent| | |
| | |assistive device. The client requires occasional or |means the client does not need assistance daily, but may need assistance a few | | |
| | |intermittent supervision or physical assistance in a |times a month or up to two (2) times per week.b. Supervision or assistance means| | |
| | |limited number of the components of the activity.a. |verbal prompting, cueing, and reminders, and means stand-by assistance or | | |
| | |Occasional or intermittent means the client does not need |monitoring to help the client if he/she needs physical assistance up to two (2) | | |
| | |assistance daily, but may need assistance a few times a |times per week.3. Moderate: score two (2) if the client is unable to perform the| | |
| | |month or up to two (2) times per week.b. Supervision or |majority of the essential components of the function even with an assistive | | |
| | |assistance means verbal prompting, cueing, and reminders, |device, and the client requires hands-on and frequent assistance to accomplish | | |
| | |and means stand-by assistance or monitoring to help the |the activity.a. Frequent means the client needs assistance at least three (3) | | |
| | |client if he/she needs physical assistance up to two (2) |times per week and up to daily.b. Hands-on assistance means the care provider | | |
| | |times per week.3. Moderate: score two (2) if the client is |must physically assist the client in completing the task.4. Severe: score three | | |
| | |unable to perform the majority of the essential components |(3) if the client is totally unable to perform the function and requires someone| | |
| | |of the function even with an assistive device, and the |to perform the task, or the client requires constant supervision for the task. | | |
| | |client requires hands-on and frequent assistance to | | | |
| | |accomplish the activity.a. Frequent means the client needs | | | |
| | |assistance at least three (3) times per week and up to | | | |
| | |daily.b. Hands-on assistance means the care provider must | | | |
| | |physically assist the client in completing the task.4. | | | |
| | |Severe: score three (3) if the client is totally unable to | | | |
| | |perform the function and requires someone to perform the | | | |
| | |task, or the client requires constant supervision for the | | | |
| | |task. | | | |
|3.584 |Program Deletion|C. The functional assessment shall be scored on the State |C. The functional assessment shall be scored on the State Department prescribed |Program deletion due to no | No |
| | |Department prescribed form, which shall list each activity |form, which shall list each activity of daily living and the functional capacity|utilization in the last four years. | |
| | |of daily living and the functional capacity score for each |score for each ADL. |No longer included in appropriation | |
| | |ADL. | |by General Assembly. | |
|3.585 |Program Deletion|A. Activities of daily living (ADLs) shall be scored using |A. Activities of daily living (ADLs) shall be scored using the functional |Program deletion due to no | No |
| | |the functional capacity impairment scale. |capacity impairment scale. |utilization in the last four years. | |
| | | | |No longer included in appropriation | |
| | | | |by General Assembly. | |
|3.585 |Program Deletion|B. The activities of daily living are: |B. The activities of daily living are: |Program deletion due to no | No |
| | |1. Critical ADLs |1. Critical ADLs |utilization in the last four years. | |
| | |a. Transfers: the ability to move between surfaces, such as|a. Transfers: the ability to move between surfaces, such as getting in and out |No longer included in appropriation | |
| | |getting in and out of bed; transferring from a bed to a |of bed; transferring from a bed to a chair, wheelchair, or walker; moving from a|by General Assembly. | |
| | |chair, wheelchair, or walker; moving from a chair or |chair or wheelchair to a walker or to a standing position; and the ability to | | |
| | |wheelchair to a walker or to a standing position; and the |use assistive devices, including prosthetics. | | |
| | |ability to use assistive devices, including prosthetics. |b. Bladder care: the extent to which the client has control of his/her bladder | | |
| | |b. Bladder care: the extent to which the client has control|functions and the ability of the client to accomplish the tasks of toileting, | | |
| | |of his/her bladder functions and the ability of the client |including catheterizing, getting on and off the toilet, changing incontinence | | |
| | |to accomplish the tasks of toileting, including |products, and cleaning him/herself. | | |
| | |catheterizing, getting on and off the toilet, changing |c. Bowel care: the extent to which the client has control of his/her bowel | | |
| | |incontinence products, and cleaning him/herself. |functions and the ability of the client to accomplish the tasks of toileting, | | |
| | |c. Bowel care: the extent to which the client has control |including getting on and off the toilet, changing incontinence products, and | | |
| | |of his/her bowel functions and the ability of the client to|cleaning him/herself. | | |
| | |accomplish the tasks of toileting, including getting on and| | | |
| | |off the toilet, changing incontinence products, and | | | |
| | |cleaning him/herself. | | | |
|3.585 |Program Deletion|B.2. Basic ADLsa. Mobility: the ability of the client to |B.2. Basic ADLsa. Mobility: the ability of the client to ambulate around the |Program deletion due to no | No |
| | |ambulate around the home and around essential places |home and around essential places outside the home, with or without assistive |utilization in the last four years. | |
| | |outside the home, with or without assistive devices.b. |devices.b. Dressing: the ability of the client to accomplish all phases of the |No longer included in appropriation | |
| | |Dressing: the ability of the client to accomplish all |activities of dressing and undressing, including getting, putting on, fastening,|by General Assembly. | |
| | |phases of the activities of dressing and undressing, |and taking off all items of clothing, braces, and artificial limbs.c. Bathing: | | |
| | |including getting, putting on, fastening, and taking off |the ability of the client to safely accomplish the task of washing body parts | | |
| | |all items of clothing, braces, and artificial limbs.c. |including getting into bathing waters, with or without assistive devices or | | |
| | |Bathing: the ability of the client to safely accomplish the|whether the client requires stand by or hands-on assistance from another | | |
| | |task of washing body parts including getting into bathing |person.d. Hygiene: the ability of the client to maintain personal hygiene other | | |
| | |waters, with or without assistive devices or whether the |than bathing, including combing hair, brushing teeth, clipping nails, and | | |
| | |client requires stand by or hands-on assistance from |shaving.e. Eating: the ability to cut food into manageable size pieces, chew, | | |
| | |another person.d. Hygiene: the ability of the client to |and swallow food, with or without assistive devices. | | |
| | |maintain personal hygiene other than bathing, including | | | |
| | |combing hair, brushing teeth, clipping nails, and | | | |
| | |shaving.e. Eating: the ability to cut food into manageable | | | |
| | |size pieces, chew, and swallow food, with or without | | | |
| | |assistive devices. | | | |
|3.585 |Program Deletion|B.3. Instrumental ADLsa. Meals: the ability to safely |B.3. Instrumental ADLsa. Meals: the ability to safely prepare food to meet the |Program deletion due to no | No |
| | |prepare food to meet the basic nutritional requirements of |basic nutritional requirements of the individual, including cutting food, |utilization in the last four years. | |
| | |the individual, including cutting food, transferring food |transferring food to cooking vessels and/or dishes, utilizing utensils, using a |No longer included in appropriation | |
| | |to cooking vessels and/or dishes, utilizing utensils, using|stove or microwave, and implementing special dietary needs.b. Housekeeping: the |by General Assembly. | |
| | |a stove or microwave, and implementing special dietary |ability to maintain the interior of the client's residence for the purpose of | | |
| | |needs.b. Housekeeping: the ability to maintain the interior|health and safety, such as wiping surfaces, cleaning floors, making a bed, and | | |
| | |of the client's residence for the purpose of health and |cleaning dishes.c. Laundry: the ability to gather and wash soiled clothing and | | |
| | |safety, such as wiping surfaces, cleaning floors, making a |linens; use washing machines and dryers; hang, fold, and put away clean clothing| | |
| | |bed, and cleaning dishes.c. Laundry: the ability to gather |and linens.d. Shopping: the ability to purchase goods that are necessary for | | |
| | |and wash soiled clothing and linens; use washing machines |health and safety. Activities include ability to make needs known, to make a | | |
| | |and dryers; hang, fold, and put away clean clothing and |list, reach for the needed items at the store, ability to estimate or determine | | |
| | |linens.d. Shopping: the ability to purchase goods that are |the cost of the item, and to move items into the home and put them away. | | |
| | |necessary for health and safety. Activities include ability| | | |
| | |to make needs known, to make a list, reach for the needed | | | |
| | |items at the store, ability to estimate or determine the | | | |
| | |cost of the item, and to move items into the home and put | | | |
| | |them away. | | | |
|3.585 |Program Deletion|B.4. Supportive ADLsa. Medicine: the ability to manage |B.4. Supportive ADLsa. Medicine: the ability to manage medications, including |Program deletion due to no | No |
| | |medications, including knowing the name of the medication, |knowing the name of the medication, knowing the amount, frequency, and how to |utilization in the last four years. | |
| | |knowing the amount, frequency, and how to take the |take the medicine, understanding the reason for taking it, and understanding |No longer included in appropriation | |
| | |medicine, understanding the reason for taking it, and |possible side effects.b. Appointment: the ability to schedule or make an |by General Assembly. | |
| | |understanding possible side effects.b. Appointment: the |appointment for essential activities, such as doctor visits, meetings with | | |
| | |ability to schedule or make an appointment for essential |caseworkers, and transportation.c. Money: the ability to manage money, such as | | |
| | |activities, such as doctor visits, meetings with |balancing a checkbook, writing checks or paying a bill electronically, and | | |
| | |caseworkers, and transportation.c. Money: the ability to |ability to understand financial decisions.d. Access: the ability to access | | |
| | |manage money, such as balancing a checkbook, writing checks|resources or services in the community, such as locating the resource/service | | |
| | |or paying a bill electronically, and ability to understand |and completing the process necessary to receive the resource or service.e. | | |
| | |financial decisions.d. Access: the ability to access |Telephone: the ability to use the telephone to communicate essential needs, such| | |
| | |resources or services in the community, such as locating |as answering the phone in a reasonable time, speaking clearly and loudly enough | | |
| | |the resource/service and completing the process necessary |to be understood, dialing the phone, initiating a conversation, hearing the | | |
| | |to receive the resource or service.e. Telephone: the |caller, and placing a call in an emergency. | | |
| | |ability to use the telephone to communicate essential | | | |
| | |needs, such as answering the phone in a reasonable time, | | | |
| | |speaking clearly and loudly enough to be understood, | | | |
| | |dialing the phone, initiating a conversation, hearing the | | | |
| | |caller, and placing a call in an emergency. | | | |
|3.586 |Program Deletion|A. The appropriateness of placement shall be determined. |A. The appropriateness of placement shall be determined. |Program deletion due to no | No |
| | |1. The appropriateness of placement shall be documented on |1. The appropriateness of placement shall be documented on the state prescribed |utilization in the last four years. | |
| | |the state prescribed form. |form. |No longer included in appropriation | |
| | |2. An AFC facility shall not admit or keep any client |2. An AFC facility shall not admit or keep any client requiring a level of care |by General Assembly. | |
| | |requiring a level of care or type of service that the |or type of service that the facility does not provide or is unable to provide. | | |
| | |facility does not provide or is unable to provide. | | | |
|3.586 |Program Deletion|B. If a client meets one or more of the following |B. If a client meets one or more of the following disqualifying criteria for |Program deletion due to no | No |
| | |disqualifying criteria for appropriateness of placement, |appropriateness of placement, he/she shall be ineligible for the AFC program, |utilization in the last four years. | |
| | |he/she shall be ineligible for the AFC program, regardless |regardless of the functional assessment score or the client's financial |No longer included in appropriation | |
| | |of the functional assessment score or the client's |eligibility. The client shall be ineligible for AFC when he/she:1. Needs skilled|by General Assembly. | |
| | |financial eligibility. The client shall be ineligible for |care services more frequently than once per week. If skilled care services are | | |
| | |AFC when he/she:1. Needs skilled care services more |provided, the services must be provided by a skilled care provider; or,2. Is | | |
| | |frequently than once per week. If skilled care services are|unable or unwilling to meet his/her own personal hygiene needs under | | |
| | |provided, the services must be provided by a skilled care |supervision; or,3. Has an acute physical illness which cannot be managed through| | |
| | |provider; or,2. Is unable or unwilling to meet his/her own |medications or prescribed therapy; or,4. Has a substance abuse problem, unless | | |
| | |personal hygiene needs under supervision; or,3. Has an |the substance abuse is no longer acute and a physician determines it to be | | |
| | |acute physical illness which cannot be managed through |manageable; or,5. Has ambulation limitations, unless compensated for by an | | |
| | |medications or prescribed therapy; or,4. Has a substance |assistive device with minimal assistance from staff; or,6. Has a reportable | | |
| | |abuse problem, unless the substance abuse is no longer |communicable or infectious disease, unless the transmittal of the disease can be| | |
| | |acute and a physician determines it to be manageable; or,5.|managed through the use of universal precautions and appropriate medical and/or | | |
| | |Has ambulation limitations, unless compensated for by an |drug treatment; or,7. Is consistently disoriented to time, person, and place to | | |
| | |assistive device with minimal assistance from staff; or,6. |such a degree that he/she poses a danger to self or others; or,8. Has a seizure | | |
| | |Has a reportable communicable or infectious disease, unless|disorder which is not adequately controlled by medications; or, | | |
| | |the transmittal of the disease can be managed through the | | | |
| | |use of universal precautions and appropriate medical and/or| | | |
| | |drug treatment; or,7. Is consistently disoriented to time, | | | |
| | |person, and place to such a degree that he/she poses a | | | |
| | |danger to self or others; or,8. Has a seizure disorder | | | |
| | |which is not adequately controlled by medications; or, | | | |
|3.586 |Program Deletion|B.9. Exhibits behavior that poses a physical threat to self|B.9. Exhibits behavior that poses a physical threat to self or others. Such |Program deletion due to no | No |
| | |or others. Such behavior includes, but is not limited to, |behavior includes, but is not limited to, violent and disruptive behavior and/or|utilization in the last four years. | |
| | |violent and disruptive behavior and/or any behavior which |any behavior which involves physical, sexual, or psychological force or |No longer included in appropriation | |
| | |involves physical, sexual, or psychological force or |intimidation; or,10. Requires intravenous or tube feeding; or,11. Is |by General Assembly. | |
| | |intimidation; or,10. Requires intravenous or tube feeding; |consistently unwilling to take medications prescribed by a physician or | | |
| | |or,11. Is consistently unwilling to take medications |psychiatrist; or,12. Is incapable of self-administration of medications. The | | |
| | |prescribed by a physician or psychiatrist; or,12. Is |client is not disqualified if the AFC facility has a staff member trained in | | |
| | |incapable of self-administration of medications. The client|medication administration, in accordance with Section 25-1.5-302, C.R.S., et | | |
| | |is not disqualified if the AFC facility has a staff member |seq., or who possesses all necessary licenses to administer medication; or,13. | | |
| | |trained in medication administration, in accordance with |Is a person whose physical safety cannot be assured in an AFC; or,14. Is | | |
| | |Section 25-1.5-302, C.R.S., et seq., or who possesses all |consistently, uncontrollably incontinent of bowel or bladder and it cannot be | | |
| | |necessary licenses to administer medication; or,13. Is a |managed by the client with assistance from staff; or,15. Needs restraints of any| | |
| | |person whose physical safety cannot be assured in an AFC; |kind. “Restraint” for the purpose of this section means any physical or chemical| | |
| | |or,14. Is consistently, uncontrollably incontinent of bowel|device, application of force, or medication that is designed or used for the | | |
| | |or bladder and it cannot be managed by the client with |purpose of modifying, altering, or controlling behavior for the convenience of | | |
| | |assistance from staff; or,15. Needs restraints of any kind.|the facility and excludes medication prescribed by a physician as part of an | | |
| | |“Restraint” for the purpose of this section means any |on-going treatment plan or pursuant to a diagnosis; or,16. Has a primary | | |
| | |physical or chemical device, application of force, or |diagnosis of mental illness and is unwilling to comply with medications | | |
| | |medication that is designed or used for the purpose of |prescribed by the physician or psychiatrist; or,17. Is receiving or is eligible | | |
| | |modifying, altering, or controlling behavior for the |to receive behavioral or mental health services, as defined in Title 27, C.R.S; | | |
| | |convenience of the facility and excludes medication |or,18. Has a developmental disability, as defined in Title 27, Article 10.5-102,| | |
| | |prescribed by a physician as part of an on-going treatment |C.R.S. | | |
| | |plan or pursuant to a diagnosis; or,16. Has a primary | | | |
| | |diagnosis of mental illness and is unwilling to comply with| | | |
| | |medications prescribed by the physician or psychiatrist; | | | |
| | |or,17. Is receiving or is eligible to receive behavioral or| | | |
| | |mental health services, as defined in Title 27, C.R.S; | | | |
| | |or,18. Has a developmental disability, as defined in Title | | | |
| | |27, Article 10.5-102, C.R.S. | | | |
|3.587 |Program Deletion|A. When the client is determined eligible for the AFC |A. When the client is determined eligible for the AFC program, the Single Entry |Program deletion due to no | No |
| | |program, the Single Entry Point (SEP) shall review |Point (SEP) shall review available AFC facilities to determine if the client's |utilization in the last four years. | |
| | |available AFC facilities to determine if the client's needs|needs can be met by any of the facilities. The review:1. May require contact |No longer included in appropriation | |
| | |can be met by any of the facilities. The review:1. May |with AFC facilities outside of the client's county of residence.2. Shall include|by General Assembly. | |
| | |require contact with AFC facilities outside of the client's|a discussion of the client's needs with the AFC facility staff. | | |
| | |county of residence.2. Shall include a discussion of the | | | |
| | |client's needs with the AFC facility staff. | | | |
|3.587 |Program Deletion|B. When an appropriate AFC facility(ies) has been located, |B. When an appropriate AFC facility(ies) has been located, the SEP shall: |Program deletion due to no | No |
| | |the SEP shall: |1. Discuss the facility(ies) and with the client; |utilization in the last four years. | |
| | |1. Discuss the facility(ies) and with the client; |2. Arrange for the client to make an initial visit to the facility(ies); and, |No longer included in appropriation | |
| | |2. Arrange for the client to make an initial visit to the |3. Develop a care plan in conjunction with the client, family, SEP, and the AFC |by General Assembly. | |
| | |facility(ies); and, |facility staff. | | |
| | |3. Develop a care plan in conjunction with the client, |4. Ensure a signed provider agreement is in place prior to placement at the AFC | | |
| | |family, SEP, and the AFC facility staff. |facility. The agreement shall be: | | |
| | |4. Ensure a signed provider agreement is in place prior to |a. Reviewed at least annually; and, | | |
| | |placement at the AFC facility. The agreement shall be: |b. Be re-signed annually, contingent upon the AFC facility's ongoing | | |
| | |a. Reviewed at least annually; and, |appropriateness for the client and ongoing licensure as an assisted living | | |
| | |b. Be re-signed annually, contingent upon the AFC |residence by CDPHE. | | |
| | |facility's ongoing appropriateness for the client and | | | |
| | |ongoing licensure as an assisted living residence by CDPHE.| | | |
|3.587 |Program Deletion|C. A client shall not be placed in an AFC facility unless: |C. A client shall not be placed in an AFC facility unless: |Program deletion due to no | No |
| | |1. The competent client gives informed consent for |1. The competent client gives informed consent for placement; or, |utilization in the last four years. | |
| | |placement; or, |2. The court-appointed guardian of the client requests placement; and, |No longer included in appropriation | |
| | |2. The court-appointed guardian of the client requests |3. The client or his/her legal representative understands and agrees to adhere |by General Assembly. | |
| | |placement; and, |to facility rules. | | |
| | |3. The client or his/her legal representative understands | | | |
| | |and agrees to adhere to facility rules. | | | |
|3.587 |Program Deletion|D. Any client admitted for respite care in an AFC shall |D. Any client admitted for respite care in an AFC shall meet the requirements |Program deletion due to no | No |
| | |meet the requirements for appropriate placement. |for appropriate placement. |utilization in the last four years. | |
| | | | |No longer included in appropriation | |
| | | | |by General Assembly. | |
|3.587 |Program Deletion|E. The SEP shall develop a care plan on the State |E. The SEP shall develop a care plan on the State Department prescribed form |Program deletion due to no | No |
| | |Department prescribed form within ten (10) working days |within ten (10) working days after program eligibility has been determined and |utilization in the last four years. | |
| | |after program eligibility has been determined and prior to |prior to the arrangement for services.1. The care plan shall be:a. Signed by the|No longer included in appropriation | |
| | |the arrangement for services.1. The care plan shall be:a. |client, SEP, and AFC facility staff.b. Reviewed and updated at least once every |by General Assembly. | |
| | |Signed by the client, SEP, and AFC facility staff.b. |twelve (12) months; and,c. Reviewed sooner if there is a change in the client's | | |
| | |Reviewed and updated at least once every twelve (12) |needs; and,d. Provided to all parties prior to admission to the facility.2. Care| | |
| | |months; and,c. Reviewed sooner if there is a change in the |planning shall include, but not be limited to, the following tasks:a. Identify | | |
| | |client's needs; and,d. Provided to all parties prior to |and document care plan goals and client choices.b. Identify and document | | |
| | |admission to the facility.2. Care planning shall include, |services, including type, duration and frequency.c. Arrange for services through| | |
| | |but not be limited to, the following tasks:a. Identify and |an AFC facility, coordinate service delivery, negotiate with the AFC facility | | |
| | |document care plan goals and client choices.b. Identify and|and the client regarding service provision, and formalize the AFC agreement.d. | | |
| | |document services, including type, duration and |Complete program requirements for the authorization of services.e. Refer the | | |
| | |frequency.c. Arrange for services through an AFC facility, |client to community resources, as needed, and attempt to develop resources for | | |
| | |coordinate service delivery, negotiate with the AFC |the client if a resource is not available within the client's community.f. | | |
| | |facility and the client regarding service provision, and |Explain the complaint procedures to the client, as listed on the care plan | | |
| | |formalize the AFC agreement.d. Complete program |document.g. Explain the client's right to appeal any decision. | | |
| | |requirements for the authorization of services.e. Refer the| | | |
| | |client to community resources, as needed, and attempt to | | | |
| | |develop resources for the client if a resource is not | | | |
| | |available within the client's community.f. Explain the | | | |
| | |complaint procedures to the client, as listed on the care | | | |
| | |plan document.g. Explain the client's right to appeal any | | | |
| | |decision. | | | |
|3.587 |Program Deletion|F. The SEP shall provide ongoing case management, as |F. The SEP shall provide ongoing case management, as follows:Monitor the quality|Program deletion due to no | No |
| | |follows:Monitor the quality of care provided to clients.1. |of care provided to clients.1. Contact service providers concerning service |utilization in the last four years. | |
| | |Contact service providers concerning service coordination, |coordination, effectiveness and appropriateness.2. Review the client's |No longer included in appropriation | |
| | |effectiveness and appropriateness.2. Review the client's |assessment, care plan, and service agreements to include changes in client |by General Assembly. | |
| | |assessment, care plan, and service agreements to include |functioning, service effectiveness, appropriateness, and cost-effectiveness that| | |
| | |changes in client functioning, service effectiveness, |may require a reassessment or a change in the care plan;3. Make changes in | | |
| | |appropriateness, and cost-effectiveness that may require a |service plans as appropriate to client needs and/or refer the client to | | |
| | |reassessment or a change in the care plan;3. Make changes |community resources, if appropriate.4. Provide conflict resolution and/or crisis| | |
| | |in service plans as appropriate to client needs and/or |intervention, as needed.5. Identify and contact appropriate individuals, and | | |
| | |refer the client to community resources, if appropriate.4. |resolve any problems or complaints raised by the client or others regarding | | |
| | |Provide conflict resolution and/or crisis intervention, as |service delivery, including corrective action processes, as appropriate.6. | | |
| | |needed.5. Identify and contact appropriate individuals, and|Notify the appropriate law enforcement and/or Adult Protective Services agency | | |
| | |resolve any problems or complaints raised by the client or |of suspected abuse, neglect, or exploitation, as required by Sections 18-6.5-101| | |
| | |others regarding service delivery, including corrective |and 26-3.1-102, C.R.S. | | |
| | |action processes, as appropriate.6. Notify the appropriate | | | |
| | |law enforcement and/or Adult Protective Services agency of | | | |
| | |suspected abuse, neglect, or exploitation, as required by | | | |
| | |Sections 18-6.5-101 and 26-3.1-102, C.R.S. | | | |
|3.587 |Program Deletion|G. The SEP shall complete a review of the client's current |G. The SEP shall complete a review of the client's current assessment or |Program deletion due to no | No |
| | |assessment or reassessment and the care plan with the |reassessment and the care plan with the client six (6) months following the |utilization in the last four years. | |
| | |client six (6) months following the assessment or |assessment or reassessment. |No longer included in appropriation | |
| | |reassessment. |1. The review shall be conducted by telephone, at the client's place of |by General Assembly. | |
| | |1. The review shall be conducted by telephone, at the |residence, at the place of service or other appropriate setting as determined by| | |
| | |client's place of residence, at the place of service or |the client's needs. | | |
| | |other appropriate setting as determined by the client's |2. A face-to-face home visit shall be completed when significant changes in the | | |
| | |needs. |client's condition are identified. | | |
| | |2. A face-to-face home visit shall be completed when | | | |
| | |significant changes in the client's condition are | | | |
| | |identified. | | | |
|3.587 |Program Deletion|H. The SEP shall complete a face-to-face functional |H. The SEP shall complete a face-to-face functional reassessment within twelve |Program deletion due to no | No |
| | |reassessment within twelve (12) months of the initial |(12) months of the initial functional assessment and every 12 months thereafter.|utilization in the last four years. | |
| | |functional assessment and every 12 months thereafter. A |A reassessment shall be completed sooner if the client's condition changes. |No longer included in appropriation | |
| | |reassessment shall be completed sooner if the client's | |by General Assembly. | |
| | |condition changes. | | | |
|3.587 |Program Deletion|I. Reassessment shall include the following tasks:1. Obtain|I. Reassessment shall include the following tasks:1. Obtain diagnoses from the |Program deletion due to no | No |
| | |diagnoses from the client's medical provider at least |client's medical provider at least annually, or sooner if the client's condition|utilization in the last four years. | |
| | |annually, or sooner if the client's condition changes.2. |changes.2. Review the care plan, service agreement, and provider contract or |No longer included in appropriation | |
| | |Review the care plan, service agreement, and provider |agreement.3. Evaluate service effectiveness, quality of care, and |by General Assembly. | |
| | |contract or agreement.3. Evaluate service effectiveness, |appropriateness of services.4. Verify continuing financial and program | | |
| | |quality of care, and appropriateness of services.4. Verify |eligibility.5. Annually, or more often if indicated, complete a new care plan | | |
| | |continuing financial and program eligibility.5. Annually, |and service agreement.6. Refer the client to community resources, as needed.7. | | |
| | |or more often if indicated, complete a new care plan and |Determine continued appropriateness of placement. | | |
| | |service agreement.6. Refer the client to community | | | |
| | |resources, as needed.7. Determine continued appropriateness| | | |
| | |of placement. | | | |
|3.587 |Program Deletion|J. The SEP shall update the information provided at the |J. The SEP shall update the information provided at the previous assessment or |Program deletion due to no | No |
| | |previous assessment or reassessment, utilizing the State |reassessment, utilizing the State Department prescribed functional assessment |utilization in the last four years. | |
| | |Department prescribed functional assessment tool. When a |tool. When a new functional assessment is completed a copy shall be sent to the |No longer included in appropriation | |
| | |new functional assessment is completed a copy shall be sent|county department within thirty (30) days of the reassessment. |by General Assembly. | |
| | |to the county department within thirty (30) days of the | | | |
| | |reassessment. | | | |
|3.588 |Program Deletion|A. The SEP shall deny or discontinue the client from the |A. The SEP shall deny or discontinue the client from the AFC program if he/she |Program deletion due to no | No |
| | |AFC program if he/she is determined functionally |is determined functionally ineligible. |utilization in the last four years. | |
| | |ineligible. |1. The client shall be informed of his/her appeal rights in accordance with |No longer included in appropriation | |
| | |1. The client shall be informed of his/her appeal rights in|rules under Section 3.850, et seq. |by General Assembly. | |
| | |accordance with rules under Section 3.850, et seq. |2. The client shall be provided appropriate referrals to other community | | |
| | |2. The client shall be provided appropriate referrals to |resources within one (1) working day of discontinuation or denial. | | |
| | |other community resources within one (1) working day of |3. The SEP shall notify all providers on the care plan within one (1) working | | |
| | |discontinuation or denial. |day of discontinuation. | | |
| | |3. The SEP shall notify all providers on the care plan |4. The SEP shall notify the county department within one (1) working day of | | |
| | |within one (1) working day of discontinuation. |discontinuation. | | |
| | |4. The SEP shall notify the county department within one |5. The SEP shall prepare for and defend at the hearing any appeal related to | | |
| | |(1) working day of discontinuation. |functional denial or discontinuation. The SEP may request assistance and/or | | |
| | |5. The SEP shall prepare for and defend at the hearing any |testimony from the county department. | | |
| | |appeal related to functional denial or discontinuation. The| | | |
| | |SEP may request assistance and/or testimony from the county| | | |
| | |department. | | | |
|3.588 |Program Deletion|B. The county department shall deny or discontinue the |B. The county department shall deny or discontinue the client from the AFC |Program deletion due to no | No |
| | |client from the AFC program if he/she is determined |program if he/she is determined financially ineligible.1. The client shall be |utilization in the last four years. | |
| | |financially ineligible.1. The client shall be informed of |informed of his/her appeal rights in accordance with rules under Section 3.850, |No longer included in appropriation | |
| | |his/her appeal rights in accordance with rules under |et seq.2. The client shall be provided appropriate referrals to other community |by General Assembly. | |
| | |Section 3.850, et seq.2. The client shall be provided |resources within one (1) working day of discontinuation or denial.3. The county | | |
| | |appropriate referrals to other community resources within |department shall notify all providers on the care plan within one (1) working | | |
| | |one (1) working day of discontinuation or denial.3. The |day of discontinuation.4. The county department shall notify the Single Entry | | |
| | |county department shall notify all providers on the care |Point (SEP) within one (1) working day of discontinuation.5. The county | | |
| | |plan within one (1) working day of discontinuation.4. The |department shall prepare for and defend at the hearing any appeal related to | | |
| | |county department shall notify the Single Entry Point (SEP)|financial denial or discontinuation. The county department may request | | |
| | |within one (1) working day of discontinuation.5. The county|assistance and/or testimony from the SEP. | | |
| | |department shall prepare for and defend at the hearing any | | | |
| | |appeal related to financial denial or discontinuation. The | | | |
| | |county department may request assistance and/or testimony | | | |
| | |from the SEP. | | | |
|3.588 |Program Deletion|C. Denial and/or discontinuation from the AFC program shall|C. Denial and/or discontinuation from the AFC program shall occur for the |Program deletion due to no | No |
| | |occur for the following reasons:1. Financial and Functional|following reasons:1. Financial and Functional Eligibility: The SEP or county |utilization in the last four years. | |
| | |Eligibility: The SEP or county department shall deny or |department shall deny or discontinue a client if the client is not financially |No longer included in appropriation | |
| | |discontinue a client if the client is not financially |eligible and/or is not functionally eligible for AFC.2. Target population: The |by General Assembly. | |
| | |eligible and/or is not functionally eligible for AFC.2. |SEP or county department shall deny or discontinue when the client:a. Has been | | |
| | |Target population: The SEP or county department shall deny |diagnosed with a developmental disability, as defined in Section 27-10.5-102, | | |
| | |or discontinue when the client:a. Has been diagnosed with a|C.R.S.; or,b. Is receiving or eligible to receive behavioral or mental health | | |
| | |developmental disability, as defined in Section |services pursuant to any provision of Title 27, C.R.S.3. Level of Care: The SEP | | |
| | |27-10.5-102, C.R.S.; or,b. Is receiving or eligible to |shall deny or discontinue when the client:a. Does not meet functional capacity | | |
| | |receive behavioral or mental health services pursuant to |score minimum requirements; or,b. Does not meet appropriateness of placement | | |
| | |any provision of Title 27, C.R.S.3. Level of Care: The SEP |criteria.4. Receipt of Services: The SEP or county department shall deny or | | |
| | |shall deny or discontinue when the client:a. Does not meet |discontinue when the client:a. Has not received services for one month;b. Has | | |
| | |functional capacity score minimum requirements; or,b. Does |twice refused to schedule an appointment for an initial assessment, six | | |
| | |not meet appropriateness of placement criteria.4. Receipt |(6)-month review, or reassessment within a thirty (30) day consecutive period;c.| | |
| | |of Services: The SEP or county department shall deny or |Has failed to keep three (3) scheduled appointments within a thirty (30) | | |
| | |discontinue when the client:a. Has not received services |consecutive day period;d. Has refused to schedule an appointment for a required | | |
| | |for one month;b. Has twice refused to schedule an |visit after the client's case has been transferred to a new SEP or county | | |
| | |appointment for an initial assessment, six (6)-month |department;e. Refuses to use the AFC payment to pay for services or uses the | | |
| | |review, or reassessment within a thirty (30) day |payment for services not identified in the service agreement; or,f. Refuses to | | |
| | |consecutive period;c. Has failed to keep three (3) |sign the intake form, care plan, or other documents and forms required to | | |
| | |scheduled appointments within a thirty (30) consecutive day|receive services. | | |
| | |period;d. Has refused to schedule an appointment for a | | | |
| | |required visit after the client's case has been transferred| | | |
| | |to a new SEP or county department;e. Refuses to use the AFC| | | |
| | |payment to pay for services or uses the payment for | | | |
| | |services not identified in the service agreement; or,f. | | | |
| | |Refuses to sign the intake form, care plan, or other | | | |
| | |documents and forms required to receive services. | | | |
|3.588 |Program Deletion|C.5. Facility Status: The SEP or county department shall |C.5. Facility Status: The SEP or county department shall deny or discontinue |Program deletion due to no | No |
| | |deny or discontinue when the client:a. Is a resident of a |when the client:a. Is a resident of a nursing facility, hospital, or other |utilization in the last four years. | |
| | |nursing facility, hospital, or other facility other than |facility other than the approved AFC facility; or,b. Enters a hospital for |No longer included in appropriation | |
| | |the approved AFC facility; or,b. Enters a hospital for |treatment and hospitalization that continues for thirty (30) days or more.6. |by General Assembly. | |
| | |treatment and hospitalization that continues for thirty |Service Limitations Related to Safety: The SEP or county department shall deny | | |
| | |(30) days or more.6. Service Limitations Related to Safety:|or discontinue when the client cannot be safely served given the type and/or | | |
| | |The SEP or county department shall deny or discontinue when|amount of services available. Evidence of safety concerns include, but are not | | |
| | |the client cannot be safely served given the type and/or |limited to:a. The results of an Adult Protective Services assessment that | | |
| | |amount of services available. Evidence of safety concerns |substantiates ongoing risk.b. A statement from the client's physician attesting | | |
| | |include, but are not limited to:a. The results of an Adult |to diminished cognitive capacity, debilitating mental illness, or ongoing | | |
| | |Protective Services assessment that substantiates ongoing |risk.c. Lack of available AFC facilities.d. A functional assessment score | | |
| | |risk.b. A statement from the client's physician attesting |indicating a level of need for services in excess of those available under the | | |
| | |to diminished cognitive capacity, debilitating mental |AFC program.e. Other available information or evidence that will support the | | |
| | |illness, or ongoing risk.c. Lack of available AFC |determination that the client's safety is at risk.7. Service Limitations Related| | |
| | |facilities.d. A functional assessment score indicating a |to Cost Effectiveness: The SEP or county department shall deny or discontinue | | |
| | |level of need for services in excess of those available |when other more cost effective alternatives are available to meet the client's | | |
| | |under the AFC program.e. Other available information or |needs. | | |
| | |evidence that will support the determination that the | | | |
| | |client's safety is at risk.7. Service Limitations Related | | | |
| | |to Cost Effectiveness: The SEP or county department shall | | | |
| | |deny or discontinue when other more cost effective | | | |
| | |alternatives are available to meet the client's needs. | | | |
|3.588 |Program Deletion|C.8. Living Arrangements: The SEP or county department |C.8. Living Arrangements: The SEP or county department shall deny or discontinue|Program deletion due to no | No |
| | |shall deny or discontinue when the client is residing |when the client is residing anywhere other than his/her approved AFC facility.a.|utilization in the last four years. | |
| | |anywhere other than his/her approved AFC facility.a. The |The SEP may continue to authorize services while a resident is on medical or |No longer included in appropriation | |
| | |SEP may continue to authorize services while a resident is |non-medical leave.b. Combined leave shall not exceed a total of forty-two (42) |by General Assembly. | |
| | |on medical or non-medical leave.b. Combined leave shall not|days in a twelve (12) month period beginning with the date the client was | | |
| | |exceed a total of forty-two (42) days in a twelve (12) |admitted into the AFC program.9. Move Out of State: The SEP or county department| | |
| | |month period beginning with the date the client was |shall deny or discontinue when the client has moved out of state.a. | | |
| | |admitted into the AFC program.9. Move Out of State: The SEP|Discontinuation shall be effective the day after the date of the move.b. Clients| | |
| | |or county department shall deny or discontinue when the |who leave the state on a temporary basis with the intent to return to Colorado | | |
| | |client has moved out of state.a. Discontinuation shall be |within thirty (30) calendar days shall not be discontinued. If the client fails | | |
| | |effective the day after the date of the move.b. Clients who|to return to Colorado the client shall be discontinued on day thirty-one | | |
| | |leave the state on a temporary basis with the intent to |(31).10. Voluntary Withdrawal from the Program: The SEP or county shall deny or | | |
| | |return to Colorado within thirty (30) calendar days shall |discontinue when the client requests withdrawal from the AFC program.11. Death: | | |
| | |not be discontinued. If the client fails to return to |The SEP or county shall discontinue the AFC program effective the day after the | | |
| | |Colorado the client shall be discontinued on day thirty-one|client's date of death. No notice of discontinuation shall be sent. | | |
| | |(31).10. Voluntary Withdrawal from the Program: The SEP or | | | |
| | |county shall deny or discontinue when the client requests | | | |
| | |withdrawal from the AFC program.11. Death: The SEP or | | | |
| | |county shall discontinue the AFC program effective the day | | | |
| | |after the client's date of death. No notice of | | | |
| | |discontinuation shall be sent. | | | |
|3.588 |Program Deletion|D. The SEP shall complete the following procedures to |D. The SEP shall complete the following procedures to transfer an AFC client to |Program deletion due to no | No |
| | |transfer an AFC client to a new county department:1. Notify|a new county department:1. Notify the county department of the client's plans to|utilization in the last four years. | |
| | |the county department of the client's plans to relocate to |relocate to another county and the date of transfer.2. If the client's current |No longer included in appropriation | |
| | |another county and the date of transfer.2. If the client's |service providers do not provide services in the area where the client is |by General Assembly. | |
| | |current service providers do not provide services in the |relocating make arrangements, in consultation with the client, for new service | | |
| | |area where the client is relocating make arrangements, in |providers.3. If the client is moving from one county to another county to enter | | |
| | |consultation with the client, for new service providers.3. |a new facility, forward copies of the following client records to the facility | | |
| | |If the client is moving from one county to another county |prior to the client's admission to the facility:a. Current client assessment;b. | | |
| | |to enter a new facility, forward copies of the following |Verification of financial eligibility status. | | |
| | |client records to the facility prior to the client's | | | |
| | |admission to the facility:a. Current client assessment;b. | | | |
| | |Verification of financial eligibility status. | | | |
|3.588 |Program Deletion|E. The SEP shall complete the following procedures to |E. The SEP shall complete the following procedures to transfer an AFC client to |Program deletion due to no | No |
| | |transfer an AFC client to a new SEP:1. The transferring SEP|a new SEP:1. The transferring SEP shall contact the receiving SEP by email or |utilization in the last four years. | |
| | |shall contact the receiving SEP by email or telephone to |telephone to give notification that the client is planning to transfer, to |No longer included in appropriation | |
| | |give notification that the client is planning to transfer, |negotiate a transfer date, and to provide information.2. The transferring SEP |by General Assembly. | |
| | |to negotiate a transfer date, and to provide information.2.|shall forward copies of the client's case records, including forms required for | | |
| | |The transferring SEP shall forward copies of the client's |the AFC program, to the receiving SEP prior to the relocation, if possible, but | | |
| | |case records, including forms required for the AFC program,|in no case later than five (5) working days after the client's relocation.3. If | | |
| | |to the receiving SEP prior to the relocation, if possible, |the client is moving to enter a new Adult Foster Care facility, the transferring| | |
| | |but in no case later than five (5) working days after the |SEP shall forward copies of the following client records to the facility prior | | |
| | |client's relocation.3. If the client is moving to enter a |to the client's admission to the facility:a. Current client assessment;b. | | |
| | |new Adult Foster Care facility, the transferring SEP shall |Verification of financial eligibility status.4. The receiving SEP shall complete| | |
| | |forward copies of the following client records to the |a face-to-face meeting with the client and an assessment and case summary update| | |
| | |facility prior to the client's admission to the facility:a.|within ten (10) working days after notification of the client's relocation.5. | | |
| | |Current client assessment;b. Verification of financial |The receiving SEP shall review the care plan and the assessment tool, revise as | | |
| | |eligibility status.4. The receiving SEP shall complete a |necessary, and coordinate services and providers. | | |
| | |face-to-face meeting with the client and an assessment and | | | |
| | |case summary update within ten (10) working days after | | | |
| | |notification of the client's relocation.5. The receiving | | | |
| | |SEP shall review the care plan and the assessment tool, | | | |
| | |revise as necessary, and coordinate services and providers.| | | |
|3.589 |Program Deletion|A. The AFC facility shall:1. Be licensed by the Colorado |A. The AFC facility shall:1. Be licensed by the Colorado Department of Public |Program deletion due to no | No |
| | |Department of Public Health and Environment (CDPHE) and |Health and Environment (CDPHE) and shall operate in compliance with the rules |utilization in the last four years. | |
| | |shall operate in compliance with the rules concerning |concerning “Standards for Hospitals and Health Facilities: Chapter VII: Assisted|No longer included in appropriation | |
| | |“Standards for Hospitals and Health Facilities: Chapter |Living Residences” (6 C.C.R. 1011-1), including operator and staff |by General Assembly. | |
| | |VII: Assisted Living Residences” (6 C.C.R. 1011-1), |qualifications, training, records, reporting, and resident rights.2. AFC | | |
| | |including operator and staff qualifications, training, |facilities shall provide all AFC services and protective oversight as outlined | | |
| | |records, reporting, and resident rights.2. AFC facilities |in Section 3.582.3. AFC facilities shall coordinate client care with the SEP as | | |
| | |shall provide all AFC services and protective oversight as |follows:a. Have a copy of the AFC's current license from the CDPHE available for| | |
| | |outlined in Section 3.582.3. AFC facilities shall |annual inspection.b. Notify the SEP of any AFC facility license revocation or | | |
| | |coordinate client care with the SEP as follows:a. Have a |suspension or of any violation of codes or ordinances within twenty-four (24) | | |
| | |copy of the AFC's current license from the CDPHE available |hours of occurrence.c. Notify the SEP of a potential crisis situation where | | |
| | |for annual inspection.b. Notify the SEP of any AFC facility|intervention from the SEP may be necessary.d. Notify the SEP of any client's | | |
| | |license revocation or suspension or of any violation of |death, acute illness, or accident requiring medical attention.e. Provide updates| | |
| | |codes or ordinances within twenty-four (24) hours of |or cooperate in periodic conferences relating to the client.f. Immediately | | |
| | |occurrence.c. Notify the SEP of a potential crisis |notify the SEP of any AFC client's planned or unplanned medical or non-medical | | |
| | |situation where intervention from the SEP may be |leave of more than twenty-four (24) hours. | | |
| | |necessary.d. Notify the SEP of any client's death, acute | | | |
| | |illness, or accident requiring medical attention.e. Provide| | | |
| | |updates or cooperate in periodic conferences relating to | | | |
| | |the client.f. Immediately notify the SEP of any AFC | | | |
| | |client's planned or unplanned medical or non-medical leave | | | |
| | |of more than twenty-four (24) hours. | | | |
|3.589 |Program Deletion|B. The county department shall:1. Ensure all requirements |B. The county department shall:1. Ensure all requirements of the county |Program deletion due to no | No |
| | |of the county department are implemented, as appropriate |department are implemented, as appropriate for the AFC program, related to:a. |utilization in the last four years. | |
| | |for the AFC program, related to:a. General county |General county requirements, as outlined in Section 3.520; and,b. Documentation,|No longer included in appropriation | |
| | |requirements, as outlined in Section 3.520; and,b. |as outlined in Section 3.520.2; and,c. Program review and oversight, as outlined|by General Assembly. | |
| | |Documentation, as outlined in Section 3.520.2; and,c. |in Section 3.520.3; and,d. Application processing, as outlined in Section | | |
| | |Program review and oversight, as outlined in Section |3.520.4.2. The county department shall determine financial eligibility for AFC | | |
| | |3.520.3; and,d. Application processing, as outlined in |in the statewide automated system and update any changes in the case record.3. | | |
| | |Section 3.520.4.2. The county department shall determine |The county shall notify the SEP in writing:a. Within five (5) working days of | | |
| | |financial eligibility for AFC in the statewide automated |determining AFC eligibility.b. Within five (5) working days after the | | |
| | |system and update any changes in the case record.3. The |eligibility worker determines that the client is no longer financially eligible | | |
| | |county shall notify the SEP in writing:a. Within five (5) |for AFC.c. Within one (1) working day when the client has filed a written appeal| | |
| | |working days of determining AFC eligibility.b. Within five |with the county department.d. Within one (1) working day when the client has | | |
| | |(5) working days after the eligibility worker determines |withdrawn the appeal or a final agency decision has been entered.4. The county | | |
| | |that the client is no longer financially eligible for |shall respond to requests for information from the SEP within ten (10) working | | |
| | |AFC.c. Within one (1) working day when the client has filed|days. | | |
| | |a written appeal with the county department.d. Within one | | | |
| | |(1) working day when the client has withdrawn the appeal or| | | |
| | |a final agency decision has been entered.4. The county | | | |
| | |shall respond to requests for information from the SEP | | | |
| | |within ten (10) working days. | | | |
|3.589 |Program Deletion|C. The SEP shall:1. Provide intake, screening, and referral|C. The SEP shall:1. Provide intake, screening, and referral activities, as |Program deletion due to no | No |
| | |activities, as follows:a. Determine of the appropriateness |follows:a. Determine of the appropriateness of a referral for a client |utilization in the last four years. | |
| | |of a referral for a client assessment.1) If appropriate, |assessment.1) If appropriate, complete intake activities within two (2) working |No longer included in appropriation | |
| | |complete intake activities within two (2) working days of |days of the referral.2) Obtain the client's or client's authorized |by General Assembly. | |
| | |the referral.2) Obtain the client's or client's authorized |representative's signature on the intake form.3) Complete the AFC functional | | |
| | |representative's signature on the intake form.3) Complete |assessment within thirty (30) calendar days of referral.b. Provide the client | | |
| | |the AFC functional assessment within thirty (30) calendar |information and referral to other agencies, as needed.2. The SEP shall identify | | |
| | |days of referral.b. Provide the client information and |potential payment source(s), including the availability of private funding:a. | | |
| | |referral to other agencies, as needed.2. The SEP shall |Refer the client to the county department to complete an application; or,b. | | |
| | |identify potential payment source(s), including the |Refer the client to another community resource that can assist in completing the| | |
| | |availability of private funding:a. Refer the client to the |application; or,c. Verify the client's ability to private pay for services.3. | | |
| | |county department to complete an application; or,b. Refer |The SEP shall complete a functional assessment when the county department | | |
| | |the client to another community resource that can assist in|provides written notification that the client has requested AFC and is receiving| | |
| | |completing the application; or,c. Verify the client's |or has submitted an application for Old Age Pension (OAP), Aid to the Needy | | |
| | |ability to private pay for services.3. The SEP shall |Disabled Colorado Supplement (AND-CS), or the client is receiving Supplemental | | |
| | |complete a functional assessment when the county department|Security Income (SSI).a. If the client is being discharged from a hospital or | | |
| | |provides written notification that the client has requested|nursing facility, the SEP shall complete the functional assessment regardless of| | |
| | |AFC and is receiving or has submitted an application for |whether the Medicaid application date has been provided by the county | | |
| | |Old Age Pension (OAP), Aid to the Needy Disabled Colorado |department.b. The SEP shall complete the functional assessment within two (2) | | |
| | |Supplement (AND-CS), or the client is receiving |working days after notification when a client is being transferred from a | | |
| | |Supplemental Security Income (SSI).a. If the client is |hospital to the AFC program.c. The SEP shall complete the functional assessment | | |
| | |being discharged from a hospital or nursing facility, the |within five (5) working days after notification when a client who is being | | |
| | |SEP shall complete the functional assessment regardless of |transferred from a nursing facility to the AFC program.d. The SEP shall complete| | |
| | |whether the Medicaid application date has been provided by |the functional assessment within ten (10) working days after notification for | | |
| | |the county department.b. The SEP shall complete the |all other clients. However, the SEP shall have a procedure for prioritizing | | |
| | |functional assessment within two (2) working days after |urgent referrals. | | |
| | |notification when a client is being transferred from a | | | |
| | |hospital to the AFC program.c. The SEP shall complete the | | | |
| | |functional assessment within five (5) working days after | | | |
| | |notification when a client who is being transferred from a | | | |
| | |nursing facility to the AFC program.d. The SEP shall | | | |
| | |complete the functional assessment within ten (10) working | | | |
| | |days after notification for all other clients. However, the| | | |
| | |SEP shall have a procedure for prioritizing urgent | | | |
| | |referrals. | | | |
|3.589 |Program Deletion|C.4. The SEP shall document all case information.a. |C.4. The SEP shall document all case information.a. Documentation of contacts |Program deletion due to no | No |
| | |Documentation of contacts and case management activities |and case management activities shall be entered into the BUS within five (5) |utilization in the last four years. | |
| | |shall be entered into the BUS within five (5) working days |working days of the contact or activity.b. All information related to intake, |No longer included in appropriation | |
| | |of the contact or activity.b. All information related to |assessment, and care planning shall be thoroughly documented within ten (10) |by General Assembly. | |
| | |intake, assessment, and care planning shall be thoroughly |working days of the intake, assessment or care planning using State Department | | |
| | |documented within ten (10) working days of the intake, |prescribed forms and the BUS.c. Additional documentation that cannot be entered | | |
| | |assessment or care planning using State Department |into the BUS shall be maintained in the case file.5. The SEP shall notify | | |
| | |prescribed forms and the BUS.c. Additional documentation |clients of their program status using the State Department prescribed form at | | |
| | |that cannot be entered into the BUS shall be maintained in |the time of initial eligibility, when there is a significant change in the | | |
| | |the case file.5. The SEP shall notify clients of their |client's payment or services, when an adverse action is taken, or at the time of| | |
| | |program status using the State Department prescribed form |discontinuation.6. The SEP shall notify the county department in writing:a. | | |
| | |at the time of initial eligibility, when there is a |Within five (5) working days of determining AFC functional eligibility.b. Within| | |
| | |significant change in the client's payment or services, |five (5) working days after the SEP determines that the client is no longer | | |
| | |when an adverse action is taken, or at the time of |functionally eligible for AFC.c. Within one (1) working day when the client has | | |
| | |discontinuation.6. The SEP shall notify the county |filed a written appeal with the SEP.d. Within one (1) working day when the | | |
| | |department in writing:a. Within five (5) working days of |client has withdrawn the appeal or a final agency decision has been entered.7. | | |
| | |determining AFC functional eligibility.b. Within five (5) |The SEP shall respond to requests for information from the county department | | |
| | |working days after the SEP determines that the client is no|within ten (10) working days.8. The SEP shall notify the client, at the time of | | |
| | |longer functionally eligible for AFC.c. Within one (1) |his or her application and at the time of reassessment or discontinuation of the| | |
| | |working day when the client has filed a written appeal with|right to request a fair hearing before an Administrative Law Judge in accordance| | |
| | |the SEP.d. Within one (1) working day when the client has |with Section 3.850, and to appeal adverse actions of the SEP or county | | |
| | |withdrawn the appeal or a final agency decision has been |department. | | |
| | |entered.7. The SEP shall respond to requests for | | | |
| | |information from the county department within ten (10) | | | |
| | |working days.8. The SEP shall notify the client, at the | | | |
| | |time of his or her application and at the time of | | | |
| | |reassessment or discontinuation of the right to request a | | | |
| | |fair hearing before an Administrative Law Judge in | | | |
| | |accordance with Section 3.850, and to appeal adverse | | | |
| | |actions of the SEP or county department. | | | |
|3.589 |Program Deletion|C.9. The SEP shall inform the client's Adult Protective |C.9. The SEP shall inform the client's Adult Protective Services caseworker, if |Program deletion due to no | No |
| | |Services caseworker, if applicable, of the client's status.|applicable, of the client's status. The case manager shall participate in mutual|utilization in the last four years. | |
| | |The case manager shall participate in mutual staffing of |staffing of the client's case.10. The SEP shall report to the Colorado |No longer included in appropriation | |
| | |the client's case.10. The SEP shall report to the Colorado |Department of Public Health and Environment any congregate facility, with three |by General Assembly. | |
| | |Department of Public Health and Environment any congregate |(3) or more residents, that is not licensed.11. The SEP shall immediately report| | |
| | |facility, with three (3) or more residents, that is not |to the county department any information that indicates an overpayment, | | |
| | |licensed.11. The SEP shall immediately report to the county|incorrect payment, or misuse of any AFC benefit, and shall cooperate with the | | |
| | |department any information that indicates an overpayment, |county department in any subsequent recovery process.12. The SEP shall be | | |
| | |incorrect payment, or misuse of any AFC benefit, and shall |subject to routine quality control, program monitoring, and contract management | | |
| | |cooperate with the county department in any subsequent |to minimally include:a. Targeted review of the BUS documentation;b. Case file | | |
| | |recovery process.12. The SEP shall be subject to routine |review;c. Targeted program review conducted via phone, email, or survey; and,d. | | |
| | |quality control, program monitoring, and contract |Onsite program review;e. A performance improvement plan to correct areas of | | |
| | |management to minimally include:a. Targeted review of the |identified non-compliance; and,f. Contract sanctions when the SEP fails to | | |
| | |BUS documentation;b. Case file review;c. Targeted program |implement a performance improvement plan. | | |
| | |review conducted via phone, email, or survey; and,d. Onsite| | | |
| | |program review;e. A performance improvement plan to correct| | | |
| | |areas of identified non-compliance; and,f. Contract | | | |
| | |sanctions when the SEP fails to implement a performance | | | |
| | |improvement plan. | | | |
|3.591 |Rule Reordering |Burial benefits are available to eligible clients to cover |Burial benefits are available to eligible clients to cover reasonable and |Struck through as Burial Section | No |
| | |reasonable and necessary costs for burial services. |necessary costs for burial services. |moved to 3.570.4 | |
|3.592 |Rule Reordering |“Burial benefit” means the State Department program to pay |“Burial benefit” means the State Department program to pay all or a portion of |Struck through as Burial Section | No |
| | |all or a portion of the cost of funeral, burial, or |the cost of funeral, burial, or cremation services for certain deceased clients.|moved to 3.570.4 | |
| | |cremation services for certain deceased clients. | | | |
|3.592 |Rule Reordering |“Burial funds” means the funds authorized by the county |“Burial funds” means the funds authorized by the county department under the |Struck through as Burial Section | No |
| | |department under the burial benefit. |burial benefit. |moved to 3.570.4 | |
|3.592 |Rule Reordering |“Burial plot” means the client's final resting place, |“Burial plot” means the client's final resting place, whether a cemetery plot, |Struck through as Burial Section | No |
| | |whether a cemetery plot, vault, or crematorium. |vault, or crematorium. |moved to 3.570.4 | |
|3.592 |Rule Reordering |“Burial services” means those services provided as part of |“Burial services” means those services provided as part of funeral, burial, or |Struck through as Burial Section | No |
| | |funeral, burial, or cremation services, including:A. |cremation services, including:A. Transportation of the body from the place of |moved to 3.570.4 | |
| | |Transportation of the body from the place of death to a |death to a funeral home or other storage facility, and/or from the funeral home | | |
| | |funeral home or other storage facility, and/or from the |to the funeral/memorial site, and/or to the burial plot;B. Storage of the body | | |
| | |funeral home to the funeral/memorial site, and/or to the |prior to final disposition and/or storage of the cremated remains for no more | | |
| | |burial plot;B. Storage of the body prior to final |than one hundred twenty (120) days, in those cases where the remains are not | | |
| | |disposition and/or storage of the cremated remains for no |buried and are not claimed by the client's family or friends;C. Embalming, where| | |
| | |more than one hundred twenty (120) days, in those cases |necessary for preservation of the body and/or preparation of the body for the | | |
| | |where the remains are not buried and are not claimed by the|casket or for cremation;D. Purchase of a casket or of an urn or other receptacle| | |
| | |client's family or friends;C. Embalming, where necessary |for the cremated remains;E. Purchase of a gravesite, vault, vault liner, or | | |
| | |for preservation of the body and/or preparation of the body|crematorium space;F. Purchase and placement of the grave marker and/or of | | |
| | |for the casket or for cremation;D. Purchase of a casket or |perpetual care of the gravesite, vault, or crematorium;G. Funeral or memorial | | |
| | |of an urn or other receptacle for the cremated remains;E. |service;H. Cremation of the body;I. Burial or internment of the body or cremated| | |
| | |Purchase of a gravesite, vault, vault liner, or crematorium|remains in a burial plot, vault, or crematorium;J. Any other items that are | | |
| | |space;F. Purchase and placement of the grave marker and/or |incidental to burial services. | | |
| | |of perpetual care of the gravesite, vault, or | | | |
| | |crematorium;G. Funeral or memorial service;H. Cremation of | | | |
| | |the body;I. Burial or internment of the body or cremated | | | |
| | |remains in a burial plot, vault, or crematorium;J. Any | | | |
| | |other items that are incidental to burial services. | | | |
|3.592 |Rule Reordering |“Contributions” means any monetary payment or donation made|“Contributions” means any monetary payment or donation made directly to the |Struck through as Burial Section | No |
| | |directly to the service provider(s) by a non-responsible |service provider(s) by a non-responsible person to defray the expenses of the |moved to 3.570.4 | |
| | |person to defray the expenses of the client's burial |client's burial services. | | |
| | |services. | | | |
|3.592 |Rule Reordering |“Legally responsible person(s)” means the parent(s) of a |“Legally responsible person(s)” means the parent(s) of a deceased minor client |Struck through as Burial Section | No |
| | |deceased minor client or the spouse of the deceased client.|or the spouse of the deceased client. |moved to 3.570.4 | |
|3.593 |Rule Reordering |A. A burial benefit shall be available to cover reasonable |A. A burial benefit shall be available to cover reasonable and necessary costs |Struck through as Burial Section | No |
| | |and necessary costs for burial services when:1. A deceased |for burial services when:1. A deceased client was receiving Old Age Pension |moved to 3.570.4 | |
| | |client was receiving Old Age Pension (OAP), Aid to the |(OAP), Aid to the Needy Disabled (AND-SO or AND-CS), and/or eligible Colorado | | |
| | |Needy Disabled (AND-SO or AND-CS), and/or eligible Colorado|Medicaid assistance at the time of death; and,2. The deceased client's estate is| | |
| | |Medicaid assistance at the time of death; and,2. The |insufficient to pay all or part of the burial services; and,3. The resources of | | |
| | |deceased client's estate is insufficient to pay all or part|the legally responsible person(s) for the support of the deceased client are | | |
| | |of the burial services; and,3. The resources of the legally|insufficient, even with contributions from the client's estate, to enable the | | |
| | |responsible person(s) for the support of the deceased |legally responsible person(s) to pay all or part of such expenses; and,4. The | | |
| | |client are insufficient, even with contributions from the |total cost for all burial services does not total more than two thousand five | | |
| | |client's estate, to enable the legally responsible |hundred dollars ($2,500), except that the cost of a burial plot shall not be | | |
| | |person(s) to pay all or part of such expenses; and,4. The |included in the $2,500 maximum cost limit when:a. The client has a prepaid | | |
| | |total cost for all burial services does not total more than|burial plot valued at two thousand dollars ($2,000) or less at the time of | | |
| | |two thousand five hundred dollars ($2,500), except that the|purchase; or,b. A burial plot was purchased by someone other than the deceased | | |
| | |cost of a burial plot shall not be included in the $2,500 |client and donated to the deceased client; and, | | |
| | |maximum cost limit when:a. The client has a prepaid burial | | | |
| | |plot valued at two thousand dollars ($2,000) or less at the| | | |
| | |time of purchase; or,b. A burial plot was purchased by | | | |
| | |someone other than the deceased client and donated to the | | | |
| | |deceased client; and, | | | |
|3.593 |Rule Reordering |B. The total burial benefit shall not exceed the current |B. The total burial benefit shall not exceed the current burial benefit rate, as|Struck through as Burial Section | No |
| | |burial benefit rate, as determined by the program of |determined by the program of assistance the client was receiving at the time of |moved to 3.570.4 | |
| | |assistance the client was receiving at the time of death.1.|death.1. Effective January 1, 2014, the burial benefit shall not exceed one | | |
| | |Effective January 1, 2014, the burial benefit shall not |thousand five hundred dollars ($1,500) for clients who were receiving Old Age | | |
| | |exceed one thousand five hundred dollars ($1,500) for |Pension (OAP), Colorado Medicaid programs for persons sixty (60) years of age | | |
| | |clients who were receiving Old Age Pension (OAP), Colorado |and older, or Colorado Medicaid for families and children, including an adult | | |
| | |Medicaid programs for persons sixty (60) years of age and |who meets the modified adjusted gross income (MAGI) criterion as defined in the | | |
| | |older, or Colorado Medicaid for families and children, |Department of Health Care Policy and Financing regulations 10 C.C.R. 2505-10 | | |
| | |including an adult who meets the modified adjusted gross |Section 8.100.4, at the time of death.2. Effective January 1, 2014, the burial | | |
| | |income (MAGI) criterion as defined in the Department of |benefit shall not exceed one thousand dollars ($1,000) for clients who were | | |
| | |Health Care Policy and Financing regulations 10 C.C.R. |receiving Aid to the Needy Disabled – State Only (AND-SO), Aid to the Needy | | |
| | |2505-10 Section 8.100.4, at the time of death.2. Effective |Disabled – Colorado Supplement (AND-CS), or any other Colorado Medicaid program | | |
| | |January 1, 2014, the burial benefit shall not exceed one |for clients under sixty (60) years of age at the time of death.3. The | | |
| | |thousand dollars ($1,000) for clients who were receiving |reimbursement rate shall be adjusted by the State Department as needed to stay | | |
| | |Aid to the Needy Disabled – State Only (AND-SO), Aid to the|within the available appropriations. There shall be no appeal granted for this | | |
| | |Needy Disabled – Colorado Supplement (AND-CS), or any other|adjustment. | | |
| | |Colorado Medicaid program for clients under sixty (60) | | | |
| | |years of age at the time of death.3. The reimbursement rate| | | |
| | |shall be adjusted by the State Department as needed to stay| | | |
| | |within the available appropriations. There shall be no | | | |
| | |appeal granted for this adjustment. | | | |
|3.593 |Rule Reordering |C. When assistance for funeral, burial, or cremation |C. When assistance for funeral, burial, or cremation services is requested |Struck through as Burial Section | No |
| | |services is requested within one (1) year from the date of |within one (1) year from the date of death on behalf of a deceased recipient of |moved to 3.570.4 | |
| | |death on behalf of a deceased recipient of public or |public or medical assistance by any interested party; an application requesting | | |
| | |medical assistance by any interested party; an application |a burial benefit shall be completed and submitted to the county department for | | |
| | |requesting a burial benefit shall be completed and |eligibility determination. The client's family or friends, or the county | | |
| | |submitted to the county department for eligibility |department when there are no known family or friends, shall make arrangements | | |
| | |determination. The client's family or friends, or the |for disposition of the client's body in a reasonable, dignified manner which | | |
| | |county department when there are no known family or |approximates the wishes and the religious and cultural preferences of the client| | |
| | |friends, shall make arrangements for disposition of the |or family, to the extent possible within the burial benefit rules and benefit | | |
| | |client's body in a reasonable, dignified manner which |funds.1. The county department shall ensure that a choice of disposition by the | | |
| | |approximates the wishes and the religious and cultural |client or a family member is made in writing. The choice of disposition may be | | |
| | |preferences of the client or family, to the extent possible|made on the client's most recent application for benefits, in the client's will,| | |
| | |within the burial benefit rules and benefit funds.1. The |on the application for burial benefits, or by any other document which the | | |
| | |county department shall ensure that a choice of disposition|county department deems credible.2. The county department shall coordinate with | | |
| | |by the client or a family member is made in writing. The |the client's family or interested parties to explain the burial benefit rules, | | |
| | |choice of disposition may be made on the client's most |including:a. Options in the event the client's or family's burial preferences | | |
| | |recent application for benefits, in the client's will, on |cannot be met within the limitations of the burial rules or benefit maximum; | | |
| | |the application for burial benefits, or by any other |and,b. If the family's burial preference is in opposition to the client's | | |
| | |document which the county department deems credible.2. The |preference, as noted on the client's most recent application for benefits or | | |
| | |county department shall coordinate with the client's family|other documentation, the burial benefit shall be used to meet the client's | | |
| | |or interested parties to explain the burial benefit rules, |preference, unless all options for meeting that preference have been exhausted | | |
| | |including:a. Options in the event the client's or family's |within the limitations of the burial benefit; and,c. The legally responsible | | |
| | |burial preferences cannot be met within the limitations of |person's responsibility to pay the cost of burial services that exceed the | | |
| | |the burial rules or benefit maximum; and,b. If the family's|approved burial benefit; and,d. That voluntary contributions from family, | | |
| | |burial preference is in opposition to the client's |friends, or other interested parties, may be used to cover some or all of the | | |
| | |preference, as noted on the client's most recent |legally responsible person's costs that exceed the approved burial benefit.3. | | |
| | |application for benefits or other documentation, the burial|The county department shall use the following procedures when the deceased | | |
| | |benefit shall be used to meet the client's preference, |client's burial preferences are unknown and a family member cannot be located:a.| | |
| | |unless all options for meeting that preference have been |If a family member has not been located within twenty-four hours after the | | |
| | |exhausted within the limitations of the burial benefit; |client dies, the county department shall have the body refrigerated or | | |
| | |and,c. The legally responsible person's responsibility to |embalmed.b. If a family member has not been located within seven (7) days, the | | |
| | |pay the cost of burial services that exceed the approved |county department shall make the determination to bury or cremate the body based| | |
| | |burial benefit; and,d. That voluntary contributions from |on the best option available.c. Complete and send written authorization to the | | |
| | |family, friends, or other interested parties, may be used |appropriate funeral home or crematorium. | | |
| | |to cover some or all of the legally responsible person's | | | |
| | |costs that exceed the approved burial benefit.3. The county| | | |
| | |department shall use the following procedures when the | | | |
| | |deceased client's burial preferences are unknown and a | | | |
| | |family member cannot be located:a. If a family member has | | | |
| | |not been located within twenty-four hours after the client | | | |
| | |dies, the county department shall have the body | | | |
| | |refrigerated or embalmed.b. If a family member has not been| | | |
| | |located within seven (7) days, the county department shall | | | |
| | |make the determination to bury or cremate the body based on| | | |
| | |the best option available.c. Complete and send written | | | |
| | |authorization to the appropriate funeral home or | | | |
| | |crematorium. | | | |
|3.593 |Rule Reordering |D. The county department shall reduce the burial benefit by|D. The county department shall reduce the burial benefit by applying the |Struck through as Burial Section | No |
| | |applying the following monies toward the full burial costs |following monies toward the full burial costs in the order listed:1. First, |moved to 3.570.4 | |
| | |in the order listed:1. First, subtract monies due from any |subtract monies due from any insurance policy of the deceased client to a | | |
| | |insurance policy of the deceased client to a legally |legally responsible person or non-responsible person who is named as beneficiary| | |
| | |responsible person or non-responsible person who is named |or a joint beneficiary; then if costs remain,2. Subtract the value of the | | |
| | |as beneficiary or a joint beneficiary; then if costs |deceased client's estate as of the date of death, including any cash or property| | |
| | |remain,2. Subtract the value of the deceased client's |of any kind which the deceased client owned at the time of death; then if costs | | |
| | |estate as of the date of death, including any cash or |remain,3. Subtract monies from the legally responsible person(s) for the client,| | |
| | |property of any kind which the deceased client owned at the|as follows:a. Social Security lump sum death benefits payable to a legally | | |
| | |time of death; then if costs remain,3. Subtract monies from|responsible person shall be exempt.b. If the legally responsible person(s) has | | |
| | |the legally responsible person(s) for the client, as |resources below the SSI resource limit of $2,000 for an individual or $3,000 for| | |
| | |follows:a. Social Security lump sum death benefits payable |a couple.1) If the legally responsible person is the widow(er), the individual | | |
| | |to a legally responsible person shall be exempt.b. If the |resource limit shall apply.2) The legally responsible person(s) may voluntarily | | |
| | |legally responsible person(s) has resources below the SSI |contribute monies toward the cost of the burial services.c. If the legally | | |
| | |resource limit of $2,000 for an individual or $3,000 for a |responsible person(s) has resources over the SSI limit, the amount of resources | | |
| | |couple.1) If the legally responsible person is the |over the limit shall be used to reduce the burial benefit; then if costs | | |
| | |widow(er), the individual resource limit shall apply.2) The|remain,4. The county department shall issue a written authorization for the | | |
| | |legally responsible person(s) may voluntarily contribute |amount of the burial benefit, up to the benefit limit, as outlined in Section | | |
| | |monies toward the cost of the burial services.c. If the |3.590. | | |
| | |legally responsible person(s) has resources over the SSI | | | |
| | |limit, the amount of resources over the limit shall be used| | | |
| | |to reduce the burial benefit; then if costs remain,4. The | | | |
| | |county department shall issue a written authorization for | | | |
| | |the amount of the burial benefit, up to the benefit limit, | | | |
| | |as outlined in Section 3.590. | | | |
|3.593 |Rule Reordering |E. Once the application and choice of burial services is |E. Once the application and choice of burial services is determined, the family |Struck through as Burial Section | No |
| | |determined, the family or county department shall contact |or county department shall contact the appropriate provider(s) to obtain a |moved to 3.570.4 | |
| | |the appropriate provider(s) to obtain a written estimate of|written estimate of the provider's proposed charges for burial services. If more| | |
| | |the provider's proposed charges for burial services. If |than one provider is involved, a separate written estimate from each provider | | |
| | |more than one provider is involved, a separate written |shall be obtained. | | |
| | |estimate from each provider shall be obtained. | | | |
|3.593 |Rule Reordering |F. Once the proposal(s) from the provider(s) is received, |F. Once the proposal(s) from the provider(s) is received, the county department |Struck through as Burial Section | No |
| | |the county department shall determine if a burial benefit |shall determine if a burial benefit is appropriate, as outlined in Section |moved to 3.570.4 | |
| | |is appropriate, as outlined in Section 3.590.1. If the |3.590.1. If the combined charges from the provider(s) exceed two thousand five | | |
| | |combined charges from the provider(s) exceed two thousand |hundred dollars ($2,500), no burial benefit shall be paid.2. The county | | |
| | |five hundred dollars ($2,500), no burial benefit shall be |department shall allow the provider(s) to resubmit a written estimate within | | |
| | |paid.2. The county department shall allow the provider(s) |thirty (30) calendar days of notification that the charges exceeded the burial | | |
| | |to resubmit a written estimate within thirty (30) calendar |benefit maximum. | | |
| | |days of notification that the charges exceeded the burial | | | |
| | |benefit maximum. | | | |
|3.593 |Rule Reordering |G. The county department of residence of the deceased |G. The county department of residence of the deceased individual shall authorize|Struck through as Burial Section | No |
| | |individual shall authorize the approved burial benefit |the approved burial benefit through the statewide automated system. The burial |moved to 3.570.4 | |
| | |through the statewide automated system. The burial benefit |benefit shall be paid directly to the provider(s). | | |
| | |shall be paid directly to the provider(s). | | | |
|3.593 |Rule Reordering |H. The county department shall have a statement of |H. The county department shall have a statement of agreement between the |Struck through as Burial Section | No |
| | |agreement between the providers, which ensures that the |providers, which ensures that the distribution of burial benefits is |moved to 3.570.4 | |
| | |distribution of burial benefits is proportional to burial |proportional to burial services provided or as the providers otherwise | | |
| | |services provided or as the providers otherwise determine. |determine. The agreement shall be signed by all provider(s) and shall be | | |
| | |The agreement shall be signed by all provider(s) and shall |approved and signed by the county department before the burial benefit is | | |
| | |be approved and signed by the county department before the |authorized in the statewide automated system. | | |
| | |burial benefit is authorized in the statewide automated | | | |
| | |system. | | | |
|3.580 |New Section |NEW RULE |PAYMENTS, OVERPAYMENTS, INTENTIONAL PROGRAM VIOLATIONS, FRAUDULENT ACTS, |Striking all of C.C.R. 2503-8 and | No |
| | | |RECOVERY, DISPUTE RESOLUTION, APPEAL, AND STATE LEVEL FAIR HEARING |moving into C.C.R. 2503-5. | |
|3.581 |New Section | |A. A CLIENT SHALL BE PLACED ON AN ISSUANCE SCHEDULE SO THAT HE OR SHE RECEIVES |Striking all of C.C.R. 2503-8 and | No |
| | | |GRANT PAYMENTS ON OR ABOUT THE SAME DATE EACH MONTH ONCE A CERTIFICATION PERIOD |moving into C.C.R. 2503-5. | |
| | | |IS ESTABLISHED. DUE TO THE EFFECTIVE DATE OF ELIGIBILITY, THE DATE ON WHICH A | | |
| | | |CLIENT RECEIVES HIS OR HER INITIAL PAYMENT NEED NOT BE THE DATE THAT THE CLIENT | | |
| | | |MUST RECEIVE ANY SUBSEQUENT PAYMENTS. | | |
|3.581 |New Section | |B. WHEN THE COUNTY DEPARTMENT DETERMINES THAT A CLIENT WAS INELIGIBLE FOR ALL OR|Striking all of C.C.R. 2503-8 and | No |
| | | |A PART OF A GRANT PAYMENT THAT THE CLIENT HAS ALREADY RECEIVED, THE COUNTY |moving into C.C.R. 2503-5. | |
| | | |DEPARTMENT SHALL, SUBJECT TO TIMELY NOTICE AND RECOVERY RULES, ESTABLISH A | | |
| | | |CLAIM, AND IF VALID, INITIATE A RECOVERY. | | |
|3.581 |New Section | |C. IF A CLIENT DIES, PAYMENTS TO THE CLIENT SHALL BE TREATED AS FOLLOWS: |Striking all of C.C.R. 2503-8 and | No |
| | | |1. A CLIENT’S ELIGIBILITY SHALL END ON THE DATE OF HIS OR HER DEATH. |moving into C.C.R. 2503-5. | |
| | | |2. IF A CLIENT OF ANY CATEGORY OF ASSISTANCE DIES BEFORE 12:00 A.M. ON THE FIRST| | |
| | | |DAY OF A MONTH, NO ELIGIBILITY FOR A GRANT PAYMENT FOR THE FOLLOWING MONTH | | |
| | | |EXISTS. | | |
| | | |3. IF A CLIENT OF ANY CATEGORY OF ASSISTANCE DIES ON OR AFTER 12:00 A.M. ON THE | | |
| | | |FIRST DAY OF A MONTH, ANY PAYMENT TO WHICH THE PERSON WAS ELIGIBLE SHALL BE | | |
| | | |MAINTAINED FOR RELEASE TO THE CLIENT'S PERSONAL REPRESENTATIVE AS DEFINED IN | | |
| | | |SECTION 15-10-201(39), C.R.S., FOR A MAXIMUM OF THREE (3) MONTHS. THE FOLLOWING | | |
| | | |RULES APPLY WHEN A PERSONAL REPRESENTATIVE REQUESTS TO RECEIVE A DECEASED | | |
| | | |CLIENT’S LAST GRANT PAYMENT: | | |
| | | |A. THE INDIVIDUAL CLAIMING TO BE THE PERSONAL REPRESENTATIVE OF THE DECEASED | | |
| | | |CLIENT MUST PROVIDE THE COURT-ISSUED LETTERS DESCRIBED IN SECTION 15-12-103, | | |
| | | |C.R.S. TO THE COUNTY DEPARTMENT IN ORDER TO RECEIVE THE DECEASED CLIENT’S LAST | | |
| | | |GRANT PAYMENT; OR | | |
| | | |B. IF THE PERSONAL REPRESENTATIVE PRESENTS A COURT ORDER ORDERING THE COUNTY | | |
| | | |DEPARTMENT TO PAY THE DECEASED CLIENT’S LAST GRANT PAYMENT TO A SPECIFIC PERSON | | |
| | | |OR ENTITY, THE COUNTY DEPARTMENT SHALL MAKE THE LAST GRANT PAYMENT PAYABLE TO | | |
| | | |THE PERSON NAMED IN THE ORDER. | | |
|3.581 |New Section | |D. TO CALCULATE PARTIAL MONTH PAYMENTS: |Striking all of C.C.R. 2503-8 and | No |
| | | |1. DETERMINE THE CLIENT’S MONTHLY GRANT PAYMENT AMOUNT FOR THE PROGRAM ACCORDING|moving into C.C.R. 2503-5. | |
| | | |TO PROGRAM RULES at 3.520.78, 3.533, 3.544, AND 3.549; | | |
| | | |2. DETERMINE THE NUMBER OF DAYS FOR WHICH THE CLIENT IS ELIGIBLE FOR ASSISTANCE | | |
| | | |AND, BASED ON THE TABLE IN SUBSECTION 4 BELOW, FIND THE DECIMAL FIGURE | | |
| | | |CORRESPONDING TO THE NUMBER OF DAYS OF ELIGIBILITY; | | |
| | | |3. MULTIPLY THE CLIENT’S MONTHLY GRANT PAYMENT AMOUNT FROM SUBSECTION 1 BY THE | | |
| | | |DECIMAL FIGURE IN THE TABLE IN SUBSECTION 4 TO DETERMINE THE GRANT PAYMENT | | |
| | | |AMOUNT FOR THE PARTIAL MONTH; | | |
| | | |4. TO CALCULATE THE PARTIAL MONTH PAYMENTS, THE FOLLOWING TABLE SHALL BE USED: | | |
| | | |DAYS STANDARD DAYS STANDARD DAYS STANDARD | | |
| | | |1 .03288 11 .36164 21 .69041 | | |
| | | |2 .06575 12 .39452 22 .72329 | | |
| | | |3 .09863 13 .42739 23 .75617 | | |
| | | |4 .13151 14 .46027 24 .78904 | | |
| | | |5 .16439 15 .49315 25 .82192 | | |
| | | |6 .19726 16 .52603 26 .85480 | | |
| | | |7 .23014 17 .55890 27 .88768 | | |
| | | |8 .26302 18 .59178 28 .92054 | | |
| | | |9 .29590 19 .62466 29 .95342 | | |
| | | |10 .32876 20 .65754 30 .98630 | | |
|3.581 |New Section | |E. ALL PAYMENTS, INCLUDING PARTIAL PAYMENTS, SHALL HAVE ANY CENTS DROPPED TO THE|Striking all of C.C.R. 2503-8 and | No |
| | | |NEAREST DOLLAR, EXCEPT IN CASES WHERE SSI INCOME REDUCES THE GRANT. |moving into C.C.R. 2503-5. | |
|3.581 |New Section | |F. COUNTY DEPARTMENTS SHALL NOT HOLD OR DELAY THE CLIENT’S GRANT PAYMENT BEYOND |Striking all of C.C.R. 2503-8 and | No |
| | | |THE REGULAR ISSUANCE DATE EXCEPT WHEN: |moving into C.C.R. 2503-5. | |
| | | |1. A FINAL AGENCY DECISION HAS BEEN MADE AUTHORIZING THE ACTION. | | |
| | | |2. IN CASES WHERE A CORRECTED PAYMENT IS TO BE ISSUED, THE CORRECTED PAYMENT | | |
| | | |SHALL BE ISSUED BY THE EFFECTIVE DATE OF THE ORIGINAL WARRANT AND THE INCORRECT | | |
| | | |PAYMENT SHALL BE CANCELLED. | | |
| | | |3. WHEN THE COUNTY DEPARTMENT RECEIVES RELIABLE INFORMATION THAT THE CLIENT NO | | |
| | | |LONGER RESIDES AT THE LAST KNOWN ADDRESS AND ATTEMPTS TO LOCATE THE PERSON | | |
| | | |THROUGH THE POST OFFICE, RELATIVES, FRIENDS, ETC., HAVE BEEN UNSUCCESSFUL, THE | | |
| | | |CASE SHALL BE DISCONTINUED FOLLOWING THE POLICIES OUTLINED IN SECTION 3.554. IF | | |
| | | |THE CLIENT CONTACTS THE COUNTY DEPARTMENT BEFORE GRANT PAYMENTS ARE DISCONTINUED| | |
| | | |AND PROVIDES THE CURRENT ADDRESS AND ALL OTHER ELIGIBILITY CRITERION HAVE BEEN | | |
| | | |MET, THE CLIENT SHALL RECEIVE THE GRANT PAYMENTS THEY ARE ELIGIBLE FOR; | | |
| | | |4. ANY GRANT PAYMENTS ISSUED TO AN ELECTRONIC BENEFIT TRANSFER (EBT) CARD AND | | |
| | | |NOT ACCESSED WITHIN THREE HUNDRED SIXTY-FIVE (365) DAYS OF ISSUANCE, SHALL BE | | |
| | | |EXPUNGED. THE COUNTY SHALL REISSUE GRANT PAYMENTS WITHIN 90 DAYS OF THE | | |
| | | |EXPUNGEMENT IF REQUESTED BY THE CLIENT VERBALLY, ELECTRONICALLY, IN PERSON, OR | | |
| | | |IN WRITING. THE COUNTY MAY REISSUE UP TO TWELVE (12) MONTHS OF EXPUNGED GRANT | | |
| | | |PAYMENTS. | | |
|3.581 |New Section | |G. THE COUNTY DEPARTMENT SHALL TAKE PROMPT ACTION TO CORRECT UNDERPAYMENTS TO |Striking all of C.C.R. 2503-8 and | No |
| | | |CLIENTS OF ADULT FINANCIAL GRANT PAYMENTS. THERE ARE TWO TYPES OF UNDERPAYMENTS:|moving into C.C.R. 2503-5. | |
| | | |1) GRANT PAYMENT(S) RECEIVED BY OR FOR A CLIENT THAT IS LESS THAN THE AMOUNT | | |
| | | |WHICH THE CLIENT SHOULD HAVE RECEIVED, BUT NOT A DENIAL OR TERMINATION, OR 2) | | |
| | | |THE FAILURE OF THE COUNTY DEPARTMENT TO ISSUE A GRANT PAYMENT TO A CLIENT WHEN | | |
| | | |SUCH PAYMENT SHOULD HAVE BEEN ISSUED (I.E., DENIALS OR TERMINATION OF ADULT | | |
| | | |FINANCIAL GRANT PAYMENTS). | | |
| | | |1. WHEN THE COUNTY DEPARTMENT BECOMES AWARE OF A POTENTIAL UNDERPAYMENT, THE | | |
| | | |COUNTY DEPARTMENT SHALL: | | |
| | | |A. DETERMINE IF AN UNDERPAYMENT OCCURRED; AND, | | |
| | | |B. RECORD THE FACTS AND BASIS OF ITS DETERMINATION IN THE CASE RECORD. | | |
| | | |2. A COUNTY SHALL CORRECT ANY UNDERPAYMENTS BY THE MONTH FOLLOWING THE DISCOVERY| | |
| | | |OF SUCH UNDERPAYMENTS. | | |
| | | |3. UNDERPAYMENTS SHALL BE USED TO PAY ANY VALIDATED CLAIMS AGAINST THE CLIENT | | |
| | | |UNLESS THE COUNTY DEPARTMENT HAS DETERMINED THIS ACTION WILL CAUSE AN UNDUE | | |
| | | |HARDSHIP TO THE CLIENT AS DETERMINED ON A CASE-BY-CASE BASIS. UNDERPAYMENTS WILL| | |
| | | |BE APPLIED TO CLAIMS USING THE FOLLOWING HIERARCHY: | | |
| | | |A. FRAUD OR IPV CLAIMS FIRST (UNDUE HARDSHIP CANNOT BE GRANTED); | | |
| | | |B. CLIENT ERROR CLAIMS SECOND; AND | | |
| | | |C. ADMINISTRATIVE ERROR CLAIMS LAST. INSTANCES THAT MAY RESULT IN AN | | |
| | | |ADMINISTRATIVE ERROR CLAIM INCLUDE, BUT ARE NOT LIMITED TO, THE FOLLOWING: | | |
| | | |1. THE COUNTY FAILED TO TAKE TIMELY ACTION ON A CHANGE REPORTED BY THE CLIENT. | | |
| | | |2. THE COUNTY INCORRECTLY COMPUTED THE CLIENT’S INCOME, RESOURCES, OR OTHER | | |
| | | |INFORMATION, OR OTHERWISE GAVE AN INCORRECT GRANT PAYMENT. | | |
| | | |3. ANY OTHER SITUATION NOT CAUSED BY WILLFUL WITHHOLDING OF INFORMATION ON THE | | |
| | | |PART OF THE CLIENT AND/OR THEIR AUTHORIZED REPRESENTATIVE. | | |
| | | |4. IF AN UNDERPAYMENT IS DISCOVERED BY THE COUNTY DEPARTMENT, THE COUNTY | | |
| | | |DEPARTMENT SHALL NOTIFY THE CLIENT IN WRITING, OF ITS DETERMINATION OF THE | | |
| | | |UNDERPAYMENT. | | |
| | | |5. PROMPT ACTION SHALL BE TAKEN TO CORRECT UNDERPAYMENTS THAT OCCURRED WITHIN | | |
| | | |THE PAST TWELVE (12) MONTHS FROM THE DISCOVERY DATE BY ISSUING A RETROACTIVE | | |
| | | |PAYMENT. RETROACTIVE PAYMENTS SHALL NOT BE MADE UNLESS THE AMOUNT IS ONE DOLLAR | | |
| | | |($1.00) OR MORE. | | |
|3.581 |New Section | |H. THE COUNTY DEPARTMENT SHALL REISSUE A LOST OR STOLEN PAYMENT IF THE LOSS OR |Striking all of C.C.R. 2503-8 and | No |
| | | |THEFT IS NOT QUESTIONABLE AND THE COUNTY DETERMINES THAT SUCH LOSS WAS BEYOND |moving into C.C.R. 2503-5. | |
| | | |THE CLIENT'S CONTROL. | | |
| | | |A LOSS WILL BE CONSIDERED WITHIN THE CLIENT’S CONTROL WHEN: | | |
| | | |1. THE CLIENT HAS SHARED THE EBT PIN NUMBER OR WRITTEN THE PIN NUMBER ON THE | | |
| | | |EBT CARD ITSELF, OR | | |
| | | |2. THE CLIENT HAS GIVEN HIS OR HER CARD TO ANOTHER PERSON FOR THAT PERSON’S USE.| | |
|3.581 |New Section | |I. A CLIENT IS PROHIBITED FROM USING OR ALLOWING THE USE OF HIS OR HER EBT CARD |Striking all of C.C.R. 2503-8 and | |
| | | |AT AUTOMATED TELLER MACHINES (ATMS) AND POINT OF SALE (POS) DEVICES LOCATED IN |moving into C.C.R. 2503-5. | |
| | | |PROHIBITED ESTABLISHMENTS AS DESCRIBED IN SECTION 3.520.4.C.4.F. | | |
| | | |A CLIENT’S EBT TRANSACTIONS SHALL BE MONITORED QUARTERLY. CLIENTS WHO USE | | |
| | | |PROHIBITED ATMS OR POS DEVICES SHALL BE CONTACTED BY THE COUNTY DEPARTMENT. | | |
| | | |INAPPROPRIATE USAGE SHALL RESULT IN: | | |
| | | |1. A WRITTEN WARNING THAT THE USE OF THE EBT CARD IN PROHIBITED ESTABLISHMENTS | | |
| | | |WILL RESULT IN THE CARD BEING DISABLED. THE COUNTY DEPARTMENT SHALL PROVIDE | | |
| | | |EDUCATION ABOUT APPROPRIATE USE, ACCESS, AND ALTERNATIVES; | | |
| | | |2. IF CONTINUED MISUSE OCCURS (IDENTIFIED ON THE QUARTERLY USAGE REPORT AFTER A | | |
| | | |WARNING HAS OCCURRED), THE CASH GRANT PAYMENT PORTION OF HIS OR HER EBT CARD | | |
| | | |SHALL BE DISABLED FOR ONE MONTH, REQUIRING THE COUNTY TO NOTIFY THE CLIENT OF | | |
| | | |ADDITIONAL OPTIONS FOR RECEIPT OF PAYMENT (DIRECT DEPOSIT OR COUNTY WARRANT) AS | | |
| | | |WELL AS NOTIFICATION OF DUE PROCESS IN ACCORDANCE WITH STATE RULES PURSUANT TO | | |
| | | |SECTIONS 3.520.1.H-I AND 3.554. | | |
| | | |3. IF MISUSE CONTINUES, THE COUNTY DEPARTMENT SHALL DENY OR DISCONTINUE THE | | |
| | | |GRANT PAYMENTS AND IMPOSE A ONE MONTH INELIGIBILITY PERIOD. THE COUNTY SHALL | | |
| | | |REQUIRE THE CLIENT TO COMPLETE A NEW APPLICATION AFTER THE ONE MONTH | | |
| | | |INELIGIBILITY PERIOD IF HE OR SHE WANTS TO RECEIVE ADULT FINANCIAL ASSISTANCE. | | |
| | | |THE COUNTY DEPARTMENT SHALL NOT ACCEPT A NEW APPLICATION FROM THE CLIENT UNTIL | | |
| | | |THE ONE MONTH INELIGIBILITY PERIOD EXPIRES. THE COUNTY DEPARTMENT SHALL FOLLOW | | |
| | | |THE DUE PROCESS PROCEDURES PURSUANT TO SECTIONS 3.520.1.H-I AND 3.554; AND, | | |
| | | |4. AFTER THE ONE MONTH INELIGIBILITY PERIOD FOR CONTINUED MISUSE, IF/WHEN THE | | |
| | | |CLIENT REAPPLIES, ANY FUTURE EBT CARD USAGE AT PROHIBITED ESTABLISHMENTS SHALL | | |
| | | |BE CONSIDERED CONTINUED MISUSE. SUCH SUBSEQUENT VIOLATIONS WILL RESULT IN THE | | |
| | | |ONE MONTH INELIGIBILITY PERIOD AND REAPPLICATION PROCESS REFERRED TO IN | | |
| | | |SUBSECTION 3, ABOVE. | | |
|3.582 |New Section | |THE COUNTY DEPARTMENT SHALL ESTABLISH A CLAIM ON AN OVERPAYMENT BEFORE THE LAST |Striking all of C.C.R. 2503-8 and | No |
| | | |DAY OF THE QUARTER FOLLOWING THE QUARTER IN WHICH THE OVERPAYMENT WAS |moving into C.C.R. 2503-5. | |
| | | |DISCOVERED. | | |
| | | |A. AN OVERPAYMENT SHALL BE ADJUSTED IF THERE IS A RECORD OF ANY UNDERPAYMENT(S) | | |
| | | |FOR A PRIOR PERIOD. THE HIERARCHY OF SUCH ADJUSTMENTS SHALL BE: | | |
| | | |1. FRAUD OR IPV CLAIMS FIRST, | | |
| | | |2. CLIENT ERROR CLAIMS SECOND; AND, | | |
| | | |3. ADMINISTRATIVE ERROR CLAIMS LAST. | | |
|3.582 |New Section | |B. LIABILITY FOR AN OVERPAYMENT MUST BE LEGALLY ESTABLISHED. METHODS FOR LEGALLY|Striking all of C.C.R. 2503-8 and | No |
| | | |ESTABLISHING AN OVERPAYMENT INCLUDE BUT ARE NOT LIMITED TO: |moving into C.C.R. 2503-5. | |
| | | |1. AN EXECUTED PROMISSORY NOTE; | | |
| | | |2. A COURT JUDGMENT; | | |
| | | |3. A FINAL AGENCY ACTION; | | |
| | | |4. A SIGNED PUBLIC ASSISTANCE REPAYMENT AGREEMENT FORM. | | |
|3.582 |New Section | |C. FAILURE TO SIGN THE PUBLIC ASSISTANCE REPAYMENT AGREEMENT FORM SHALL BE |Striking all of C.C.R. 2503-8 and | No |
| | | |HANDLED AS FOLLOWS: |moving into C.C.R. 2503-5. | |
| | | |1. IF THE CLIENT AGAINST WHOM A COLLECTION ACTION HAS BEEN INITIATED IS | | |
| | | |CURRENTLY PARTICIPATING IN ANY ADULT FINANCIAL PROGRAM AND DOES NOT RESPOND TO | | |
| | | |THE PUBLIC ASSISTANCE REPAYMENT AGREEMENT FORM WITHIN ELEVEN (11) CALENDAR DAYS | | |
| | | |OF THE DATE THE NOTICE IS MAILED, GRANT PAYMENT REDUCTION SHALL BEGIN WITH THE | | |
| | | |FIRST MONTH FOLLOWING THE TIMELY NOTICING PERIOD WITHOUT FURTHER NOTICE AS | | |
| | | |DESCRIBED IN SECTION 3.585.A.2. | | |
| | | |2. IF THE CLIENT AGAINST WHOM A COLLECTION ACTION HAS BEEN INITIATED IS NOT | | |
| | | |PARTICIPATING IN THE PROGRAM WHEN A COLLECTION ACTION FOR A CLAIM IS INITIATED | | |
| | | |OR IF A COLLECTION ACTION HAS BEEN INITIATED FOR REPAYMENT OF A CLAIM AND NO | | |
| | | |RESPONSE IS MADE TO THE PUBLIC ASSISTANCE REPAYMENT AGREEMENT FORM WITHIN ELEVEN| | |
| | | |(11) CALENDAR DAYS OF THE DATE THE NOTICE IS MAILED, THE COUNTY DEPARTMENT SHALL| | |
| | | |PURSUE ALL LEGAL RECOVERY METHODS AS DESCRIBED IN SECTION 3.585 IN ORDER TO | | |
| | | |RECOVER THE OVERPAYMENT. LEGAL REMEDIES INCLUDE, BUT ARE NOT LIMITED TO, | | |
| | | |JUDGMENTS, GARNISHMENTS, CLAIMS ON ESTATES AND THE STATE INCOME TAX REFUND | | |
| | | |INTERCEPT PROCESS. | | |
|3.582 |New Section | |D. THE AMOUNT OF THE OVERPAYMENTS INVOLVING INCOME SHALL BE CALCULATED TO ALLOW|Striking all of C.C.R. 2503-8 and | No |
| | | |FOR INCOME DISREGARDS DESCRIBED IN SECTIONS 3.533, 3.544, AND 3.549 BASED ON THE|moving into C.C.R. 2503-5. | |
| | | |ADULT FINANCIAL PROGRAM FROM WHICH THE CLIENT RECEIVED GRANT PAYMENTS. | | |
|3.582 |New Section | |E. COMPUTATION OF THE OVERPAYMENT FOR ADULT FINANCIAL GRANT PAYMENTS IS BASED ON|Changed previous language from 3.800 | No |
| | | |THE AMOUNT RECEIVED THAT A CLIENT WAS ORIGINALLY ELIGIBLE TO RECEIVE. ALL EARNED|to allow for the calculation of | |
| | | |AND UNEARNED INCOME RECEIVED BY THE CLIENT AND ANY RESOURCES ARE TAKEN INTO |disregards in determining the amount | |
| | | |CONSIDERATION IN THE COMPUTATION. |of overpayment. | |
| | | |IN THE INSTANCES WHERE THE OVERPAYMENT IS THE DIRECT RESULT OF ACTIONS TIED TO | | |
| | | |THE DETERMINATION OF IPV AND/OR FRAUD, WHICH RESULTED IN RECEIPT OF GRANT | | |
| | | |PAYMENTS IN ERROR, OR GRANT PAYMENTS RECEIVED THAT THE CLIENT WAS NOT ELIGIBLE | | |
| | | |TO RECEIVE, THE OVERPAID GRANT PAYMENTS SHALL BE RECOVERED FROM THE CLIENT | | |
| | | |AND/OR A LIABLE INDIVIDUAL PURSUANT TO THE REQUIREMENTS OF 3.583. | | |
|3.582 |New Section | |F. THE CALCULATION OF OVERPAYMENT SHALL BEGIN IN THE MONTH THAT THE OVERPAYMENT |Striking all of C.C.R. 2503-8 and | No |
| | | |OCCURRED. |moving into C.C.R. 2503-5. | |
| | | |1. START WITH THE AMOUNT ISSUED TO THE CLIENT; | | |
| | | |2. DETERMINE THE CORRECT PAYMENT ACCORDING TO PROGRAM RULES AT SECTIONS | | |
| | | |3.520.78, 3.533, 3.544, 3.549, AND 3.581.D. | | |
| | | |3. COMPARE THE AMOUNT ISSUED TO THE CLIENT TO THE CORRECT PAYMENT AMOUNT. | | |
| | | |A. IF THE AMOUNT ISSUED TO THE CLIENT IS GREATER THAN THE CORRECT PAYMENT | | |
| | | |AMOUNT, THE DIFFERENCE IS THE OVERPAYMENT AMOUNT. | | |
| | | |B. IF THE AMOUNT ISSUED TO THE CLIENT IS LESS THAN THE CORRECT PAYMENT AMOUNT, | | |
| | | |THE DIFFERENCE IS THE UNDERPAYMENT AMOUNT, AS ADDRESSED IN SECTION 3.581.G. | | |
| | | |4. IF THE CLIENT IS OVER THE RESOURCE LIMIT IN ANY MONTH, THE CLIENT IS TOTALLY | | |
| | | |INELIGIBLE FOR THAT MONTH. ANY PAYMENT RECEIVED IN SUCH MONTH(S) IS AN | | |
| | | |OVERPAYMENT. | | |
| | | |5. IF A CLIENT DOES NOT MEET THE NON-FINANCIAL ELIGIBILITY REQUIREMENTS IN ANY | | |
| | | |MONTH, THE CLIENT IS TOTALLY INELIGIBILE FOR THE MONTH. ANY PAYMENT RECEIVED IN | | |
| | | |SUCH MONTH(S) IS AN OVERPAYMENT. | | |
| |New Section | |G. WHEN THE COUNTY DEPARTMENT HAS DETERMINED THAT A CLIENT HAS RECEIVED AN |Striking all of C.C.R. 2503-8 and | No |
| | | |OVERPAYMENT, THE DEPARTMENT SHALL: |moving into C.C.R. 2503-5. | |
| | | |1. TAKE ACTION TO RESEARCH THE OVERPAYMENT AND DETERMINETHE AMOUNT OF THE | | |
| | | |OVERPAYMENT. | | |
| | | |2. DETERMINE IF THE OVERPAYMENT IS TO BE RECOVERED AS DESCRIBED IN SECTION | | |
| | | |3.585. | | |
| | | |3. DOCUMENT THE FACTS AND SITUATION THAT PRODUCED THE OVERPAYMENT. DOCUMENT | | |
| | | |WHETHER THE OVERPAYMENT IS TO BE RECOVERED. RETAIN ALL ASSOCIATED DOCUMENTATION | | |
| | | |AND NOTICES UNTIL THE OVERPAYMENT IS REPAID IN FULL. | | |
| | | |4. DETERMINE WHETHER THERE WAS WILLFUL WITHHOLDING OF INFORMATION, FRAUD, OR IPV| | |
| | | |AS DESCRIBED IN SECTIONS 3.583 AND 3.584. | | |
| | | |5. PROVIDE THE CLIENT WITH TIMELY OR ADEQUATE NOTICE AS REQUIRED BY SECTION | | |
| | | |3.554 OF THE AMOUNT DUE AND THE REASON FOR THE RECOVERY INCLUDING: | | |
| | | |A. THE LIABLE INDIVIDUAL(S) RESPONSIBLE FOR THE REPAYMENT; | | |
| | | |B. THE AMOUNT OF THE CLAIM; | | |
| | | |C. THE PERIOD THE CLAIM IS FOR; | | |
| | | |D. THE REASON FOR THE OVERPAYMENT INCLUDING WHETHER THE OVERPAYMENT IS A RESULT | | |
| | | |OF FRAUD/IPV, CLIENT ERROR, OR ADMINISTRATIVE ERROR; | | |
| | | |E. THE CLIENT’S RIGHTS AND RESPONSIBILITIES; | | |
| | | |F. THE METHOD OF REPAYMENT; | | |
| | | |G. HOW TO OBTAIN FREE LEGAL ASSISTANCE; AND | | |
| | | |H. THE APPLICABLE RULES CONCERNING THE OVERPAYMENT. | | |
| | | |6. SEND QUARTERLY STATEMENTS WITH THE BALANCE DUE. | | |
|3.583 |New Section | |A. ALL CLIENTS MUST BE PROVIDED WITH THEIR RIGHTS IN RELATION TO IPV AS FOLLOWS:|Addition of Intentional Program | No |
| | | |1. THE CLIENT HAS THE RIGHT TO AN ADMINISTRATIVE DISQUALIFICATION HEARING (ADH) |Violation as required by Statute. | |
| | | |BEFORE AN ADMINISTRATIVE LAW JUDGE (ALJ). | | |
| | | |2. THE COUNTY DEPARTMENT MAY OFFER AN ADH AT THE COUNTY. THIS DOES NOT PRECLUDE | | |
| | | |THE CLIENT FROM REQUESTING THE ADH BE HELD BEFORE AN ALJ. | | |
| | | |3. A CLIENT MAY WAIVE THE RIGHT TO AN ADH, EITHER BEFORE AN ALJ OR WITH THE | | |
| | | |COUNTY DEPARTMENT BY SIGNING A WAIVER OF ADH FORM. CLIENTS HAVE A RIGHT TO LOOK | | |
| | | |AT ALL THE EVIDENCE THAT WOULD BE USED AT AN ADH BEFORE DECIDING WHETHER TO | | |
| | | |WAIVE THE RIGHT TO AN ADH. | | |
| | | |4. IF A CLIENT CHOOSES TO APPEAR AT THE ADH HE OR SHE WILL BE AFFORDED THE RIGHT| | |
| | | |TO REPRESENT HIM OR HERSELF OR TO BE REPRESENTED BY AN ATTORNEY AT HIS OR HER | | |
| | | |EXPENSE. | | |
| | | |5. THE CLIENT MAY CHOOSE TO BE REPRESENTED BY ANY OTHER PERSON HE OR SHE CHOOSES| | |
| | | |PURSUANT TO SECTION 26-2-127(1)(A)(IV), C.R.S.. | | |
| | | |6. A CLIENT AND/OR HIS OR HER REPRESENTATIVE, UPON PROVIDING A SIGNED RELEASE, | | |
| | | |MAY LOOK AT HIS OR HER CASE FILE, INCLUDING ALL THE EVIDENCE THAT WILL BE USED | | |
| | | |AT THE ADH. THE CLIENT AND/OR HIS OR HER REPRESENTATIVE HAS THE RIGHT TO LOOK AT| | |
| | | |HIS OR HER CASE FILE BEFORE AND DURING THE ADH. | | |
| | | |7. THE COUNTY DEPARTMENT SHALL PROVIDE A FREE COPY OF THE EVIDENCE TO BE | | |
| | | |UTILIZED DURING THE ADH TO THE CLIENT AT LEAST FIFTEEN (15) DAYS PRIOR TO AN ADH| | |
| | | |HEARD BY THE COUNTY. UPON REQUEST, THE COUNTY DEPARTMENT WILL PROVIDE A FREE | | |
| | | |COPY OF ANY OTHER PARTS OF THE CASE FILE THAT THE CLIENT DETERMINES IS NEEDED AT| | |
| | | |THE ADH. | | |
| | | |8. A CLIENT MAY BRING WITNESSES TO SPEAK ON HIS OR HER BEHALF AT THE ADH. | | |
| | | |9. THE CLIENT AND OR HIS OR HER REPRESENTATIVE HAS THE RIGHT TO QUESTION OR DENY| | |
| | | |ANY EVIDENCE OR STATEMENTS MADE AGAINST HIM OR HER AT THE ADH. THIS INCLUDES THE| | |
| | | |RIGHT TO ASK QUESTIONS OF PERSONS TESTIFYING AGAINST HIM OR HER. | | |
| | | |10. THE CLIENT HAS THE RIGHT TO PRESENT ANY EVIDENCE THAT HE OR SHE FEELS IS | | |
| | | |IMPORTANT TO PROVE HIS OR HER CASE. | | |
|3.583 |New Section | |B. ALL CLIENTS FOR ADULT FINANCIAL PROGRAMS MUST BE PROVIDED WITH A WRITTEN |Addition of Intentional Program | No |
| | | |NOTICE OF THE PENALTIES FOR AN IPV ON THE ADULT FINANCIAL APPLICATION FORM. ALL |Violation as required by Statute. | |
| | | |ADULT FINANCIAL CLIENTS SHALL BE NOTIFIED OF THE PENALTIES FOR AN IPV WHEN | | |
| | | |REPORTING CHANGES ON THE REDETERMINATION FORM. | | |
|3.583 |New Section | |C. A COUNTY DEPARTMENT IS REQUIRED TO REFER THE INVESTIGATION TO THE APPROPRIATE|Addition of Intentional Program | No |
| | | |INVESTIGATORY AGENCY FOR ANY CLIENT OR REPRESENTATIVE PAYEE WHENEVER THERE IS AN|Violation as required by Statute. | |
| | | |ALLEGATION OR REASON TO BELIEVE THAT INDIVIDUAL HAS COMMITTED AN IPV AS | | |
| | | |DESCRIBED BELOW. | | |
| | | |WHEN CONDUCTING AN INTERVIEW FOR IPV AND/OR FRAUD, THE COUNTY DEPARTMENT | | |
| | | |INVESTIGATOR OR REPRESENTATIVE HAS THE RESPONSIBILITY TO ENSURE THE FOLLOWING: | | |
| | | |1. THAT AN EXPLANATION WAS GIVEN TO THE INDIVIDUAL REGARDING THE REASON THE | | |
| | | |INTERVIEW IS TAKING PLACE; AND, | | |
| | | |2. THAT THE INDIVIDUAL’S RIGHTS HAVE BEEN PROVIDED TO HIM OR HER (SECTION | | |
| | | |3.520.1.I); AND, | | |
| | | |3. THAT THE INDIVIDUAL’S RIGHTS AND RESPONSIBILITIES INCLUDING CONFIDENTIALITY | | |
| | | |OF RECORDS AND INFORMATION, THE RIGHT TO NON-DISCRIMINATION PROVISIONS, THE | | |
| | | |RIGHT TO A COUNTY CONFERENCE, AND THE RIGHT TO A STATE LEVEL FAIR HEARING HAVE | | |
| | | |BEEN PROVIDED TO HIM OR HER; AND, | | |
| | | |4. THAT THE RIGHTS AND RESPONSIBILITIES PRESENTED IN THE “WHAT I SHOULD KNOW” | | |
| | | |SECTION OF THE APPLICATION THAT THE CLIENT ACKNOWLEDGED WHEN HE OR SHE SIGNED | | |
| | | |THE APPLICATION FORM HAVE NOT BEEN VIOLATED; AND, | | |
| | | |5. THAT THE COUNTY AND/OR REPRESENTATIVE OF THE COUNTY SHALL NOT THREATEN THE | | |
| | | |INDIVIDUAL OR ENGAGE IN ANY OTHER INTIMIDATION TACTICS TOWARD THE CLIENT. | | |
|3.583 |New Section | |D. IF THE COUNTY RECEIVES QUESTIONABLE INFORMATION THAT IS NECESSARY FOR |Addition of Intentional Program | No |
| | | |DETERMINING A CLIENT’S ELIGIBILITY AND THE VERIFICATION REQUESTED BY THE COUNTY |Violation as required by Statute. | |
| | | |DEPARTMENT IS NOT SUPPLIED BY THE CLIENT AS REQUIRED BY THE COUNTY DEPARTMENT’S | | |
| | | |VERIFICATION REQUEST TIMEFRAMES, GRANT PAYMENTS MAY BE REDUCED AND/OR THE CASE | | |
| | | |CLOSED AND GRANT PAYMENTS TERMINATED FOR A CLIENT’S FAILURE TO PROVE ELIGIBILITY| | |
| | | |FOLLOWING THE POLICIES OUTLINED IN SECTION 3.554. THESE ACTIONS AND NOTIFICATION| | |
| | | |SHALL NOT BE USED AS AN INTIMIDATION TACTIC OR THREAT. | | |
|3.583 |New Section | |E. FOLLOWING AN INVESTIGATION, ACTION MUST BE TAKEN ON CASES WHERE DOCUMENTED |Addition of Intentional Program | No |
| | | |EVIDENCE EXISTS TO SHOW A CLIENT HAS COMMITTED ONE OR MORE ACTS OF IPV. ACTION |Violation as required by Statute. | |
| | | |MUST BE TAKEN THROUGH: | | |
| | | |1. OBTAINING A "WAIVER OF ADMINISTRATIVE DISQUALIFICATION HEARING"; OR, | | |
| | | |2. AN ADMINISTRATIVE DISQUALIFICATION HEARING; OR, | | |
| | | |3. REFERRAL FOR CIVIL OR CRIMINAL ACTION IN A COUNTY OR DISTRICT COURT; OR, | | |
| | | |4. DOCUMENTING IN THE CASE FILE THE COUNTY DEPARTMENT’S DECISION TO TAKE NO | | |
| | | |ACTION TO PURSUE IPV USING DOCUMENTED EVIDENCE TO SUPPORT THE DECISION. THE | | |
| | | |COUNTY DEPARTMENT SHALL ESTABLISH A CLAIM IF APPROPRIATE. | | |
|3.583 |New Section | |F. IN PROCEEDING AGAINST SUCH A CLIENT, THE COUNTY DEPARTMENT MUST COORDINATE |Addition of Intentional Program | No |
| | | |ANY ACTION WITH ACTIONS TAKEN UNDER THE FOOD ASSISTANCE PROGRAM WHERE THE |Violation as required by Statute. | |
| | | |FACTUAL ISSUES ARE THE SAME OR RELATED. | | |
|3.583 |New Section | |G. OVERPAYMENT ACTIONS SHALL BE INITIATED WITHIN TEN (10) CALENDAR DAYS OF THE |Addition of Intentional Program | No |
| | | |INVESTIGATION’S CONCLUSION, UNLESS OTHERWISE SPECIFIED IN THE CASE FILE. THIS IS|Violation as required by Statute. | |
| | | |REQUIRED IN ALL CASES EVEN IF ADH PROCEDURES OR REFERRAL FOR PROSECUTION IS NOT | | |
| | | |INITIATED, EXCEPT IN INSTANCES WHERE NOTIFICATION OF OVERPAYMENTS MAY PREJUDICE | | |
| | | |THE ONGOING CRIMINAL CASE OR INVESTIGATION. IN THESE INSTANCES, THE COUNTY | | |
| | | |DEPARTMENT MAY MAKE THE DETERMINATION TO POSTPONE NOTIFICATION OF CLAIMS TO THE | | |
| | | |CLIENT IF THE OVERPAYMENT IS BEING REFERRED TO A COURT OF APPROPRIATE | | |
| | | |JURISDICTION. THE DETERMINATION TO POSTPONE NOTIFICATION MUST BE CLEARLY | | |
| | | |DOCUMENTED IN THE CASE FILE. | | |
|3.583 |New Section | |H. THE STATE DEPARTMENT WILL NOT CONDONE ANY ACTIONS OF THE COUNTY DEPARTMENT |Addition of Intentional Program | No |
| | | |THAT COULD BE DETERMINED TO BE A VIOLATION OF STATE OR FEDERAL LAW. ANY ACTIONS |Violation as required by Statute. | |
| | | |TAKEN BY A COUNTY DEPARTMENT THAT IS DETERMINED TO BE IN VIOLATION OF STATE OR | | |
| | | |FEDERAL LAW MAY BE SUBJECT TO CORRECTIVE ACTION PER 9 C.C.R. 2501-1 SECTION | | |
| | | |1.150 ET SEQ. | | |
|3.583 |New Section | |I. THESE RULES APPLY TO ALL CLIENTS WHO COMMIT AN IPV WHO ARE RECIPIENTS OR |Addition of Intentional Program | No |
| | | |REPRESENTATIVE PAYEES OF GRANT PAYMENTS AND/OR SERVICES. THE DETERMINATION OF |Violation as required by Statute. | |
| | | |IPV SHALL BE BASED ON A PREPONDERANCE OF EVIDENCE THAT DEMONSTRATES INTENT TO | | |
| | | |COMMIT IPV. | | |
| |New Section | |J. SUPPORTING EVIDENCE WARRANTING THE PURSUIT OF AN IPV DISQUALIFICATION MUST BE|Addition of Intentional Program | No |
| | | |DOCUMENTED WITH A SUPERVISORY REVIEW. IF THE COUNTY DEPARTMENT DETERMINES THERE |Violation as required by Statute. | |
| | | |IS EVIDENCE TO SUBSTANTIATE THAT A PERSON HAS COMMITTED AN IPV, THE PERSON HAS A| | |
| | | |RIGHT TO AN ADH. HOWEVER, THE COUNTY DEPARTMENT SHALL ALLOW THAT PERSON THE | | |
| | | |OPPORTUNITY TO WAIVE THE RIGHT TO AN ADH. | | |
| | | |1. THE STATE APPROVED IPV FORMS SHALL BE PROVIDED TO THE INDIVIDUAL SUSPECTED OF| | |
| | | |AN IPV. THESE MAY BE OFFERED TO THE INDIVIDUAL DURING THE INVESTIGATION OR | | |
| | | |MAILED ONCE IT HAS BEEN SUSPECTED AN IPV HAS OCCURRED, BUT THERE IS NO PLAN TO | | |
| | | |PURSUE CRIMINAL CHARGES. | | |
| | | |2. ONE OF THE STATE APPROVED FORMS AFFORDS THE INDIVIDUALTHE RIGHT TO WAIVE THE | | |
| | | |ADH. IF THE INDIVIDUAL CHOOSES TO WAIVE HIS OR HER RIGHT TO AN ADH, THE | | |
| | | |INDIVIDUAL SHALL HAVE FIFTEEN (15) CALENDAR DAYS FROM THE DATE THE IPV FORMS ARE| | |
| | | |PROVIDED BY THE COUNTY TO RETURN THE WAIVER. IF THE FORM IS NOT RETURNED, THE | | |
| | | |COUNTY DEPARTMENT SHALL PURSUE AN ADH. | | |
| | | |3. THE COMPLETION OF THE WAIVER IS VOLUNTARY AND THE COUNTY DEPARTMENT MAY NOT | | |
| | | |REQUIRE, NOR BY ITS ACTIONS APPEAR TO REQUIRE, THE COMPLETION OF THE WAIVER. | | |
|3.583 |New Section | |K. AN IPV ADH MUST BE REQUESTED WHENEVER: |Addition of Intentional Program | No |
| | | |1. THE FACTS OF THE CASE DO NOT WARRANT CIVIL OR CRIMINAL PROSECUTION; |Violation as required by Statute. | |
| | | |2. DOCUMENTARY EVIDENCE EXISTS TO SHOW AN INDIVIDUAL HAS COMMITTED ONE OR MORE | | |
| | | |ACTS OF IPV; AND | | |
| | | |3. THE INDIVIDUAL HAS FAILED TO SIGN AND RETURN THE WAIVER OF ADH FORM. | | |
|3.583 |New Section | |L. AN ADH MAY BE REQUESTED AGAINST AN ACCUSED INDIVIDUAL WHOSE CASE IS CURRENTLY|Addition of Intentional Program | No |
| | | |BEING REFERRED FOR PROSECUTION ON A CIVIL OR CRIMINAL ACTION IN COUNTY OR |Violation as required by Statute. | |
| | | |DISTRICT COURT. | | |
|3.583 |New Section | |M. A COUNTY DEPARTMENT MAY CONDUCT AN ADH OR MAY USE THE OFFICE OF |Addition of Intentional Program | No |
| | | |ADMINISTRATIVE COURTS (OAC) TO CONDUCT THE ADH. |Violation as required by Statute. | |
| | | |1. THE INDIVIDUAL MAY REQUEST VERBALLY, IN WRITING, ELECTRONICALLY, OR IN PERSON| | |
| | | |THAT THE OAC CONDUCT THE ADH IN LIEU OF A COUNTY ADH. SUCH AN ADH MUST BE | | |
| | | |REQUESTED TEN (10) CALENDAR DAYS BEFORE THE SCHEDULED DATE OF THE COUNTY ADH. | | |
| | | |2. THE OAC OR THE COUNTY DEPARTMENT MUST MAIL BY CERTIFIED MAIL, RETURN RECEIPT | | |
| | | |REQUESTED, A NOTICE OF THE DATE OF THE ADH ON THE FORM PRESCRIBED BY THE STATE | | |
| | | |DEPARTMENT, TO THE INDIVIDUAL ALLEGED TO HAVE COMMITTED AN IPV. THE NOTICE MUST | | |
| | | |BE MAILED AT LEAST THIRTY (30) CALENDAR DAYS PRIOR TO THE ADH DATE, TO THE | | |
| | | |INDIVIDUAL’S LAST KNOWN ADDRESS. THE NOTICE FORM SHALL INCLUDE A STATEMENT THAT | | |
| | | |THE INDIVIDUAL MAY WAIVE THE RIGHT TO APPEAR AT AN ADH. | | |
| | | |3. THE ALJ OR ADH OFFICER SHALL NOT ENTER A DEFAULT JUDGMENT AGAINST THE | | |
| | | |INDIVIDUAL FOR FAILURE TO FILE A WRITTEN ANSWER TO THE NOTICE OF HEARING OR | | |
| | | |FAILURE TO APPEAR AT THE ADH, BUT SHALL BASE THE INITIAL DECISION UPON THE | | |
| | | |EVIDENCE INTRODUCED AT THE ADH. | | |
| | | |4. THE ADH MUST BE CONTINUED AT THE ACCUSED INDIVIDUAL'S REQUEST IF GOOD CAUSE | | |
| | | |IS SHOWN. THE REQUEST FOR CONTINUANCE MUST BE RECEIVED BY THE PRESIDING ALJ OR | | |
| | | |ADH OFFICER AT LEAST TEN (10) CALENDAR DAYS PRIOR TO THE ADH. | | |
| | | |THE ADH SHALL NOT BE CONTINUED FOR MORE THAN A TOTAL OF THIRTY (30) CALENDAR | | |
| | | |DAYS FROM THE ORIGINAL ADH DATE. ONE ADDITIONAL CONTINUANCE IS PERMITTED AT THE | | |
| | | |ADH OFFICER OR ALJ'S DISCRETION. IF THE ADH OFFICER OR ALJ CONSIDERS IT | | |
| | | |NECESSARY, A MEDICAL ASSESSMENT MAY BE ORDERED TO SUBSTANTIATE OR DISPROVE A | | |
| | | |GOOD CAUSE STATEMENT OF AN ACCUSED INDIVIDUAL. SUCH ASSESSMENT SHALL BE OBTAINED| | |
| | | |AT THE AGENCY’S EXPENSE AND MADE PART OF THE RECORD. | | |
|3.583 |New Section | |N. DISQUALIFICATION FOR IPV SHALL BE AS FOLLOWS: |Addition of Intentional Program | No |
| | | |1. IF THE INDIVIDUAL SIGNS AND RETURNS THE REQUEST FOR WAIVER OF ADH WITHIN |Violation as required by Statute. | |
| | | |FIFTEEN (15) CALENDAR DAYS FROM THE DATE THE WAIVER IS SENT, THAT PERSON SHALL | | |
| | | |BE PROVIDED WITH A NOTICE OF THE PERIOD OF DISQUALIFICATION. | | |
| | | |2. THE DISQUALIFICATION PERIOD SHALL BEGIN NO LATER THAN THE FIRST DAY OF THE | | |
| | | |FOLLOWING MONTH FROM THE DATE DETERMINED THROUGH THE ADH PROCESS OR, IF THE | | |
| | | |INDIVIDUAL SIGNED AN ADH WAIVER, THE DATE HE OR SHE SIGNED THE WAIVER. | | |
| | | |A. ONCE THE DISQUALIFICATION IS IMPOSED IT SHALL CONTINUE WITHOUT INTERRUPTION. | | |
| | | |TO CONSIDER A DISQUALIFICATION PERIOD SERVED, THE CLIENT SHALL HAVE A BREAK IN | | |
| | | |GRANT PAYMENTS TOTALING THE TIME PERIOD OF THE DISQUALIFICATION. THE | | |
| | | |DISQUALIFICATION PERIOD SHALL REMAIN IN EFFECT UNLESS AND UNTIL THE FINDING IS | | |
| | | |REVERSED BY THE OFFICE OF APPEALS OR A COURT OF APPROPRIATE JURISDICTION OR | | |
| | | |UNTIL THE PERIOD OF DISQUALIFICATION IS SERVED PER SECTION C BELOW. | | |
| | | |B. THE DISQUALIFICATION MAY BE IN ADDITION TO ANY OTHER PENALTIES WHICH MAY BE | | |
| | | |IMPOSED BY A COURT OF LAW FOR THE SAME OFFENSES (I.E. CRIMINAL OR CIVIL | | |
| | | |SANCTIONS). | | |
| | | |C. THE DISQUALIFICATION SHALL BE IN EFFECT FOR TWELVE (12) MONTHS UPON THE FIRST| | |
| | | |OCCASION OF ANY SUCH OFFENSE; TWENTY-FOUR (24) MONTHS UPON THE SECOND OCCASION | | |
| | | |OF ANY SUCH OFFENSE AND PERMANENTLY UPON THE THIRD SUCH OFFENSE. ALL | | |
| | | |DISQUALIFICATIONS IMPOSED SHALL RUN AND BE SERVED CONSECUTIVELY. | | |
| | | |D. IF THE CLIENT IS FOUND TO HAVE COMMITTED AN IPV IN ANY OTHER PUBLIC | | |
| | | |ASSISTANCE PROGRAM, THE CLIENT IS DISQUALIFIED FROM PARTICIPATION IN ADULT | | |
| | | |FINANCIAL PROGRAMS FOR THE PENALTY PERIODS ASCRIBED TO THOSE VIOLATIONS AND FOR | | |
| | | |THE SAME TIME PERIOD. | | |
| | | |4. THE DISQUALIFICATION PENALIZES ONLY THE INDIVIDUAL(S) FOUND TO HAVE COMMITTED| | |
| | | |AN IPV. IF A CLIENT’S SPOUSE AND/OR SPONSOR(S) HAVE RECEIVED AN IPV ON HIS OR | | |
| | | |HER OWN CASE(S), THE SPOUSE’S AND/OR SPONSOR(S)’ INCOME AND RESOURCES, WHEN | | |
| | | |APPLICABLE, WILL BE CONSIDERED AVAILABLE TO THE CLIENT AND USED FOR DETERMINING | | |
| | | |ELIGIBILITY. | | |
| | | |5. AN IPV DISQUALIFICATION IN ONE COUNTY IS VALID AND EFFECTIVE IN ALL OTHER | | |
| | | |COLORADO COUNTIES. A COUNTY DEPARTMENT SHALL CONSIDER A DISQUALIFICATION IMPOSED| | |
| | | |BY ANOTHER COUNTY DEPARTMENT WHEN DETERMINING THE APPROPRIATE DISQUALIFICATION | | |
| | | |PENALTY FOR THE DISQUALIFIED INDIVIDUAL WITHOUT AN ADDITIONAL ADH OR FURTHER | | |
| | | |RIGHT TO APPEAL. | | |
|3.583 |New Section | |O. IF, AS A RESULT OF THE ADH, THE COUNTY ADH OFFICER OR ALJ FINDS THE |Addition of Intentional Program | No |
| | | |INDIVIDUAL HAS COMMITTED AN IPV, A WRITTEN NOTICE SHALL BE PROVIDED TO NOTIFY |Violation as required by Statute. | |
| | | |THE INDIVIDUAL OF THE DECISION. THE COUNTY HEARING DECISION NOTICE SHALL BE A | | |
| | | |STATE PRESCRIBED FORM, WHICH INCLUDES A STATEMENT THAT A STATE ADH AT THE OAC | | |
| | | |MAY BE REQUESTED. | | |
| | | |1. IN AN ADH BEFORE AN ALJ, THE DETERMINATION OF IPV SHALL BE AN INITIAL | | |
| | | |DECISION, WHICH SHALL NOT BE IMPLEMENTED WHILE PENDING STATE DEPARTMENT REVIEW | | |
| | | |AND A FINAL AGENCY DECISION. THE INITIAL DECISION SHALL ADVISE THE CLIENT THAT | | |
| | | |FAILURE TO FILE EXCEPTIONS TO FINDINGS OF THE INITIAL DECISION WILL WAIVE THE | | |
| | | |RIGHT TO SEEK JUDICIAL REVIEW OF A FINAL AGENCY DECISION AFFIRMING THE INITIAL | | |
| | | |DECISION. | | |
| | | |2. WHEN AN INDIVIDUAL WAIVES HIS OR HER RIGHT TO AN ADH, A WRITTEN NOTICE OF THE| | |
| | | |DISQUALIFICATION PENALTY SHALL BE MAILED TO THE INDIVIDUAL. THIS NOTICE SHALL BE| | |
| | | |ON A STATE PRESCRIBED NOTICE FORM. | | |
| | | |3. IN THE EVENT THAT THE ADH WAS HEARD BY THE COUNTY, THE CLIENT MAY APPEAL THE | | |
| | | |DECISION OF THE COUNTY ADH TO THE OAC. AN APPEAL MUST BE RECEIVED BY THE COUNTY | | |
| | | |DEPARTMENT OR BY THE OAC WITHIN FIFTEEN (15) CALENDAR DAYS OF THE DATE THE | | |
| | | |COUNTY DEPARTMENT MAILS THE LOCAL ADH DECISION TO THE CLIENT. SEE SECTION 3.587 | | |
| | | |FOR RULES REGULATING THE APPEAL PROCESS. | | |
| | | |4. A COPY OF THE COUNTY ADH DECISION SHALL BE FORWARDED TO THE STATE | | |
| | | |DEPARTMENT’S EMPLOYMENT AND BENEFITS DIVISION FOR REVIEW AT THE SAME TIME THE | | |
| | | |DECISION IS MAILED TO THE CLIENT. | | |
|3.584 |New Section | |A. WHEN THE COUNTY DEPARTMENT OR LOCAL SERVICE DELIVERY AGENCY DETERMINES THAT |Striking all of C.C.R. 2503-8 and | No |
| | | |IT HAS PAID A CLIENT A GRANT PAYMENT AS A RESULT OF A FRAUDULENT ACT, THE FACTS |moving into C.C.R. 2503-5. | |
| | | |USED IN THE DETERMINATION SHALL BE REVIEWED WITH THE DEPARTMENT’S LEGAL COUNSEL | | |
| | | |WITHIN THE ATTORNEY GENERAL’S OFFICE AND/OR A REPRESENTATIVE FROM THE DISTRICT | | |
| | | |ATTORNEY’S OFFICE. IF SUSPECTED FRAUD IS SUBSTANTIATED BY THE AVAILABLE | | |
| | | |EVIDENCE, THE CASE SHALL BE REFERRED TO THE DISTRICT ATTORNEY. ALL REFERRALS TO | | |
| | | |THE DISTRICT ATTORNEY SHALL BE MADE IN WRITING AND SHALL INCLUDE THE AMOUNT OF | | |
| | | |ASSISTANCE FRAUDULENTLY RECEIVED BY THE CLIENT. | | |
|3.584 |New Section | |B. IF ANY DEDUCTION IS BEING MADE FROM THE CLIENT’S ASSISTANCE PAYMENT IT MUST |Striking all of C.C.R. 2503-8 and | No |
| | | |BE CONSISTENT WITH ANY COURT ORDER RESULTING FROM A PROSECUTION BY THE DISTRICT |moving into C.C.R. 2503-5. | |
| | | |ATTORNEY. IF THE INDIVIDUAL BEING PROSECUTED IS NOT AN ADULT FINANCIAL PROGRAM | | |
| | | |CLIENT, ANOTHER METHOD OF RECOVERY SHALL BE USED TO COLLECT AMOUNTS DUE TO THE | | |
| | | |DEPARTMENT. | | |
| | | |1. INTEREST SHALL BE CHARGED FROM THE MONTH IN WHICH THE OVERPAYMENT WAS | | |
| | | |RECEIVED UNTIL THE DATE THE OVERPAYMENT IS RECOVERED. INTEREST SHALL BE | | |
| | | |CALCULATED AT THE LEGAL RATE. | | |
| | | |2. THE CLIENT MAY CHOOSE TO REPAY THE COUNTY DEPARTMENT THE ENTIRE AMOUNT OF THE| | |
| | | |OVERPAYMENT AT ONE TIME OR ESTABLISH A REPAYMENT PLAN. IN EITHER INSTANCE, THE | | |
| | | |FRAUD CHARGE SHOULD BE DISCUSSED WITH THE DISTRICT ATTORNEY OR APPROPRIATE | | |
| | | |INVESTIGATIVE AUTHORITY. | | |
|3.584 |New Section | |C. IF THE DISTRICT ATTORNEY DECLINES TO PROSECUTE, THE AMOUNT OF OVERPAYMENT |Striking all of C.C.R. 2503-8 and | No |
| | | |DUE, AS ESTABLISHED BY THE DEPARTMENT, WILL CONTINUE TO BE RECOVERED BY |moving into C.C.R. 2503-5. | |
| | | |DEDUCTION FROM SUBSEQUENT GRANT PAYMENTS OR OTHER METHOD OF RECOVERY IF THE | | |
| | | |INDIVIDUAL IS NOT A CLIENT OF ADULT FINANCIAL GRANT PAYMENTS. | | |
|3.585 |New Section | |A. A COUNTY DEPARTMENT MUST TAKE ACTION TO RESEARCH AND DETERMINE IF RECOVERY |Striking all of C.C.R. 2503-8 and | No |
| | | |SHOULD BE INITIATED WITHIN TEN (10) CALENDAR DAYS OF DISCOVERING A CLIENT |moving into C.C.R. 2503-5. | |
| | | |RECEIVED AN OVERPAYMENT. THE RECOVERY OF VALID OVERPAYMENTS IS REQUIRED | | |
| | | |REGARDLESS OF WHEN THE OVERPAYMENT OCCURRED EXCEPT IN SITUATIONS AS DESCRIBED IN| | |
| | | |SECTION 3.585.H. OVERPAYMENTS MAY BE RECOVERED FROM THE CLIENT WHO WAS OVERPAID | | |
| | | |OR WHO FRAUDULENTLY RECEIVED THE ASSISTANCE PAYMENT OR ANOTHER LIABLE | | |
| | | |INDIVIDUAL. | | |
| | | |IF A CLIENT IS DECEASED, OVERPAYMENTS SHALL BE RECOVERED FROM THE DECEASED | | |
| | | |CLIENT'S ESTATE. | | |
|3.585 |New Section | |B. THE FOLLOWING RULES DO NOT APPLY IN INSTANCES WHERE THE STATE OR COUNTY |Created a new claim threshold of $200| No |
| | | |DEPARTMENT SEEKS RECOVERY IN A CASE THAT WAS TRANSFERRED TO THE DISTRICT |to align with Food Assistance. | |
| | | |ATTORNEY AND PROSECUTED THROUGH THE COURTS: | | |
| | | |1. THE CLIENT SHALL BE NOTIFIED OF THE RECOVERY ACTION TO BE TAKEN, USING THE | | |
| | | |NOTICE RULES FOUND AT SECTION 3.554.C.; | | |
| | | |2. WHEN THE OVERPAYMENT IS CAUSED BY AN UNINTENTIONAL ERROR, THE CLIENT'S | | |
| | | |WILLFUL WITHHOLDING OR AN ADMINISTRATIVE ERROR, SUCH OVERPAYMENT SHALL BE | | |
| | | |DEDUCTED, AFTER NOTICE HAS BEEN GIVEN PURSUANT TO SECTION 3.554, FROM SUBSEQUENT| | |
| | | |GRANT PAYMENTS WHILE THE CLIENT IS ACTIVELY RECEIVING ADULT FINANCIAL GRANT | | |
| | | |PAYMENTS. | | |
| | | |A. THE CLIENT MAY CHOOSE TO REPAY THE COUNTY DEPARTMENT THE ENTIRE AMOUNT OF THE| | |
| | | |OVERPAYMENT AT ONE TIME. THE CLIENT SHALL WORK WITH THE COUNTY DEPARTMENT TO | | |
| | | |DETERMINE HOW A LUMP SUM REPAYMENT CAN BE MADE. | | |
| | | |B. WHEN THE RECOVERY AMOUNT IS NOT TO BE REPAID IN A SINGLE PAYMENT PER | | |
| | | |SUBSECTION A ABOVE, AND THE CASE REMAINS ACTIVE, THE COUNTY DEPARTMENT SHALL | | |
| | | |ESTABLISH A MONTHLY RECOVERY DEDUCTION FROM SUBSEQUENT ASSISTANCE PAYMENTS. THE | | |
| | | |MONTHLY RATE OF RECOVERY SHALL BE TEN DOLLARS OR TEN PERCENT OF THE ASSISTANCE | | |
| | | |PAYMENT, WHICHEVER IS HIGHER. | | |
| | | |THE FOLLOWING PROCEDURE SHALL BE USED TO ARRIVE AT THE MONTHLY RECOVERY | | |
| | | |DEDUCTION AMOUNT: | | |
| | | |1. IF THE ERROR IS A RESULT OF AN AGENCY ERROR AND THE CLIENT DOES NOT MEET | | |
| | | |CRITERIA SET FORTH IN SECTION 3.585, COMPUTE TEN PERCENT (10%) OF THE ADULT | | |
| | | |FINANCIAL GRANT PAYMENT AMOUNT. IF THE RESULTING PERCENTAGE AMOUNT IS LESS THAN | | |
| | | |TEN DOLLARS ($10), THE DEDUCTION FROM THE GRANT PAYMENT AMOUNT SHALL BE TEN | | |
| | | |DOLLARS ($10). | | |
| | | |2. DEDUCT THE PERCENTAGE AMOUNT OR TEN DOLLARS ($10), WHICHEVER IS HIGHER, FROM | | |
| | | |THE GRANT PAYMENT. THE RESULT SHALL BE ROUNDED TO THE NEXT LOWER WHOLE DOLLAR | | |
| | | |AMOUNT, IF NOT ALREADY A WHOLE DOLLAR AMOUNT. THIS ROUNDED AMOUNT IS THE FINAL | | |
| | | |PAYMENT AMOUNT. | | |
| | | |3. WHEN THE AUTHORIZED PAYMENT AMOUNT IS LESS THAN TEN DOLLARS ($10), THE CASE | | |
| | | |IS CONSIDERED A “NO PAYMENT” CASE AND NO DEDUCTION SHALL BE MADE. | | |
| | | |4. WHEN THE RECOVERY IS DUE TO A FRAUDULENT ACTION ON THE PART OF THE CLIENT AND| | |
| | | |INTEREST MAY BE ADDED THERETO IN ACCORDANCE WITH SECTION 3.584.B.1., THE | | |
| | | |INTEREST AMOUNT SHALL NOT BE INCLUDED IN THE GRANT PAYMENT DEDUCTION UNLESS THE | | |
| | | |CLIENT AGREES TO SUCH INCLUSION. IF THE CLIENT DOES NOT SO AGREE, THE INTEREST | | |
| | | |AMOUNT SHALL BE COLLECTED SEPARATELY. | | |
| | | |5. THE AMOUNT OF THE GRANT PAYMENT DEDUCTION FOR RECOVERY SHALL BE RECORDED IN | | |
| | | |THE CLIENT'S CASE FILE AND COLLECTED VIA THE STATEWIDE AUTOMATED SYSTEM. | | |
| | | |C. THE COUNTY DEPARTMENT SHALL NOT ESTABLISH A CLAIM UNLESS THE AMOUNT OF THE | | |
| | | |CLAIM IS GREATER THAN $200, EXCEPT IN THE FOLLOWING CIRCUMSTANCES: | | |
| | | |1. THE OVERPAYMENT IS IDENTIFIED THROUGH A FEDERAL OR STATE LEVEL QUALITY | | |
| | | |CONTROL REVIEW; OR, | | |
| | | |2. THE CLAIM IS BEING PURSUED AS AND RESULTS IN AN IPV. | | |
| | | |3. WHEN THE OVERPAYMENT IS CAUSED BY THE CLIENT’S WILLFUL WITHHOLDING OF | | |
| | | |INFORMATION OR AN ADMINISTRATIVE ERROR, AND THE ADULT FINANCIAL CASE IS NO | | |
| | | |LONGER ACTIVE, RECOVERY OF SUCH OVERPAYMENT SHALL BE BASED UPON THE PUBLIC | | |
| | | |ASSISTANCE REPAYMENT AGREEMENT FORM OR OTHER METHODS OF RECOVERY. | | |
| | | |A. THE COUNTY SHALL ESTABLISH A MONTHLY REPAYMENT AGREEMENT WITH A FORMER | | |
| | | |CLIENT. THE REPAYMENT AGREEMENT SHALL NOT EXCEED TWENTY-FIVE PERCENT (25%) OF | | |
| | | |AVAILABLE MONTHLY INCOME. DETERMINATION OF THE REPAYMENT AMOUNT MUST BE CLEARLY | | |
| | | |DOCUMENTED IN THE ELECTRONIC CASE FILE. | | |
| | | |B. THE CLIENT MAY CHOOSE TO REPAY THE COUNTY DEPARTMENT THE ENTIRE AMOUNT OF THE| | |
| | | |OVERPAYMENT AT ONE TIME. THE CLIENT SHALL WORK WITH THE COUNTY DEPARTMENT TO | | |
| | | |DETERMINE HOW A LUMP SUM REPAYMENT CAN BE MADE. | | |
| | | |C. THE COUNTY DEPARTMENT MAY WRITE-OFF UNPAID VALID CLAIMS AS FOLLOWS: | | |
| | | |1. VALID ADMINISTRATIVE ERROR CLAIMS LESS THAN ONE HUNDRED TWENTY-FIVE DOLLARS | | |
| | | |($125.00) CAN BE WRITTEN OFF NINETY (90) DAYS AFTER THE TERMINATION OF ALL | | |
| | | |PUBLIC ASSISTANCE. | | |
| | | |2. VALID CLAIMS FOR CLIENT ERROR, FRAUD, AND IPV LESS THAN THREE HUNDRED DOLLARS| | |
| | | |($300.00). | | |
| | | |3. ANY UNPAID VALID CLAIM OF $125 OR MORE FOR AN INDIVIDUAL WHO WAS NOT | | |
| | | |CONVICTED OF AN IPV OR FRAUD SPECIFIC TO THE OVERPAYMENT, IS NO LONGER RECEIVING| | |
| | | |PUBLIC ASSISTANCE, AND THE OVERPAYMENT WAS ESTABLISHED SIX (6) OR MORE YEARS | | |
| | | |AGO, AND THE COUNTY DEPARTMENT HAS DETERMINED THAT IT IS NO LONGER COST | | |
| | | |EFFECTIVE TO PURSUE COLLECTION. | | |
| | | |D. IF THE CLIENT BEGINS TO RECEIVE ADULT FINANCIAL GRANT PAYMENTS AGAIN AFTER | | |
| | | |THE OVERPAYMENT HAS BEEN ESTABLISHED AND STILL HAS A CLAIM BALANCE, THE | | |
| | | |DEDUCTION OF GRANT PAYMENTS SHALL OCCUR AS DESCRIBED IN SECTION 3.585.B.2. | | |
|3.585 |New Section | |C. THE CLIENT MAY ISSUE THE STATE A REFUND OF ANY OVERPAID GRANT PAYMENTS FROM |Striking all of C.C.R. 2503-8 and | No |
| | | |HIS OR HER EXISTING BALANCE OF ADULT FINANCIAL GRANT PAYMENTS ON HIS OR HER |moving into C.C.R. 2503-5. | |
| | | |ELECTRONIC BENEFITS TRANSFER (EBT) CARD BY CONTACTING THE COUNTY DEPARTMENT. | | |
| | | |THIS REQUIRES A WRITTEN STATEMENT FROM THE CLIENT. | | |
|3.585 |New Section | |D. CLIENTS ARE NOT ENTITLED TO GRANT PAYMENTS THAT WERE PAID IN ERROR OR |Striking all of C.C.R. 2503-8 and | No |
| | | |MISTAKENLY PROVIDED TO THE CLIENT BASED ON A DATA ENTRY ERROR INTO THE STATEWIDE|moving into C.C.R. 2503-5. | |
| | | |AUTOMATED SYSTEM OR AN ERROR RESULTING FROM THE STATEWIDE AUTOMATED SYSTEM. THE | | |
| | | |COUNTY SHALL CREATE A CLAIM AND MAY RETRIEVE THE GRANT PAYMENTS FROM THE | | |
| | | |CLIENT’S EBT CARD WITHIN TWENTY-FOUR (24) HOURS OF THE ISSUANCE WITHOUT PRIOR | | |
| | | |WRITTEN AUTHORIZATION BY THE CLIENT. THE CLIENT SHALL HAVE NO APPEAL RIGHTS IN | | |
| | | |RELATION TO THIS GRANT PAYMENT BECAUSE HE OR SHE WAS NOT ELIGIBLE FOR THE | | |
| | | |INITIAL RECEIPT OF THE GRANT PAYMENT(S) IN THE FIRST INSTANCE. | | |
| | | |WHEN GRANT PAYMENTS ISSUED IN ERROR ARE NOT RETRIEVED FROM THE CLIENT’S EBT CARD| | |
| | | |WITHIN TWENTY-FOUR (24) HOURS, FUNDS SHALL NOT BE TAKEN FROM THE CARD USING THIS| | |
| | | |METHOD UNLESS PERMISSION IS GRANTED FROM THE CLIENT IN WRITING USING THE STATE | | |
| | | |PRESCRIBED FORM. IF PERMISSION IS NOT GRANTED, THE COUNTY DEPARTMENT SHALL | | |
| | | |PURSUE OTHER METHODS OF RECOVERY AS DESCRIBED IN SECTION 3.585. | | |
|3.585 |New Section | |E. THE CLIENT MAY REQUEST VOLUNTARY DEDUCTIONS BE APPLIED TO THE OVERPAYMENT. |Striking all of C.C.R. 2503-8 and | No |
| | | |THESE ARE CONSIDERED TO BE AN AMOUNT IN ADDITION TO THE DEDUCTION FROM THE GRANT|moving into C.C.R. 2503-5. | |
| | | |PAYMENT AS ESTABLISHED THROUGH THE RECOVERY CALCULATIONS IN SECTION 3.585.B. THE| | |
| | | |CLIENT SHALL BE PROVIDED WRITTEN CONFIRMATION OF THE AMOUNT TO BE DEDUCTED AND | | |
| | | |THAT HE OR SHE HAS THE RIGHT TO STOP THE VOLUNTARY DEDUCTION AT ANY TIME BY | | |
| | | |WRITTEN REQUEST. | | |
| |New Section | |F. A CLAIM MAY BE FILED AGAINST THE ESTATE OF A CLIENT FOR OVERPAYMENT. THIS |Striking all of C.C.R. 2503-8 and | No |
| | | |INCLUDES CASES WHERE OVERPAYMENTS WERE MADE AND NOT RECOVERED. THE COUNTY |moving into C.C.R. 2503-5. | |
| | | |DEPARTMENT'S LEGAL ADVISOR MUST BE CONSULTED IN DETERMINING THE AMOUNT OF | | |
| | | |ASSISTANCE PAYMENTS FOR WHICH A CLAIM IS TO BE FILED. | | |
|3.585 |New Section | |G. IN ACCORDANCE WITH SECTIONS 26-2-133 AND 39-21-108, C.R.S., THE STATE AND |Striking all of C.C.R. 2503-8 and | No |
| | | |COUNTY DEPARTMENTS MAY RECOVER OVERPAYMENTS OF PUBLIC OR MEDICAL ASSISTANCE |moving into C.C.R. 2503-5. | |
| | | |BENEFITS THROUGH THE OFFSET (INTERCEPT) OF A TAXPAYER'S STATE INCOME TAX REFUND.| | |
| | | |TAX REFUNDS SHALL NOT BE OFFSET IN INSTANCES WHERE THE TAXPAYER IS MAKING | | |
| | | |REGULAR, ONGOING PAYMENTS AS AGREED TO IN THE PUBLIC ASSISTANCE REPAYMENT | | |
| | | |AGREEMENT AND/OR BASED ON ARRANGEMENTS BETWEEN THE TAXPAYER AND THE COUNTY(IES).| | |
| | | |UNLESS AGREED TO BY THE CLIENT, THE COUNTY SHALL NOT OFFSET TAX REFUNDS DURING | | |
| | | |THE SAME MONTH THE CLIENT MAKES A PAYMENT ON A CLAIM IF THE PAYMENT AGREEMENT | | |
| | | |WAS ESTABLISHED PRIOR TO THE OFFSET. RENT REBATES ARE SUBJECT TO THE OFFSET | | |
| | | |PROCEDURE. THE OFFSET OF THE TAXPAYER STATE INCOME TAX REFUND AND/OR RENT REBATE| | |
| | | |MAY BE USED TO RECOVER OVERPAYMENTS THAT HAVE BEEN: | | |
| | | |1. DETERMINED BY FINAL AGENCY ACTION; OR, | | |
| | | |2. ORDERED BY A COURT AS RESTITUTION; OR, | | |
| | | |3. REDUCED TO JUDGMENT. | | |
|3.585 |New Section | |H. PRIOR TO CERTIFYING THE TAXPAYER'S NAME AND OTHER INFORMATION TO THE COLORADO|Striking all of C.C.R. 2503-8 and | No |
| | | |DEPARTMENT OF REVENUE, THE COLORADO DEPARTMENT OF HUMAN SERVICES SHALL NOTIFY |moving into C.C.R. 2503-5. | |
| | | |THE TAXPAYER, IN WRITING AT HIS OR HER LAST-KNOWN ADDRESS, THAT THE STATE | | |
| | | |INTENDS TO USE THE TAX REFUND OFFSET TO RECOVER THE OVERPAYMENT. IN ADDITION TO | | |
| | | |THE REQUIREMENTS OF SECTION 26-2-133(2), C.R.S., THE PRE-OFFSET NOTICE SHALL | | |
| | | |INCLUDE THE NAME OF THE COUNTY DEPARTMENT CLAIMING THE OVERPAYMENT, THE PROGRAM | | |
| | | |THAT MADE THE OVERPAYMENT, AND THE CURRENT BALANCE OWED. | | |
|3.585 |New Section | |I. EFFECTIVE AUGUST 1, 1991, THE TAXPAYER IS ENTITLED TO OBJECT TO THE OFFSET BY|Striking all of C.C.R. 2503-8 and | No |
| | | |FILING A REQUEST FOR A COUNTY CONFERENCE OR STATE LEVEL FAIR HEARING WITHIN |moving into C.C.R. 2503-5. | |
| | | |THIRTY (30) CALENDAR DAYS FROM THE DATE THAT THE STATE DEPARTMENT MAILS ITS | | |
| | | |PRE-OFFSET NOTICE TO THE TAXPAYER. IN ALL OTHER RESPECTS, THE PROCEDURES | | |
| | | |APPLICABLE TO SUCH HEARINGS SHALL BE THOSE THAT ARE STATED IN SECTION 3.587. AT | | |
| | | |THE HEARING ON THE OFFSET, THE COUNTY DEPARTMENT OR ALJ SHALL NOT CONSIDER | | |
| | | |WHETHER AN OVERPAYMENT HAS OCCURRED BECAUSE OVERPAYMENT HAS ALREADY BEEN | | |
| | | |OTHERWISE LEGALLY ESTABLISHED, BUT MAY CONSIDER THE FOLLOWING ISSUES IF RAISED | | |
| | | |BY THE TAXPAYER IN HIS OR HER REQUEST FOR A HEARING: | | |
| | | |1. WHETHER THE TAXPAYER WAS PROPERLY NOTIFIED OF THE OVERPAYMENT; | | |
| | | |2. WHETHER THE TAXPAYER IS THE PERSON, WHO OWES THE OVERPAYMENT; | | |
| | | |3. WHETHER THE AMOUNT OF THE OVERPAYMENT HAS BEEN PAID OR IS INCORRECT; | | |
| | | |4. WHETHER THE DEBT CREATED BY THE OVERPAYMENT HAS BEEN DISCHARGED THROUGH | | |
| | | |BANKRUPTCY; OR, | | |
| | | |5. WHETHER OTHER SPECIAL CIRCUMSTANCES EXIST INCLUDING, BUT NOT LIMITED TO, THE | | |
| | | |CIRCUMSTANCES DESCRIBED IN SECTION 3.585.H., (I.E., FACTS THAT SHOW THAT THE | | |
| | | |TAXPAYER WAS WITHOUT FAULT IN CREATING THE OVERPAYMENT AND WILL INCUR FINANCIAL | | |
| | | |HARDSHIP IF THE INCOME TAX REFUND IS OFFSET). | | |
|3.585 |New Section | |J. IF AN OFFSET IS ESTABLISHED, AN OVERPAYMENT SHALL NOT BE RECOVERED USING |Striking all of C.C.R. 2503-8 and | No |
| | | |ANOTHER METHOD DESCRIBED IN SECTION 3.585 IN THE MONTH THE OFFSET OCCURS UNLESS |moving into C.C.R. 2503-5. | |
| | | |PRIOR AUTHORIZATION IS RECEIVED FROM THE INDIVIDUAL MAKING THE RECOVERY | | |
| | | |PAYMENTS. | | |
|3.585 |New Section | |K. THE COUNTY DEPARTMENT IS REQUIRED TO PURSUE COLLECTION OF THE OVERPAYMENT |Striking all of C.C.R. 2503-8 and | |
| | | |FROM THE CLIENT/RESPONSIBLE PAYEE WHO MANAGED AND ADMINISTERED THE ADULT |moving into C.C.R. 2503-5. | |
| | | |FINANCIAL FUNDS. THE COUNTY DEPARTMENT SHALL PURSUE ALL AVAILABLE OVERPAYMENT | | |
| | | |RECOVERY OPTIONS TO COLLECT THE OVERPAYMENT FROM THE CLIENT/RESPONSIBLE PAYEE | | |
| | | |FIRST AND THEN ANY OTHER LIABLE INDIVIDUALS LEGALLY RESPONSIBLE FOR | | |
| | | |OVERPAYMENTS, UNLESS OTHERWISE SPECIFIED. | | |
| | | |1. IN INSTANCES WHERE A TRUSTEE HAS USED A CLIENT'S TRUST INCOME OR PROPERTY IN | | |
| | | |A MANNER CONTRARY TO THE TERMS OF THE TRUST: | | |
| | | |A. DETERMINE WHETHER AN OVERPAYMENT OF ADULT FINANCIAL GRANT PAYMENTS HAS | | |
| | | |OCCURRED AS A RESULT OF THE CLIENT’S LOSS OF INCOME BASED ON THE TRUSTEE’S | | |
| | | |IMPROPER ACTIONS; | | |
| | | |B. CONSULT WITH THE COUNTY ATTORNEY OR OTHER LEGAL RESOURCE TO DETERMINE HOW | | |
| | | |TO PURSUE ACTION AGAINST A TRUST/TRUSTEE; | | |
| | | |C. ADVISE THE TRUSTEE OF THE OVERPAYMENT CIRCUMSTANCES; AND | | |
| | | |D. IF THE TRUSTEE DISAGREES WITH SUCH CIRCUMSTANCES AND OVERPAYMENT, PURSUE THE| | |
| | | |RECOVERY ESTABLISHMENT AND COLLECTION THROUGH APPROPRIATE LEGAL MEANS; OR | | |
| | | |E. TAKE APPROPRIATE STEPS TO SECURE REPAYMENT WITH THE COOPERATION OF THE | | |
| | | |TRUSTEE; OR, | | |
| | | |F. REPORT SUCH BEHAVIOR OR ACTION BY THE TRUSTEE TO THE COUNTY ADULT | | |
| | | |PROTECTIVE SERVICES TO ENSURE THE PROTECTION OF THE CLIENT’S RIGHTS IN THE | | |
| | | |TRUST. | | |
| | | |2. IN INSTANCES WHERE A POWER OF ATTORNEY HAS USED HIS OR HER LEGAL AUTHORITY | | |
| | | |FOR PURPOSES OTHER THAN FOR THE BENEFIT OF THE CLIENT: | | |
| | | |A. DETERMINE WHETHER AN OVERPAYMENT OF ADULT FINANCIAL GRANT PAYMENTS HAS | | |
| | | |OCCURRED AS A RESULT OF THE POWER OF ATTORNEY’S IMPROPER ACTIONS; | | |
| | | |B. CONSULT WITH THE COUNTY ATTORNEY OR OTHER LEGAL RESOURCE TO DETERMINE HOW | | |
| | | |TO PURSUE ACTION AGAINST A POWER OF ATTORNEY; | | |
| | | |C. ADVISE THE HOLDER OF THE POWER OF ATTORNEY OF THE OVERPAYMENT | | |
| | | |CIRCUMSTANCES; AND, | | |
| | | |D. IF THE HOLDER OF THE POWER OF ATTORNEY DISAGREES WITH SUCH CIRCUMSTANCES AND| | |
| | | |OVERPAYMENT, PURSUE THE RECOVERY ESTABLISHMENT AND COLLECTION THROUGH | | |
| | | |APPROPRIATE LEGAL MEANS; OR | | |
| | | |E. TAKE APPROPRIATE STEPS TO SECURE REPAYMENT WITH THE COOPERATION OF THE | | |
| | | |HOLDER OF THE POWER OF ATTORNEY; OR | | |
| | | |F. REPORT SUCH BEHAVIOR OR ACTION BY THE TRUSTEE TO THE COUNTY ADULT | | |
| | | |PROTECTIVE SERVICES TO ENSURE THE PROTECTION OF THE CLIENT’S RIGHTS AND | | |
| | | |BENEFITS. | | |
|3.585 |New Section | |L. IN ANY CASE IN WHICH AN OVERPAYMENT HAS BEEN MADE, THERE SHALL BE NO RECOVERY|Striking all of C.C.R. 2503-8 and | |
| | | |FROM ANY PERSON: |moving into C.C.R. 2503-5. | |
| | | |1. WHO IS WITHOUT FAULT IN THE CREATION OF THE OVERPAYMENT; AND, | | |
| | | |2. WHO HAS REPORTED ANY INCREASE IN INCOME OR OTHER CIRCUMSTANCES AFFECTING THE | | |
| | | |CLIENT'S ELIGIBILITY WITHIN THE TIMELY REPORTING REQUIREMENTS FOR THE PROGRAM; | | |
| | | |AND, | | |
| | | |3. IF SUCH RECOVERY WOULD DEPRIVE THE PERSON OF INCOME REQUIRED FOR ORDINARY AND| | |
| | | |NECESSARY LIVING EXPENSES AND WOULD BE AGAINST EQUITY AND GOOD CONSCIENCE. THE | | |
| | | |FACT THAT THE CLIENT IS RECEIVING PUBLIC ASSISTANCE SHALL NOT BE THE ONLY FACTOR| | |
| | | |IN MAKING A DETERMINATION THAT THE PERSON WOULD BE DEPRIVED OF INCOME REQUIRED | | |
| | | |FOR ORDINARY AND NECESSARY LIVING EXPENSES AND THAT EQUITY AND GOOD CONSCIENCE | | |
| | | |EXIST. | | |
| | | |A. IF A CLIENT HAS TEN (10) PERCENT OR MORE OF INCOME REMAINING AFTER NECESSARY | | |
| | | |LIVING EXPENSES, HE OR SHE SHALL NOT BE CONSIDERED DEPRIVED OF INCOME. | | |
| | | |B. IF A CLIENT’S EXPENSES EXCEED HIS OR HER INCOME, ADDITIONAL QUESTIONS MUST BE| | |
| | | |ASKED TO DETERMINE HOW HE OR SHE IS MEETING EXPENSES TO ASCERTAIN IF OTHER | | |
| | | |INCOME (I.E. GIFT, IN-KIND) NEEDS TO BE INCLUDED IN THE INCOME CALCULATION. | | |
|3.585 |New Section | |M. WHEN THE OVERPAYMENT RECOVERY IS NOT PURSUED, SUCH FACT, TOGETHER WITH THE |Striking all of C.C.R. 2503-8 and | |
| | | |REASON, SHALL BE DOCUMENTED IN THE STATEWIDE AUTOMATED SYSTEM. ALL INFORMATION |moving into C.C.R. 2503-5. | |
| | | |PERTAINING TO THE REASON, ESTABLISHMENT, AND COLLECTION OF CLAIMS SHALL BE | | |
| | | |RETAINED IN THE CASE RECORD UNTIL THE CLAIM IS WRITTEN OFF OR PAID IN FULL. | | |
|3.586 |New Section | |THE DISPUTE RESOLUTION PROCESS IS AVAILABLE FOR DISPUTES CONCERNING COUNTY |Striking all of C.C.R. 2503-8 and | No |
| | | |DEPARTMENT ACTIONS RELATED TO ELIGIBILITY, REDUCTION OF GRANT PAYMENT AMOUNTS, |moving into C.C.R. 2503-5. | |
| | | |REDETERMINATION PROCEDURES, AND OTHER COUNTY ACTIONS THAT DO NOT INVOLVE | | |
| | | |ALLEGATIONS OF FRAUDULENT ACTS OR IPV ON THE PART OF THE CLIENT. IF THERE IS A | | |
| | | |DISPUTE REGARDING FRAUDULENT ACTIONS OR IPV, THAT DISPUTE MUST BE HANDLED | | |
| | | |ACCORDING TO SECTIONS 3.583 AND 3.584 REGARDING IPVS AND FRAUDULENT ACTS. | | |
| | | |IN ORDER TO RESOLVE DISPUTES BETWEEN COUNTY DEPARTMENTS AND/OR THE LOCAL SERVICE| | |
| | | |DELIVERY AGENCY AND CLIENTS, COUNTY DEPARTMENTS AND LOCAL SERVICE DELIVERY | | |
| | | |AGENCIES SHALL ADOPT PROCEDURES FOR THE RESOLUTION OF DISPUTES CONSISTENT WITH | | |
| | | |THIS SECTION. THE PROCEDURES SHALL BE DESIGNED TO ESTABLISH A SIMPLE | | |
| | | |NON-ADVERSARIAL FORMAT FOR THE INFORMAL RESOLUTION OF DISPUTES. | | |
|3.586 |New Section | |A. THE COUNTY DEPARTMENT OR LOCAL SERVICE DELIVERY AGENCY, PRIOR TO TAKING |Striking all of C.C.R. 2503-8 and | No |
| | | |ACTION TO DENY, TERMINATE, RECOVER, INITIATE VENDOR PAYMENTS OR MODIFY FINANCIAL|moving into C.C.R. 2503-5. | |
| | | |ASSISTANCE PROVIDED UNDER THE ADULT FINANCIAL PROGRAM TO A CLIENT, SHALL, AT A | | |
| | | |MINIMUM, PROVIDE THE CLIENT AN OPPORTUNITY FOR A COUNTY CONFERENCE. | | |
| | | |1. THE RIGHT OF A CLIENT TO A COUNTY CONFERENCE IS PRIMARILY TO ENSURE THAT THE | | |
| | | |PROPOSED ACTION IS VALID, TO PROTECT THE CLIENT AGAINST AN ERRONEOUS ACTION | | |
| | | |CONCERNING GRANT PAYMENTS, AND TO ENSURE REASONABLE PROMPTNESS OF COUNTY ACTION.| | |
| | | |THE CLIENT MAY CHOOSE, HOWEVER, TO BYPASS THE COUNTY CONFERENCE AND APPEAL | | |
| | | |DIRECTLY TO THE STATE OFFICE OF ADMINISTRATIVE COURTS, PURSUANT TO SECTION | | |
| | | |3.587. | | |
| | | |2. THE CLIENT IS ENTITLED TO: | | |
| | | |A. REPRESENTATION BY AN AUTHORIZED REPRESENTATIVE RETAINED AT HIS OR HER OWN | | |
| | | |EXPENSE, SUCH AS LEGAL COUNSEL, RELATIVE, FRIEND, OR ANOTHER SPOKESPERSON, OR HE| | |
| | | |OR SHE MAY REPRESENT HIMSELF OR HERSELF; | | |
| | | |B. EXAMINE THE CONTENTS OF THE CASE FILE AND ALL DOCUMENTS AND RECORDS USED BY | | |
| | | |THE COUNTY DEPARTMENT OR AGENCY IN MAKING ITS DECISION. EXAMINATION OF THE FILE | | |
| | | |IS AVAILABLE AT A REASONABLE TIME BEFORE THE CONFERENCE AND DURING THE | | |
| | | |CONFERENCE. HOWEVER, THE FILE SHALL NOT INCLUDE NAMES OF CONFIDENTIAL | | |
| | | |INFORMANTS, PRIVILEGED COMMUNICATIONS BETWEEN THE COUNTY DEPARTMENT AND ITS | | |
| | | |ATTORNEY, OR THE NATURE AND STATUS OF PENDING CRIMINAL PROSECUTIONS AND ANY | | |
| | | |OTHER INFORMATION THAT IS CONFIDENTIAL OR PRIVILEGED; AND | | |
| | | |C. PRESENT NEW INFORMATION OR DOCUMENTATION TO SUPPORT REVERSAL OR MODIFICATION | | |
| | | |OF THE PROPOSED ADVERSE ACTION. | | |
| | | |3. FAILURE OF THE CLIENT TO REQUEST A COUNTY CONFERENCE WITHIN NINETY (90) | | |
| | | |CALENDAR DAYS FROM THE DATE TIMELY NOTICE OF THE PROPOSED ACTION WAS MAILED TO | | |
| | | |THE CLIENT WITHOUT MAKING A REQUEST FOR POSTPONEMENT WITHIN THAT SAME NINETY | | |
| | | |(90) DAYS, SHALL CONSTITUTE ABANDONMENT OF THE RIGHT TO A CONFERENCE. THE CLIENT| | |
| | | |DOES NOT LOSE THE RIGHT TO APPEAL DIRECTLY TO THE OAC PURSUANT TO SECTION 3.587.| | |
| | | |4. FAILURE OF THE CLIENT TO APPEAR AT THE SCHEDULED COUNTY CONFERENCE WITHOUT | | |
| | | |MAKING A REQUEST FOR POSTPONEMENT PRIOR TO THE SCHEDULED DATE OF THE CONFERENCE | | |
| | | |SHALL CONSTITUTE ABANDONMENT OF THE RIGHT TO A CONFERENCE UNLESS THE CLIENT CAN | | |
| | | |SHOW GOOD CAUSE FOR HIS OR HER FAILURE TO APPEAR. THE CLIENT DOES NOT LOSE THE | | |
| | | |RIGHT TO APPEAL DIREACTLY TO THE OAC PURSUANT TO SECTION 3.587. | | |
|3.586 |New Section | |B. THE COUNTY CONFERENCE SHALL BE HELD BEFORE A PERSON WHO WAS NOT DIRECTLY |Striking all of C.C.R. 2503-8 and | No |
| | | |INVOLVED IN THE INITIAL DETERMINATION OF THE ACTION IN QUESTION IN THE COUNTY |moving into C.C.R. 2503-5. | |
| | | |DEPARTMENT OR AGENCY WHERE THE PROPOSED DECISION IS PENDING. THE COUNTY WORKER | | |
| | | |OR CONTRACTOR WHO INITIATED THE ACTION IN DISPUTE SHALL NOT CONDUCT THE COUNTY | | |
| | | |CONFERENCE. | | |
| | | |1. THE PERSON DESIGNATED TO CONDUCT THE CONFERENCE SHALL BE IN A POSITION WHICH,| | |
| | | |BASED ON KNOWLEDGE, EXPERIENCE, AND TRAINING, WOULD ENABLE HIM OR HER TO | | |
| | | |DETERMINE IF THE PROPOSED ACTION IS VALID. THIS COULD INCLUDE, BUT IS NOT | | |
| | | |LIMITED TO, A SUPERVISOR, QUALITY ASSURANCE PERSONNEL, OR A MANAGER WITH NO | | |
| | | |PREVIOUS KNOWLEDGE OF THE CASE. | | |
| | | |2. TWO OR MORE COUNTY DEPARTMENTS/LOCAL SERVICE DELIVERY AGENCIES MAY SCHEDULE A| | |
| | | |JOINT COUNTY CONFERENCE RELATED TO THE SAME CLIENT. IF TWO OR MORE | | |
| | | |COUNTIES/LOCAL SERVICE DELIVERY AGENCIES SCHEDULE A JOINT COUNTY CONFERENCE, THE| | |
| | | |LOCATION OF THE CONFERENCE NEED NOT BE HELD IN THE COUNTY OR AGENCY TAKING THE | | |
| | | |ACTION, AND THE CONFERENCE LOCATION SHALL BE CONVENIENT TO THE CLIENT. | | |
| | | |3. THE COUNTY CONFERENCE MAY BE CONDUCTED EITHER IN PERSON, BY TELEPHONE, OR | | |
| | | |VIDEO CONFERENCE. A TELEPHONIC OR VIDEO CONFERENCE MUST BE AGREED TO BY THE | | |
| | | |CLIENT. | | |
| | | |4. THE COUNTY/AGENCY WORKER OR OTHER COUNTY OR DEPARTMENT EMPLOYEE OR CONTRACTOR| | |
| | | |SHALL ATTEND THE COUNTY CONFERENCE AND PRESENT THE FACTUAL BASIS FOR THE | | |
| | | |DISPUTED ACTION. | | |
| | | |5. THE COUNTY CONFERENCE SHALL BE CONDUCTED ON AN INFORMAL BASIS. THE COUNTY | | |
| | | |DEPARTMENT/AGENCY MUST PROVIDE SPECIFIC REASONS FOR THE PROPOSED ACTION, AND THE| | |
| | | |APPLICABLE STATE DEPARTMENT'S RULES, OR COUNTY POLICY. IN THE EVENT THE CLIENT | | |
| | | |DOES NOT SPEAK ENGLISH, AN INTERPRETER SHALL BE PROVIDED BY THE COUNTY | | |
| | | |DEPARTMENT/AGENCY. | | |
| | | |6. THE COUNTY/AGENCY SHALL HAVE AVAILABLE AT THE CONFERENCE ALL PERTINENT | | |
| | | |DOCUMENTS AND RECORDS IN THE CASE FILE RELEVANT TO THE SPECIFIC ACTION IN | | |
| | | |DISPUTE. | | |
| | | |7. TO THE EXTENT POSSIBLE, THE COUNTY CONFERENCE SHALL BE SCHEDULED AND | | |
| | | |CONDUCTED PRIOR TO GRANT PAYMENTS BEING REDUCED OR TERMINATED. | | |
| | | |8. THE COUNTY DEPARTMENT/LOCAL SERVICE AGENCY SHALL PROVIDE NOTICE TO THE CLIENT| | |
| | | |AT LEAST FOUR (4) DAYS PRIOR TO THE SCHEDULED TIME AND LOCATION FOR THE | | |
| | | |CONFERENCE, OR THE TIME OF THE SCHEDULED TELEPHONE OR VIDEO CONFERENCE. NOTICE | | |
| | | |SHOULD BE IN WRITING. THE CLIENT MAY PROVIDE A WRITTEN OR VERBAL WAIVER THAT | | |
| | | |WRITTEN NOTICE OF THE SCHEDULED CONFERENCE IS NOT NECESSARY WHEN THE COUNTY | | |
| | | |DEPARTMENT IS ABLE TO CONDUCT THE CONFERENCE WITHIN FOUR (4) DAYS. | | |
| | | |9. THE COUNTY DEPARTMENT MAY CONSOLIDATE A CLIENT’S DISPUTES REGARDING THE ADULT| | |
| | | |FINANCIAL PROGRAM, THE FOOD ASSISTANCE PROGRAM, OR ANY OTHER PUBLIC ASSISTANCE | | |
| | | |PROGRAM IF THE FACTS ARE SIMILAR AND CONSOLIDATION WOULD FACILITATE RESOLUTION | | |
| | | |OF ALL DISPUTES. | | |
| | | |10. THE GOAL OF THE COUNTY CONFERENCE IS TO REACH AN AGREEMENT BETWEEN THE | | |
| | | |CLIENT AND THE COUNTY DEPARTMENT AND/OR THE LOCAL SERVICE DELIVERY AGENCY. | | |
|3.586 |New Section | |C. AT THE CONCLUSION OF THE CONFERENCE, THE PERSON PRESIDING SHALL SUMMARIZE THE|Striking all of C.C.R. 2503-8 and | No |
| | | |DISCUSSION IN WRITING. THE SUMMARY SHALL INCLUDE WHETHER THE ISSUE WAS RESOLVED |moving into C.C.R. 2503-5. | |
| | | |AND INCLUDE THE CLIENT’S APPEAL RIGHTS AS DESCRIBED IN SECTION 3.587.A. A COPY | | |
| | | |OF THE WRITTEN SUMMARY SHALL BE PROVIDED TO THE CLIENT AND/OR HIS OR HER | | |
| | | |REPRESENTATIVE WITHIN ELEVEN (11) CALENDAR DAYS. A COPY OF THE SUMMARY WILL ALSO| | |
| | | |BE MAINTAINED IN THE CLIENT’S CASE FILE. | | |
|3.587 |New Section | |A. THESE RULES APPLY TO ALL STATE LEVEL FAIR HEARINGS OF COUNTY DEPARTMENT |Striking all of C.C.R. 2503-8 and | No |
| | | |ACTIONS CONCERNING ASSISTANCE PAYMENTS AND ACTIONS TAKEN PURSUANT TO STATE RULES|moving into C.C.R. 2503-5. | |
| | | |GOVERNING THE ADULT FINANCIAL PROGRAM. AN AFFECTED CLIENT WHO IS DISSATISFIED | | |
| | | |WITH A COUNTY DEPARTMENT OR LOCAL SERVICE DELIVERY AGENCY ACTION OR THE RESULT | | |
| | | |OF A COUNTY CONFERENCE OR FAILURE TO ACT CONCERNING GRANT PAYMENTS MAY APPEAL TO| | |
| | | |THE OFFICE OF ADMINISTRATIVE COURTS (OAC) FOR A STATE LEVEL FAIR HEARING BEFORE | | |
| | | |AN INDEPENDENT ADMINISTRATIVE LAW JUDGE (ALJ). THIS WILL BE A FULL EVIDENTIARY | | |
| | | |HEARING OF ALL RELEVANT AND PERTINENT FACTS TO REVIEW THE DECISION OF THE COUNTY| | |
| | | |DEPARTMENT OR LOCAL SERVICE DELIVERY AGENCY. THE TIME LIMITATIONS FOR SUBMITTING| | |
| | | |A REQUEST FOR AN APPEAL ARE: | | |
| | | |1. WHEN THE CLIENT ELECTS TO AVAIL HIM OR HERSELF OF A COUNTY CONFERENCE, BUT IS| | |
| | | |DISSATISFIED WITH THAT DECISION, THE REQUEST MUST BE SUBMITTED IN WRITING AND | | |
| | | |MAILED OR DELIVERED AS DESCRIBED IN 3 BELOW WITHIN THE NINETY (90) DAY PERIOD | | |
| | | |SPECIFIED IN 2, BELOW; | | |
| | | |2. WHEN THE CLIENT ELECTS NOT TO AVAIL HIM OR HERSELF OF A COUNTY CONFERENCE BUT| | |
| | | |WISHES TO APPEAL DIRECTLY TO THE STATE, A WRITTEN REQUEST FOR AN APPEAL MUST BE | | |
| | | |MAILED OR DELIVERED AS DESCRIBED IN 3 BELOW NO LATER THAN NINETY (90) CALENDAR | | |
| | | |DAYS FROM THE DATE TIMELY NOTICE OF THE PROPOSED ACTION WAS MAILED TO THE | | |
| | | |PERSON; | | |
| | | |3. A REQUEST FOR AN APPEAL MUST BE MAILED OR DELIVERED TO THE OFFICE OF | | |
| | | |ADMINISTRATIVE COURTS. IF THE REQUEST FOR APPEAL IS SENT TO OR MADE WITH THE | | |
| | | |COUNTY DEPARTMENT, THE COUNTY SHALL FORWARD SUCH REQUEST TO THE OAC. | | |
|3.587 |New Section | |B. REQUESTS FOR STATE LEVEL FAIR HEARINGS MAY RESULT FROM SUCH REASONS AS: |Striking all of C.C.R. 2503-8 and | No |
| | | |1. THE OPPORTUNITY TO MAKE AN APPLICATION OR REAPPLICATION HAS BEEN DENIED; |moving into C.C.R. 2503-5. | |
| | | |2. AN APPLICATION FOR ASSISTANCE OR SERVICES HAS NOT BEEN ACTED UPON WITHIN THE | | |
| | | |MAXIMUM TIME PERIOD FOR THE CATEGORY OF ASSISTANCE; | | |
| | | |3. THE APPLICATION FOR ASSISTANCE HAS BEEN DENIED; THE GRANT PAYMENT HAS BEEN | | |
| | | |MODIFIED OR DISCONTINUED; REQUESTED RECONSIDERATION OR A GRANT PAYMENT AMOUNT | | |
| | | |DEEMED INCORRECT HAS BEEN REFUSED OR DELAYED; GRANT PAYMENT HAS BEEN DELAYED | | |
| | | |THROUGH THE HOLDING OF PAYMENTS; THE COUNTY DEPARTMENT IS DEMANDING REPAYMENT | | |
| | | |FOR ANY PART OF A GRANT PAYMENT TO A CLIENT WHICH THE CLIENT DOES NOT BELIEVE IS| | |
| | | |JUSTIFIED; OR THE CLIENT DISAGREES WITH THE TYPE OR LEVEL OF BENEFITS OR | | |
| | | |SERVICES PROVIDED. | | |
|3.587 |New Section | |C. THE BASIC OBJECTIVES AND PURPOSES OF THE APPEAL AND STATE LEVEL FAIR HEARING |Striking all of C.C.R. 2503-8 and | No |
| | | |PROCESS ARE: |moving into C.C.R. 2503-5. | |
| | | |1. TO SAFEGUARD THE INTERESTS OF THE CLIENT; | | |
| | | |2. TO PROVIDE A PRACTICAL MEANS BY WHICH THE CLIENT IS AFFORDED A PROTECTION | | |
| | | |AGAINST INCORRECT ACTION ON THE PART OF THE COUNTY DEPARTMENT OR LOCAL SERVICE | | |
| | | |DELIVERY AGENCY; | | |
| | | |3. TO BRING TO THE ATTENTION OF THE STATE DEPARTMENT AND COUNTY DEPARTMENT OR | | |
| | | |LOCAL SERVICE DELIVERY AGENCY INFORMATION THAT MAY INDICATE NEED FOR | | |
| | | |CLARIFICATION OR REVISION OF STATE AND COUNTY POLICIES AND PROCEDURES; | | |
| | | |4. TO ASSURE EQUITABLE TREATMENT THROUGH THE ADMINISTRATIVE PROCESS WITHOUT | | |
| | | |RESORT TO LEGAL ACTION IN THE DISTRICT COURTS. | | |
|3.587 |New Section | |D. ANY CLEAR EXPRESSION VERBALLY OR IN WRITING BY THE CLIENT OR HIS OR HER |Striking all of C.C.R. 2503-8 and | No |
| | | |REPRESENTATIVE, THAT THE CLIENT WANTS AN OPPORTUNITY TO HAVE A SPECIFIC ACTION |moving into C.C.R. 2503-5. | |
| | | |OF A COUNTY DEPARTMENT OR LOCAL SERVICE DELIVERY AGENCY REVIEWED BY THE STATE | | |
| | | |DEPARTMENT IS CONSIDERED AN APPEAL AND A REQUEST FOR A STATE LEVEL FAIR HEARING.| | |
| | | |THE COUNTY DEPARTMENT OR LOCAL SERVICE DELIVERY AGENCY SHALL, WHEN ASKED, AID | | |
| | | |THE PERSON IN PREPARING A REQUEST FOR A HEARING. IF THE REQUEST FOR A HEARING IS| | |
| | | |MADE VERBALLY, THE COUNTY DEPARTMENT SHALL PREPARE A WRITTEN REQUEST WITHIN TEN | | |
| | | |(10) CALENDAR DAYS FOR THE CLIENT OR HIS OR HER REPRESENTATIVE'S SIGNATURE OR | | |
| | | |HAVE THE CLIENT PREPARE SUCH REQUEST, SPECIFYING THE ACTION HE OR SHE WOULD LIKE| | |
| | | |TO APPEAL AND THE REASON FOR APPEALING THAT ACTION. | | |
| | | |1. THE CLIENT IS ENTITLED TO: | | |
| | | |A. REPRESENTATION BY ANY PERSON HE OR SHE CHOOSES PURSUANT TO SECTION | | |
| | | |26-2-127(1)(A)(IV), C.R.S., LEGAL COUNSEL RETAINED AT THE CLIENT’S OWN EXPENSE, | | |
| | | |OR HE OR SHE MAY REPRESENT HIM OR HERSELF; | | |
| | | |B. EXAMINE THE COMPLETE CASE FILE AND ANY OTHER DOCUMENTS, RECORDS, OR PERTINENT| | |
| | | |MATERIAL TO BE USED BY THE COUNTY AT THE STATE LEVEL FAIR HEARING, AT A | | |
| | | |REASONABLE TIME BEFORE THE DATE OF HEARING AS WELL AS DURING THE HEARING. | | |
| | | |HOWEVER, THE FILE SHALL NOT INCLUDE THE NAMES OF CONFIDENTIAL INFORMANTS, | | |
| | | |PRIVILEGED COMMUNICATIONS BETWEEN THE COUNTY DEPARTMENTS AND ITS ATTORNEY, THE | | |
| | | |NATURE AND STATUS OF PENDING CRIMINAL PROSECUTIONS, AND ANY OTHER INFORMATION | | |
| | | |THAT IS CONFIDENTIAL OR PRIVILEGED. | | |
| | | |2. THE CLIENT AND STAFF OF THE COUNTY DEPARTMENT ARE ENTITLED TO: | | |
| | | |A. PRESENT WITNESSES; | | |
| | | |B. ESTABLISH ALL FACTS AND CIRCUMSTANCES PERTINENT TO THE DECISION BEING | | |
| | | |APPEALED; | | |
| | | |C. ADVANCE ANY ARGUMENTS WITHOUT UNDUE INTERFERENCE; | | |
| | | |D. QUESTION OR REFUTE ANY TESTIMONY OR EVIDENCE, INCLUDING OPPORTUNITY TO | | |
| | | |CONFRONT AND CROSS-EXAMINE ADVERSE WITNESSES. | | |
|3.587.1 |New Section | |ONE OR MORE PERSONS FROM THE COLORADO DEPARTMENT PERSONNEL & ADMINISTRATION, |Striking all of C.C.R. 2503-8 and | No |
| | | |OAC, ARE APPOINTED TO SERVE AS ALJ FOR THE STATE DEPARTMENT. |moving into C.C.R. 2503-5. | |
|3.587.1 |New Section | |A. THE STATE ALJ SHALL, IN PREPARATION FOR THE HEARING, REVIEW THE REASONS FOR |Striking all of C.C.R. 2503-8 and | No |
| | | |THE DECISION UNDER APPEAL AND BE PREPARED TO INTERPRET APPLICABLE DEPARTMENTAL |moving into C.C.R. 2503-5. | |
| | | |RULES GOVERNING THE ADULT FINANCIAL PROGRAM AND THE ISSUE(S) UNDER APPEAL. | | |
|3.587.1 |New Section | |B. WHEN LEGAL COUNSEL DOES NOT REPRESENT THE CLIENT AND/OR THE DEPARTMENT OR |Striking all of C.C.R. 2503-8 and | No |
| | | |LOCAL SERVICE DELIVERY AGENCY, THE ALJ SHALL ASSIST IN BRINGING FORTH ALL |moving into C.C.R. 2503-5. | |
| | | |RELEVANT EVIDENCE AND ISSUES RELATING TO THE APPEAL. | | |
|3.587.1 |New Section | |C. UPON RECEIPT BY THE OAC OF AN APPEAL REQUEST, OAC ASSIGNS A CASE NUMBER. THE |Striking all of C.C.R. 2503-8 and | No |
| | | |OAC SETS A HEARING DATE AT LEAST TEN (10) DAYS FROM THE DATE THE APPEAL WAS |moving into C.C.R. 2503-5. | |
| | | |REQUESTED, AND SENDS A LETTER BY FIRST CLASS OR CERTIFIED MAIL TO THE APPELLANT | | |
| | | |AND THE COUNTY DEPARTMENT OR LOCAL SERVICE DELIVERY AGENCY NOTIFYING THEM OF THE| | |
| | | |DATE, TIME, AND PLACE OF THE HEARING. | | |
| | | |1. THE LETTER ADVISES THE APPELLANT THAT IF THESE ARRANGEMENTS ARE NOT | | |
| | | |SATISFACTORY, HE OR SHE MUST NOTIFY THE OAC. AN ALJ WILL DECIDE IF GOOD CAUSE | | |
| | | |EXISTS, AND WHETHER THE DATE, TIME, AND/OR PLACE OF THE HEARING WILL BE CHANGED.| | |
| | | |2. AN INFORMATION SHEET SHALL BE ENCLOSED WITH THE LETTER THAT EXPLAINS THE | | |
| | | |HEARING PROCEDURES TO THE APPELLANT. THE INFORMATION SHEET INFORMS THE APPELLANT| | |
| | | |THAT: | | |
| | | |A. HE OR SHE HAS THE RIGHT TO REPRESENTATION BY AN AUTHORIZED REPRESENTATIVE | | |
| | | |RETAINED AT HIS OR HER OWN EXPENSE, SUCH AS LEGAL COUNSEL, A RELATIVE, A FRIEND,| | |
| | | |OR ANOTHER SPOKESPERSON, OR HE OR SHE MAY REPRESENT HIMSELF OR HERSELF; | | |
| | | |B. THE APPELLANT OR HIS OR HER REPRESENTATIVE HAS THE RIGHT TO EXAMINE ALL | | |
| | | |MATERIALS TO BE USED AT THE HEARING, BEFORE AND DURING THE HEARING; AND | | |
| | | |C. FAILURE TO APPEAR AT THE HEARING AS SCHEDULED, WITHOUT HAVING SECURED A | | |
| | | |PROPER EXTENSION IN ADVANCE, OR WITHOUT HAVING SHOWN GOOD CAUSE FOR FAILURE TO | | |
| | | |APPEAR, SHALL CONSTITUTE ABANDONMENT OF THE APPEAL AND CAUSE A DISMISSAL | | |
| | | |THEREOF. | | |
| | | |3. IF OAC SETS THE HEARING FORTY-FIVE (45) DAYS OR MORE FROM THE DATE OF THE | | |
| | | |NOTICE OF HEARING, THE COUNTY DEPARTMENT/AGENCY SHALL, WITHIN FIFTEEN (15) DAYS | | |
| | | |BUT NO LATER THAN THIRTY (30) DAYS PRIOR TO THE HEARING, PREPARE AND MAIL A | | |
| | | |HEARING PACKET TO THE APPELLANT WITH A COPY TO OAC. IF THE HEARING IS SET LESS | | |
| | | |THAN 45 DAYS FROM THE DATE OF THE NOTICE OF HEARING, THE COUNTY | | |
| | | |DEPARTMENT/AGENCY SHALL, WITHIN FIVE (5) DAYS BUT NO LATER THAN TEN (10) DAYS | | |
| | | |PRIOR TO THE HEARING, PREPARE AND MAIL THE HEARING PACKET. THE HEARING PACKET | | |
| | | |SHALL CONTAIN THE FOLLOWING INFORMATION: | | |
| | | |A. THE REASONS FOR THE DECISION OF THE COUNTY DEPARTMENT OR LOCAL SERVICE | | |
| | | |DELIVERY AGENCY AND A SPECIFIC EXPLANATION OF EACH FACTOR INVOLVED, SUCH AS THE | | |
| | | |AMOUNT OF EXCESS PROPERTY OR INCOME, ASSIGNMENT OR TRANSFER OF PROPERTY, OR | | |
| | | |RESIDENCE FACTORS; | | |
| | | |B. THE SPECIFIC STATE RULES GOVERNING THE ADULT FINANCIAL PROGRAM ON WHICH THE | | |
| | | |DECISION IS BASED WITH A NUMERIC REFERENCE TO EACH SUCH RULE, INCLUDING THE | | |
| | | |APPROPRIATE CODE OF COLORADO REGULATIONS (C.C.R.) CITES; | | |
| | | |C. NOTICE THAT THE COUNTY DEPARTMENT OR LOCAL SERVICE DELIVERY AGENCY WILL | | |
| | | |ASSIST HIM OR HER BY PROVIDING RELEVANT DOCUMENTS FROM THE CASE FILE FOR HIS OR | | |
| | | |HER CLAIM, IF HE OR SHE SO DESIRES, AND THAT HE OR SHE HAS THE OPPORTUNITY TO | | |
| | | |EXAMINE RULES AND OTHER MATERIALS TO BE USED AT THE HEARING CONCERNING THE BASIS| | |
| | | |OF THE COUNTY DECISION. | | |
| | | |4. INFORMATION THAT THE APPELLANT OR HIS OR HER REPRESENTATIVE DOES NOT HAVE AN | | |
| | | |OPPORTUNITY TO SEE SHALL NOT BE MADE AVAILABLE AS A PART OF THE HEARING RECORD | | |
| | | |OR USED IN A DECISION ON AN APPEAL. NO MATERIAL MADE AVAILABLE FOR REVIEW BY THE| | |
| | | |ALJ MAY BE WITHHELD FROM REVIEW BY THE APPELLANT OR HIS OR HER REPRESENTATIVE. | | |
| | | |5. IN ADULT FINANCIAL PROGRAM APPEALS, THE ALJ HAS TWENTY (20) CALENDAR DAYS | | |
| | | |FROM THE HEARING DATE TO ARRIVE AT AN INITIAL DECISION. ONCE AN INITIAL DECISION| | |
| | | |IS RENDERED, THE OAC IMMEDIATELY SENDS THE CASE AND THE INITIAL DECISION TO THE | | |
| | | |STATE DEPARTMENT, OFFICE OF APPEALS. THE OFFICE OF APPEALS SERVES THE INITIAL | | |
| | | |DECISION ON THE PARTIES VIA FIRST CLASS MAIL AND PROVIDES FOR AN OPPORTUNITY FOR| | |
| | | |THE PARTIES TO FILE EXCEPTIONS TO THE INITIAL DECISION PRIOR TO THE OFFICE OF | | |
| | | |APPEALS ISSUING A FINAL AGENCY DECISION. | | |
| | | |6. THE INITIAL DECISION SHALL NOT BE IMPLEMENTED PENDING REVIEW BY THE OFFICE OF| | |
| | | |APPEALS AND ENTRY OF A FINAL AGENCY DECISION. ALL FINAL AGENCY DECISIONS ON | | |
| | | |THESE APPEALS SHALL BE MADE WITHIN NINETY (90) CALENDAR DAYS FROM THE DATE THE | | |
| | | |REQUEST FOR HEARING IS RECEIVED. | | |
|3.587.1 |New Section | |D. WHEN THE CLIENT HAS HAD A COUNTY CONFERENCE AND WISHES TO APPEAL THE COUNTY |Striking all of C.C.R. 2503-8 and | No |
| | | |DEPARTMENT OR LOCAL SERVICE DELIVERY AGENCY 'S ACTION TO THE OAC, THE FOLLOWING |moving into C.C.R. 2503-5. | |
| | | |PROCEDURES SHALL BE FOLLOWED: | | |
| | | |1. AS PART OF THE COUNTY CONFERENCE THE CLIENT IS INFORMED THAT IF HE OR SHE | | |
| | | |WISHES TO APPEAL TO THE OAC FOR A HEARING, THE COUNTY DEPARTMENT OR LOCAL | | |
| | | |SERVICE DELIVERY AGENCY SHALL PROVIDE RELEVANT DOCUMENTS FROM THE CASE FILE FOR | | |
| | | |THE CLIENT’S CLAIM, IF HE OR SHE SO DESIRES, AND THAT HE OR SHE MAY HAVE THE | | |
| | | |OPPORTUNITY TO EXAMINE MATERIALS AS DESCRIBED IN THE SECTION 3.587.1.C.2.; | | |
| | | |2. THE COUNTY DEPARTMENT OR LOCAL SERVICE DELIVERY AGENCY SHALL FORWARD A COPY | | |
| | | |OF THE COUNTY DECISION BEING APPEALED AND A COPY OF THE WRITTEN NOTIFICATION OF | | |
| | | |THE DECISION GIVEN TO THE CLIENT TO THE OAC. | | |
| | | |3. A COPY OF THE OAC’S NOTICE TO THE CLIENT SETTING A DATE FOR THE HEARING IS | | |
| | | |FORWARDED TO THE COUNTY DEPARTMENT OR LOCAL SERVICE DELIVERY AGENCY. THE COUNTY| | |
| | | |DEPARTMENT OR LOCAL SERVICE DELIVERY AGENCY SHALL PROVIDE THE CLIENT WITH A | | |
| | | |HEARING PACKET IN ACCORDANCE TO SECTION 3.587.1.C.3. | | |
| | | |4. IF THE CLIENT INDICATES TO THE COUNTY DEPARTMENT THAT HE OR SHE DESIRES TO | | |
| | | |WITHDRAW THE APPEAL, THE COUNTY DEPARTMENT SHALL OBTAIN A STATEMENT TO THAT | | |
| | | |EFFECT IN WRITING AND FORWARD IT TO THE OAC. | | |
| | | |5. IF A CLIENT HAS LEGAL COUNSEL OR ANOTHER AUTHORIZED REPRESENTATIVE FOR THE | | |
| | | |APPEAL, THE COUNTY DEPARTMENT OR LOCAL SERVICE DELIVERY AGENCY WILL NOT DISCUSS | | |
| | | |THE MERITS OF THE APPEAL OR THE QUESTION OF WHETHER OR NOT TO PROCEED WITH IT | | |
| | | |WITH THE CLIENT UNLESS THE DISCUSSION IS IN THE PRESENCE OF, OR WITH THE | | |
| | | |PERMISSION OF, SUCH COUNSEL OR SUCH OTHER AUTHORIZED REPRESENTATIVE. | | |
| | | |6. IF THE COUNTY DEPARTMENT OR LOCAL SERVICE DELIVERY AGENCY LEARNS THAT LEGAL | | |
| | | |COUNSEL WILL REPRESENT THE CLIENT, THE COUNTY DEPARTMENT OR LOCAL SERVICE | | |
| | | |DELIVERY AGENCY SHALL MAKE EVERY EFFORT TO ENSURE THAT IT, TOO, IS REPRESENTED | | |
| | | |BY AN ATTORNEY AT THE HEARING. THE COUNTY DEPARTMENT/AGENCY MAY BE REPRESENTED | | |
| | | |BY AN ATTORNEY IN ANY APPEAL THAT IT CONSIDERS SUCH REPRESENTATION DESIRABLE. | | |
| | | |7. IF THE APPELLANT NEEDS INTERPRETATION SERVICES, THE COUNTY DEPARTMENT SHALL | | |
| | | |ARRANGE TO HAVE PRESENT AT THE HEARING A CERTIFIED INTERPRETER WHO WILL BE SWORN| | |
| | | |TO TRANSLATE CORRECTLY. | | |
| | | |8. THE FACT THAT AN APPELLANT AND THE COUNTY DEPARTMENT OR LOCAL SERVICE | | |
| | | |DELIVERY AGENCY HAVE BEEN NOTIFIED THAT A HEARING WILL BE HELD DOES NOT PREVENT | | |
| | | |THE COUNTY DEPARTMENT/AGENCY FROM REVIEWING THE CASE AND CONSIDERING ANY NEW | | |
| | | |FACTORS WHICH MIGHT CHANGE THE STATUS OF THE CASE, OR TAKING SUCH ACTION AS MAY | | |
| | | |BE INDICATED TO REVERSE ITS DECISION OR OTHERWISE SETTLE THE ISSUE. ANY CHANGE | | |
| | | |THAT RESULTS IN VOIDING THE CAUSE OF APPEAL SHALL BE IMMEDIATELY REPORTED BY THE| | |
| | | |COUNTY DEPARTMENT TO THE OAC. | | |
| | | |9. UPON RECEIPT OF NOTICE OF A STATE HEARING ON AN APPEAL, THE COUNTY DEPARTMENT| | |
| | | |OR LOCAL SERVICE DELIVERY AGENCY SHALL ARRANGE FOR A SUITABLE HEARING ROOM | | |
| | | |APPROPRIATE TO ACCOMMODATE THE NUMBER OF PERSONS, INCLUDING WITNESSES, WHO ARE | | |
| | | |EXPECTED TO BE IN ATTENDANCE, TAKING INTO CONSIDERATION SUCH FACTORS AS PRIVACY;| | |
| | | |ABSENCE OF DISTRACTING NOISE; AND THE NEED FOR TABLE, CHAIRS, ELECTRICAL | | |
| | | |OUTLETS, ADEQUATE LIGHTING AND VENTILATION, AND CONFERENCE TELEPHONE FACILITIES.| | |
|3.587.1 |New Section | |E. TELEPHONIC CONFERENCE HEARINGS MAY BE CONDUCTED AS AN ALTERNATIVE TO |Striking all of C.C.R. 2503-8 and | No |
| | | |IN-PERSON HEARINGS UNLESS OTHERWISE REQUESTED BY ANY OF THE PARTIES. ALL |moving into C.C.R. 2503-5. | |
| | | |APPLICABLE PROVISIONS OF THE IN-PERSON HEARING PROCEDURES WILL APPLY, SUCH AS | | |
| | | |THE RIGHT TO BE REPRESENTED BY COUNSEL, THE RIGHT TO EXAMINE AND CROSS-EXAMINE | | |
| | | |WITNESSES, THE RIGHT TO EXAMINE THE CONTENTS OF THE CASE FILE, AND THE RIGHT TO | | |
| | | |HAVE THE HEARING CONDUCTED AT A REASONABLE TIME AND DATE. | | |
| | | |1. THE ALJ SHALL CONDUCT THE HEARINGS IN ACCORDANCE WITH THE STATE | | |
| | | |ADMINISTRATIVE PROCEDURE ACT, ARTICLE 4 OF TITLE 24, C.R.S, SPECIFICALLY, | | |
| | | |SECTION 24-4-105. | | |
| | | |2. THE COUNTY DEPARTMENT OR LOCAL SERVICE DELIVERY AGENCY SHALL HAVE THE BURDEN | | |
| | | |OF PROOF, BY A PREPONDERANCE OF THE EVIDENCE, TO ESTABLISH THE BASIS OF THE | | |
| | | |DECISION BEING APPEALED. EVERY PARTY TO THE PROCEEDING SHALL HAVE THE RIGHT TO | | |
| | | |PRESENT HIS OR HER CASE OR DEFENSE BY VERBAL AND DOCUMENTARY EVIDENCE, TO SUBMIT| | |
| | | |REBUTTAL EVIDENCE, AND TO CONDUCT SUCH CROSS-EXAMINATION AS MAY BE REQUIRED FOR | | |
| | | |A FULL AND TRUE DISCLOSURE OF THE FACTS. SUBJECT TO THESE RIGHTS AND | | |
| | | |REQUIREMENTS, WHERE A HEARING IS EXPEDITED AND THE INTERESTS OF THE PARTIES WILL| | |
| | | |NOT BE SUBSEQUENTLY PREJUDICED THEREBY, THE ALJ MAY RECEIVE ALL OR PART OF THE | | |
| | | |EVIDENCE IN WRITTEN FORM OR BY VERBAL STIPULATIONS. | | |
|3.587.1 |New Section | |F. THE FOLLOWING PROVISIONS GOVERN THE PROCEDURE AT STATE HEARINGS BEFORE THE |Striking all of C.C.R. 2503-8 and | No |
| | | |ALJ: |moving into C.C.R. 2503-5. | |
| | | |1. THE HEARING IS CLOSED TO THE PUBLIC. HOWEVER, ANY PERSON OR PERSONS WHOM THE | | |
| | | |APPELLANT WISHES TO APPEAR FOR OR WITH HIM OR HER MAY BE PRESENT, AND, IF | | |
| | | |REQUESTED BY THE APPELLANT ON THE RECORD, SUCH HEARING MAY BE PUBLIC; | | |
| | | |2. THE PURPOSE OF THE HEARING IS TO DETERMINE THE PERTINENT FACTS IN ORDER TO | | |
| | | |ARRIVE AT A FAIR AND EQUITABLE DECISION IN ACCORDANCE WITH THE RULES OF THE | | |
| | | |STATE DEPARTMENT. IN ARRIVING AT A DECISION, ONLY THE EVIDENCE AND TESTIMONY | | |
| | | |INTRODUCED AT THE HEARING IS CONSIDERED BY THE ALJ. HOWEVER, IN CIRCUMSTANCES | | |
| | | |WHEN IT IS SHOWN AT THE HEARING THAT MEDICAL OR OTHER EVIDENCE COULD NOT, FOR | | |
| | | |GOOD CAUSE, BE OBTAINED IN TIME FOR THE HEARING, THE ALJ MAY PERMIT THE | | |
| | | |INTRODUCTION OF SUCH EVIDENCE AFTER THE HEARING. THE OPPOSING PARTY MUST ALSO BE| | |
| | | |FURNISHED WITH A COPY OF THIS NEW EVIDENCE AND MUST HAVE THE OPPORTUNITY TO | | |
| | | |CONTROVERT OR OTHERWISE RESPOND TO IT. DELAYS IN RENDERING THE INITIAL DECISION | | |
| | | |WILL BE ATTRIBUTED TO THE PARTY REQUESTING THAT THE ALJ HEAR ADDITIONAL EVIDENCE| | |
| | | |AFTER THE HEARING; | | |
| | | |3. ALTHOUGH THE HEARING IS CONDUCTED ON AN INFORMAL BASIS AND AN EFFORT IS MADE | | |
| | | |TO PLACE ALL THE PARTIES AT EASE, IT IS ESSENTIAL THAT THE EVIDENCE BE PRESENTED| | |
| | | |IN AN ORDERLY MANNER SO AS TO RESULT IN AN ADEQUATE RECORD; | | |
| | | |4. WHEN AN ALJ MAKES A DECISION REGARDING THE MERITS OF THE CASE, OR THE | | |
| | | |DISMISSAL OF THE APPEAL, THAT DECISION IS CALLED AN INITIAL DECISION, SEE | | |
| | | |SECTION 3.587.2 ADDRESSING INITIAL DECISIONS; | | |
| | | |5. A COMPLETE AND EXACT RECORD OF THE HEARING SHALL BE MADE BY ELECTRONIC OR | | |
| | | |OTHER MEANS. WHEN REQUESTED BY THE PARTY, THE OAC SHALL CAUSE THE PROCEEDINGS TO| | |
| | | |BE TRANSCRIBED AT THE EXPENSE OF THE REQUESTING PARTY; | | |
| | | |6. THE ALJ SHALL NOT ENTER A DEFAULT AGAINST ANY PARTY FOR FAILURE TO FILE A | | |
| | | |WRITTEN ANSWER IN RESPONSE TO THE NOTICE OF HEARING, BUT SHALL BASE THE INITIAL | | |
| | | |DECISION UPON THE EVIDENCE INTRODUCED AT THE HEARING. HOWEVER, AN APPELLANT MAY | | |
| | | |BE GRANTED A POSTPONEMENT OF THE HEARING IF THE COUNTY DEPARTMENT OR LOCAL | | |
| | | |SERVICE DELIVERY AGENCY HAS FAILED TO PROVIDE THE HEARING PACKET REQUIRED BY | | |
| | | |SECTION 3.587.1.D.3, AND THE APPELLANT HAS THEREFORE BEEN UNABLE TO PREPARE FOR | | |
| | | |THE HEARING. | | |
| | | |7. WHEN THE ALJ DISMISSES AN APPEAL FOR REASONS OTHER THAN FAILURE TO APPEAR, | | |
| | | |THE DECISION OF THE ALJ SHALL BE AN INITIAL DECISION WHICH SHALL NOT BE | | |
| | | |IMPLEMENTED UNTIL AFTER THE OFFICE OF APPEALS COMPLETES ITS REVIEW AND ENTERS A | | |
| | | |FINAL AGENCY DECISION. | | |
| | | |8. WHEN OAC HAS NOTIFIED THE APPELLANT OF THE TIME, DATE, AND PLACE OF THE OAC | | |
| | | |HEARING AND THE APPELLANT FAILS TO APPEAR AT THE HEARING, WITHOUT GIVING NOTICE | | |
| | | |TO THE ALJ OF ACCEPTABLE GOOD CAUSE FOR HIS OR HER INABILITY TO APPEAR AT THE | | |
| | | |HEARING, THEN THE APPEAL SHALL BE CONSIDERED ABANDONED. THE ALJ SHALL ENTER AN | | |
| | | |ORDER OF DISMISSAL AND THE OAC SHALL SERVE IT UPON THE PARTIES. THE DISMISSAL | | |
| | | |ORDER SHALL NOT BE IMPLEMENTED PENDING REVIEW BY THE OFFICE OF APPEALS AND ENTRY| | |
| | | |OF A FINAL AGENCY DECISION. | | |
| | | |HOWEVER, THE APPELLANT, SHALL HAVE TEN (10) CALENDAR DAYS FROM THE DATE THE | | |
| | | |ORDER OF DISMISSAL WAS MAILED TO DRAFT AND SEND A LETTER TO THE ALJ EXPLAINING | | |
| | | |THE REASON FOR HIS OR HER FAILURE TO APPEAR. IF THE ALJ THEN FINDS THAT THERE | | |
| | | |WAS GOOD CAUSE FOR THE APPELLANT NOT APPEARING, THE ALJ SHALL VACATE THE ORDER | | |
| | | |DISMISSING THE APPEAL AND RESCHEDULE THE HEARING DATE. | | |
| | | |IF THE APPELLANT SUBMITS A LETTER SEEKING TO SHOW GOOD CAUSE AND THE ALJ FINDS | | |
| | | |THAT THE STATED FACTS DO NOT CONSTITUTE GOOD CAUSE, THE ALJ SHALL ENTER AN | | |
| | | |INITIAL DECISION CONFIRMING THE DISMISSAL. | | |
| | | |IF THE APPELLANT DOES NOT SUBMIT A LETTER SEEKING TO SHOW GOOD CAUSE WITHIN THE | | |
| | | |TEN (10) DAY PERIOD, THE ORDER OF DISMISSAL SHALL BE FILED WITH THE OFFICE OF | | |
| | | |APPEALS OF THE STATE DEPARTMENT. THE OFFICE OF APPEALS SHALL CONFIRM THE | | |
| | | |DISMISSAL OF THE APPEAL BY A FINAL AGENCY DECISION, WHICH SHALL BE SERVED UPON | | |
| | | |THE PARTIES. | | |
| | | |AFTER THE FINAL AGENCY DECISION IS SERVED ON THE PARTIES, THE COUNTY DEPARTMENT | | |
| | | |OR LOCAL SERVICE DELIVERY AGENCY SHALL CARRY OUT THE NECESSARY ACTIONS WITHIN | | |
| | | |TEN (10) CALENDAR DAYS OF THE FINAL AGENCY DECISION BECOMING EFFECTIVE. THE | | |
| | | |ACTIONS MAY BE: TO PROVIDE ASSISTANCE IN THE CORRECT AMOUNT; TO TERMINATE | | |
| | | |ASSISTANCE; TO RECOVER ASSISTANCE INCORRECTLY PAID; AND/OR OTHER APPROPRIATE | | |
| | | |ACTIONS IN ACCORDANCE WITH THE RULES AND FINAL AGENCY DECISION. | | |
| | | |9. THE APPELLANT MAY FILE EXCEPTIONS TO ANY ALJ INITIAL DECISION PURSUANT TO | | |
| | | |SECTION 3.587.2.C. | | |
|3.587.2 |New Section | |A. FOLLOWING THE CONCLUSION OF THE STATE LEVEL FAIR HEARING, THE ALJ SHALL |Striking all of C.C.R. 2503-8 and | No |
| | | |PROMPTLY PREPARE AND ISSUE AN INITIAL DECISION AND FILE IT WITH THE STATE |moving into C.C.R. 2503-5. | |
| | | |DEPARTMENT, OFFICE OF APPEALS. | | |
| | | |THE OFFICE OF APPEALS OF THE STATE DEPARTMENT IS THE DESIGNEE OF THE STATE | | |
| | | |DEPARTMENT’S EXECUTIVE DIRECTOR FOR REVIEWING THE INITIAL DECISION OF THE ALJ. | | |
| | | |THE OFFICE OF APPEALS ENTERS A FINAL AGENCY DECISION ON BEHALF OF THE EXECUTIVE | | |
| | | |DIRECTOR AFFIRMING, MODIFYING, OR REVERSING THE INITIAL DECISION. | | |
| | | |1. THE INITIAL DECISION SHALL MAKE AN INITIAL DETERMINATION WHETHER THE COUNTY, | | |
| | | |LOCAL SERVICE DELIVERY AGENCY, OR STATE DEPARTMENT OR ITS AGENT ACTED IN | | |
| | | |ACCORDANCE WITH, AND/OR PROPERLY INTERPRETED, THE RULES OF THE STATE DEPARTMENT | | |
| | | |GOVERNING THE ADULT FINANCIAL PROGRAM. | | |
| | | |2. THE ALJ HAS NO JURISDICTION OR AUTHORITY TO DETERMINE ISSUES OF | | |
| | | |CONSTITUTIONALITY OR LEGALITY OF DEPARTMENTAL RULES. | | |
| | | |3. THE INITIAL DECISION SHALL ADVISE THE CLIENT WHO BROUGHT THE APPEAL THAT | | |
| | | |FAILURE TO FILE EXCEPTIONS TO FINDINGS OF THE INITIAL DECISION WILL WAIVE THE | | |
| | | |RIGHT TO SEEK JUDICIAL REVIEW OF A FINAL AGENCY DECISION THAT AFFIRMS THOSE | | |
| | | |FINDINGS. | | |
| | | |4. THE OFFICE OF APPEALS SHALL PROMPTLY SERVE THE INITIAL DECISION UPON EACH | | |
| | | |PARTY BY FIRST CLASS MAIL, AND SHALL TRANSMIT A COPY OF THE DECISION EITHER | | |
| | | |ELECTRONICALLY OR IN WRITING TO THE DIVISION OF THE STATE DEPARTMENT THAT | | |
| | | |ADMINISTERS THE PROGRAM(S) PERTINENT TO THE APPEAL. | | |
| | | |5. THE INITIAL DECISION SHALL NOT BE IMPLEMENTED PENDING REVIEW BY THE OFFICE OF| | |
| | | |APPEALS AND ENTRY OF A FINAL AGENCY DECISION. | | |
|3.587.2 |New Section | |B. UPON RECEIVING THE INITIAL DECISION, THE OFFICE OF APPEALS MAY ISSUE AN ORDER|Striking all of C.C.R. 2503-8 and | No |
| | | |OF REMAND BASED ON AN ISSUE THAT WARRANTS AN IMMEDIATE REMAND BEFORE THE INITIAL|moving into C.C.R. 2503-5. | |
| | | |DECISION IS EVEN MAILED TO THE PARTIES. | | |
| | | |ADDITIONALLY, THE OFFICE OF APPEALS MAY ISSUE AN ORDER OF REMAND AFTER ITS | | |
| | | |SUBSTANTIVE REVIEW OF AN INITIAL DECISION, AND PRIOR TO ISSUING A FINAL AGENCY | | |
| | | |DECISION, BASED ON THE NEED FOR FURTHER CLARIFICATION, FINDINGS, CONCLUSIONS OF | | |
| | | |LAW, AND/OR FURTHER PROCEEDINGS. AN ORDER OF REMAND IS NOT A FINAL AGENCY | | |
| | | |DECISION THAT IS SUBJECT TO JUDICIAL REVIEW. | | |
|3.587.2 |New Section | |C. ANY PARTY SEEKING A FINAL AGENCY DECISION WHICH REVERSES, MODIFIES, OR |Striking all of C.C.R. 2503-8 and | |
| | | |REMANDS THE INITIAL DECISION OF THE ADMINISTRATIVE LAW JUDGE SHALL FILE |moving into C.C.R. 2503-5. | |
| | | |EXCEPTIONS TO THE DECISION WITH THE OFFICE OF APPEALS, WITHIN FIFTEEN (15) DAYS | | |
| | | |(PLUS THREE DAYS FOR MAILING) FROM THE DATE THE INITIAL DECISION IS MAILED TO | | |
| | | |THE PARTIES. IF THAT DATE FALLS ON A WEEKEND OR STATE HOLIDAY, THE DUE DATE | | |
| | | |SHALL BE MOVED TO THE NEXT BUSINESS DAY. EXCEPTIONS MUST STATE SPECIFIC GROUNDS | | |
| | | |FOR REVERSAL, MODIFICATION OR REMAND OF THE INITIAL DECISION. | | |
| | | |1. IF THE PARTY ASSERTS THAT THE ALJ’S FINDINGS OF FACT ARE NOT SUPPORTED BY THE| | |
| | | |WEIGHT OF THE EVIDENCE, THE PARTY SHALL, SIMULTANEOUSLY WITH, OR PRIOR TO, THE | | |
| | | |FILING OF EXCEPTIONS, REQUEST THAT THE OAC CREATE A TRANSCRIPT OF ALL OR A | | |
| | | |PORTION OF THE HEARING AND FILE IT WITH THE OFFICE OF APPEALS. NO TRANSCRIPT IS | | |
| | | |REQUIRED IF THE REVIEW IS LIMITED TO A PURE QUESTION OF LAW. SIMILARLY, IF THE | | |
| | | |EXCEPTIONS ASSERT ONLY THAT THE ALJ IMPROPERLY INTERPRETED OR APPLIED STATE | | |
| | | |RULES OR STATUTES, THE PARTY FILING EXCEPTIONS IS NOT REQUIRED TO PROVIDE A | | |
| | | |TRANSCRIPT OR RECORDING TO THE OFFICE OF APPEALS. | | |
| | | |IF APPLICABLE, THE EXCEPTIONS SHALL STATE THAT A TRANSCRIPT HAS BEEN REQUESTED. | | |
| | | |WITHIN FIVE (5) DAYS OF THE REQUEST FOR A TRANSCRIPT, THE PARTY REQUESTING IT | | |
| | | |SHALL ADVANCE THE COST THEREFORE TO THE TRANSCRIBER DESIGNATED BY THE OAC, | | |
| | | |UNLESS THE TRANSCRIBER WAIVES PRIOR PAYMENT. | | |
| | | |2. A PARTY WHO IS INDIGENT AND UNABLE TO PAY THE COST OF A TRANSCRIPT MAY FILE A| | |
| | | |WRITTEN REQUEST, WHICH NEED NOT BE SWORN, WITH THE OFFICE OF APPEALS FOR | | |
| | | |PERMISSION TO SUBMIT A COPY OF THE HEARING AUDIO RECORDING INSTEAD OF THE | | |
| | | |TRANSCRIPT. IF SUBMISSION OF A RECORDING IS PERMITTED, THE PARTY FILING | | |
| | | |EXCEPTIONS MUST PROMPTLY REQUEST A COPY OF THE RECORDING FROM THE OAC AND | | |
| | | |DELIVER IT TO THE OFFICE OF APPEALS. PAYMENT IN ADVANCE SHALL BE REQUIRED FOR | | |
| | | |THE PREPARATION OF A COPY OF THE RECORDING. | | |
| | | |3. THE OFFICE OF APPEALS SHALL SERVE A COPY OF THE EXCEPTIONS ON EACH PARTY BY | | |
| | | |FIRST CLASS MAIL. EACH PARTY SHALL BE LIMITED TO TEN (10) CALENDAR DAYS FROM THE| | |
| | | |DATE EXCEPTIONS ARE MAILED TO THE PARTIES IN WHICH TO FILE A WRITTEN RESPONSE TO| | |
| | | |SUCH EXCEPTIONS. THE OFFICE OF APPEALS SHALL NOT PERMIT VERBAL ARGUMENT. | | |
| | | |4. THE OFFICE OF APPEALS SHALL NOT CONSIDER EVIDENCE THAT WAS NOT PART OF THE | | |
| | | |RECORD BEFORE THE ALJ. HOWEVER, THE CASE MAY BE REMANDED TO THE ALJ FOR | | |
| | | |REHEARING IF A PARTY ESTABLISHES IN ITS EXCEPTIONS THAT MATERIAL EVIDENCE HAS | | |
| | | |BEEN DISCOVERED THAT THE PARTY COULD NOT WITH REASONABLE DILIGENCE HAVE PRODUCED| | |
| | | |AT THE HEARING. | | |
| | | |5. WHILE REVIEW OF THE INITIAL DECISION IS PENDING BEFORE THE OFFICE OF APPEALS,| | |
| | | |THE RECORD ON REVIEW, INCLUDING ANY TRANSCRIPT OR RECORDING OF TESTIMONY FILED | | |
| | | |WITH THE OFFICE OF APPEALS, SHALL BE AVAILABLE FOR EXAMINATION BY ANY PARTY AT | | |
| | | |THE OFFICE OF APPEALS DURING REGULAR BUSINESS HOURS. | | |
| | | |6. THE STATE DEPARTMENT’S DIVISION RESPONSIBLE FOR ADMINISTERING THE PROGRAM | | |
| | | |RELEVANT TO THE APPEAL MAY FILE EXCEPTIONS TO THE INITIAL DECISION, OR RESPOND | | |
| | | |TO EXCEPTIONS FILED BY A PARTY, EVEN THOUGH THE DIVISION HAS NOT PREVIOUSLY | | |
| | | |APPEARED AS A PARTY TO THE APPEAL. THE DIVISION'S EXCEPTIONS OR RESPONSES MUST | | |
| | | |BE FILED IN COMPLIANCE WITH THE REQUIREMENTS OF THIS SECTION. EXCEPTIONS FILED | | |
| | | |BY A DIVISION THAT DID NOT APPEAR AS A PARTY AT THE HEARING SHALL BE TREATED AS | | |
| | | |REQUESTING REVIEW OF THE INITIAL DECISION UPON THE STATE DEPARTMENT'S OWN | | |
| | | |MOTION. | | |
| | | |7. IN THE ABSENCE OF EXCEPTIONS FILED BY ANY PARTY OR BY A DIVISION OF THE STATE| | |
| | | |DEPARTMENT, THE OFFICE OF APPEALS SHALL REVIEW THE INITIAL DECISION, AND MAY | | |
| | | |REVIEW THE HEARING FILE OF THE ALJ AND/OR THE RECORDED TESTIMONY OF WITNESSES, | | |
| | | |BEFORE ENTERING A FINAL AGENCY DECISION. REVIEW BY THE OFFICE OF APPEALS SHALL | | |
| | | |DETERMINE WHETHER THE DECISION PROPERLY INTERPRETS AND APPLIES THE RULES OF THE | | |
| | | |STATE DEPARTMENT AND/OR RELEVANT STATUTES, AND WHETHER THE FINDINGS OF FACT AND | | |
| | | |CONCLUSIONS OF LAW SUPPORT THE DECISION. IF A PARTY OR DIVISION OF THE STATE | | |
| | | |DEPARTMENT OBJECTS TO THE FINAL AGENCY DECISION ENTERED UPON REVIEW BY THE | | |
| | | |OFFICE OF APPEALS, THE PARTY OR DIVISION MAY SEEK RECONSIDERATION OF THE FINAL | | |
| | | |AGENCY DECISION PURSUANT TO SUBSECTION D. BELOW. | | |
| | | |8. THE OFFICE OF APPEALS SHALL MAIL COPIES OF THE FINAL AGENCY DECISION TO ALL | | |
| | | |PARTIES BY FIRST CLASS MAIL. | | |
| | | |9. FOR PURPOSES OF REQUESTING JUDICIAL REVIEW, THE EFFECTIVE DATE OF THE FINAL | | |
| | | |AGENCY DECISION SHALL BE THE THIRD DAY AFTER THE DATE THE DECISION IS MAILED TO | | |
| | | |THE PARTIES, EVEN IF THE THIRD DAY FALLS ON SATURDAY, SUNDAY, OR A LEGAL | | |
| | | |HOLIDAY. THE PARTIES SHALL BE ADVISED OF THIS IN THE FINAL AGENCY DECISION. | | |
| | | |10. THE STATE OR COUNTY DEPARTMENT OR LOCAL SERVICE DELIVERY AGENCY SHALL | | |
| | | |INITIATE ACTION TO COMPLY WITH THE FINAL AGENCY DECISION WITHIN THREE (3) | | |
| | | |WORKING DAYS AFTER THE EFFECTIVE DATE. THE DEPARTMENT SHALL COMPLY WITH THE | | |
| | | |DECISION EVEN IF RECONSIDERATION IS REQUESTED; UNLESS THE EFFECTIVE DATE OF THE | | |
| | | |FINAL AGENCY DECISION IS POSTPONED BY ORDER OF THE OFFICE OF APPEALS OR A | | |
| | | |REVIEWING COURT. | | |
|3.587.2 |New Section | |D. NO MOTION FOR RECONSIDERATION SHALL BE GRANTED UNLESS IT IS FILED IN WRITING |Striking all of C.C.R. 2503-8 and | No |
| | | |WITH THE OFFICE OF APPEALS WITHIN FIFTEEN (15) DAYS OF THE DATE THAT THE FINAL |moving into C.C.R. 2503-5. | |
| | | |AGENCY DECISION IS MAILED TO THE PARTIES. THE MOTION MUST STATE SPECIFIC GROUNDS| | |
| | | |FOR RECONSIDERATION OF THE FINAL AGENCY DECISION. | | |
| | | |THE OFFICE OF APPEALS SHALL MAIL A COPY OF THE MOTION FOR RECONSIDERATION TO | | |
| | | |EACH PARTY OF RECORD AND TRANSMIT ELECTRONICALLY OR IN WRITING TO THE | | |
| | | |APPROPRIATE DIVISION OF THE STATE DEPARTMENT. | | |
| | | |A MOTION FOR RECONSIDERATION OF A FINAL AGENCY DECISION MAY BE GRANTED BY THE | | |
| | | |OFFICE OF APPEALS FOR THE FOLLOWING REASONS: | | |
| | | |1. A SHOWING OF GOOD CAUSE FOR FAILURE TO FILE EXCEPTIONS TO THE INITIAL | | |
| | | |DECISION WITHIN THE FIFTEEN (15) DAY PERIOD ALLOWED BY SECTION 3.587.2.B; OR, | | |
| | | |2. A SHOWING THAT THE FINAL AGENCY DECISION IS BASED UPON A CLEAR OR PLAIN ERROR| | |
| | | |OF FACT OR LAW. AN ERROR OF LAW MEANS FAILURE BY THE OFFICE OF APPEALS TO FOLLOW| | |
| | | |A RULE, STATUTE, OR COURT DECISION, WHICH CONTROLS THE OUTCOME OF THE APPEAL. | | |
|3.587.2 |New Section | |E. WHEN A FINAL AGENCY DECISION CONCLUDES THAT AN ACTION OF THE COUNTY, LOCAL |Striking all of C.C.R. 2503-8 and | No |
| | | |SERVICE DELIVERY AGENCY, OR STATE DEPARTMENT WAS NOT IN ACCORDANCE WITH THE |moving into C.C.R. 2503-5. | |
| | | |RULES OF THE STATE DEPARTMENT, OR WHEN THE COUNTY/AGENCY OR STATE DEPARTMENT | | |
| | | |DETERMINES THAT ITS ACTION WAS NOT SUPPORTED BY THE STATE DEPARTMENT’S RULES | | |
| | | |AFTER THE CLIENT MAKES A REQUEST FOR A HEARING, THE ADJUSTMENT OR CORRECTIVE | | |
| | | |PAYMENT IS MADE RETROACTIVELY TO THE DATE OF THE INCORRECT ACTION. | | |
|3.587.2 |New Section | |F. THE CLIENT IS TO BE FULLY INFORMED BY THE FINAL AGENCY DECISION OF HIS OR HER|Striking all of C.C.R. 2503-8 and | No |
| | | |FURTHER RIGHT TO APPLY FOR JUDICIAL REVIEW OF THE FINAL AGENCY DECISION. |moving into C.C.R. 2503-5. | |
| | | |JUDICIAL REVIEW CAN BE STARTED BY FILING AN ACTION FOR REVIEW IN THE APPROPRIATE| | |
| | | |STATE DISTRICT COURT. ANY SUCH ACTION MUST BE FILED IN ACCORDANCE WITH SECTION | | |
| | | |24-4-106, C.R.S. AND WITH THE COLORADO RULES OF CIVIL PROCEDURE WITHIN | | |
| | | |THIRTY-FIVE (35) DAYS AFTER THE FINAL AGENCY DECISION BECOMES EFFECTIVE. | | |
|3.587.2 |New Section | |G. THE STATE DEPARTMENT WILL ESTABLISH AND MAINTAIN A METHOD FOR INFORMING, IN |Striking all of C.C.R. 2503-8 and | No |
| | | |SUMMARY AND DEPERSONALIZED FORM, ALL COUNTY DEPARTMENTS AND OTHER INTERESTED |moving into C.C.R. 2503-5. | |
| | | |PERSONS CONCERNING THE ISSUES RAISED AND DECISIONS MADE ON APPEALS. | | |
STAKEHOLDER COMMENT SUMMARY
Development
The following individuals and/or entities were included in the development of these proposed rules (such as other Program Areas, Legislative Liaison, and Sub-PAC):
Colorado Gerontological Society; Colorado Cross Disability Coalition; Colorado Center on Law and Policy; Colorado Legal Services; Colorado Department of Human Services Food & Energy Assistance Division; Denver County Department of Human Services; Jefferson County Department of Human Services; Arapahoe County Department of Human Services; El Paso County Department of Human Services; Pueblo County Department of Social Services; Larimer County Department of Human Services; Colorado Access
This Rule-Making Package
The following individuals and/or entities were contacted and informed that this rule-making was proposed for consideration by the State Board of Human Services:
County Human Services Directors Association; Colorado Commission on Aging; Colorado Senior Lobby; Colorado Gerontological Society; Colorado Cross Disability Coalition; Single Entry Point agencies; Economic Security PAC & Sub-PAC; Colorado Center on Law and Policy; Colorado Legal Services;
Other State Agencies
Are other State Agencies (such as HCPF or CDPHE) impacted by these rules? If so, have they been contacted and provided input on the proposed rules?
| |Yes |X |No |
If yes, who was contacted and what was their input?
Sub-PAC
Have these rules been reviewed by the appropriate Sub-PAC Committee?
|X |Yes | |No |
|Name of Sub-PAC |Economic Security |
|Date presented |08/08/19 |
|What issues were raised? |Due to the size of the rule package, counties requested to vote by email. The vote was due 8/21/19 by 4 |
| |p.m. |
| | |
| |During the email voting process, two concerns were raised by Weld County. See below. These have been |
| |added to the Q&A document as well. |
| | |
| |Question: Regarding adding verbiage currently in state statute about the disqualification for any public |
| |assistance due to an IPV in Adult Financial, I believe public policy has shifted since the bill. Why did |
| |it take so long for the verbiage to be added to the administrative rules? What programming requirements |
| |are needed in CBMS to enforce this provision? |
| | |
| |Answer: During the rule rewrite process, a cross walk was completed with statute and other regulations. |
| |This penalty is required by statute and has been written into this volume of rules with the rest of the |
| |administrative rules from 9 C.C.R. 2503-8. If counties do not agree with the language in current statute,|
| |there are other remedies that can be pursued; however the Department needs to comply with the statute as |
| |currently written. Changes are being programmed in CBMS to automate this process and will not require |
| |county intervention. |
| | |
| |Question: I do not agree with including “willful withholding” in the definition of client error claim. |
| |State EBD is proposing to include a definition of a client error AF claim as, “an over-issuance was |
| |caused by unintentional or willful withholding of information on the part of the client.” “Willful |
| |withholding” is an intentional and deliberate act, not |
| |an unintentional, inadvertent or “honest mistake” sort of error. The phrase “willful withholding” has |
| |historically (and long-standing fraud investigation practice) been associated with cases meeting the |
| |threshold of referral to the District Attorney for potential criminal charges – which is not “client |
| |error.” |
| | |
| |Answer: This definition encompasses both intentional and unintentional client errors. There are times |
| |that a client could willfully withhold information that will not rise to the level of an IPV. In these |
| |instances, the client is still responsible and the error was caused by the client, not an administrative |
| |error. It is necessary to include willful withholding in the definition to capture these types of |
| |situations. |
|Vote Count |For |Against |Abstain |
| |11 |0 |5 |
|If not presented, explain why. | |
PAC
Have these rules been approved by PAC?
|x |Yes | |No |
|Date presented |09/05/19 |
|What issues were raised? |No issues were raised. |
|Vote Count |For |Against |Abstain |
| |Unanimous |0 |0 |
|If not presented, explain why. | |
Other Comments
Comments were received from stakeholders on the proposed rules:
|X |Yes | |No |
If “yes” to any of the above questions, summarize and/or attach the feedback received, including requests made by the State Board of Human Services, by specifying the section and including the Department/Office/Division response. Provide proof of agreement or ongoing issues with a letter or public testimony by the stakeholder.
See Attachment 1 “Adult Financial Programs Rule Package Sub-PAC Q&A Document”
See Attachment 2 “Requests from Rule Policy Group Community Partners”
(9 C.C.R. 2503-5)
3.500 Adult Financial Programs- Adult Financial Programs consist of the Old Age Pension (OAP) program, Aid to the Needy Disabled (AND) program consisting of AND- State Only (AND-SO) and AND-Colorado Supplement (AND-CS), Home Care Allowance (HCA), Special Populations-Home Care Allowance (SP-HCA), Adult Foster Care (AFC), and Burial Assistance [Eff. 3/2/14]
3.510 DEFINITIONS [Eff. 3/2/14]
“Actual value” means the true value of real property, as reported by the county assessor.
“ADEQUATE” (RELATED TO NOTICE) MEANS A WRITTEN NOTICE SENT TO THE CLIENT WHICH DETAILS ANY DETERMINATION OF ELIGIBILITY, AS WELL AS A CHANGE OR DISCONTINUATION OF GRANT PAYMENTS AND THE REASON FOR THAT CHANGE.
“ADMINISTRATIVE DISQUALIFICATION HEARING” (ADH) MEANS A DISQUALIFICATION HEARING AGAINST AN INDIVIDUAL ACCUSED OF WRONGFULLY OBTAINING OR ATTEMPTING TO OBTAIN ASSISTANCE.
“ADMINISTRATIVE ERROR CLAIM” MEANS A GRANT PAYMENT WAS OVER-PAID AND A CLAIM VALIDATED BASED ON AN ERROR ON THE PART OF THE COUNTY DEPARTMENT OF HUMAN SERVICES.
“ADMINISTRATIVE LAW JUDGE” (ALJ) ADMINISTRATIVE LAW JUDGE MEANS AN ADMINISTRATIVE LAW JUDGE APPOINTED PURSUANT TO SECTION 24-30-1003, C.R.S.
“ADULT FINANCIAL APPROVED SETTING” MEANS A FACILITY WITH THIS SPECIFIC DESIGNATION BY THE STATE DEPARTMENT.
“Anticipated income” means income which can be anticipated with reasonable certainty concerning the amount and month in which it is to be received.
“Applicant” means ANY INDIVIDUAL OR FAMILY WHO INDIVIDUALLY OR THROUGH A DESIGNATED REPRESENTATIVE OR SOMEONE ACTING RESPONSIBLY FOR HIM OR HER HAS APPLIED FOR BENEFITS UNDER THE PROGRAMS OF PUBLIC ASSISTANCE administered or supervised by the state department PURSUANT TO TITLE 26, ARTICLE 2, C.R.S., AS DEFINED AT SECTION 26-2-103(1), C.R.S. a person who is applying for benefits.
“Application” means aAN INITIAL OR REDETERMINATION request on state approved forms (PAPER OR ELECTRONIC) for A GRANT PAYMENTbenefits and/or services, which can include the electronic state prescribed form.
“Approval” means assistance is authorized by the county department.
“Authorized representative” means someone acting reasonably for the client with the authority to make decisions on behalf of the client and who has taken responsibility for the case including but not limited to signing documents and speaking with county departments. THE AUTHORIZATION MUST BE IN WRITING AND SIGNED BY THE CLIENT.
“AVAILABLE” (RELATED TO FUNDS OR ASSETS)Availability of income or resources” means when actually ACCESSIBLE available OR COULD BE ACCESSIBLE, and when the client has a legal interest in a sum (includes cash or equity value of a resource), and has the legal ability to make such sum available for support and maintenance.
“Bona fide loan” means a borrower receives money (from relatives, friends or others) which creates a loan if there is an understanding between the parties that the money borrowed is to be repaid and it is recognized as an enforceable contract under State COLORADO law. The transaction which creates a loan can be in the form of a written or VERBAL oral agreement if enforceable under State COLORADO law. Absent a negotiable instrument, a bona fide loan must still be convertible to cash in order to be considered a resource. THE OBLIGATION TO REPAY CANNOT BE CONTINGENT ON FUTURE INCOME THAT MIGHT BE RECEIVED BY THE BORROWER. THE WRITTEN OR VERBAL AGREEMENT MUST BE IN EFFECT AT THE TIME OF THE TRANSACTION AND THERE MUST BE A REASONABLE PLAN FOR REPAYMENT.
“Cash benefit” means a money payment provided to an eligible client, for the purpose of meeting day-to-day ongoing living costs.
“Cash surrender value” means the dollar value at which a resource could be sold or cashed in.
“CERTIFICATION PERIOD” MEANS THE TIME PERIOD FOR WHICH AN ADULT FINANCIAL CLIENT IS APPROVED TO RECEIVE GRANT PAYMENTS BEFORE A REDETERMINATION IS REQUIRED.
“Claim” means an overpayment of A GRANT PAYMENT benefits that needs to be researched AND for validity and, if validated, must be collected from the client by the county department.
“Client” means a current or past applicant or a current or past recipient of AN ADULT FINANCIAL GRANT PAYMENT benefits.
“CLIENT ERROR CLAIM” MEANS A GRANT PAYMENT WAS OVER-PAID AND A CLAIM WAS VALIDATED BASED ON UNINTENTIONAL OR WILLFUL WITHHOLDING OF INFORMATION ON THE PART OF THE CLIENT.
“COLLATERAL CONTACT” MEANS A PERSON OUTSIDE THE CLIENT’S HOUSEHOLD (EXCLUDING SPONSOR(S) AND LANDLORD WHO ALSO LIVE IN THE HOME) WHO HAS FIRST-HAND KNOWLEDGE OF THE CLIENT’S CIRCUMSTANCE AND PROVIDES A VERBAL OR WRITTEN CONFIRMATION THEREOF. THIS CONFIRMATION MAY BE MADE EITHER IN PERSON, IN WRITING, ELECTRONICALLY SUBMITTED, OR BY TELEPHONE. ACCEPTABLE COLLATERAL CONTACTS INCLUDE BUT ARE NOT LIMITED TO: EMPLOYERS, LANDLORDS, SOCIAL/MIGRANT SERVICE AGENCIES, AND MEDICAL PROVIDERS WHO CAN BE EXPECTED TO PROVIDE ACCURATE THIRD PARTY VERIFICATION. THE NAME/TITLE OF THE COLLATERAL CONTACT AS WELL AS THE INFORMATION OBTAINED MUST BE DOCUMENTED IN THE STATEWIDE AUTOMATED SYSTEM.
“Countable income” means income considered to be available to the client, spouse of the client, or sponsor(s) of the client after the application of valid exemptions, disregards, and deductions.
“Countable resource” means resources considered to be available to the client, spouse of the client, or sponsor(s) of the client after the application of valid exemptions, disregards, and deductions.
“County department” means the county department of human/social services.
“CREDITOR” MEANS A PERSON OR COMPANY, ASIDE FROM THE COLORADO DEPARTMENT OF HUMAN SERVICES, TO WHOM MONEY IS OWED.
“DATE OF ENTRY” OR “DATE OF ADMISSION” MEANS THE DATE ESTABLISHED BY THE UNITED STATES CITIZENSHIP AND IMMIGRATION SERVICES (USCIS), FORMERLY KNOWN AS THE IMMIGRATION AND NATURALIZATION SERVICE (INS), AS THE DATE THE SPONSORED NONCITIZEN WAS ADMITTED FOR PERMANENT RESIDENCE.
“Denial” means that the client was not eligible for A GRANT PAYMENTbenefits upon initial application.
“DEMONSTRABLE EVIDENCE” MEANS EVIDENCE THAT A COLORADO WORKS CASE IS CLOSED DUE TO REFUSAL TO COMPLY WITH THE WORKFORCE PROGRAM.
“DISABLING CONDITION” MEANS A MEDICAL IMPAIRMENT WHICH PREVENTS AN INDIVIDUAL FROM ENGAGING IN WORK.
“Disability Benefits Guide (Guide)” means a representative appointed to assist an individual to work with the Social Security Administration (SSA). The Guide is responsible for assisting the client with securing a protected filing date for Supplemental Security Income (SSI) within ten (10) days. The Guide must assist the client in completing and submitting a thorough application for SSI. This Guide may be selected by the client and must be:
A. Any attorney licensed in Colorado or licensed to appear in any United States federal court, in good standing who:
1. Is not disqualified or suspended from acting as a representative in dealings with the SSA; and,
2. Is not prohibited by any law from acting as a representative; or,
B. Any person who:
1. Has SSI/SSDI Outreach, Access, and Recovery (SOAR) certification or is employed and endorsed by an organization that has experience in assisting with the SSI application process. Experience is determined by the county worker verifying place and type of employment; and,
2. Is not disqualified or suspended from acting as a representative in interactions with the SSA or the county department; and,
3. Is not prohibited by any law from acting as a representative.
C. If the person selected by the client meets these requirements, the county department shall notify the client verbally or in writing that the person has been approved to work with them as the Guide.
D. The county department or the SSA may refuse to recognize the person chosen by the client if the person does not meet the requirements in this section. The county department or the SSA will notify the client and the person disqualified to act as the client’s Guide. If disqualified by the county department, the county department must provide written notification within three (3) days of the decision to disqualify. The client shall notify the county department within ten (10) days if he/she has selected a new Guide.
E. If a person is disqualified from acting as the Guide, and HE/SHE he or she wishes to dispute this decision, he or she may request a formal review through the Colorado Department of Human Services, Employment and Benefits Division. The Division will review and make decisions on the dispute.
“Discontinuation” means that the client who is currently receiving A GRANT PAYMENTbenefits is no longer eligible and his OR /her GRANT PAYMENTbenefits will be stopped.
“Earned Income” means payment in cash or in-kind received by a client, spouse of a client, or sponsor(s) of the client for services performed as an employee or as a result of the client, spouse of the client, or sponsor(s) of the client being engaged in self-employment.
“EFFECTIVE DATE OF ELIGIBILITY” MEANS THE FIRST DATE A CLIENT IS ELIGIBLE FOR THE PUBLIC ASSISTANCE PROGRAM.
“Eligibility requirements” means State Department criteria used to determine client eligibility or ineligibility to receive assistance and/or services.
“Eligible client” means a client whose countable resources are below the resource limit, whose countable income is below the grant standard, and who meets all non-financial eligibility criteria.
“Encumbrance” means the valid and legal outstanding payments, loans, or liens on a given resource.
“ESTATE” MEANS THE PROPERTY OF THE DECEDENT, TRUST, OR OTHER PERSON WHOSE AFFAIRS ARE SUBJECT TO THE COLORADO PROBATE CODE, TITLE 15, ARTICLE 10, OF THE COLORADO REVISED STATUTES, AS ORIGINALLY CONSTITUTED AND AS IT EXISTS FROM TIME TO TIME DURING ADMINISTRATION, AS DEFINED IN SECTION 15-10-201(17), C.R.S.
“Equity value of real property” means actual value less encumbrances.
“Exempt income” means any income that is not countable income for the purpose of eligibility.
“Exempt resource” means any property whose value is not a countable resource for the purpose of determining eligibility.
“Face value” means the value predominantly stamped or printed on the resource verification (insurance policy, bonds, stocks, etc.) which represents the future potential worth of the resource, but does not usually represent the true value of the item due to activities that can reduce or increase the value (loans, dividends, etc.).
“Facility” means the residence of a client where the intent is either to care for or provide treatment to the client. Facilities include general medical and surgical hospitals, nursing homes, regional centers, group and host homes, and mental health institutions. Facilities do not include penal institutions, such as federal and state prisons or county, local, and municipal jails, AND COMMUNITY CORRECTIONS RESIDENTIAL PROGRAMS.
“Fair Market Value” means the median resale market value of a resource.
“FEDERAL POVERTY GUIDELINES” ALSO CALLED FEDERAL POVERTY LEVEL (FPL) MEANS THE INCOME LEVEL FOR A HOUSEHOLD AS SET FORTH IN THE FEDERAL REGISTER 8 FR 1167, AS OF JANUARY 15, 2020. THIS RULE DOES NOT CONTAIN ANY LATER AMENDMENTS OR EDITIONS. THESE GUIDELINES ARE AVAILABLE FOR NO COST AT . THESE GUIDELINES ARE ALSO AVAILABLE FOR PUBLIC INSPECTION AND COPYING AT THE COLORADO DEPARTMENT OF HUMAN SERVICES, DIRECTOR OF THE EMPLOYMENT AND BENEFITS DIVISION, 1575 SHERMAN STREET, DENVER, COLORADO, 80203, OR AT ANY STATE PUBLICATIONS LIBRARY DURING REGULAR BUSINESS HOURS.
“Fleeing felon” means a person fleeing to avoid prosecution or custody or confinement after conviction for a felony.
“Fraud” means any person who obtains or any person who willfully aids or abets another to obtain public assistance as defined in title 26 of the c.r.s. to which the person is not entitled or in an amount greater than that to which the person is justly entitled or payment of any forfeited installment grants or benefits to which the person is not entitled or in a greater amount than that to which the person is entitled, by means of a willfully false statement or representation, or by impersonation, or by any other fraudulent device, AS DESCRIBED IN SECTION 26-1-127(1), c.r.s. the deliberate and conscious violation of rules or law for personal economic gain, including making any falsified claim for payment or benefit issued by the county department on behalf of the State Department by the client or others or receiving financial benefit from the county department on behalf of the State Department by means of willful misrepresentation including intentional concealment of essential fact(s) pertinent to determining eligibility.
“Good cause” means the client is unable to provide verifications, completed redetermination packets, or otherwise complete eligibility requirements timely because of circumstances beyond the control of the client. Good cause includes, but is not limited to, DOCUMENTED AND VERIFIABLE medical emergencies or hospitalization, A CLIENT an individual who has a disability or other medical condition(s) requiring additional time and/or assistance, a delayed appointment with the Social Security Administration beyond the client's control, or other good cause determined reasonable by the county department using THE prudent person principle. THE FOLLOWING CIRCUMSTANCES DO NOT CONSTITUTE GOOD CAUSE: AN EXCESSIVE WORKLOAD OF A PARTY OR HIS OR HER REPRESENTATIVE OR ATTORNEY; WHEN A PARTY OBTAINS LEGAL REPRESENTATION IN AN UNTIMELY MANNER; A PARTY’S FAILURE TO EITHER RECEIVE OR TIMELY RECEIVE, A TIMELY MAILED INITIAL DECISION, OR OTHER TIMELY MAILED CORRESPONDENCE FROM THE OFFICE OF ADMINISTRATIVE COURTS AND/OR THE OFFICE OF APPEALS, OR FROM THE COUNTY DEPARTMENT, WHEN A PARTY HAS FAILED TO ADVISE THE OFFICE OF ADMINISTRATIVE COURTS,THE COUNTY DEPARTMENT, OR THE OFFICE OF APPEALS OF A CHANGE OF ADDRESS OR FAILED TO PROVIDE A CORRECT ADDRESS; OR ANY OTHER CIRCUMSTANCE WHICH WAS FORESEEABLE OR PREVENTABLE.
“GRANT PAYMENT” MEANS THE ADULT FINANCIAL PROGRAM PAYMENT AND MAY ALSO BE REFERRED TO AS THE BENEFIT.
“GRANT STANDARD” MEANS THE MAXIMUM ADULT FINANCIAL GRANT PAYMENT THAT CAN BE PROVIDED TO A CLIENT BASED ON EACH SPECIFIC ADULT FINANCIAL PROGRAM.
“HEALTH CARE POLICY AND FINANCING” (HCPF) MEANS THE COLORADO DEPARTMENT OF HEALTH CARE POLICY AND FINANCING.
“HOMELESS” MEANS A PERSON WITH NO PERMANENT LIVING ARRANGEMENT, I.E., NO REGULAR NIGHTTIME OR FIXED PLACE OF RESIDENCE. HE OR SHE IS NEITHER A MEMBER OF A HOUSEHOLD NOR A RESIDENT OF AN INSTITUTION. THIS CAN MEAN SOMEONE WHO SLEEPS IN A DOORWAY; SUPERVISED SHELTER DESIGNED FOR TEMPORARY ACCOMMODATIONS; A HALFWAY HOUSE OR SIMILAR FACILITY THAT PROVIDES TEMPORARY RESIDENCE; A PLACE NOT DESIGNED FOR OR ORDINARILY USED AS REGULAR SLEEPING ACCOMMODATIONS FOR HUMAN BEINGS, SUCH AS PARKS, BUS STATIONS, ETC.; OR A PERSON WHO STAYS WITH A SUCCESSION OF FRIENDS OR RELATIVES AND HAS NO PERMANENT LIVING ARRANGEMENT.
“IM-14” MEANS THE AUTHORIZATION FOR REIMBURSEMENT OF INTERIM ASSISTANCE AVAILABLE AT THE COUNTY DEPARTMENT OR FOUND WITHIN THE STATEWIDE AUTOMATED SYSTEM.
“IM-19” MEANS THE APPORTIONMENT NOTICE AVAILABLE AT THE COUNTY DEPARTMENT OR FOUND WITHIN THE STATEWIDE AUTOMATED SYSTEM.
“Immediate family” means PEOPLE WITH THE FOLLOWING RELATIONSHIPS TO THE CLIENT: the spouse, MINOR AND ADULT CHILDREN, STEPCHILDREN, ADOPTED CHILDREN, parents, ADOPTIVE PARENTS, and children of the client AND THE SPOUSES OF THOSE PERSONS.
“Income” means any financial gain by means of money payment or in-kind payment.
“In-kind income” means something of value received for the benefit of a client, spouse of a client, or sponsor(s) of a client AND IS CONSIDERED EITHER EARNED OR UNEARNED INCOME. EXAMPLES OF THIS ARE FOOD OR SHELTER THAT THE CLIENT RECEIVED FOR FREE OR AT FAIR MARKET VALUE OR LESS.
“INTENT” AND/OR “INTENTIONALLY" MEANS A PERSON’S CONSCIOUS OBJECTIVE IS TO CAUSE THE SPECIFIC RESULT, WHETHER OR NOT THE RESULT OCCURRED, AS DESCRIBED IN SECTION 18-1-501(5), C.R.S.
"INTENTIONAL PROGRAM VIOLATION” (IPV) OCCURS WHEN AN INDIVIDUAL MAKES A FALSE OR MISLEADING STATEMENT OR FAILS TO DISCLOSE BY MISREPRESENTATION OR CONCEALMENT OF FACTS, OR ACTS IN A WAY THAT IS INTENDED TO MISLEAD OR CONCEAL ANY ELIGIBILITY FACTOR ON ANY APPLICATION OR OTHER WRITTEN AND/OR ELECTRONIC COMMUNICATION FOR THE PURPOSE OF ESTABLISHING OR MAINTAINING ELIGIBILITY TO:
1. RECEIVE A GRANT PAYMENT FOR WHICH THE CLIENT IS NOT ELIGIBLE; OR,
2. INCREASE A GRANT PAYMENT FOR WHICH THE CLIENT IS NOT ELIGIBLE; OR,
3. PREVENT A DENIAL, REDUCTION OR TERMINATION OF A GRANT PAYMENT.
“Intermittent redetermination” means a redetermination that is generated prior to the annual redetermination date due to questionable circumstances surrounding the case, a client moving to a new county, or other reasons.
“Involuntary transfer” means the loss of a resource due to fraud, theft, financial exploitation, or legal action such as judgment, foreclosure, or tax sale, provided that the client can demonstrate that:
A. Every reasonable effort has been made to recover the property through court action or other procedures; or,
B. The client is unable to pursue recovery; or,
C. Pursuit of lost resources or income would constitute a safety issue.
“IRREGULAR” (RELATED TO INCOME) MEANS INCOME WHICH AN INDIVIDUAL CANNOT REASONABLY EXPECT TO RECEIVE ON A MONTHLY BASIS.
“LEGAL FIDUCIARY” MEANS A PERSON OR AGENCY WHO HOLDS THE LEGAL POWER TO ACT ON BEHALF OF A CLIENT AND IS REQUIRED TO ACT IN THE BEST INTEREST OF THE CLIENT.
“LIABLE INDIVIDUAL” MEANS A PERSON FINANCIALLY RESPONSIBLE FOR AN OVERPAYMENT INCLUDING THE CLIENT, SPONSOR(S) OF A CLIENT, A PAYEE, PARENTS OF DEPENDENT CHILDREN, AND/OR OTHER PERSONS DETERMINED TO BE FINANCIALLY LIABLE BY A COURT.
“Life Estate” means a legal estate planning procedure in which the client transfers real property to another individual but retains the right of occupancy and income from the property during the client's lifetime. The life estate's duration is limited to the life of the individualCLIENT. The life tenantCLIENT, during his or her life, retains the use and possession of the property, the rights to rents and profits, and the costs of maintaining the property. The life tenantCLIENT cannot sell or waste the property without the consent of the person(s) to whom the property was transferred.
“LOCAL SERVICE DELIVERY AGENCY” MEANS AN AGENCY OPERATING ON BEHALF OF THE COUNTY DEPARTMENT OR STATE DEPARTMENT TO DETERMINE ALL OR PART OF A CLIENT’S ELIGIBILITY FOR ADULT FINANCIAL PROGRAMS.
“Marriage” (for the purpose of these rules) means a marriage as defined in Section 14-2-10114-2-104(1), C.R.S., a common law marriage as defined in Section 14-2-10114-2-104(2), C.R.S., and a civil union, as defined in Section 14- 15-10114-15-103(1), C.R.S.
“MATERIAL FACT” MEANS INFORMATION THAT HAS LOGICAL CONNECTION TO THE CONSEQUENCES AND/OR THE DECISION BEING DETERMINED AND THE NATURE OF THE INFORMATION OR FACT IS SUCH THAT A REASONABLE PERSON UNDER THE CIRCUMSTANCES WOULD ATTACH IMPORTANCE TO IT IN DETERMINING HIS OR HER COURSE OF ACTION.
“Non-recipient spouse” means the client's spouse who is not receiving AN ADULT financial GRANT PAYMENT benefits.
“Ownership” means lawful title to, legal right of possession of, or legal interest in a property.
“OVERPAYMENT” MEANS A GRANT PAYMENT WAS MADE IN EXCESS OF THE AMOUNT A CLIENT WAS ELIGIBLE FOR.
“Periodic payments” means payments that are irregular or a one-time payment.
“Personal Needs Allowance” (PNA) means a payment to a client who is currently in a facility to cover additional hygiene costs not usually supplied by the provider.
“Personal property” means all items of ownership that are not considered real property.
“Potential income” means a benefit or payment to which the client, spouse of a client, or sponsor(s) of a client may be entitled and could secure, such as SPOUSAL SUPPORT, annuities, pensions, retirement or disability benefits, veterans compensation and pensions, workers' compensation, Social Security retirement or disability benefits, SUPPLEMENTAL SECURITY INCOME (SSI) benefits, and unemployment compensation.
“Potential resource” means a resource to which the client, spouse of a client, or sponsor(s) of a client has the legal ability to acquire or reacquire rights of ownership, SUCH AS INHERITANCES, REAL AND PERSONAL PROPERTY, AND SETTLEMENTS.
“PREPONDERANCE OF EVIDENCE” MEANS THAT THE EVIDENCE MUST PREPONDERATE OVER, OR OUTWEIGH, EVIDENCE TO THE CONTRARY.
“Prudent Person Principle” means that, based on experience and knowledge of the program, the county department exercises a degree of discretion, care, judiciousness, and circumspection, as would a reasonable person, in a given case.
“Qualified non-citizen” ALSO CALLED QUALIFIED ALIEN means an individual who is not a citizen or national of the United States and who was lawfully admitted to the United States by the United States Citizenship and Immigration Services (USCIS) as an actual or prospective permanent resident or whose physical presence is known and allowed by the USCIS. A qualified non-citizen is defined as follows, consistent with the provisions of federal regulations found at 45 CFR 1626.7 as of DECEMBER 30, 2016 October 1, 2010, WHICH ARE herein incorporated BY REFERENCE. This rule does not contain any later amendments or editions. THESE REGULATIONS ARE AVAILABLE AT NO COST AT . THESE REGULATIONS ARE ALSO AVAILABLE FOR PUBLIC INSPECTION AND COPYING AT the Colorado Department of Human Services, Director of the Employment and Benefits Division, 1575 Sherman Street, Denver, Colorado, 80203, or at any state publications library DURING REGULAR BUSINESS HOURS.:
A. A non-citizen lawfully admitted for permanent residence;
B. A non-citizen paroled into the United States under Section 212(d)(5) of the Immigration and Naturalization Act (INA) for a period of at least 1 year;
C. A non-citizen granted conditional entry pursuant to Section 203(a)(7) of the INA prior to April 1, 1980;
D. A refugee under Section 207 of the INA;
E. An asylee under Section 208 of the INA;
F. A non-citizen whose deportation is withheld under Section 243(h) or 241(B)(3) of the INA;
G. A Cuban or Haitian entrant as defined in Section 501(3) of the Refuge Education Assistance Act of 1980;
H. A Victim of Severe Form of Trafficking who has been certified as such by the U.S. Dept. of Health and Human Services (HHS);
I. Iraqis and Afghans granted Special Immigrant Visa status under Section 101(A)(27) of the INA;
J. A non-citizen who has been battered or subjected to extreme cruelty in the U.S. by a family member;
K. A non-citizen admitted to the U.S. as an Amerasian immigrant pursuant to Section 584 of the Foreign Operations, Export Financing, and Related Programs Appropriations Act of 1988 (as amended by P.L. No. 100-461); or,
L. An individual who was born in Canada and possesses at least fifty percent (50%) American Indian blood or is a member of an Indian tribe as defined in 25 U.S.C. Sec. 450B(E).
“QUESTIONABLE” MEANS THE INFORMATION PROVIDED IS UNCLEAR OR CONFLICTING OR THE COUNTY HAS REASON TO BELIEVE THE FACTS PRESENTED ARE CONTRARY TO THE INFORMATION PROVIDED BY THE CLIENT.
“Real property” means houses; land, including land rights such as oil, mineral and water rights; and outbuildings and other objects affixed to land.
“Received” (for the purpose of income and resources) means the date on which the income and/or resource is actually received or legally becomes available for use, whichever occurs first, whether reported timely by the client or not.
“Received” (as it applies to receipt of verification, documentary evidence, and reported changes in circumstances) means the date the verification, documentary evidence, and reported changes were received by the county department.
“Recipient” means a person who is currently receiving or previously received.
“Recovery” means the collection of a valid claim to repay GRANT PAYMENTSbenefits to which a client was not entitled.
“Redetermination” means a case review/determination of necessary information and verifications to determine ongoing eligibility.
“Resources” means real and personal property held as of the first day of a calendar month or as of the date of application if not counted as income IN THE SAME for the application month.
“SCHEDULED APPOINTMENT” OR “SCHEDULED INTERVIEW” MEANS AN APPOINTMENT OR INTERVIEW SET USING A STATE PRESCRIBED OR STATE APPROVED APPOINTMENT NOTICE PROVIDED TO THE CLIENT.
“SHELTER COSTS” MEANS MORTGAGE PAYMENTS, PROPERTY INSURANCE (IF REQUIRED), HOME OWNER ASSOCIATION DUES, RENT, GAS, ELECTRICITY, HEATING FUEL, WATER, SEWER, GARBAGE COLLECTION SERVICE, AND REAL PROPERTY TAXES. TELEPHONE, INTERNET AND TELEVISION PROVIDER SERVICES ARE NOT ALLOWABLE SHELTER COSTS.
“SIGNATURE” MEANS HANDWRITTEN SIGNATURES, ELECTRONIC SIGNATURE TECHNIQUES, RECORDED TELEPHONIC SIGNATURES, OR DOCUMENTED GESTURED SIGNATURES. A VALID HANDWRITTEN SIGNATURE INCLUDES A DESIGNATION OF AN X.
“Sponsor” means any person(s) who executed an affidavit of support (INS USCIS FORM I-864 OR I-864A (MARCH 6, 2018) OR ANOTHER FORM DEEMED LEGALLY BINDING BY THE DEPARTMENT OF HOMELAND SECURITY or similar agreement with the United States Citizenship and Immigration Service (USCIS) on behalf of a non-citizen as a condition of THE NON-CITIZEN'S DATE OF entry OR ADMISSION into the United States AS A PERMANENT RESIDENT. THESE FORMS ARE HEREIN INCORPORATED BY REFERENCE. THIS RULE DOES NOT CONTAIN ANY LATER AMENDMENTS OR EDITIONS. THESE FORMS ARE AVAILABLE AT NO COST FROM . THESE FORMS ARE ALSO AVAILABLE FOR PUBLIC INSPECTION AND COPYING AT THE COLORADO DEPARTMENT OF HUMAN SERVICES, DIRECTOR OF THE EMPLOYMENT AND BENEFITS DIVISION, 1575 SHERMAN STREET, DENVER, COLORADO, 80203, OR AT ANY STATE PUBLICATIONS LIBRARY DURING REGULAR BUSINESS HOURS.
“SSI BENEFIT STANDARD” MEANS THE MAXIMUM MONTHLY FEDERAL AMOUNT FOR A SSI RECIPIENT AS LISTED IN FEDERAL REGULATIONS FOUND AT 20 CFR 416.405-415 (2019), WHICH ARE HEREIN INCORPORATED BY REFERENCE. THIS RULE DOES NOT CONTAIN ANY LATER AMENDMENTS OR EDITIONS. THESE REGULATIONS ARE AVAILABLE FOR NO COST AT . THESE REGULATIONS ARE ALSO AVAILABLE FOR PUBLIC INSPECTION AND COPYING AT THE COLORADO DEPARTMENT OF HUMAN SERVICES, DIRECTOR OF THE EMPLOYMENT AND BENEFITS DIVISION, 1575 SHERMAN STREET, DENVER, COLORADO, 80203, OR AT ANY STATE PUBLICATIONS LIBRARY DURING REGULAR BUSINESS HOURS.
“State Department” OR “THE DEPARTMENT” means the Colorado Department of Human Services.
“STATEWIDE AUTOMATED SYSTEM” MEANS THE ELECTRONIC PLATFORM USED TO CALCULATE PUBLIC ASSISTANCE PROGRAM BENEFITS AND GRANT PAYMENTS.
“Termination” means that the client who is currently receiving Adult Financial program GRANT PAYMENTS benefits is no longer eligible and his OR /her GRANT PAYMENTSbenefits will be stopped.
“TIMELY NOTICE” MEANS THE COUNTY SHALL GENERATE A NOTICE TO THE CLIENT AT LEAST ELEVEN (11) CALENDAR DAYS PRIOR TO THE INITIATION OF ANY DECREASE, SUSPENSION, TERMINATION, OR DISCONTINUANCE IN GRANT PAYMENTS OR SERVICES. THIS SHALL BE SENT TO HIS OR HER LAST KNOWN ADDRESS.
“Transfer Without Fair Consideration” (TWFC)” means a property transaction in which the proceeds of the transfer, assignment, or sale are less than the actual value of the resource.
“Unearned income” means any income that is not earned through employment or self-employment. IT INCLUDES MONEY TRANSFERS, SUCH AS THE TRANSFER OF MONEY INTO ONE’S CHECKING ACCOUNT FROM THAT PERSON’S OR ANOTHER PERSON’S MONEY ACCOUNT REGARDLESS OF THE TYPE OF ACCOUNT, INCLUDING, BUT NOT LIMITED TO, SAVINGS ACCOUNT(S), RETIREMENT ACCOUNT(S), OR ANY OTHER TYPE OF MONEY ACCOUNT.
“UNINTENTIONAL” OR “WITHOUT INTENT” MEANS AN ACT, OR SOMETHING DONE OR PERFORMED THAT WAS NOT VOLUNTARY OR INTENDED.
“Value (for liquid resources such as cash, savings/checking accounts, IRA accounts, etc.)” means the current redemption rate, less encumbrances.
“Value (for real and personal property)” means the actual value of the property less encumbrances.
“Verification” means confirming the accuracy of statements, application information, and other case information by obtaining written, audio, or OTHER video evidence or other information that proves such fact or statement to be true.
“VERIFIED UPON RECEIPT” MEANS INFORMATION THAT IS PROVIDED DIRECTLY FROM THE PRIMARY SOURCE AND IS NOT QUESTIONABLE AND NO ADDITIONAL VERIFICATION IS REQUIRED.
“WILLFUL” MEANS THAT A PERSON IS AWARE THAT HIS OR HER CONDUCT IS PRACTICALLY CERTAIN TO CAUSE THE RESULT AS DESCRIBED IN SECTION 18-1-501(6), C.R.S.
"WILLFUL WITHHOLDING OF INFORMATION" INCLUDES:
A. WILLFUL MISSTATEMENT INCLUDING UNDERSTATEMENT, OVERSTATEMENT, OR OMISSION, WHETHER VERBAL OR WRITTEN, MADE BY A CLIENT IN RESPONSE TO VERBAL OR WRITTEN QUESTIONS FROM THE COUNTY DEPARTMENT;
B. WILLFUL FAILURE BY A CLIENT TO REPORT CHANGES IN INCOME OR OTHER CIRCUMSTANCES WHICH MAY AFFECT THE AMOUNT OF GRANT PAYMENT; AND/OR,
C. WILLFUL FAILURE BY THE CLIENT TO REPORT RECEIPT OF A GRANT PAYMENT MADE BY THE COUNTY DEPARTMENT TO THE CLIENT WHICH THE CLIENT KNEW REPRESENTED AN OVERPAYMENT.
“WITHDRAW” OR “Withdrawal” means an application is not processed because the client who submitted the application withdraws his OR /her request for assistance prior to eligibility determination, OR REQUESTS HIS OR HER GRANT PAYMENT BE DISCONTINUED.
3.520 GENERAL REQUIREMENTS, CASE PROCESSING, AND CASE ACTIONS
3.520.1 GENERAL REQUIREMENTS [Eff. 3/2/14]
A. Information concerning public assistance programs shall be available to all persons in the community. Available information shall include:
1. Benefits and programs available;
2. Eligibility requirements;
3. Related services; and,
4. Rights and responsibilities of clients;
5. THE PROPERTY TAX/RENT/HEAT CREDIT (PTC) REBATE ELIGIBILITY INFORMATION AVAILABLE THROUGH THE COLORADO DEPARTMENT OF REVENUE; AND,
6. EARNED INCOME TAX CREDIT (EITC).
B. The county department shall:
1. Receive applications AND DATE ALL APPLICATIONS and assist the client to complete the application and secure documentation when needed;
2. Provide language translation via an interpreter, as needed;
3. Inform the client of his OR /her responsibility to accurately and fully complete the application and provide documents to substantiate eligibility factors;
4. Inform the client that he OR /she may use friends, relatives, or other persons to assist in the completion of the application;
5. Inform the client, in writing at the time of application, that the county department shall use the client's Social Security Number (SSN) to obtain information available through the Income and Eligibility Verification System (IEVS) to verify income and that such information may be shared with other assistance programs, other states, the Social Security Administration, the Department of Labor and Employment, and the Child Support SERVICES Enforcement program;
6. CONDUCT AN EVALUATION OF NEEDS RELATED TO THE CLIENT’S HEALTH AND WELL-BEING. BASED ON IDENTIFIED NEEDS, THE COUNTY WORKER WILL RRefer the client to other agencies or services available in the community, such as food banks, Area Agencies on Aging (AAA), AGING AND DISABILITY RESOURCES FOR COLORADO (ADRC), or the Division of Vocational Rehabilitation (DVR);
7. Refer the client to the other benefits for which he OR /she may be eligible;
8. Inform the client that he OR /she may terminate the application process at any time;
A decision by the applicant CLIENT to “withdraw” shall be treated as a denial by the county department. The applicant CLIENT shall be notified of the county department's action by the state approved Notice of Action form within ELEVEN (11) ten (10) calendar days of the action.
9. Review applications, MAKE NECESSARY COLLATERAL CONTACTS OR REQUEST ANY NEEDED VERIFICATION, and determine eligibility for assistance; and,
10. Calculate all claims, initiate recoveries, and prepare for and appear at all appeals.
C. The county department shall require a written application, signed under penalty of perjury, using the State Department's prescribed public assistance application form. THE DATE OF APPLICATION SHALL BE THE FIRST WORKING DAY THE COUNTY DEPARTMENT RECEIVES A SIGNED APPLICATION FORM, INDICATING THE CLIENT'S DESIRE TO RECEIVE PUBLIC ASSISTANCE BENEFITS. INCOMPLETE APPLICATIONS SHALL BE DENIED FOLLOWING THE POLICIES OUTLINED IN SECTION 3.554. FOR CLIENTS WHO HAVE BEEN COMMITTED TO A FACILITY BY ORDER OF THE DISTRICT OR PROBATE COURT OR WHO HAVE BEEN MADE A WARD OF THE STATE, APPLICATION FOR AN ADULT FINANCIAL PROGRAM SHALL BE COMPLETED BY THE FACILITY'S ADMINISTRATION OR THE CLIENT'S GUARDIAN. The application form shall be used as the primary source of information and TO BE CONSIDERED COMPLETE, shall contain, at a minimum:
1. The name, date of birth, and residence of the client;
2. The program(s) requested by the client;
3. A list of all income and resources available to the client at the time of application;
4. Any other information required by state and federal law or regulation; and,
5. The NAME OF THE APPLICANT AND signature of the APPLICANT client, parent, legal guardian, FACILITY ADMINISTRATION or authorized representative AND AN ADDRESS FOR THE APPLICANT WHICH CAN INCLUDE GENERAL DELIVERY OR A COUNTY OFFICE. IF AN ADDRESS IS NOT PROVIDED, ANOTHER MEANS OF CONTACT SUCH AS PHONE NUMBER OR EMAIL ADDRESS SHALL BE UTILIZED TO OBTAIN AN ADDRESS.
A CLIENT WHO MAY BE PARTIALLY OR TOTALLY ILLITERATE CAN SATISFY THE SIGNATURE REQUIREMENT BY:
1.a. A client who may be partially or totally illiterate or cannot write his/her name shall makeMAKING a mark ON THE SIGNATURE LINE.
2.b. The mark shall be witnessed by AT LEAST ONE OTHER INDIVIDUAL. THE WITNESS SHALL PROVIDE HIS OR HER OWNthe signature and address NEXT TO THE CLIENT’S MARK IN THE SIGNATURE BLOCK of at least one witness.
3.c. A county department staff member may act as witnesses if he OR /she is not related to the client.; and,
6. The date of application shall be the first working day the county department receives a signed application form, indicating the client's desire to receive public assistance benefits.
7. Incomplete applications shall be denied.
D. The client shall be required to answer all applicable questions on the application form. If the client does not answer any question(s) in writing on the form, the question(s) shall be asked of the client during the interview and the client must provide an answer at that time. ANY QUESTIONS NOT ANSWERED IN WRITING ON THE APPLICATION SHALL BE ASKED OF THE CLIENT DURING THE INTERVIEW AND THE CLIENT MUST PROVIDE AN ANSWER AT THAT TIME. THE RESPONSE MUST BE DOCUMENTED ON THE APPLICATION OR ENTERED INTO THE STATEWIDE AUTOMATED SYSTEM.
E. Clients shall be provided the opportunity to register to vote during initial application and at each redetermination.
F. The county department shall adhere to the requirements of the Colorado Address Confidentiality Program (ACP) as defined in Section 24-30-2101, C.R.S. The ACP provides survivors of domestic violence, sexual offenses, and/or stalking with a legal substitute address for creating public records and interacting with all state and local government agencies.
G. THE CLIENT HAS THE RIGHT TO DECIDE HOW TO USE HIS OR HER GRANT PAYMENT. THE COUNTY DEPARTMENT SHALL NOT:
1. IMPOSE ANY RESTRICTION, EITHER DIRECT OR IMPLIED, ON A CLIENT’S USE OF HIS OR HER GRANT PAYMENT INCLUDING, BUT NOT LIMITED TO, REQUESTING A CLIENT TO PROVIDE RECEIPTS OR PROOF OF HOW THE MONEY HAS BEEN SPENT; OR,
2. REQUIRE THE CLIENT TO ACCOUNT FOR THE USE OF THE GRANT PAYMENT, EXCEPT FOR THE ELECTRONIC BENEFITS TRANSFER (EBT) CARD POINT OF SALE LIMITATIONS LISTED IN 26-2-104(2), C.R.S.; OR,
3. GIVE ASSISTANCE TO CREDITORS IN THE COLLECTION OF THE CLIENT’S DEBTS.
H. EACH CLIENT OF FINANCIAL ASSISTANCE PROVIDED UNDER ADULT FINANCIAL PROGRAMS, SHALL RECEIVE PRIOR WRITTEN NOTICE OF ANY AGENCY ACTION AFFECTING HIS OR HER ELIGIBILITY FOR OR RECEIPT OF GRANT PAYMENTS.
1. THE CLIENT SHALL BE NOTIFIED IN WRITING OF COUNTY DEPARTMENT APPROVAL OF:
A. AN APPLICATION FOR FINANCIAL ASSISTANCE THROUGH THE ADULT FINANCIAL PROGRAMS;
B. AN INCREASE IN THE AMOUNT OF GRANT PAYMENT. TO THE EXTENT PRACTICABLE, NOTICE SHALL BE IN HIS OR HER PRIMARY LANGUAGE AND SHALL BE MAILED OR DELIVERED WITHIN ELEVEN CALENDAR DAYS AFTER THE DETERMINATION IS MADE. IF THE CLIENT NEEDS ASSISTANCE IN UNDERSTANDING THE ACTION, THE ACTION SHALL BE EXPLAINED VERBALLY.
C. IF THE CLIENT IS DISSATISFIED WITH THE EFFECTIVE DATE OF ELIGIBILITY, OR THE AMOUNT OR TYPE OF ASSISTANCE AUTHORIZED, HE OR SHE HAS THE RIGHT TO A COUNTY CONFERENCE AND/OR STATE LEVEL FAIR HEARING.
2. A CLIENT SHALL BE GIVEN NOTICE OF ANY ACTION BY THE COUNTY DEPARTMENT, OR ANY PERSON OR AGENCY ACTING ON ITS BEHALF, WHICH ADVERSELY AFFECTS THE CLIENT’S ELIGIBILITY FOR, OR RIGHT TO GRANT PAYMENTS AUTHORIZED UNDER THE ADULT FINANCIAL PROGRAMS. FAILURE TO GIVE NOTICE OF AN ADVERSE ACTION SHALL BE GROUNDS FOR SETTING ASIDE THE ACTION ON APPEAL. THE NOTICE MUST MEET THE FOLLOWING STANDARDS:
A. THE NOTICE MUST BE IN WRITING; AND,
B. IT MUST DESCRIBE CLEARLY AND IN PLAIN LANGUAGE THE ACTION TO BE TAKEN AND THE REASON(S) FOR THE ACTION; AND,
C. IT MUST REFER SPECIFICALLY BY NUMBER TO THE SECTION(S) OF THE STATE DEPARTMENT'S RULES THAT REQUIRE OR PERMIT THE ACTION BEING TAKEN, OR CITE THE SPECIFIC CHANGES IN FEDERAL OR STATE LAW REQUIRING THE ACTION; AND,
D. IT MUST STATE THE EFFECTIVE DATE OF THE PROPOSED ACTION; AND,
E. IT MUST EXPLAIN THE CLIENT’S RIGHT TO REQUEST A COUNTY CONFERENCE AND STATE LEVEL FAIR HEARING, THE TIME PERIOD FOR REQUESTING A CONFERENCE OR HEARING, AND THE STEPS WHICH MUST BE TAKEN TO OBTAIN A CONFERENCE OR HEARING; AND,
F. IT MUST EXPLAIN THE CLIENT'S RIGHT TO CONTINUED GRANT PAYMENTS AND THE OBLIGATION TO REPAY IF IT IS DETERMINED THAT THE CLIENT WAS NOT ELIGIBLE TO RECEIVE THEM; AND,
G. IT MUST INFORM THE CLIENT OF HIS OR HER RIGHT TO BE REPRESENTED OR ASSISTED BY LEGAL COUNSEL, A RELATIVE, A FRIEND OR A SPOKESPERSON OF HIS OR HER CHOOSING; AND,
H. TO THE EXTENT PRACTICABLE, NOTICE SHALL BE IN HIS OR HER PRIMARY LANGUAGE. IF HE OR SHE IS ILLITERATE, THE ACTION SHALL ALSO BE EXPLAINED VERBALLY.
3. ANY NEGATIVE ACTION TAKEN ON THE CASE SHALL BE PRECEDED BY A TIMELY NOTICE PERIOD OF AT LEAST ELEVEN (11) CALENDAR DAYS. THE 11 DAY TIMELY NOTICE PERIOD CONSTITUTES THE PERIOD DURING WHICH ASSISTANCE IS CONTINUED AND NO NEGATIVE ACTION IS TO BE TAKEN DURING THIS TIME UNLESS DESCRIBED IN SECTION 3.554.
4. WHEN CHANGES IN EITHER STATE OR FEDERAL LAW REQUIRE GRANT PAYMENT ADJUSTMENTS FOR ALL PERSONS RECEIVING ADULT FINANCIAL ASSISTANCE, ADEQUATE NOTICE SHALL INCLUDE:
A. A STATEMENT OF THE INTENDED ACTION;
B. THE REASONS FOR SUCH ACTION;
C. THE SPECIFIC CHANGE IN LAW REQUIRING SUCH ACTION; AND,
D. THE CIRCUMSTANCES UNDER WHICH A COUNTY CONFERENCE AND/OR STATE LEVEL FAIR HEARING MAY BE OBTAINED AND FINANCIAL ASSISTANCE CONTINUED. A COUNTY CONFERENCE OR STATE LEVEL FAIR HEARING NEED NOT BE GRANTED UNLESS THE REASON FOR AN INDIVIDUAL APPEAL IS INCORRECT GRANT COMPUTATION.
I. A CLIENT WHO DISAGREES WITH A PROPOSED ACTION HAS THE RIGHT TO:
1. A COUNTY CONFERENCE THAT MUST BE REQUESTED NO LATER THAN NINETY (90) CALENDAR DAYS FROM THE DATE THE NOTICE OF ACTION IS MAILED TO THE CLIENT;
2. A STATE LEVEL FAIR HEARING BEFORE AN ALJ WHICH CAN BE REQUESTED IF THE CLIENT DOES NOT WISH TO UTILIZE THE COUNTY CONFERENCE TO RESOLVE THE DISPUTE OR IS DISSATISFIED WITH THE OUTCOME OF THE COUNTY CONFERENCE. THE CLIENT MUST SUBMIT A WRITTEN REQUEST FOR A FAIR HEARING BY MAIL OR DELIVERY TO THE OAC NO LATER THAN NINETY (90) CALENDAR DAYS FROM THE DATE THE NOTICE OF ACTION IS MAILED TO THE CLIENT;
3. JUDICIAL REVIEW OF THE FINAL AGENCY DECISION IN THE APPROPRIATE STATE DISTRICT COURT, AFTER EXHAUSTING THE ADMINISTRATIVE APPEAL RIGHTS GRANTED UNDER THESE RULES; AND,
4. CONTINUED GRANT PAYMENTS AS DESCRIBED IN SECTION 3.554.
J. CLIENT CONFIDENTIALITY MUST BE TREATED AS FOLLOWS:
1. ALL INFORMATION OBTAINED BY THE COUNTY DEPARTMENT CONCERNING A CLIENT OF ADULT FINANCIAL PROGRAMS IS CONFIDENTIAL INFORMATION.
A. THE COUNTY DEPARTMENT SHALL INFORM COUNTY OFFICIALS AND OTHER PERSONS WHO HAVE DEALINGS WITH THE DEPARTMENT AS TO THE CONFIDENTIAL NATURE OF PERSONALLY IDENTIFIABLE INFORMATION, WHICH MAY COME INTO THEIR POSSESSION THROUGH TRANSACTION OF DEPARTMENT BUSINESS.
WHEN A COUNTY WORKER CONSULTS A BANK, CURRENT/ FORMER EMPLOYER OF A CLIENT, ANOTHER SOCIAL AGENCY, AND OTHER SIMILAR AGENCIES, TO OBTAIN INFORMATION OR ELIGIBILITY VERIFICATION INFORMATION, THE IDENTIFICATION OF THE COUNTY WORKER AS AN EMPLOYEE OF THE COUNTY DEPARTMENT CAN, IN ITSELF, DISCLOSE THAT AN APPLICATION FOR ASSISTANCE HAS BEEN MADE BY A CLIENT. IN THIS TYPE OF CONTACT, AS WELL AS OTHER COMMUNITY CONTACTS, THE DEPARTMENT SHALL MAINTAIN CONFIDENTIALITY WHENEVER POSSIBLE.
B. ENSURING PRIVACY WHILE INTERVIEWING AND THE CONTINUOUS CONFIDENTIALITY OF INFORMATION IS ESSENTIAL. THIS INVOLVES BOTH OFFICE FACILITIES AND COUNTY WORKER DISCRETION. OFFICE PROCEDURES AND FACILITIES SHOULD BE SUCH THAT INFORMATION IS NOT INADVERTENTLY REVEALED TO PERSONS NOT CONCERNED WITH THE AFFAIRS OF A PARTICULAR CLIENT. THE COUNTY WORKER MUST ALSO USE DISCRETION IN MENTIONING DEPARTMENT BUSINESS OUTSIDE THE OFFICE.
2. GENERAL INFORMATION NOT IDENTIFIED WITH ANY CLIENT IS NOT CONFIDENTIAL AND MAY BE RELEASED FOR ANY PURPOSE.
3. INFORMATION SECURED BY THE COUNTY DEPARTMENT FOR THE PURPOSE OF DETERMINING ELIGIBILITY AND NEED IS CONFIDENTIAL.
4. UNLESS DISCLOSURE IS SPECIFICALLY PERMITTED BY THE STATE DEPARTMENT, THE FOLLOWING TYPES OF INFORMATION ARE THE EXCLUSIVE PROPERTY OF, AND ARE RESTRICTED TO USE BY, THE STATE AND COUNTY DEPARTMENTS:
A. NAMES AND ADDRESSES OF ADULT FINANCIAL CLIENTS, AND/OR THE GRANT PAYMENT AMOUNT;
B. INFORMATION CONTAINED IN APPLICATIONS, REPORTS OF MEDICAL EXAMINATIONS, CORRESPONDENCE, AND OTHER INFORMATION CONCERNING ANY PERSON FROM WHOM, OR ABOUT WHOM, INFORMATION IS OBTAINED BY THE COUNTY DEPARTMENT;
C. RECORDS OF STATE OR COUNTY DEPARTMENTAL EVALUATIONS OF THE ABOVE INFORMATION.
D. ALL INFORMATION OBTAINED THROUGH THE INCOME AND ELIGIBILITY VERIFICATION SYSTEM (IEVS).
5. NO ONE OUTSIDE THE STATE OR COUNTY DEPARTMENT SHALL HAVE ACCESS TO RECORDS OF THE DEPARTMENT EXCEPT FOR THE FOLLOWING INDIVIDUALS: THOSE EXECUTING THE INCOME AND ELIGIBILITY VERIFICATION SYSTEM (IEVS); CHILD SUPPORT SERVICES OFFICIALS; THE SSA; FEDERAL AND STATE AUDITORS AND PRIVATE AUDITORS FOR THE COUNTY; AND SINGLE ENTRY POINTS. THESE INDIVIDUALS SHALL HAVE ACCESS ONLY FOR PURPOSES NECESSARY FOR THE ADMINISTRATION OF THE PROGRAM.
A. CLIENT RECORDS MAY BE USED AS EXHIBITS FOR ADMINISTRATIVE, CIVIL AND/OR CRIMINAL PROCEEDINGS WHEN THE PROCEEDINGS RELATE DIRECTLY TO THE RECEIPT OF ADULT FINANCIAL PROGRAMS.
B. ADDITIONAL INDIVIDUALS SHALL HAVE ACCESS TO THE CLIENT’S RECORDS AS LONG AS THE CLIENT IS NOTIFIED AND HIS OR HER PRIOR PERMISSION FOR RELEASE OF INFORMATION IS OBTAINED, UNLESS THE INFORMATION IS TO BE USED TO VERIFY INCOME OR ELIGIBILITY UNDER ADMINISTRATION OF THE IEVS.
C. IF THE INFORMATION IS NEEDED TO PROVIDE BENEFITS TO A CLIENT IN AN EMERGENCY SITUATION, AND THE CLIENT IS PHYSICALLY OR MENTALLY INCAPACITATED TO THE EXTENT THAT HE OR SHE CANNOT SIGN THE RELEASE FORM, AND TIME DOES NOT PERMIT OBTAINING THE CLIENT’S CONSENT PRIOR TO RELEASE OF INFORMATION, THE COUNTY DEPARTMENT MUST NOTIFY THE CLIENT WITHIN ELEVEN (11) CALENDAR DAYS AFTER SUPPLYING THE INFORMATION. IF THE APPLICANT OR CLIENT DOES NOT HAVE A TELEPHONE OR CANNOT BE PERSONALLY CONTACTED WITHIN ELEVEN (11) DAYS, THE COUNTY DEPARTMENT MUST SEND WRITTEN NOTIFICATION CONTAINING THE REQUIRED INFORMATION. THE VERBAL OR WRITTEN NOTIFICATION SHALL INCLUDE THE NAME AND ADDRESS OF THE AGENCY THAT REQUESTED THE INFORMATION, THE REASON THE INFORMATION WAS REQUESTED AND A SUMMARY OF THE INFORMATION RELEASED.
D. THE FOLLOWING INDIVIDUALS SHALL HAVE ACCESS TO THE RECORDS OF THE DEPARTMENT, EXCLUDING IEVS INFORMATION, IF THE PREVIOUSLY IDENTIFIED CONSENT OR NOTICE CONDITIONS ARE MET:
1. A DISTRICT ATTORNEY UPON PRESENTATION OF A WRITTEN REQUEST ACCOMPANIED BY EVIDENCE THAT FRAUD IS THE REASON FOR THE REQUEST.
2. A COUNTY HUMAN SERVICES BOARD MEMBER, AS DESCRIBED IN SECTION 26-1-116, C.R.S.
E. WHEN A COUNTY BOARD MEMBER OR A DISTRICT ATTORNEY NEEDS INFORMATION ABOUT A CLIENT THAT IS NOT IN THE POSSESSION OF THE COUNTY DEPARTMENT, THE REQUESTOR, WITH THE AID OF THE COUNTY DEPARTMENT, MAY CONTACT THE STATE DEPARTMENT TO INQUIRE AS TO THE APPROPRIATE METHODS OF SECURING IT.
F. THE RELEASE OF RECORDS IS STRICTLY CONDITIONED UPON THE INFORMATION BEING USED SOLELY FOR THE PURPOSE AUTHORIZED AND THE PERSON REQUESTING THE INFORMATION MUST CERTIFY THE USE TO BE MADE OF THE INFORMATION AND THAT IT WILL NOT BE DISCLOSED OR USED FOR ANY OTHER PURPOSE.
6. COUNTY DEPARTMENTS SHALL NOT RELEASE INFORMATION REGARDING APPLICANTS OR CLIENTS TO LAW ENFORCEMENT AGENCIES UNLESS A VALID SEARCH WARRANT IS RECEIVED BY THE COUNTY OR STATE DEPARTMENT, EXCEPT AS PROVIDED IN SECTION 3.520.1.J.5.A.
7. UPON REQUEST TO THE STATE DEPARTMENT BY THE COLORADO BUREAU OF INVESTIGATION, WITH THE RESPONSIBILITY FOR LOCATION AND APPREHENSION OF FLEEING FELONS (I.E., A PERSON WITH AN OUTSTANDING FELONY ARREST WARRANT), THE ADDRESSES OF A FLEEING FELON WHO IS A CLIENT OF ADULT FINANCIAL PROGRAMS SHALL BE RELEASED PURSUANT TO SECTION 26-1-114(3)(A)(III) C.R.S.
8. THE CLIENT SHALL HAVE AN OPPORTUNITY TO EXAMINE SUCH PERTINENT RECORDS CONCERNING HIM OR HER AS CONSTITUTES A BASIS FOR ADVERSE ACTION AND IN THE CASE OF A COUNTY CONFERENCE OR A STATE LEVEL FAIR HEARING. OTHER REQUESTS FOR INFORMATION BY THE CLIENT SHALL BE HONORED ONLY WHEN THE CLIENT MAKES THE REQUEST IN PERSON AND HIS OR HER IDENTITY IS VERIFIED OR THE REQUEST IS IN THE FORM OF A WRITTEN AND SIGNED STATEMENT.
THE CLIENT MAY DESIGNATE AN INDIVIDUAL, FIRM, OR AGENCY TO REPRESENT HIM OR HER AT CONFERENCES AND HEARINGS. THE CLIENT MUST PUT THE DESIGNATION OF SUCH REPRESENTATIVE IN WRITING. THE REPRESENTATIVE SHALL HAVE ACCESS TO ALL PERTINENT RECORDS.
9. THE CLIENT MAY GIVE A FORMAL WRITTEN RELEASE FOR DISCLOSURE OF INFORMATION TO OTHER AGENCIES, SUCH AS HOSPITALS OR ADVOCATE AGENCIES. IF THE CLIENT IS NOT PRESENT, OR THE OPPORTUNITY TO AGREE OR OBJECT TO THE USE OR DISCLOSURE CANNOT PRACTICABLY BE PROVIDED BECAUSE OF THE CLIENT’S INCAPACITY OR AN EMERGENCY CIRCUMSTANCE, THE DEPARTMENT MAY, IN THE EXERCISE OF PROFESSIONAL JUDGMENT, DETERMINE WHETHER THE DISCLOSURE IS IN THE BEST INTERESTS OF THE CLIENT AND, IF SO, DISCLOSE ONLY THE MINIMUM PROTECTED HEALTH INFORMATION NECESSARY THAT IS DIRECTLY RELEVANT TO THE CLIENT’S CARE.
10. INFORMATION PROVIDED TO AGENCIES AND/ OR INDIVIDUALS MUST BE LIMITED TO THE SPECIFIC INFORMATION REQUIRED TO DETERMINE ELIGIBILITY, CONDUCT ONGOING CASE MANAGEMENT, OR OTHERWISE NECESSARY FOR THE ADMINISTRATION OF THE ADULT FINANCIAL PROGRAM. INFORMATION OBTAINED THROUGH IEVS WILL BE STORED AND PROCESSED SO THAT NO UNAUTHORIZED PERSONNEL CAN ACQUIRE OR RETRIEVE THE INFORMATION. COUNTY DEPARTMENTS ARE RESPONSIBLE FOR LIMITING IEVS DATA TO ONLY THOSE INDIVIDUALS REQUIRING ACCESS TO DETERMINE ELIGIBILITY OR OTHERWISE ADMINISTER THE PROGRAMS.
ALL PERSONS WITH ACCESS TO INFORMATION OBTAINED PURSUANT TO THE INCOME AND ELIGIBILITY VERIFICATION REQUIREMENTS WILL BE ADVISED OF THE CIRCUMSTANCES UNDER WHICH ACCESS IS PERMITTED, HOW DATA WILL BE UTILIZED, CONFIDENTIALITY OF DATA, AND THE SANCTIONS IMPOSED FOR ILLEGAL USE OR DISCLOSURE OF THE INFORMATION.
K. COUNTY DEPARTMENTS AND CONTRACTORS ARE TO ADMINISTER ADULT FINANCIAL PROGRAMS IN SUCH A MANNER THAT NO PERSON WILL, ON THE BASIS OF RACE, COLOR, RELIGION, CREED, NATIONAL ORIGIN, ANCESTRY, SEX/GENDER (INCLUDING TRANSGENDER STATUS), PREGNANCY, AGE, SEXUAL ORIENTATION, GENDER IDENTITY, POLITICAL AFFILIATION, OR PHYSICAL OR MENTAL DISABILITY, OR ANY OTHER PROTECTED GROUPS AS DESCRIBED IN THE STATE DEPARTMENT’S ANTI-DISCRIMINATION POLICY, BE EXCLUDED FROM PARTICIPATION, BE DENIED ANY AID, CARE, OR SERVICES, OR OTHER BENEFITS OF, OR BE OTHERWISE SUBJECTED TO DISCRIMINATION IN HIS OR HER INTERACTIONS WITH ADULT FINANCIAL PROGRAMS.
1. THE REFERENCES TO "AID" INCLUDES ALL FORMS OF ASSISTANCE, INCLUDING INFORMATION AND REFERRAL SERVICES.
2. THE COUNTY DEPARTMENT SHALL NOT, DIRECTLY OR THROUGH CONTRACTUAL OR OTHER ARRANGEMENTS, ON THE BASIS OF RACE, COLOR, RELIGION, CREED, NATIONAL ORIGIN, ANCESTRY, SEX/GENDER (INCLUDING TRANSGENDER STATUS), PREGNANCY, AGE, SEXUAL ORIENTATION, GENDER IDENTITY, POLITICAL AFFILIATION, OR PHYSICAL OR MENTAL DISABILITY, OR ANY OTHER PROTECTED STATUS:
A. PROVIDE ANY AID TO AN INDIVIDUAL THAT IS DIFFERENT, OR IS PROVIDED IN A DIFFERENT MANNER, FROM THAT PROVIDED TO OTHERS;
B. SUBJECT AN INDIVIDUAL TO SEGREGATION BARRIERS OR SEPARATE TREATMENT IN ANY MANNER RELATED TO ACCESS TO OR RECEIPT OF ASSISTANCE, CARE, SERVICES, OR OTHER BENEFITS;
C. RESTRICT AN INDIVIDUAL IN ANY WAY IN THE ENJOYMENT OR ANY ADVANTAGE OR PRIVILEGE ENJOYED BY OTHERS RECEIVING AID PROVIDED UNDER ADULT FINANCIAL PROGRAMS;
D. TREAT AN INDIVIDUAL DIFFERENTLY FROM OTHERS IN DETERMINING WHETHER HE OR SHE SATISFIES ANY ELIGIBILITY OR OTHER REQUIREMENTS OR CONDITIONS WHICH INDIVIDUALS MUST MEET IN ORDER TO RECEIVE AID, SERVICES, CARE, OR OTHER BENEFITS PROVIDED UNDER ADULT FINANCIAL PROGRAMS;
E. DENY AN INDIVIDUAL AN OPPORTUNITY TO PARTICIPATE IN ASSISTANCE PROGRAMS THROUGH THE PROVISION OF SERVICES OR OTHERWISE, OR AFFORD HIM OR HER AN OPPORTUNITY TO DO SO WHICH IS DIFFERENT FROM THAT AFFORDED TO OTHERS UNDER PROGRAMS OF ASSISTANCE.
F. DENY AN INDIVIDUAL THE OPPORTUNITY TO PARTICIPATE AS A MEMBER OF A PLANNING OR ADVISORY BODY THAT IS AN INTEGRAL PART OF THE PROGRAM.
3. NO DISTINCTION IS PERMITTED IN RELATION TO THE USE OF PHYSICAL FACILITIES, INTAKE AND APPLICATION PROCEDURES, CASELOAD ASSIGNMENTS, DETERMINATION OF ELIGIBILITY, AND THE AMOUNT AND TYPE OF BENEFITS EXTENDED BY THE COUNTY DEPARTMENT TO CLIENTS.
4. THE COUNTY DEPARTMENT SHALL ENSURE THAT OTHER NON-FEDERAL AGENCIES, PERSONS, CONTRACTORS AND OTHER ENTITIES WITH WHICH IT CONTRACTS BUSINESS ARE IN COMPLIANCE WITH THE ABOVE PROHIBITION AGAINST DISCRIMINATION REQUIREMENTS ON A CONTINUING BASIS. THE COUNTY DEPARTMENT STAFF IS RESPONSIBLE FOR BEING ALERT TO ANY DISCRIMINATORY ACTIVITY OF OTHER AGENCIES AND FOR NOTIFYING THE STATE DEPARTMENT CONCERNING THE SITUATION.
5. THE STATE DEPARTMENT, THROUGH ITS VARIOUS CONTACTS WITH AGENCIES, PERSONS, AND REFERRAL SOURCES, WILL BE CONTINUOUSLY ALERT TO DISCRIMINATORY ACTIVITY AND WILL TAKE APPROPRIATE ACTION TO ENSURE COMPLIANCE WITH THESE PROHIBITIONS AGAINST DISCRIMINATION. THE COUNTY DEPARTMENT, ON NOTIFICATION BY THE STATE DEPARTMENT, WILL ALSO TERMINATE PAYMENTS TO THE OFFENDER OR ASSOCIATION WITH ANY AGENCY, PERSON, OR RESOURCE BEING USED THAT HAS BEEN FOUND BY THE STATE DEPARTMENT OR THE COLORADO CIVIL RIGHTS DIVISION TO CONTINUE DISCRIMINATORY ACTIVITY IN REGARD TO APPLICANTS OR CLIENTS.
6. AN INDIVIDUAL WHO BELIEVES HE OR SHE IS BEING DISCRIMINATED AGAINST MAY FILE A COMPLAINT WITH THE COUNTY DEPARTMENT, THE STATE DEPARTMENT, THE COLORADO CIVIL RIGHTS DIVISION, OR DIRECTLY WITH THE FEDERAL GOVERNMENT.
WHEN A COMPLAINT IS FILED WITH THE COUNTY DEPARTMENT, THE COUNTY DIRECTOR IS RESPONSIBLE FOR INITIATING AN IMMEDIATE INVESTIGATION OF THE MATTER AND TAKING NECESSARY CORRECTIVE ACTION TO ELIMINATE ANY DISCRIMINATORY ACTIVITIES FOUND. IF SUCH ACTIVITIES ARE NOT FOUND, THE INDIVIDUAL IS GIVEN A WRITTEN EXPLANATION OF THE OUTCOME. IF THE PERSON IS NOT SATISFIED, HE OR SHE IS REQUESTED TO DIRECT HIS OR HER COMPLAINT, IN WRITING, TO THE STATE DEPARTMENT, COMMUNICATIONS SECTION, WHICH WILL BE RESPONSIBLE FOR FURTHER INVESTIGATION AND OTHER NECESSARY ACTION.
3.520.2 DOCUMENTATION [Eff. 3/2/14]
A. The county department shall create a case record upon initial application and maintain the record while the case is open for assistance. The major purposes of a case record shall be:
1. To assist the county department in reaching a valid decision concerning eligibility and for the amount of GRANT PAYMENT A CLIENT IS ELIGIBLE TO RECEIVEpayment;
2. To ensure eligibility is based on factual information;
3. To provide for continuity of assistance when a worker is absent, when a case is reopened, and when a case is transferred from one county department to another; and,
4. To provide accountability for the county department's actions.
B. The county department shall document all income, resources, and non-financial eligibility information into the statewide automated system.
1. The county department shall not omit case information from the statewide automated system based on the assumption that the information is unnecessary for eligibility determination.
2. All case information USED TO DETERMINE ELIGIBILITY AND CHANGES IN BASIC BIOGRAPHICAL INFORMATION shall be updated at the time of redetermination.
C. The county department shall document all case actions in case comments. THIS INFORMATION SHALL INCLUDE ACTIONS TAKEN BY THE COUNTY DEPARTMENT, THE BASIS OF SUCH ACTIONS, AND THE RESULT OR OUTCOME OF THE ACTION TAKEN ON THE CASE AND MUST ALSO, to include:
1. All case decisions related to prudent person principle;
2. All decisions related to the disposition of claims;
3. Any atypical interactions with the client;
4. Actions related to a county conference and/or state level FAIR hearing;
5. Cause of untimely processing of the application or redetermination; and,
6. Other information that would be critical to document county department actions and/or would be necessary to justify case decisions during a case review, audit, appeal, or lawsuit.; AND,
7. INFORMATION PERTAINING TO ELIGIBILITY, VERIFICATIONS, AND COLLATERAL CONTACTS.
D. Unless otherwise specified in rule, all forms, packets, notices, and applications, shall be state-prescribed OR STATE APPROVED.
E. The county department shall be responsible for securely storing paper and/or electronic case records and other confidential material to prevent accidental or intentional disclosure or access by unauthorized persons. If a county department shares building space with other county offices, case materials shall be stored in locked files. Janitors and other maintenance personnel shall be instructed concerning the confidential nature of information.
F. Case records are the property of and shall be restricted to use by the State Department and county department.
G. Case files shall be kept for a minimum of three (3) years beyond the year of the case closure date UNLESS THERE HAS BEEN A CLAIM, AUDIT, NEGOTIATION, LITIGATION OR OTHER ACTION STARTED BEFORE THE EXPIRATION OF THE THREE-YEAR PERIOD. IN SUCH CASES, THE RETENTION PERIOD SHALL INITIATE AT THE CONCLUSION OF THE CLAIM, AUDIT, NEGOTIATION, LITIGATION, OR OTHER ACTION.
3.520.3 PROGRAM REVIEW AND OVERSIGHT [Eff. 3/2/14]
A. The county department shall be subject to the provisions outlined in Section 26-1-111, C.R.S., requiring the State Department to ensure that the county department complies with requirements provided by statute, State Board of Human Services and Executive Director rules, federal laws and regulations, and contract and grant terms.
B. The county department shall be subject to routine quality control and program monitoring by the State Department, to minimally include:
1. Targeted review of the statewide automated system documentation;
2. Review and analysis of data reports generated from the statewide automated system;
3. Case file review;
4. Targeted program review conducted via phone, email, or survey; and,
5. Onsite program review.
C. The focus of State Department monitoring shall be to identify:
1. Compliance with program statutes and rules;
A. THE COUNTY DEPARTMENT SHALL PROVIDE WRITTEN RESPONSES TO THE STATE REGARDING ACTION TAKEN TO CORRECT AREAS OF NON-COMPLIANCE. THE STATE DEPARTMENT MUST APPROVE THE ACTION(S) TAKEN.
B. THE COUNTY DEPARTMENT SHALL PROVIDE TO THE STATE A WRITTEN PLAN, INCLUDING STEPS AND MEASURES, TO MITIGATE THE ERROR(S) FROM RECURRING. THIS PLAN MUST BE APPROVED BY THE STATE DEPARTMENT.
2. Best practices that can be shared with other county offices; and,
3. Training needs. ; and,
4. PERFORMANCE OUTCOMES.
D. The county department shall be subject to a performance improvement plan to correct areas of identified non-compliance.
E. The county department shall be subject to corrective action and sanction as outlined in Section 1.100, et seq. (9 C.C.R. 2501-1), General Policies and Administration, in case of failure to make improvements required under the performance improvement plan.
F. County department supervisory personnel AND/OR QUALITY ASSURANCE STAFF shall review eligibility determinations (certifications, denials, and/or pending cases) monthly FOR THE PURPOSES SET FORTH IN 3.520.3.C. The supervisor SUPERVISORY PERSONNEL AND/OR QUALITY ASSURANCE STAFF shall:
1. REVIEW A MINIMUM NUMBER OF CASES, INCLUDING SPECIFIC PROGRAMS AND/OR ACTIONS, PER MONTH AS OUTLINED ANNUALLY BY THE STATE DEPARTMENT BASED ON THE COUNTY DEPARTMENT’S ADULT FINANCIAL CASELOAD SIZE. THE STATE DEPARTMENT WILL NOTIFY THE COUNTY OF THE MINIMUM NUMBER OF CASES TO BE REVIEWED VIA MEMORANDUM. THE COUNTY MAY ELECT TO:
A. CREATE A PLAN TO PPull a random sample of THAT INCLUDES AT LEAST THE MINIMUM NUMBER OF ADULT FINANCIAL CASES SET FORTH BY THE STATE DEPARTMENT IN ITS MEMORANDUM AND SUBMIT THAT PLAN TO THE STATE FOR APPROVAL.a minimum of two determinations per technician;
B. USE THE STATE PRESCRIBED RANDOM SAMPLE.
2. Determine the correctness of eligibility determinations accomplished;
3. Ensure timely correction OF ANY ERRORS WITHIN TEN (10) BUSINESS DAYS OR THE TIME FRAME SPECIFIED WITHIN THE APPROVED REVIEW PLAN of any determination errors; and,
4. Maintain a record of the cases reviewed for audit purposes, INCLUDING AUDIT RESULTS AND ANY REQUIRED ACTIONS TAKEN BY THE COUNTY. COUNTY DEPARTMENTS MUST KEEP CASE FILE REVIEWS FOR A MINIMUM OF THREE (3) YEARS.
5. REPORT THESE RESULTS AND ACTIONS TO THE STATE ON A MONTHLY BASIS VIA THE STATE PRESCRIBED PROCESS.
3.520.4 APPLICATION PROCESSING [Rev. eff. 8/1/14]
A. The county department shall utilize the following steps to process the application:
1. Date-stamp the application on the date the signed application is received by the county department;
2. Review the application;
3. For AND only, provide the client with a medical disability certification form;
4. Interview the client;
5. Verify statements made by the client on the application and during the interview using the statewide automated system interfaces, documents received from the client, or information gathered from other collateral sources;
6. Approve or deny the application within sixty (60) calendar days for AND and within forty-five (45) calendar days for OAP from the date of receipt of a completed and signed application. Delay in processing the application shall not be allowed for any of the following:
a. When the client has applied for a Social Security number and is awaiting action by the Social Security Administration; or,
b. When the county department is awaiting receipt of information from the State Verification Exchange System (SVES); or,
c. When the county department is awaiting the response for required secondary verification through the Systematic Alien Verification for Entitlements (SAVE).
7. Provide a notice of action to the client by postal or electronic mail or in person using the State Department's prescribed form.
B. A request for benefits following an action to deny an application shall be considered in the following ways:
1. If the client has good cause as outlined in Section 3.510 and notifies the county department that he/she is requesting benefits within thirty (30) calendar days of the denial, the county department shall reschedule the interview and the current application date shall be used.
2. If the client does not have good cause and notifies the county department that he/she is requesting benefits, and the request is made within sixty (60) calendar days of the current application, that application may be used but the date of application shall be the most recent date the client requested benefits.
C. A face-to-face interview, either at the county department office or in the client's home, is mandatory for an initial application for Adult Financial benefits, unless there is good cause.
1. If the client can show good cause, a telephone interview shall be conducted. Good cause includes:
a. Hospitalization of the client;
b. Client resides in a long-term facility or has regular contact with a Single Entry Point case manager;
c. Travel for the client would cause serious medical or physical harm; or,
d. Other good cause determined by the county department using prudent person principle.
2. If the county department determines good cause prevents a face-to-face interview upon initial application, it shall be documented as to why a telephone interview was conducted and proof of good cause shall be entered into the case record.
D. The interview shall include:
1. An explanation of the various assistance programs available and an opportunity to apply for those additional programs;
2. A brief explanation of the eligibility process and the eligibility requirements;
3. A review of the application with the client to:
a. Confirm all information on the application;
b. Answer questions not completed on the application; and,
c. Provide the client an opportunity to clarify unclear, inconsistent, inaccurate, or questionable statements.
d. For AND only, provide, explain and obtain necessary signatures on the Authorization for Reimbursement of Interim Assistance form (IM-14).
4. A request for verification of application declarations.
a. The client has the primary responsibility to provide information necessary to establish eligibility.
b. If the client is unable to do so, the county department shall assist the client to obtain verification through collateral contacts or a home visit.
c. If the client returns the verifications within thirty (30) calendar days after denial, the following processing requirements shall be implemented:
1) If the client has good cause, the denial shall be rescinded and eligibility determined, using the original application date.
2) If the client does not have good cause, the county department shall use the original application, but the date of the application shall be the date all verifications were received.
d. If the client returns the verification thirty-one (31) or more calendar days after the denial, the county department shall require the client to complete a new application.
5. Discussion of the client's rights and responsibilities, to include:
a. The county department's requirement to inform the client in writing at application and redetermination of the requirement for a client to report any changes in circumstances within thirty (30) calendar days.
b. The client's responsibility to notify the county department in writing within thirty (30) calendar days of any change in resources or income or other change in circumstances which affects eligibility or benefit amount.
c. The county department's responsibility to maintain confidentiality of records and information.
d. The client's right to non-discrimination provisions.
e. The client's right to a county conference or state-level appeal.
f. The client's right to review and copy his/her case file.
6. An explanation provided regarding the process of utilizing the Electronic Benefit Transfer (EBT) card. This explanation shall include:
a. Identification of the following establishments in which clients shall not be allowed to access cash benefits through the Electronic Benefits Transfer service from automated teller machines and point of sale (POS) devices:
1) Licensed gaming establishments;
2) In-state simulcast facilities;
3) Tracks for racing;
4) Commercial bingo facilities;
5) Stores or establishments in which the principal business is the sale of firearms;
6) Retail establishments licensed to sell malt, vinous, or spirituous liquors;
7) Establishments licensed to sell medical marijuana or medical marijuana-infused products, or retail marijuana or retail marijuana products, effective June 30, 2015;
8) Establishments that provide adult-oriented entertainment in which performers disrobe or perform in an unclothed state for entertainment, effective June 30, 2015.
b. An explanation that the cash portion issued on the EBT card may be suspended with identified misuse.
E. County departments shall require no more than one interview per application.
1. The county department shall review the application for completeness for all programs requested and secure signed copies of the Authorization for Release of Information form and any other forms necessary to determine eligibility.
2. If the client wishes to apply for benefits while already receiving benefits under a different program, such as Food Assistance, the county department may use a redetermination packet if received within sixty (60) calendar days of the request; otherwise a new application will be required. A verbal request to apply for an Adult Financial program shall be documented in the statewide automated system and the date of the request will secure the application date for the client.
F. For clients who have been committed to a facility by order of the district or probate court or who have been made a ward of the court, application for an Adult Financial program shall be completed by the facility's administration or the client's guardian.
G. When the client does not keep a scheduled interview appointment and does not request an alternate time or arrangement the county department shall assume the client is withdrawing his/her request for benefits and shall deny or discontinue the case, as specified in 3.520.4, C.
THE COUNTY DEPARTMENT SHALL PROCESS APPLICATIONS AS EXPEDITIOUSLY AS POSSIBLE BUT NO LATER THAN FORTY-FIVE (45) CALENDAR DAYS FOLLOWING THE DATE THE APPLICATION WAS FILED. APPLICATIONS MEETING THE CRITERIA IDENTIFIED IN SECTION 3.520.1.C, SHALL BE PROCESSED AS FOLLOWS:
A. RECORD THE DATE THE SIGNED APPLICATION WAS RECEIVED BY THE COUNTY DEPARTMENT.
B. REVIEW THE APPLICATION FOR COMPLETENESS FOR ALL PROGRAMS APPLIED FOR AND/OR ANY PROGRAMS NOT APPLIED FOR BUT THAT THE CLIENT IS POTENTIALLY ELIGIBLE FOR.
C. SCHEDULE AN INTERVIEW WITH THE CLIENT IF THE INTERVIEW IS NOT TAKING PLACE IMMEDIATELY.
1. THE CLIENT SHALL BE OFFERED AN IN-PERSON INTERVIEW. IF THE CLIENT DOES NOT ELECT AN IN-PERSON INTERVIEW, THE COUNTY SHALL SCHEDULE AND CONDUCT A PHONE INTERVIEW.
2. THE CLIENT SHALL BE PROVIDED WRITTEN NOTICE OF THE INTERVIEW AT LEAST FOUR (4) CALENDAR DAYS OF THE SCHEDULED INTERVIEW. THE CLIENT MAY PROVIDE A WRITTEN OR VERBAL WAIVER THAT WRITTEN NOTICE OF THE SCHEDULED INTERVIEW IS NOT NECESSARY WHEN THE COUNTY DEPARTMENT IS ABLE TO CONDUCT THE INTERVIEW DURING APPLICATION PROCESSING. NOTICE SHALL INCLUDE:
A. THE DATE AND TIME FOR THE INTERVIEW;
B. IDENTIFICATION OF ANY DOCUMENTATION THAT MAY BE NEEDED;
C. THE OPPORTUNITY TO RESCHEDULE THE APPOINTMENT OR MAKE OTHER ARRANGEMENTS IN THE EVENT OF GOOD CAUSE.
3. WHEN THE CLIENT DOES NOT KEEP THE INTERVIEW APPOINTMENT AND DOES NOT REQUEST AN ALTERNATE TIME OR ARRANGEMENT, AS DESCRIBED IN THIS SECTION, GRANT PAYMENTS WILL BE DENIED.
4. THE INTERVIEW MUST BE DOCUMENTED AND SHALL INCLUDE:
A. AN EXPLANATION OF THE VARIOUS ASSISTANCE PROGRAMS AVAILABLE TO THE APPLICANT, EVEN IF NOT SPECIFICALLY APPLIED FOR, AND AN OPPORTUNITY TO APPLY FOR THOSE ADDITIONAL PROGRAMS NOT IN THE CLIENT’S ORIGINAL APPLICATION;
B. AN EXPLANATION OF THE ELIGIBILITY PROCESS AND THE ELIGIBILITY REQUIREMENTS;
C. A REVIEW OF THE APPLICATION WITH THE CLIENT TO:
1) CONFIRM ALL INFORMATION ON THE APPLICATION;
2) ANSWER QUESTIONS NOT COMPLETED ON THE APPLICATION; AND,
3) PROVIDE THE CLIENT AN OPPORTUNITY TO CLARIFY UNCLEAR, INCONSISTENT, INACCURATE, OR QUESTIONABLE STATEMENTS.
4) FOR AID TO THE NEEDY DISABLED STATE ONLY (AND-SO), PROVIDE THE CLIENT WITH A MEDICAL DISABILITY CERTIFICATION FORM. PROVIDE, EXPLAIN AND OBTAIN NECESSARY SIGNATURES ON THE AUTHORIZATION FOR REIMBURSEMENT OF INTERIM ASSISTANCE FORM (IM-14), AS DEFINED IN SECTION 3.510, AND EXPLAIN THE REQUIREMENT TO APPLY FOR SUPPLEMENTAL SECURITY INCOME (SSI).
D. A REQUEST FOR VERIFICATION OF APPLICATION DECLARATIONS.
1) THE CLIENT HAS THE PRIMARY RESPONSIBILITY TO PROVIDE INFORMATION NECESSARY TO ESTABLISH ELIGIBILITY.
2) THE COUNTY DEPARTMENT SHALL ASSIST THE CLIENT TO OBTAIN VERIFICATION THROUGH COLLATERAL CONTACTS, INTERFACES, OR A HOME VISIT.
E. DISCUSSION OF THE CLIENT'S RIGHTS AND RESPONSIBILITIES THAT MUST INCLUDE:
1) THE CLIENT'S RESPONSIBILITY TO NOTIFY AND PROVIDE VERIFICATION TO THE COUNTY DEPARTMENT IN WRITING BY THE 10TH OF THE MONTH FOLLOWING THE MONTH IN WHICH THE CHANGE OCCURRED OF ANY CHANGE IN RESOURCES OR INCOME OR OTHER CHANGE IN CIRCUMSTANCES WHICH AFFECTS ELIGIBILITY OR GRANT PAYMENT AMOUNT.
2) THE CLIENT’S RIGHT TO CONFIDENTIALITY OF RECORDS AND INFORMATION.
3) THE CLIENT'S RIGHT TO NON-DISCRIMINATION PROVISIONS, INCLUDING THE PROCESS IN SECTION 3.520.1.K.6, FOR FILING DISCRIMINATION COMPLAINTS.
4) THE CLIENT'S RIGHT TO A COUNTY CONFERENCE OR STATE LEVEL FAIR HEARING.
5) THE CLIENT'S RIGHT TO REVIEW AND COPY HIS OR HER CASE FILE.
F. AN EXPLANATION PROVIDED REGARDING THE PROCESS OF UTILIZING THE EBT CARD. THIS EXPLANATION SHALL INCLUDE:
1) IDENTIFICATION OF THE FOLLOWING ESTABLISHMENTS IN WHICH CLIENTS SHALL NOT BE ALLOWED TO ACCESS CASH GRANT PAYMENTS THROUGH THE EBT SERVICE FROM AUTOMATED TELLER MACHINES (ATM) AND POINT OF SALE (POS) DEVICES:
A) LICENSED GAMING ESTABLISHMENTS;
B) IN-STATE SIMULCAST FACILITIES;
C) TRACKS FOR RACING;
D) COMMERCIAL BINGO FACILITIES;
E) STORES OR ESTABLISHMENTS IN WHICH THE PRINCIPAL BUSINESS IS THE SALE OF FIREARMS;
F) RETAIL ESTABLISHMENTS LICENSED TO SELL MALT, VINOUS, OR SPIRITUOUS LIQUORS;
G) ESTABLISHMENTS LICENSED TO SELL MEDICAL MARIJUANA OR MEDICAL MARIJUANA-INFUSED PRODUCTS, OR RETAIL MARIJUANA OR RETAIL MARIJUANA PRODUCTS, EFFECTIVE JUNE 30, 2015;
H) ESTABLISHMENTS THAT PROVIDE ADULT-ORIENTED ENTERTAINMENT IN WHICH PERFORMERS DISROBE OR PERFORM IN AN UNCLOTHED STATE FOR ENTERTAINMENT, EFFECTIVE JUNE 30, 2015.
2) AN EXPLANATION THAT THE CASH GRANT PAYMENT PORTION ISSUED ON THE EBT CARD MAY BE SUSPENDED WITH IDENTIFIED MISUSE AS OUTLINED IN SECTION 3.520.4.F.1.
G. AN ASSESSMENT OF OTHER NEEDS THE CLIENT MAY HAVE AND APPROPRIATE REFERRALS TO COMMUNITY RESOURCES, INCLUDING FOOD BANKS, AREA AGENCIES ON AGING (AAA), AGING AND DISABILITY RESOURCES FOR COLORADO (ADRC), CENTERS FOR INDEPENDENT LIVING, THE DIVISION OF VOCATIONAL REHABILITATION (DVR), LOW INCOME ENERGY ASSISTANCE PROGRAM (LEAP), PHONE ASSISTANCE, AND THE PROPERTY TAX/RENT/HEAT CREDIT (PTC) REBATE ELIGIBILITY INFORMATION.
H. AN OPPORTUNITY TO REGISTER TO VOTE.
5. COUNTY DEPARTMENTS SHALL REQUIRE NO MORE THAN ONE INTERVIEW PER APPLICATION.
A. THE COUNTY DEPARTMENT SHALL SECURE SIGNED COPIES OF ANY OTHER FORMS NECESSARY TO DETERMINE ELIGIBILITY. IF THE CLIENT REFUSES TO SIGN ANY REQUIRED FORMS, THE CASE SHALL BE DENIED OR DISCONTINUED FOLLOWING THE POLICIES OUTLINED IN SECTION 3.554.
B. IF THE CLIENT WISHES TO APPLY FOR ADULT FINANCIAL BENEFITS WHILE APPLYING FOR OR ALREADY RECEIVING BENEFITS UNDER A DIFFERENT PROGRAM, SUCH AS FOOD ASSISTANCE, THE COUNTY DEPARTMENT MAY ACCEPT THE CLIENT’S VERBAL OR WRITTEN REQUEST FOR ADULT FINANCIAL BENEFITS AND USE THE CLIENT’S EXISTING APPLICATION OR REDETERMINATION FOR THE OTHER PROGRAM’S BENEFITS IF RECEIVED WITHIN SIXTY (60) CALENDAR DAYS OF THE REQUEST; OTHERWISE A NEW APPLICATION WILL BE REQUIRED. THE COUNTY DEPARTMENT MUST VERIFY AND DOCUMENT ANY CHANGES THAT OCCURRED BETWEEN THE INITIAL APPLICATION SUBMISSION OR REDETERMINATION AND THE REQUEST FOR ADULT FINANCIAL GRANT PAYMENTS. A VERBAL REQUEST TO APPLY FOR AN ADULT FINANCIAL PROGRAM SHALL BE DOCUMENTED IN THE STATEWIDE AUTOMATED SYSTEM AND THE DATE OF THE REQUEST WILL SECURE THE APPLICATION DATE FOR THE CLIENT.
6. WHEN THE CLIENT DOES NOT KEEP A SCHEDULED INTERVIEW APPOINTMENT AND HAS NOT CONTACTED THE COUNTY DEPARTMENT TO RESCHEDULE, AS SPECIFIED IN THIS SECTION, THE COUNTY DEPARTMENT SHALL DENY THE APPLICATION FOLLOWING THE POLICIES OUTLINED IN SECTION 3.554.
A. IF THE CLIENT MAKES A REQUEST FOR ADULT FINANCIAL GRANT PAYMENTS FOLLOWING THE COUNTY DEPARTMENT’S DENIAL OF HIS OR HER APPLICATION BASED ON THE CLIENT FAILING TO ATTEND THE INTERVIEW APPOINTMENT, THE FOLLOWING SHALL OCCUR:
1) IF THE CLIENT HAS GOOD CAUSE AS OUTLINED IN SECTION 3.510 AND NOTIFIES THE COUNTY DEPARTMENT THAT HE OR SHE WISHES TO CONTINUE HIS OR HER APPLICATION FOR ADULT FINANCIAL GRANT PAYMENTS WITHIN THIRTY (30) CALENDAR DAYS OF THE DENIAL, THE COUNTY DEPARTMENT SHALL RESCHEDULE THE INTERVIEW AND THE INITIAL APPLICATION DATE SHALL BE USED. DURING THE INTERVIEW, THE COUNTY DEPARTMENT MUST VERIFY AND DOCUMENT ANY CHANGES THAT OCCURRED BETWEEN THE INITIAL APPLICATION SUBMISSION AND THE CLIENT’S REQUEST TO CONTINUE THE APPLICATION PROCESS. IF THE CONTINUED APPLICATION RESULTS IN A DENIAL FOR ANY REASON AND THE CLIENT MAKES A SUBSEQUENT REQUEST FOR ADULT FINANCIAL GRANT PAYMENTS, A NEW APPLICATION SHALL BE REQUIRED.
2) IF THE CLIENT DOES NOT HAVE GOOD CAUSE AND NOTIFIES THE COUNTY DEPARTMENT THAT HE OR SHE WISHES TO CONTINUE HIS OR HER APPLICATION FOR ADULT FINANCIAL GRANT PAYMENTS WITHIN THIRTY (30) CALENDAR DAYS OF THE DENIAL, THE CURRENT APPLICATION MAY BE USED AND THE DATE OF APPLICATION SHALL BE THE MOST RECENT DATE THE CLIENT REQUESTED TO CONTINUE HIS OR HER APPLICATION FOR ADULT FINANCIAL GRANT PAYMENTS. THE COUNTY DEPARTMENT SHALL RESCHEDULE THE INTERVIEW AND MUST VERIFY AND DOCUMENT ANY CHANGES THAT OCCURRED BETWEEN THE INITIAL APPLICATION SUBMISSION AND THE REQUEST TO CONTINUE THAT APPLICATION. IF THE REQUEST TO CONTINUE THE APPLICATION RESULTS IN A DENIAL FOR ANY REASON AND THE CLIENT MAKES A SUBSEQUENT REQUEST FOR ADULT FINANCIAL GRANT PAYMENTS, A NEW APPLICATION SHALL BE REQUIRED.
3) IF THE CLIENT REQUESTS GRANT PAYMENTS AFTER THIRTY (30) CALENDAR DAYS FROM THE DATE OF THE INITIAL DENIAL, HE OR SHE MUST SUBMIT A NEW APPLICATION.
D. VERIFY STATEMENTS MADE BY THE CLIENT ON THE APPLICATION AND DURING THE INTERVIEW USING THE STATEWIDE AUTOMATED SYSTEM INTERFACES DESCRIBED IN SECTION 3.520.5, GATHERED FROM OTHER COLLATERAL CONTACTS OR REQUESTED FROM THE CLIENT.
1. IF THE CLIENT IS MISSING ANY VERIFICATION, THE COUNTY DEPARTMENT SHALL REQUEST ADDITIONAL AND/OR REQUIRED VERIFICATIONS FROM THE CLIENT. THE REQUEST SHALL INCLUDE:
A. A SPECIFIC LIST OF VERIFICATIONS NECESSARY TO DETERMINE ELIGIBILITY;
B. THE DUE DATE FOR WHEN THE VERIFICATIONS MUST BE RETURNED, WHICH SHALL BE ELEVEN (11) CALENDAR DAYS FROM THE DATE THE VERIFICATION WAS REQUESTED IN WRITING UNLESS OTHERWISE SPECIFIED IN SECTION 3.540; AND,
C. NOTIFICATION THAT IF THE CLIENT FAILS TO RETURN THE VERIFICATIONS BY THE DUE DATE, THE COUNTY DEPARTMENT SHALL PROCESS THE APPLICATION WITHOUT THOSE VERIFICATIONS, WHICH MAY LEAD TO A DENIAL OF GRANT PAYMENTS.
2. THE CLIENT SHALL BE ADVISED THAT A COLLATERAL CONTACT OR HOME VISIT MAY BE USED TO CONFIRM QUESTIONABLE EVIDENCE, TO INVESTIGATE POTENTIAL FRAUD, OR WHEN DOCUMENTARY EVIDENCE IS INSUFFICIENT TO MAKE A DETERMINATION OF ELIGIBILITY OR GRANT PAYMENT AMOUNT OR CANNOT OTHERWISE BE OBTAINED. IF A COLLATERAL CONTACT IS NEEDED, THE COUNTY DEPARTMENT SHALL:
A. REQUEST THE NAME OF AN APPROPRIATE COLLATERAL CONTACT FROM THE CLIENT; OR,
B. INDEPENDENTLY DETERMINE AN APPROPRIATE COLLATERAL CONTACT; OR,
C. SUBSTITUTE A HOME VISIT WHEN AN APPROPRIATE COLLATERAL CONTACT CANNOT BE IDENTIFIED; OR,
D. DENY AN APPLICATION FOLLOWING THE POLICIES OUTLINED IN SECTION 3.554 IF A COLLATERAL CONTACT REFUSES TO PROVIDE DOCUMENTATION OF ESSENTIAL VERIFICATIONS AND THE APPLICANT IS UNWILLING TO COOPERATE IN OBTAINING SUCH DOCUMENTATION.
1) THE CLIENT’S AUTHORIZATION FOR THE COLLATERAL CONTACT TO RELEASE SUCH INFORMATION OR DOCUMENTATION ALONE DOES NOT CONSTITUTE COOPERATION IF THE COUNTY DEPARTMENT REQUESTS FURTHER ASSISTANCE FROM THE CLIENT. DOCUMENTATION OF LACK OF COOPERATION MUST BE ENTERED IN THE CASE RECORD.
2) HOWEVER, IF THE CLIENT IS WILLING TO COOPERATE, BUT UNABLE TO OBTAIN THE INFORMATION OR DOCUMENTATION FROM THE COLLATERAL CONTACT, THE COUNTY SHALL ASSIST HIM OR HER IN GAINING THE INFORMATION OR DOCUMENTATION REQUIRED TO MAKE A DETERMINATION OF ELIGIBILITY. IF THE COUNTY IS ALSO UNABLE TO OBTAIN THE INFORMATION OR DOCUMENTATION, ELIGIBILITY WILL BE DETERMINED BASED ON THE INFORMATION PROVIDED.
E. MAINTAIN CLIENT CONFIDENTIALITY TO THE GREATEST EXTENT POSSIBLE WHEN USING A COLLATERAL CONTACT FOR VERIFICATION.
3. RECORD THE DATE EACH VERIFICATION DOCUMENT WAS RECEIVED BY THE COUNTY DEPARTMENT OFFICE.
4. UPON RECEIPT OF THE REQUIRED VERIFICATIONS, THE COUNTY DEPARTMENT SHALL ENTER VERIFICATIONS INTO THE STATEWIDE AUTOMATED SYSTEM. ONCE ALL VERIFICATIONS HAVE BEEN ENTERED, THE COUNTY DEPARTMENT SHALL REVIEW THE RESULTS, VERIFY ACCURACY, AND DETERMINE ELIGIBILITY. IF A CLIENT FAILS TO TIMELY RETURN VERIFICATIONS, THE CASE MAY BE DENIED FOLLOWING THE POLICIES OUTLINED IN SECTION 3.554.
A. IF THE CLIENT PROVIDES NEW INFORMATION REGARDING A CHANGE IN CIRCUMSTANCES AFTER HE OR SHE WAS DETERMINED INELIGIBLE, THE CHANGE IN CIRCUMSTANCES SHALL BE TREATED AS FOLLOWS:
1) IF THE CHANGE IN CIRCUMSTANCES OCCURRED WITHIN THIRTY (30) CALENDAR DAYS OF THE DENIAL, THE CLIENT’S ORIGINAL APPLICATION MAY BE USED AND THE DATE OF THE APPLICATION SHALL BE THE DATE ALL VERIFICATIONS WERE RECEIVED SUPPORTING THE NEW CIRCUMSTANCE. THE COUNTY DEPARTMENT SHALL VERIFY AND DOCUMENT ANY CHANGES THAT OCCURRED BETWEEN THE ORIGINAL APPLICATION SUBMISSION AND THE NEW REQUEST TO CONTINUE HIS OR HER APPLICATION. THE COUNTY DEPARTMENT SHALL ENTER THE VERIFICATIONS INTO THE STATEWIDE AUTOMATED SYSTEM, REVIEW THE RESULTS, VERIFY ACCURACY, AND DETERMINE ELIGIBILITY. IF THE CLIENT’S REQUEST TO CONTINUE HIS OR HER APPLICATION RESULTS IN A DENIAL FOR ANY REASON AND THE CLIENT MAKES A SUBSEQUENT REQUEST FOR ADULT FINANCIAL GRANT PAYMENTS, A NEW APPLICATION SHALL BE REQUIRED.
2) IF THE CLIENT IDENTIFIES A CHANGE IN CIRCUMSTANCE MORE THAN THIRTY (30) CALENDAR DAYS FROM THE DATE OF THE DENIAL, HE OR SHE MUST SUBMIT A NEW APPLICATION.
5. WHEN THE CLIENT DOES NOT SUBMIT THE REQUIRED VERIFICATIONS, AND THE CASE IS DENIED OR DISCONTINUED:
A. IF A CLIENT RETURNS THE REQUIRED VERIFICATIONS WITHIN THIRTY (30) CALENDAR DAYS OF THE DENIAL OR DISCONTINUATION AND GOOD CAUSE IS PROVIDED FOR THE DELAYED SUBMISSION, THE COUNTY DEPARTMENT SHALL UTILIZE THE CURRENT APPLICATION DATE AND SHALL ENTER THE VERIFICATIONS INTO THE STATEWIDE AUTOMATED SYSTEM. WHEN ALL VERIFICATIONS HAVE BEEN ENTERED, THE COUNTY DEPARTMENT SHALL REVIEW THE RESULTS, VERIFY ACCURACY, AND DETERMINE ELIGIBILITY. IF THAT REQUEST TO CONTINUE THE APPLICATION RESULTS IN A DENIAL FOR ANY REASON AND THE CLIENT MAKES A SUBSEQUENT REQUEST FOR ADULT FINANCIAL GRANT PAYMENTS, A NEW APPLICATION SHALL BE REQUIRED.
B. IF THE CLIENT DOES NOT HAVE GOOD CAUSE AND RETURNS THE REQUIRED VERIFICATIONS WITHIN THIRTY (30) CALENDAR DAYS OF THE DENIAL, THAT APPLICATION MAY BE USED AND THE DATE OF THE APPLICATION SHALL BE THE DATE ALL VERIFICATIONS WERE RECEIVED. THE COUNTY DEPARTMENT SHALL ENTER THE VERIFICATIONS INTO THE STATEWIDE AUTOMATED SYSTEM. WHEN ALL VERIFICATIONS HAVE BEEN ENTERED, THE COUNTY DEPARTMENT SHALL REVIEW THE RESULTS, VERIFY ACCURACY, AND DETERMINE ELIGIBILITY. IF THAT REQUEST TO CONTINUE THE APPLICATION RESULTS IN A DENIAL FOR ANY REASON AND THE CLIENT MAKES A SUBSEQUENT REQUEST FOR ADULT FINANCIAL GRANT PAYMENTS, A NEW APPLICATION SHALL BE REQUIRED.
C. IF THE CLIENT PROVIDES THE VERIFICATIONS MORE THAN THIRTY (30) CALENDAR DAYS FROM THE DATE OF THE DENIAL, HE OR SHE MUST SUBMIT A NEW APPLICATION.
6. IF A CLIENT BELIEVES THAT THE VALUE USED BY THE COUNTY DEPARTMENT FOR INCOME OR RESOURCE CALCULATION WAS INCORRECT, THE CLIENT MAY REQUEST VERBALLY OR IN WRITING TO HAVE HIS OR HER CASE REEVALUATED BY THE COUNTY WITHIN THIRTY (30) CALENDAR DAYS OF THE DENIAL. THE COUNTY DEPARTMENT SHALL EVALUATE AND REQUEST ADDITIONAL DOCUMENTATION IF NEEDED. IF AN INCORRECT DETERMINATION WAS MADE, THE COUNTY DEPARTMENT SHALL CORRECT THE CASE AND GRANT PAYMENTS SHALL BE RECALCULATED AND ISSUED BASED ON THE ORIGINAL APPLICATION DATE.
7. DELAY IN PROCESSING THE APPLICATION SHALL NOT BE ALLOWED FOR ANY OF THE FOLLOWING:
A. WHEN THE CLIENT HAS APPLIED FOR A SOCIAL SECURITY NUMBER AND IS AWAITING ACTION BY THE SSA; OR,
B. WHEN THE COUNTY DEPARTMENT IS AWAITING RECEIPT OF INFORMATION FROM THE STATE VERIFICATION EXCHANGE SYSTEM (SVES).
E. PROVIDE A NOTICE OF ACTION TO THE CLIENT BY MAIL, ELECTRONIC NOTIFICATION, OR IN PERSON USING THE STATE DEPARTMENT'S PRESCRIBED FORM EXPLAINING THE ELIGIBILITY DETERMINATION RESULTS AND THE CLIENT'S APPEAL RIGHTS AS OUTLINED IN SECTION 3.586, ET SEQ.
3.520.5 INTERFACE VERIFICATIONS [Eff. 3/2/14]
INTERFACES ARE ACCEPTABLE VERIFICATION SOURCES FOR THE ADULT FINANCIAL PROGRAMS. APPROPRIATE INTERFACES FOR VERIFICATION PURPOSES ARE DESCRIBED BELOW.
A. The Income and Eligibility Verification System (IEVS) provides for the exchange of information on clients with the Social Security Administration (SSA), Internal Revenue Service (IRS) and the Colorado Department of Labor and Employment (DOLE). The county department shall query IEVS, using the client's, client's spouse's, and client's sponsors' SSNSSocial Security Numbers. Source agency records shall be matched on a regular basis to identify potential earned and unearned income, resources, and assets, including:
1. The following data shall be considered verified upon receipt:
a. SSA (BENEFICIARY AND EARNINGS DATA EXCHANGE (BENDEX) AND STATE DATA EXCHANGE (SDX)) Social Security benefits, SSI, pensions, self-employment earnings, federal employee earnings; and,
b. IRS unearned income information including interest on checking or savings accounts, dividends, royalties, winnings from betting establishments, capital gains, etc.; and,
Bc. Unemployment benefits (UIB).
2. DOLE wage data shall not be considered verified upon receipt.
A. ADDITIONAL VERIFICATION MUST BE OBTAINED TO VERIFY WAGE INFORMATION. THE COUNTY DEPARTMENT SHALL REQUEST THIS INFORMATION BE PROVIDED BY THE CLIENT AND/OR HIS OR HER EMPLOYER IN WRITING. THIS INFORMATION MUST BE PROVIDED WITHIN ELEVEN (11) DAYS FOLLOWING THE DATE OF THE COUNTY’S REQUEST OR THE CASE WILL BE DISCONTINUED OR DENIED FOLLOWING THE POLICIES OUTLINED IN SECTION 3.554. However, benefits shall not be delayed pending receipt of verification from a collateral source (e.g., employers).
B. THE COUNTY DEPARTMENT SHALL QUERY DOLE AT INITIAL APPLICATION AND AT REDETERMINATION.
3. PRIOR TO APPROVAL OF GRANT PAYMENTS, TThe county department shall, at a minimum, prior to approval of benefits, verify potential earnings or unemployment benefits for the client, client's spouse, and sponsor(s).
4. The county department shall act on all information received through IEVS within forty five (45) calendar days of receipt.
5. THE COUNTY DEPARTMENT SHALL NOT DELAY PROCESSING OF IEVS BEYOND FORTY-FIVE (45) CALENDAR DAYS ON MORE THAN TWENTY (20) PERCENT OF THE INFORMATION TARGETED FOR FOLLOW-UP, IF:
a. THE REASON THAT THE ACTION CANNOT BE COMPLETED WITHIN FORTY-FIVE (45) CALENDAR DAYS IS THE NONRECEIPT OF REQUESTED THIRD PARTY VERIFICATION; AND,
b. ACTION IS COMPLETED PROMPTLY, WHEN THIRD PARTY VERIFICATION IS RECEIVED OR AT THE NEXT TIME ELIGIBILITY IS REDETERMINED, WHICHEVER IS EARLIER. IF ACTION IS COMPLETED WHEN ELIGIBILITY IS REDETERMINED AND THIRD PARTY VERIFICATION HAS NOT BEEN RECEIVED, THE COUNTY DEPARTMENT SHALL MAKE ITS DECISION BASED ON INFORMATION PROVIDED BY THE CLIENT AND ANY OTHER INFORMATION IN ITS POSSESSION.
6. AT INITIAL APPLICATION AND AT REDETERMINATION, A CLIENT SHALL BE NOTIFIED THROUGH A WRITTEN STATEMENT PROVIDED ON OR WITH THE APPLICATION FORM THAT (1) THE INFORMATION AVAILABLE THROUGH IEVS WILL BE REQUESTED, AND THAT SUCH INFORMATION WILL BE USED FOR DETERMINATION OF ELIGIBILITY; (2) THE INFORMATION IN IEVS MUST BE VERIFIED THROUGH SOURCES, SUCH AS COLLATERAL CONTACTS WITH THE CLIENT, WHEN DISCREPANCIES ARE FOUND BY THE COUNTY DEPARTMENT; AND, (3) THAT THE VERIFIED INFORMATION MAY AFFECT THE CLIENT’S ELIGIBILITY AND GRANT PAYMENT AMOUNT.
a. ALL VERIFICATION TYPES OBTAINED BY A COLLATERAL CONTACT TO VALIDATE OR INVALIDATE ANY IEVS DISCREPANCY SHALL BE DOCUMENTED;
b. CASE DOCUMENTATION SHALL BE AVAILABLE IN THE CASE FILE OR STATEWIDE AUTOMATED SYSTEM DOCUMENTING THE ACTION TAKEN ON THE CASE WITHIN FORTY-FIVE (45) CALENDAR DAYS OF INITIAL RECEIPT. CASE DOCUMENTATION MUST INCLUDE THE PURPOSE OF THE REVIEW OF THE IEVS, THE ACTION TAKEN ON THE CASE, AND HOW THE COUNTY DEPARTMENT MADE THE DETERMINATION AND WHETHER THAT DETERMINATION SUPPORTS THE COUNTY’S ACTION ON THE CASE.
B. The county department shall query DOLE at initial application and at redetermination. DOLE wage data shall not be considered verified upon receipt. DOLE unemployment benefit data shall be considered verified upon receipt. However, benefits shall not be delayed pending receipt of verification from a collateral source. THE STATE VERIFICATION EXCHANGE SYSTEM (SVES) MAY BE USED TO VERIFY SOCIAL SECURITY NUMBER, SSA INCOME, AND SUPPLEMENTAL SECURITY INCOME APPLICATION STATUS. SVES MAY ALSO BE USED TO IDENTIFY POTENTIAL MARITAL STATUS, POTENTIAL RESOURCES, AND OTHER POTENTIAL SOURCES OF INCOME; ADDITIONAL VERIFICATION MAY BE NECESSARY.
C. The county department shall query the Public Assistance Reporting Information System (PARIS) at initial application and at redetermination to determine whether the client is receiving benefits in another state, veterans' benefits, or military wages or allotments. THIS INFORMATION IS NOT CONSIDERED VERIFIED UPON RECEIPT AND ADDITIONAL VERIFICATION MUST BE OBTAINED TO VERIFY THE INFORMATION PROVIDED IN PARIS. THE COUNTY DEPARTMENT SHALL REQUEST THIS INFORMATION BE PROVIDED BY THE CLIENT AND/OR THE OTHER STATE, VETERAN’S AGENCY, OR MILITARY BRANCH IN WRITING.
D. The county department shall query the Systematic Alien Verification for Entitlements (SAVE) at initial application and at redetermination. INFORMATION OBTAINED THROUGH SAVE IS CONSIDERED VERIFIED UPON RECEIPT. THE PURPOSE OF THE SAVE QUERY IS to:
1. Determine whether a qualified non-citizen has a sponsor(s); and,
2. Verify the non-citizen registration number provided by the client; and, IF THE NUMBER AND NAME SUBMITTED DO NOT MATCH, REFER THE CLIENT TO RESOLVE THE DISCREPANCY, AND IF UNABLE TO RESOLVE, TAKE PROMPT ACTION TO TERMINATE ASSISTANCE TO THE CLIENT FOLLOWING THE POLICIES OUTLINED IN SECTION 3.554; AND,
3. If the number and name submitted do not match, the county department shall take prompt action to terminate assistance to the client.
3.4. Determine if there has been a change in the non-citizen's IMMIGRATION status.
E. The Colorado Department of Revenue, Division of Motor Vehicles (DMV), may be used by the county department to verify lawful presence and identity.
3.520.6 NON-FINANCIAL ELIGIBILITY REQUIREMENTS
3.520.61 Non-Financial Eligibility Requirements [Eff. 3/2/14]
To be eligible for Adult Financial programs, a client shall:
A. Be eighteen (18) through fifty-nine (59) years of age for AND-SO (unless diagnosed with blindness, then age zero (0) through 59 years of age); age zero (0) through 59 years of age for AND-CS; and age sixty (60) years of age or older for OAP; and,
B. Be a resident of Colorado, except that inmates of a city, municipal, county, state, or federal correctional institution, and fleeing felons, shall not be eligible for Adult Financial programs; and,
C. Be a citizen of the United States or be a qualified non-citizen or legal immigrant as outlined in Sections 3.520.66 who is lawfully present IN THE UNITED STATES; and,
D. Have a valid Social Security Number, as outlined in Section 3.520.65; and,
E. For AND only, have a disability, as outlined in Section 3.541; and,
F. Not be currently receiving or eligible for financial assistance from Colorado Works, AS OUTLINED IN SECTION 3.520.71.F; and,
G. Take reasonable steps to aApply for and accept all retirement and public assistance benefits for which they may be eligible, UNLESS GOOD CAUSE IS PROVIDED AS TO WHY SUCH BENEFITS WERE NOT APPLIED FOR OR ACCEPTED; and,
H. Pursue and accept all other POTENTIAL income and resources that may be available, AS OUTLINED IN SECTION 3.520.71; and,
I. Meet all other program eligibility requirements, including income and resource limits.
3.520.62 Age Requirements [Eff. 3/2/14]
The county department shall verify the client's age by viewing the statewide automated system interface information or ANY OF THE FOLLOWING documents, as follows:
A. One of the following valid government issued documents or identification:
1. Birth certificate;
2. Valid Colorado state identification or driver's license;
3. Valid out of state identification or driver's license;
4. Naturalization, immigration, or passport papers;
5. Legal documents from vital statistics; or,
6. Social Security information (SOLQ, SVES, SDX, and BENDEX); or,
B. Two or more of the following documents:
71. School records;
82. Baptismal certificates or other well documented church records;
93. Genealogy records or other well documented family records of birth;
104. Voting records; OR,
115. United States census records.
3.520.63 Marital Status [Eff. 3/2/14]
A. The county department shall determine AND VERIFY IF QUESTIONABLE the client's marital status as one of the following:
1. Single, never married;
2. Married;
3. Widowed; or,
4. Divorced or legally separated.
B. If married, both spouses may apply for and/or receive Adult Financial programs. Each spouse shall have a separate case.
C. If the client is divorced, or legally separated OR WIDOWED, AND THIS STATUS IS QUESTIONABLE, the client shall provide verification in the form of:
1. Legal COURT documents OR ALTERNATE VERIFICATION FROM A VITAL STATISTIC SOURCE SUBSTANTIATING showing divorce or legal separation; or,
2. Written statements by two or more persons who are unrelated to each other and to the spouses, who can establish that they are in a position to know and assert that both physical and financial ties have been dissolved and a complete and permanent separation does, in fact, exist. The county department shall use prudent person principle and weigh the documentation and make a decision regarding marital status.
2. DEATH CERTIFICATE OR OBITUARY OF THE CLIENT’S SPOUSE.
D. CLIENTS WHO ARE NOT LEGALLY SEPARATED OR DIVORCED ARE CONSIDERED MARRIED.
3.520.64 Residency Requirements [Eff. 3/2/14]
A. To be eligible for Adult Financial programs, a client shall be a resident of Colorado.
B. Residency is established on the first day the client declares him/herself to be a resident of Colorado.
1. A person shall not acquire residence while the person has established his OR /her permanent place of residence in another state or country.
2. A person receiving FINANCIAL assistance from another state shall not be eligible for Adult Financial programs in Colorado during any month in which a payment is made by the other state.
C. The client shall live in the county in which the application is made.
1. A client who resides in a county but who IS HOMELESSdoes not reside in a permanent dwelling or have a fixed mailing address shall be considered eligible for assistance, provided all other eligibility requirements are met.
2. Clients who do not have a fixed address may provide a postal box within their county as their mailing address, or may use the county department as their mailing address. It shall be the client's responsibility to go to the postal box or the county department to check for and pick up their mail. Failure to regularly check for and pick up mail shall not be grounds for appealing timely notice.
D. A client who moves out of Colorado or is shown to be a resident of another state shall not be considered a resident of Colorado. A move or residence in another state may be established by actions such as:
1. Purchasing or obtaining a lease of a dwelling unit in another state;
2. Household effects, equipment, and personal belongings being removed to another state;
3. Obtaining a driver's license or state-issued identification card in another state;
4. Registering to vote in another state;
5. Applying for or receiving local, state, or federal assistance in another state;
6. Registering vehicles of any type in another state;
7. Securing a resident hunting or fishing license in another state;
8. Using an address in another state; or,
9. Statements or other positive acts indicating that the client has taken up residence in another state.
E. A client who is out of state temporarily shall be considered a resident, with the following exceptions:
1. A client who leaves the country for a period of thirty (30) or more consecutive days creates a rebuttable presumption (unless the client comes forward with enough information to prove otherwise) that the client shall no longer be considered a resident and shall be ineligible for Adult Financial programs.
2. A client who leaves the state for a period of ninety (90) or more consecutive days creates a rebuttable presumption (unless the client comes forward with enough information to prove otherwise) that the client shall no longer be considered a resident and shall be ineligible for Adult Financial programs. An exception to this is for individuals temporarily out of the state to receive DOCUMENTED medical treatment.
3. A client who leaves the state for a period of more than ONE HUNDRED EIGHTY (180) DAYS six (6) months in any calendar year, even if that time has not been consecutive time away, creates a rebuttable presumption (unless the client comes forward with enough information to prove otherwise) that the client shall no longer be considered a resident and shall be ineligible for Adult Financial programs.
4. A client who leaves the state to care for an immediate family member injured in the line of military duty for a period of one hundred eighty (180) or more consecutive days creates a rebuttable presumption (unless the client comes forward with enough information to prove otherwise) that the client shall no longer be considered a resident and shall be ineligible for Adult Financial programs.
F. When a determination of principal place of residence is difficult to secure due to conflicting documentation, other sources shall be used to gather verification and make a decision, such as addresses obtained from voter registrations, tax returns, Social Security and Medicare, a driver's license, car registrations, or other statements or documents. The county department shall use THE prudent person principle to weigh the documentation and/or verification and make a decision regarding residency.
G. The burden to prove residency shall be on the client. IF A CLIENT REFUSES TO PROVIDE REQUESTED OR NECESSARY DOCUMENTATION OR INFORMATION TO VERIFY RESIDENCY, ADULT FINANCIAL GRANT PAYMENTS SHALL BE DENIED FOLLOWING THE POLICIES OUTLINED IN SECTION 3.554.
3.520.65 Social Security Numbers (SSN) [Eff. 3/2/14]
A. Each Adult Financial program client shall provide his OR /her Social Security number (SSN) to the county department.
1. If a client has multiple numbers, all numbers shall be required.
2. If a client is unable to provide their SSN, the client shall be required to apply for an SSN at the local Social Security office and provide the county department with verification of application for an SSN.
3. Refusal or failure to apply for or provide their SSN shall result in denial for Adult Financial programs.
4. Upon proof of application for an SSN, the time required for issuance OF THE NUMBER or to secure verification of the number shall not be used as a basis for delaying action on the Adult Financial program application.
B. The county department shall verify the client's Social Security Number (SSN) with the Social Security Administration (SSA) in accordance with procedures established by the State Department for the State Verification Exchange System (SVES).
1. The county department shall accept as verified a SSN that has been confirmed by the SVES.
2. When the county department receives notification that an SSN cannot be verified or is otherwise discrepant (e.g., name or number do not match SSA records), the county department shall:
a. Conduct a case record review to confirm that the SSN in the case record matches the SSN submitted to the SSA for verification.
1) If an error occurred in the original submittal (e.g., digits transposed, incorrect name submitted) the county department shall correct the error and resubmit the SSN through SVES for verification.
2) If no error is identified, the county department shall advise the client in writing that THE an SSN could not be verified, and instruct the client to contact the local Social Security office to resolve the discrepancy.
b. Make every effort to assist the client to obtain available documents required by the SSA.
3. If the client is unable to provide his OR /her valid SSN, the application shall be denied or the case terminated FOLLOWING THE POLICIES OUTLINED IN SECTION 3.554.
3.520.66 Lawful Presence [Eff. 3/2/14]
A. Pursuant to Section 24-76.5-103, C.R.S., Adult Financial program clients are required to produce verification of lawful presence in the United States prior to receiving GRANT PAYMENTSbenefits. For purposes of this section:
1. “Affidavit” means a State prescribed form wherein an applicant CLIENT attests, subject to the penalties of perjury, that HE OR SHE ISthey are lawfully present in the United States. An affidavit need not be notarized.
2. “Produce” means to provide for inspection either: 1) an original, or 2) a true and complete copy of the original document. A document may be produced either in person or by mail.
B. In order to verify his or her lawful presence in the United States, the client shall:
1. Execute an affidavit saying that:
a. He or she is a United States citizen or legal permanent resident; or,
b. He or she is otherwise lawfully present in the United States pursuant to federal law; and,
2. Produce and provide to the county department:
a. A valid Colorado driver's license or a Colorado identification card issued pursuant to Article 2 of Title 42, C.R.S.; or,
b. A United States military card or military dependent's identification card; or,
c. A United States Coast Guard Merchant Mariner Card; or,
d. A Native American tribal document; or,
e. Any other document authorized by rules adopted by the Colorado Department of Revenue PERTAINING TO LAWFUL PRESENCE FOUND AT 1 C.C.R. 204-30:5 AS OF APRIL 14, 2019. THESE DEPARTMENT OF REVENUE RULES ARE HEREIN INCORPORATED BY REFERENCE AND DO NOT INCLUDE ANY LATER AMENDMENTS OR EDITIONS OF THESE RULES. THESE RULES ARE AVAILABLE FOR PUBLIC INSPECTION AT THE COLORADO DEPARTMENT OF REVENUE, 1375 SHERMAN ST., DENVER, CO 80261 OR FOR NO COST AT WWW.SOS.STATE.CO.US. COPIES OF THESE RULES ARE AVAILABLE FOR REASONABLE COST DURING NORMAL BUSINESS HOURS AT THE COLORADO DEPARTMENT OF HUMAN SERVICES, DIRECTOR OF THE EMPLOYMENT AND BENEFITS DIVISION, 1575 SHERMAN ST., DENVER, CO 80203 OR THE COLORADO DEPARTMENT OF REVENUE, 1375 SHERMAN ST., DENVER, CO 80203; or,
f. Adult Financial program clients who cannot produce one of the required documents may demonstrate lawful presence by both executing the affidavit and BY REQUESTING AND OBTAININGexecuting a request for waiver FROM THE COLORADO DEPARTMENT OF REVENUE. The request for waiver must be provided to the Colorado Department of Revenue in person, by mail, or online, and must be accompanied by all documents the client can produce to prove lawful presence. An approved waiver must be issued by the Colorado Department of Revenue in accordance with 1 C.C.R. 201-17 204-30:5. The county department is responsible for verifying that the applicant CLIENT is the same individual indicated as being lawfully present through the approved waiver.
3.520.67 Citizenship and Qualified Non-Citizens [Eff. 3/2/14]
A. The following are citizens of the United States and are eligible to apply for Adult Financial programs:
1. Persons born in the United States, Puerto Rico, Guam, Virgin Islands (U.S.), American Samoa, or Swain's Island;
2. Persons who have become citizens through the naturalization process;
3. Persons born to U.S. citizens outside the United States with appropriate documentation.
B. The county department shall verify citizenship when:
1. The claim of citizenship is inconsistent with statements made by the client or with other information on the current or previous applications; or,
2. The claim of citizenship is inconsistent with information received from another source.
C. Citizenship may be verified by a birth certificate, possession of a U.S. passport, a certificate of U.S. citizenship (ISSUED BY USCIS form N-560 or NH-561), a certificate of naturalization (ISSUED BY USCIS form N-550 or N-570), a certificate of birth abroad of a citizen of the United States (ISSUED BY THE Department of State forms FS-545 or DS-1350), or Identification Cards for U.S. citizens (ISSUED BY USCIS-I-179 or CIS-I-197). DOCUMENTS THAT ARE ACCEPTABLE AS VERIFICATION OF CITIZENSHIP CAN BE FOUND IN THE FEDERAL REGULATIONS AT 45 CFR 1626.6 AS OF MAY 19, 2014, WHICH ARE HEREIN INCORPORATED BY REFERENCE. THIS RULE DOES NOT CONTAIN LATER AMENDMENTS OR ADDITIONS. THESE REGULATIONS ARE AVAILABLE AT NO COST AT . THESE REGULATIONS ARE ALSO AVAILABLE FOR PUBLIC INSPECTION AND COPYING AT THE COLORADO DEPARTMENT OF HUMAN SERVICES, DIRECTOR OF THE EMPLOYMENT AND BENEFITS DIVISION, 1575 SHERMAN STREET, DENVER, COLORADO, 80203, OR AT ANY STATE PUBLICATIONS LIBRARY DURING REGULAR BUSINESS HOURS.
D. Verification of citizenship by the county department shall not result in discrimination based on race, religion, ethnic background or national origin, and groups such as migrant farm workers or Native Americans shall not be targeted for special verification. The county department shall not rely on a surname, accent, or appearance that seems foreign to find a claim to citizenship questionable. Nor shall the county department rely on a lack of English speaking, reading, or writing ability as grounds to question a claim to citizenship.
E. A qQualified non-citizenS, WHO ARE considered a legal immigrantS by the United States Citizenship and Immigration Services (USCIS), ARE ELIGIBLE TO APPLY FOR ADULT FINANCIAL PROGRAMS AND shall provide one of the following verification OF LAWFUL PRESENCE ACCORDING TO 1 C.C.R. 204-30:5documents: AS OF APRIL 14, 2019, WHICH IS HEREIN INCORPORATED BY REFERENCE. THIS RULE DOES NOT CONTAIN ANY LATER AMENDMENTS OR ADDITIONS. THESE REGULATIONS ARE AVAILABLE IN PERSON AT THE COLORADO DEPARTMENT OF REVENUE, 1375 SHERMAN ST., DENVER, CO 80261. THESE REGULATIONS ARE ALSO AVAILABLE FOR PUBLIC INSPECTION AND COPYING AT THE COLORADO DEPARTMENT OF HUMAN SERVICES, DIRECTOR OF THE EMPLOYMENT AND BENEFITS DIVISION, 1575 SHERMAN STREET, DENVER, COLORADO, 80203, OR AT ANY STATE PUBLICATIONS LIBRARY DURING REGULAR BUSINESS HOURS.
1. USCIS I-94 Arrival/Departure Record.
2. USCISI-551: Resident Alien Card (I-551).
3. USCIS Forms I-688B or I-766 Employment Authorization Document.
4. A letter from USCIS indicating a person's status.
5. Letter from the U.S. Dept. of Health and Human Services (HHS) certifying a person's status as a Victim of a Severe Form of Trafficking.
6. Iraqi and Afghan individuals who worked as translators for the U.S. military, or on behalf of the U.S. government, or families of such individuals; and have been admitted under a Special Immigrant Visa (SIV) with specific visa categories of SI1, SI2, SI3, SI6, SI7, SI9, SQ1, SQ2, SQ3, SQ6, SQ7, or SQ9.
7. Any of the documents permitted by the Colorado Department of Revenue rules for evidence of lawful presence (1 C.C.R. 201-17 204-30-5, Attachment B).
F. Qualified non-citizens applying for Adult Financial programs shall present documentation from USCIS showing the client's non-citizen status. All documents shall be verified through SAVE (Systematic Alien Verification for Entitlements) to determine the validity of the document.
G. The following non-citizens and temporary residents shall not be eligible for Adult Financial programs:
1. A non-citizen with no status verification (undocumented) from the USCIS.S. Citizenship and Immigration Service;
2. A non-citizen granted a specific voluntary departure date;
3. A non-citizen WITHOUT A CURRENT QUALIFIED STATUS, REGARDLESS OF APPLICATION applying for a status; or,
4. A citizen of foreign nations residing temporarily in the United States on the basis of a visa issued to permit employment, education, or a visit.
3.520.68 Five Year Bar from Eligibility [Eff. 3/2/14]
A. Qualified non-citizens arriving in the U.S. on or after August 22, 1996, are generally barred from receiving Adult Financial programs for five years beginning on the qualified non-citizen's date of admission into the United States for legal permanent residence, as verified through the Systematic Alien Verification for Entitlements (SAVE) system, unless they meet one of the following exceptions consistent with the provisions of federal regulations found at 45 CFR 286.5 as of February 18, 2000, herein incorporated by reference. This rule does not contain any later amendments or editions. THESE REGULATIONS ARE AVAILABLE FOR NO COST AT . Copies of these federal laws REGULATIONS are available FOR PUBLIC INSPECTION AND COPYING AT from the Colorado Department of Human Services, Director of the Employment and Benefits Division, 1575 Sherman Street, Denver, Colorado, 80203, or at any state publications library.:
1. An honorably discharged U.S. veteran or active U.S. military personnel and/or spouse, unmarried children, widow, or widower;
2. A refugee, asylee, deportation withheld, a non-citizen granted status as a Cuban or Haitian entrant, or a certified Victim of a Severe Form of Trafficking (these humanitarian immigrants maintain their original status when adjusting to Legal Permanent Resident (LPR) status and remain exempt from the five year bar);
3. An individual who was born in Canada and possesses at least fifty percent (50%) American Indian blood, or who is a member of an Indian tribe;
4. An individual admitted to the U.S. as an Amerasian immigrant pursuant to Section 584 of the Foreign Operations, Export Financing, and Related Programs Appropriations Act of 1988, as amended by Public Law No. 100-461;
5. A lawfully admitted permanent resident who is a Hmong or Highland Lao veteran of the Vietnam War;
6. An Afghan or Iraqi Special Immigrant Visa (SIV) holder;
7. A qualified non-citizen who receives Supplemental Security Income (SSI) benefits.
B. For OAP only, a client that has a documented hardship, as follows, shall not be subject to a five-year bar from benefits:
1. Abuse or mistreatment by the sponsor(s). Suspension of five-year bar from benefits is permitted if there is credible evidence that the qualified non-citizen CLIENT has been physically abused, battered, or subjected to extreme cruelty by his OR /her sponsor(s) in the United States, and meets the following requirements:
a. The qualified non-citizen CLIENT subject to such physical abuse, battery, or extreme cruelty does not live in the same household with the individual responsible for the physical abuse, battery, or extreme cruelty; and,
b. There is a substantial connection between the physical abuse, battery, or extreme cruelty and the need for benefits; and,
c. There is documented credible evidence of physical abuse, battery, or extreme cruelty, including, but not limited to:
1) A copy of the protection order issued against the abuser or batterer of the qualified non-citizen claimant CLIENT; or,
2) A copy of the verdict and the judgment or sentence against the abuser or batterer committing the act of violence against the qualified non-citizen claimant CLIENT; or,
3) Reports or affidavits from police, judges, or other court officials; or,
4) Written statements from medical/health professionals treating the individualCLIENT; or,
5) Verification from the USCIS.S. Citizenship and Immigration Services or the Executive Office for Immigration Review (EOIR) that a petition to qualify under this category has been approved.
2. Indigence: Suspension of the five-year bar from benefits is permitted if the qualified non-citizen's income and resources, and income and resources of the qualified non-citizen's sponsor(s) are inadequate. If the qualified non-citizen does not have a sponsor, then their own income and resources would be considered.
a. It is the responsibility of the qualified non-citizen to obtain all required information and documentation from the sponsor(s).
b. The county department shall determine if the total household income available exceeds 125% of the federal poverty guidelines AS DEFINED IN 3.510 for the household size. by dividing the total household income by the number of people in the household.
1) For purposes of this section, the household includes the qualified non-citizen, the qualified non-citizen's spouse, the qualified non-citizen's dependent children, the sponsor(s), the spouse of the sponsor(s), and the sponsor(s)' dependent children, i.e., the children the sponsor(s) claim on his OR /her income tax.
2) The county department shall total the countable income of the household by adding together income of the non-citizen, and that of his OR her spouse, and the sponsor(s) AND THE SPONSOR(S) SPOUSE(S).
3) If the total household income available exceeds the monthly amount of 125% of the federal poverty guidelines, AS DEFINED IN 3.510, for the household size, the indigence exception does not apply. If the total household income is less than 125% of the monthly federal poverty guidelineS AS DEFINED IN 3.510 for the household size, then,
a) The county department shall determine whether the household resources are above the resource limits, as outlined in Section 3.520.72. If yes, the indigence exception does not apply. If no, then,
b) The indigence exception applies.
A) DETERMINE THE SPONSOR(S) COUNTABLE RESOURCES. RESOURCES ARE ATTRIBUTED TO THE SPONSOR IN THE SAME MANNER AS THE NON-CITIZEN, AS OUTLINED THROUGHOUT 3.520.72.
B) ALL COUNTABLE RESOURCES OVER THE SPONSOR(S) RESOURCE LIMIT, AS OUTLINED IN SECTION 3.520.72, ARE THEN APPLIED TO THE NON-CITIZEN.
C) THIS IS ADDED TO THE NON-CITIZEN’S COUNTABLE RESOURCES AND COMPARED TO THE NON-CITIZEN’S RESOURCE LIMIT, AS OUTLINED IN SECTION 3.520.72.
D) IF THE NON-CITIZEN IS UNDER THE RESOURCE LIMIT, THE INDIGENCE HARDSHIP EXCEPTION APPLIES.
c. The county department shall determine if the non-citizen is receiving free room and board from another source, such as a family member, friend, or a non-profit agency. If yes, the indigence exception does not apply.
3. Abandonment by the sponsor(s): suspension of the five-year bar from benefits may be applicable when the qualified non-citizen is abandoned by his OR /her sponsor(s) and the qualified non-citizen's income and resources are so inadequate that the qualified non-citizen is unable to obtain food and shelter.
a. The county department shall contact the sponsor to confirm the non-citizen's allegations regarding amounts of income and resources the sponsor provides or makes available to the non-citizen. If the non-citizen does not know the sponsor's whereabouts, the county department shall obtain this information if available through SAVE.
b. If the county cannot locate the sponsor of the sponsored non-citizen, OR NO SUPPORT IS BEING PROVIDED, a signed allegation FROM THE NON-CITIZEN (if the allegation is credible and does not conflict with other information in the file) shall be utilized TO DETERMINE ABANDONMENT. If the allegations are not credible or conflict with other information in file, the county department shall weigh all information and use THE prudent person principle to make a decision REGARDING THE APPLICABILITY OF THE ABANDONMENT HARDSHIP based on all the information obtained. IF SUPPORT IS BEING PROVIDED, THE ABANDONMENT HARDSHIP EXCEPTION SHALL NOT APPLY.
c. When a determination of abandonment is made, the county department shall notify the UNITED STATES Department of Homeland Security.
C. For OAP only, if approved for a hardship exception to the five-year bar, the county department shall process the application or redetermination to determine whether the qualified non-citizen meets the eligibility criteria for OAP. Requirements for the hardship exception shall be reassessed at each redetermination or when circumstances change.
D. For OAP only, the county department shall pursue recovery of OAP GRANT PAYMENTS benefits from the sponsor(s).
1. The qualified non-citizen shall be notified of the recovery requirement at the time of request for a hardship exception from the five year bar from benefits; and,
2. If granted a hardship, the client shall be notified during the interview of each redetermination of the requirement to recover funds from the sponsor(s).
3.520.69 Sponsorship of Qualified Non-Citizens [Eff. 3/2/14]
This section shall apply to qualified non-citizens who entered the country on or after August 22, 1996.
A. As a condition of eligibility for financial assistance, any legal non-citizen applying for or receiving financial assistance shall agree that, during the time period the client is receiving financial assistance, the client shall not sign an affidavit of support for the purpose of sponsoring a non-citizen seeking permission from USCIS to enter or remain in the United States. A legal non-citizen's eligibility for financial assistance shall not be affected by the fact that the legal non-citizen has signed an affidavit of support for a non-citizen prior to his OR /her application for benefits.
B. IF A CLIENT IS AThe sponsored qualified non-citizen, HE OR SHE shall be responsible for the provision of any information and documentation related to the sponsor(s) and shall obtain cooperation from the sponsor(s) necessary to determine:
1. The identity and current address and contact information of the sponsor(s);
2. The relationship of the sponsor(s) to the qualified non-citizen;
3. Income and resources of the sponsor(s), which may be deemed available to the qualified non-citizen or recovered for repayment of GRANT PAYMENTSbenefits paid to or on behalf of the qualified non-citizen.
C. It shall be presumed that an affidavit of support demonstrates the sponsor's ability to make income and resources available to a non-citizen whom he or she sponsors at a minimum of one hundred twenty-five percent (125%) of the federal poverty levelGUIDELINES, AS DEFINED IN 3.510. Sponsors are expected to meet their financial commitments to the qualified non-citizen whom they sponsor and for whom they signed an affidavit of support until such time as the:
1. Qualified non-citizen has obtained U.S. citizenship; or,
2. Qualified non-citizen has worked, or can be credited with forty (40) qualifying quarters of coverage under Title II of the federal Social Security Act, 42 U.S.C. SECTION 413 (2018); or
3. Qualified non-citizen leaves the United States and gives up lawful permanent resident status; or,
4. Qualified non-citizen dies; or,
5. Sponsor of the qualified non-citizen dies. The death of one sponsor does not terminate the support obligation of a joint sponsor. The sponsor's estate shall be required to repay public benefits.; OR,
6. QUALIFIED NON-CITIZEN BECOMES SUBJECT TO REMOVAL PROCEEDINGS, BUT HE OR SHE APPLIES FOR AND OBTAINS A NEW GRANT OF ADMISSION STATUS IN THOSE PROCEEDINGS BASED ON A NEW AFFIDAVIT OF SUPPORT, IF ONE IS REQUIRED.
D. Income and resources of the sponsor(s) shall be deemed to the client, as follows:
1. SPONSOR DDeeming shall not apply to qualified non-citizens admitted as refugees or as political asylees. A NON-CITIZEN WHOSE STATUS AS A POLITICAL ASYLEE OR REFUGEE HAS NOT YET BEEN DETERMINED OR FINALIZED BECAUSE HIS OR HER APPLICATION TO BECOME A QUALIFIED NON-CITIZEN IS IN A PENDING STATUS OR FOR SOME OTHER REASON SHALL NOT BE CONSIDERED A QUALIFIED NON-CITIZEN ADMITTED AS A POLITICAL ASYLEE OR REFUGEE, AND THEREFORE, SUCH NON-CITIZEN IS NOT ELIGIBLE TO RECEIVE GRANT PAYMENTS.
2. Sponsors who signed sponsorship agreements prior to DECEMBER 19, 1997, August 22, 1996, shall not be subject to resource and income deeming.
3. Effective December 19, 1997 through December 31, 2013, sponsor deeming shall apply only to the qualified non-citizen's spouse and/or non-relative sponsor(s) identified in sponsorship agreements signed on or after DECEMBER 19, 1997 August 22, 1996.
a. A relative is defined as any relation by blood, adoption, or marriage.
b. Kinship relations by marriage continue to exist even if the marriage is terminated by death or divorce.
4. Effective January 1, 2014, sponsor deeming shall apply to all of the qualified non-citizen's sponsors identified in sponsorship agreements signed on or after December 19, 1997, no matter the sponsor's relationship to the client.
5. For OAP only, the hardship exceptions as described in SECTION 3.520.68.B-D, shall also be evaluated in relation to sponsor deeming. If it is determined that hardship has been established, sponsor deeming shall not be applied to the non-citizen. Eligibility under one of the hardship exceptions will be reviewed and reassessed at redetermination or when changes in circumstance are reported to determine if hardship still applies. The county department shall pursue recovery of OAP benefits from the sponsor(s).
a. The qualified non-citizen shall be notified of the recovery requirement at the time of request for a hardship exception from the sponsor deeming; and, UPON DETERMINATION THAT A NON-CITIZEN IS GRANTED A HARDSHIP EXCEPTION, THE COUNTY DEPARTMENT WILL NOTIFY THE SPONSOR OF ITS DETERMINATION AND REQUIREMENT OF REPAYMENT OF THE FULL AMOUNT OF THE GRANT PAYMENTS MADE TO THE NON-CITIZEN. THIS REQUIREMENT MAY BE WAIVED BY THE COUNTY DEPARTMENT IN CASES UTILIZING THE HARDSHIP EXCEPTIONS. SUCH WAIVER MUST BE DOCUMENTED IN THE CASE RECORD.
b. If granted a hardship, the client shall be notified during the interview of each redetermination of the requirement to recover funds from the sponsor(s).
IF THE SPONSOR FAILS TO COMPLY WITH THE REPAYMENT TERMS ESTABLISHED BY THE COUNTY DEPARTMENT, THE COUNTY DEPARTMENT WILL PURSUE OTHER REMEDIES FOR REPAYMENT, WHICH SHALL INCLUDE BUT ARE NOT LIMITED TO:
1) INCOME ASSIGNMENTS;
2) STATE INCOME TAX REFUND OFFSET;
3) STATE LOTTERY WINNINGS OFFSET; AND,
4) ADMINISTRATIVE LIEN AND ATTACHMENT.
5. BECAUSE THE SPONSOR, NOT THE NON-CITIZEN, IS SOLELY LIABLE FOR REPAYMENT, THE SPONSOR CANNOT USE THE SPONSORED NON-CITIZEN'S GRANT PAYMENTS TO REPAY THE PAYMENTS.
E. If the qualified non-citizen fails to provide information related to the sponsor(s), as outlined in Section 3.520.69.B, assistance shall be denied or discontinued FOLLOWING THE POLICIES OUTLINED IN SECTION 3.554.
If it is determined that the client received Adult Financial program GRANT PAYMENTS benefits because the client failed to provide necessary information related to the sponsor(s) or the sponsor(s) failed to cooperate with the county department in determining income and resources that are required to be deemed to the client, the county department shall recover such funds, AS OUTLINED IN SECTION 3.520.69.D. from the sponsor(s) and/or the client via the following:
1. Income assignments;
2. State income tax refund offset;
3. State lottery winnings offset; and,
4. Administrative lien and attachment.
F. Income and resources shall be deemed as outlined in Sections 3.534, C, and 3.520.72.
3.520.7 FINANCIAL ELIGIBILITY REQUIREMENTS
3.520.71 Financial Eligibility Requirements [Eff. 3/2/14]
A. To receive Adult Financial program assistance, the client shall meet all financial requirements in addition to all other program eligibility requirements. The client shall:
1. Have countable resources below the resource limit as outlined in Section 3.520.72; and,
2. Have income below the income limit, as outlined in Section 3.520.78; and,
3. Make reasonable attempts to pursue all available POTENTIAL income and resources at the client's disposal.
B. The AND-SO client shall apply for Supplemental Security Income (SSI) benefits. If the client has work hours during his OR /her lifetime, the client shall also apply for Social Security Disability Insurance (SSDI). THE CLIENT SHALL REPORT ANY DENIAL FOR SSI BENEFITS. The client shall appeal all negative decisions regarding their SSI eligibility. Failure to appeal all negative decisions WITHIN THIRTY (30) CALENDAR DAYS OF SUCH DECISION, UNLESS ADDITIONAL TIME IS GIVEN FOR GOOD CAUSE, shall result in denial or discontinuation of AND GRANT PAYMENTS benefits.
IF THE CLIENT IS APPROVED FOR SSI AND SSDI BENEFITS AT THE SAME TIME AND IS GIVEN THE CHOICE BETWEEN THE TWO (2) BENEFIT OPTIONS, HE OR SHE MUST CONTACT THE COUNTY DEPARTMENT TO DETERMINE IF ANY INTERIM ASSISTANCE HE OR SHE RECEIVED FROM THE COUNTY IS REQUIRED TO BE REPAID. IF REPAYMENT IS REQUIRED, THE CLIENT SHALL BE ADVISED THAT HE OR SHE MUST ACCEPT THE SSI BENEFITS AND THAT IF HE OR SHE VOLUNTARILY WITHDRAWS HIS OR HER SSI APPLICATION, WITHDRAWAL WOULD VIOLATE THE AUTHORIZATION FOR REIMBURSEMENT OF INTERIM ASSISTANCE, AS OUTLINED IN SECTION 3.545.
For OAP, the client shall apply for AND ACCEPT Social Security and/or SSI benefits IF DETERMINED ELIGIBLE, as follows:
1. Clients sixty (60) years of age and older who report a disability may be eligible for SSI or SSDI.
2. Clients sixty (60) years of age and older may be eligible for Social Security survivor benefits.
3. Clients sixty-two (62) years of age and older may be eligible for early Social Security retirement benefits; otherwise the client shall provide documentation from the SSA that HE OR SHE he/she is ineligible due to insufficient work hours.
4. Clients sixty-five (65) years of age and older may be eligible for Social Security retirement benefits and/or SSI benefits when the client's income from any source is less than the SSI grant BENEFIT standard, AS DEFINED IN SECTION 3.510, plus $20.00.
C. For all Adult Financial programs other than AND-SO, clients referred to the SSA to apply for any SSA related benefit shall be required to provide verification of application for such benefits within ELEVEN (11) ten (10) calendar days of HIS OR HER application for SSA benefits.
For AND-SO, clients referred to the SSA to apply for any SSA related benefit shall be required to provide verification of application for such benefits within sixty (60) calendar days from the initial interview date with the county department. The client will have up to sixty days of conditional approval from the date of the initial interview with the county department for AND-SO. Subsequent applications for AND-SO submitted by the client shall not be approved prior to receipt of proof of application for SSA benefits. Subsequent applications for AND-SO require verification of application for SSA benefits within thirty (30) calendar days.
D. For OAP, the client shall apply for SSI, AND SHALL TIMELY SCHEDULE AND COMPLETE ANY AND ALL SCHEDULED INTERVIEWS WITH THE SSA, AND IN THE EVENT OF A DENIAL BY SSA, THE OAP CLIENT SHALL CONTINUE TO APPEAL ALL NEGATIVE DECISIONS FROM THE SSA UNTIL A FINAL RESOLUTION IS REACHED AND NO FURTHER RIGHT TO APPEAL EXISTS. HOWEVER, THE REQUIREMENT TO CONTINUE TO APPEAL ALL NEGATIVE DECISIONS MAY BE EXCUSED IF ANY OF THE FOLLOWING APPLY: or continue to appeal negative decisions unless good cause is provided. Good cause is defined as follows:
1. The client's and the client's spouse's gross income exceeds the maximum allowed for SSI for an individual or a couple; or,
2. The client's and the client's spouse's total resources exceed that allowed for SSI for an individual or a couple; or,
3. The client is not disabled as defined in Section 3.541; or,
4. As otherwise directed by the SSA; OR,
5. GOOD CAUSE EXISTS AS DEFINED IN SECTION 3.510.
E. Clients newly approved for SSI benefits who have been charged an in-kind support and maintenance (ISM) deduction by the SSA shall apply to SSA to remove the ISM as soon as the client begins paying his OR /her fair share for shelter costs. The county department shall deduct an identical ISM amount for Adult Financial programs until the SSA ISM is removed.
F. The client shall apply for AND ACCEPT TANF/Colorado Works when he OR /she might be eligible, as follows:
1. An Adult Financial program client with a dependent child is required to apply for and accept, if eligible, TANF/Colorado Works financial benefits.
a. A grandparent or any other specified caretaker who is not a parent is not required to be a member of the TANF/Colorado Works case when they are not requesting assistance for hiMsELF OR /herself.
b. A TANF/Colorado Works client is not required to apply for an extension to be potentially eligible for Adult Financial program GRANT PAYMENTS benefits.
c. The TANF/Colorado Works funds received for the support of a child are not used in determining the specified caretaker's eligibility for Adult Financial program GRANT PAYMENTS benefits.
2. The client shall be ineligible for Adult Financial program GRANT PAYMENTS benefits if his OR /her TANF/Colorado Works case was denied or discontinued:
a. Due to a sanction, DEMONSTRABLE EVIDENCE, or disqualification; OR,
b. Because the client withdrew from the program prior to exhausting all benefits. ; and,
c. The ineligibility period shall continue until the sanction or disqualification is removed or until the client rejoins the program and has exhausted all TANF/Colorado Works benefits.
3. AFTER BECOMING INELIGIBLE DUE TO THE REASONS OUTLINED IN SECTION 3.520.71.F.2, ABOVE, THE INELIGIBILITY PERIOD SHALL CONTINUE UNTIL THE SANCTION, DEMONSTRABLE EVIDENCE, OR DISQUALIFICATION IS REMOVED; OR UNTIL THE CLIENT IS FOUND OTHERWISE INELIGIBLE FOR TANF/COLORADO WORKS BENEFITS.
G. The client OR LEGAL FIDUCIARY shall TAKE REASONABLE STEPS TO apply for AND ACCEPT any other retirement income for which the client is eligible. CLIENTS REFERRED TO PURSUE OTHER INCOME SHALL BE REQUIRED TO PROVIDE VERIFICATION OF APPLICATION FOR OR PURSUIT OF SUCH INCOME. GRANT PAYMENTS SHALL NOT BE APPROVED PRIOR TO RECEIPT OF PROOF OF APPLICATION OR PURSUIT OF OTHER INCOME, UNLESS IT IS DEMONSTRATED THAT GOOD CAUSE EXISTS.
1. IF THE CLIENT OR LEGAL FIDUCIARY REFUSES OR FAILS TO MAKE A REASONABLE EFFORT TO SECURE POTENTIAL INCOME, SUCH INCOME SHALL BE CONSIDERED AS IF AVAILABLE TO THE CLIENT, AND TIMELY NOTICE SHALL BE GIVEN REGARDING A PROPOSED ACTION TO DENY, REDUCE, OR TERMINATE ASSISTANCE.
2. IF THE CLIENT OR LEGAL FIDUCIARY SECURES THE POTENTIAL INCOME PRIOR TO THE EFFECTIVE ACTION DATE IDENTIFIED IN THE NOTICE, THE PROPOSED ACTION TO DENY, REDUCE, OR TERMINATE ASSISTANCE SHALL BE WITHDRAWN BY THE COUNTY, AND THE CASE SHALL BE UPDATED. GRANT PAYMENTS MAY STILL BE DENIED, REDUCED, OR DISCONTINUED DUE TO A CHANGE IN INCOME.
H. The client shall take reasonable steps to pursue all other income and resources that may be available, to include, but not be limited to, alimony, equitable distribution of resources in a divorce, inheritance income or resources, child support arrears, co-ownership of property, lottery or sweepstakes winnings that are due to the client, lawsuit judgments that are due to the client, or insurance settlements, unless it is demonstrated that good cause exists.
H. THE CLIENT OR LEGAL FIDUCIARY SHALL TAKE REASONABLE STEPS TO OBTAIN AND ACCEPT ANY OTHER POTENTIAL RESOURCES FOR WHICH THE CLIENT IS ELIGIBLE. CLIENTS REFERRED TO PURSUE OTHER RESOURCES SHALL BE REQUIRED TO PROVIDE VERIFICATION OF THE PURSUIT OF SUCH RESOURCE. GRANT PAYMENTS SHALL NOT BE APPROVED PRIOR TO VERIFICATION OF THE ATTEMPT TO SELL, LIQUIDATE, OR LEGALLY ACQUIRE A RESOURCE, UNLESS THE CLIENT DEMONSTRATES THAT GOOD CAUSE EXISTS.
1. IF THE CLIENT OR LEGAL FIDUCIARY REFUSES OR FAILS TO MAKE A REASONABLE EFFORT TO SECURE POTENTIAL RESOURCE(S), SUCH RESOURCE(S) SHALL BE CONSIDERED AS IF AVAILABLE TO THE CLIENT, AND TIMELY NOTICE SHALL BE GIVEN REGARDING A PROPOSED ACTION TO DENY, REDUCE, OR TERMINATE ASSISTANCE.
2. IF THE CLIENT OR LEGAL FIDUCIARY SECURES THE POTENTIAL RESOURCE(S) PRIOR TO THE EFFECTIVE ACTION DATE IDENTIFIED IN THE NOTICE, THE PROPOSED ACTION TO DENY, REDUCE, OR TERMINATE ASSISTANCE SHALL BE WITHDRAWN BY THE COUNTY, AND THE CASE SHALL BE UPDATED. GRANT PAYMENTS MAY STILL BE DENIED, REDUCED, OR DISCONTINUED DUE TO A CHANGE IN RESOURCE(S).
3.520.72 Resources [Eff. 3/2/14]
A. Unless otherwise specified, a resource is countable, and together with all other countable resources of the client, spouse, and sponsor(s) shall be considered against the resource limit. The resource limit is:
1. $2,000 for:
a. An unmarried client who is a citizen or non-sponsored qualified non-citizen;
b. An unmarried sponsor; and,
c. A married sponsor whose spouse is a co-sponsor. Each sponsor shall receive the $2,000 resource limit for a combined resource limit of $4,000.
2. $3,000 for:
a. A married client who is a citizen or non-sponsored qualified non-citizen; or,
b. A married sponsor whose spouse is not a co-sponsor.
B. Countable assets include, but are not limited to:
1. Cash on hand, or in a savings or checking account, OR OTHER ACCESSIBLE ELECTRONIC CURRENCY AND/OR CRYPTOCURRENCY.
2. Equity value of real property that is not used as the client's primary home or not exempt as income producing.
3. Proceeds from the sale of the primary home that are in excess of the cost of expenses incurred to purchase or build a replacement home.
4. Personal property or the proceeds from the sale of personal property, such as mobile homes or recreational vehicles not used as the client's primary home and not exempt as income producing.
5. Personal property or the proceeds from the sale of personal property, such as motor vehicles, recreational off road vehicles, boats, trailers, or similar that are not exempt per Section 3.520.77 or exempt as income producing.
6. Stocks, bonds, mutual fund shares, 401Ks, 457Ks, IRAs, Certificates of Deposit (CDs), and other retirement or investment accounts and investment vehicles.
7. Mortgages, promissory notes, and similar properties that can be converted to cash.
8. Cash surrender value of all life insurance policies as outlined in Section 3.520.75.
9. Prepaid revocable funeral or burial expense contracts or trust deposits, as outlined in Section 3.520.77.G-H.
10. The value of the burial space in excess of that required to meet the burial needs of the immediate family, as outlined in Section 3.520.77.HI.
11. Proceeds of fire or casualty insurance payments that were in excess of the expenses incurred to repair or replace the damaged, lost, or stolen property.
12. Proceeds of a loan when those proceeds were not expended to meet the purpose of the loan or proceeds of a loan with no bona fide debt repayment schedule.
13. The estate and all resources identified in the estate inventory for a client adjudicated incapacitated by a court.
14. TRUSTS, BOTH REVOCABLE AND IRREVOCABLE, WILL BE COUNTABLE AS RESOURCES OR INCOME ACCORDING TO THE GUIDELINES OF SSA, EXCEPT AS PROHIBITED BY SECTION 15-14-412.5, C.R.S., ET SEQ. AND IS CONSISTENT WITH THE PROVISIONS OF FEDERAL GUIDELINES FOUND IN THE SSA PROGRAMS OPERATIONS MANUAL SYSTEM (POMS) AT SI CHI01120.201 (EFFECTIVE AS OF JUNE 29, 2009) AND SI 01120.200 (EFFECTIVE AS OF JUNE 7, 2018), WHICH ARE HEREIN INCORPORATED BY REFERENCE. THIS RULE DOES NOT CONTAIN ANY LATER AMENDMENTS OR EDITIONS. THESE GUIDELINES ARE AVAILABLE FOR NO COST AT . THESE GUIDELINES ARE ALSO AVAILABLE FOR PUBLIC INSPECTION AND COPYING AT THE COLORADO DEPARTMENT OF HUMAN SERVICES, DIRECTOR OF THE EMPLOYMENT AND BENEFITS DIVISION, 1575 SHERMAN STREET, DENVER, COLORADO, 80203, OR AT ANY STATE PUBLICATIONS LIBRARY DURING REGULAR BUSINESS HOURS.
A. WHEN ALL OR A PORTION OF THE CORPUS OF A TRUST, CANNOT BE PAID TO OR FOR THE BENEFIT OF THE CLIENT, THE PORTION THAT CANNOT BE PAID IS CONSIDERED A TRANSFER OF RESOURCES FOR LESS THAN FAIR MARKET VALUE AND A PENALTY SHALL BE ASSESSED AS OUTLINED IN SECTION 3.520.76.D.
B. REFUSAL OF A TRUSTEE TO MAKE PAYMENTS TO OR FOR THE BENEFIT OF THE CLIENT DOES NOT EXEMPT THE TRUST FROM BEING A COUNTABLE ASSET AND THE FULL AMOUNT OF THE TRUST SHALL BE CONSIDERED AVAILABLE AS A RESOURCE TO THE CLIENT.
C. IF A CLIENT PLACES AN EXEMPT RESOURCE IN A TRUST THE RESOURCE EXEMPTION MAY STILL APPLY TO THAT RESOURCE.
C. If it is determined that a married couple is legally or permanently separated as identified in Section 3.520.63, sole ownership of property by the non-recipient spouse does not affect the client's eligibility for assistance.
D. The county department shall obtain verification of all resources and associated values.
1. The county department shall include case notes describing verification documentation in the statewide automated system.
2. Original copies of verification documents shall be returned to the client.
3. The client's authorization ON THE APPLICATION OR REDETERMINATION FORM shall be obtained to contact a collateral CONTACT source for valuation information or verification.
4. The client shall disclose the contents of a safety deposit box on request of the county department. The value of the contents is determined by obtaining any necessary valuations for countable items.
E. A sponsor(s)'s resources are only counted toward the non-citizen CLIENT they sponsor. RESOURCES ARE ATTRIBUTED TO THE SPONSOR IN THE SAME MANNER AS THE NON-CITIZEN CLIENT, AS OUTLINED IN SECTION 3.520.7. ALL COUNTABLE RESOURCES OVER THE SPONSOR(S) RESOURCE LIMIT, AS OUTLINED IN SECTION 3.520.72.A, ARE THEN DEEMED TO THE NON-CITIZEN CLIENT. THE DEEMED AMOUNT FROM THE CLIENT’S SPONSOR(S) IS THEN ADDED TO THE NON-CITIZEN CLIENT’S COUNTABLE RESOURCES AND COMPARED TO THE NON-CITIZEN CLIENT’S RESOURCE LIMIT, AS OUTLINED IN SECTION 3.520.72.A.
Determine the total amount of the non-citizen's resources after deeming, and use the SSI individual resource standard to determine resource eligibility for the sponsored non-citizen. To determine the amount of resources deemed to the non-citizen, subtract the resource standard from the amount of the sponsor(s) resources. The difference is the amount of resources that is added to the non-citizen's own resources.
1. When a sponsor is married, but the spouse is not a sponsor to the non-citizen, use the couple resource standard for SSI.
2. When the sponsor is married and the sponsor's spouse is also a sponsor to the non-citizen, the individual resource standard for SSI is applied separately to each spouse.
F. IF A CLIENT IS APPROVED FOR SUPPLEMENTAL SECURITY INCOME (SSI) AS VERIFIED THROUGH THE SVES INTERFACE, THERE SHALL BE NO ADDITIONAL REQUIREMENT TO VERIFY RESOURCES AT INITIAL APPLICATION, UNLESS THE RESOURCES REPORTED ARE QUESTIONABLE.
1. IF THE COUNTY DEPARTMENT HAS OBTAINED OR RECEIVED INFORMATION RELATED TO RESOURCES THAT IS CONTRARY TO THE SVES INTERFACE, THE COUNTY DEPARTMENT SHALL INDEPENDENTLY VERIFY THE INFORMATION; AND,
2. THE COUNTY DEPARTMENT SHALL FORWARD SUCH CONTRARY INFORMATION TO THE LOCAL SSA OFFICE.
3.520.73 Liquid Assets [Eff. 3/2/14]
A. Checking and savings accounts OR OTHER ACCESSIBLE ELECTRONIC DEPOSITS:
1. The current amount in a savings or checking account OR OTHER ACCESSIBLE ELECTRONIC DEPOSITS is determined by verifying OWNERSHIP AND the AVAILABLE balance in the account:
a. From a copy of a current statement of the account; or,
b. With the financial institution online, by phone, or in writing.
2. The balance in a joint account shall be considered available to the client in proportion to the number of persons on the account.
a. If the co-owner of the joint account is the client's legal fiduciary, such as a guardian, conservator, or power of attorney, the account shall be considered to be 100% owned by the client and all funds in the account shall be considered available to the client.
b. If the client establishes BY A PREPONDERANCE OF clear and convincing evidence that the intent of ownership is other than the client's equal and proportionate share of the account balance, the county department shall apply the prudent person principle to the evidence to determine the amount to be considered available to the client.
c. In cases where it has been shown the client has no interest in the account, the county department shall request a change in the account designation removing the client's name, and submittal of the original and revised account records showing the change was made.
B. A county department may selectively contact one or more financial institutions to establish whether a client has any account at the institution or has an account in addition to one declared. The client's signature on the application provides authorization to make such contacts.
3.520.74 Real Property and Personal Property [Eff. 3/2/14]
3.520.741 Real Property [Eff. 3/2/14]
A. In order for real property to be considered a resource to the client, the following shall be determined:
1. The actual value less encumbrances of the client's ownership interest:
a. Actual value of real property may be obtained by using the actual value reported by a county assessor or from the most recent property assessment notice.
b. The assessed value shall be verified from a copy of the most recent property assessment notice or with the county assessor's office on the Internet, by phone, personal contact, or in writing.
c. Encumbrances include mortgages, liens, judgments, delinquent taxes, loan agreements, and other forms of indebtedness. Encumbrances shall be verified BY SUCH METHODS AS COLLATERAL CONTACT, COUNTY RECORDER RECORDS, BANK RECORDS, AND OTHER CREDIBLE SOURCES. Only direct and documented encumbrances against a specific item or property shall be considered in determining its equity value. Verbal agreements of indebtedness shall not be accepted.
2. The negotiability of the ownership interest (that is, there are no legal restrictions from selling the client's property interest); and,
3. The ability to sell the property interest (that is, that the ownership interest can, in fact, be sold on the open market at any price).
B. The degree of the client's ownership interest is determined by the type of ownership. Generally, the types of ownership are:
1. Sole ownership, in which the client, THE CLIENT’S SPOUSE, OR SPONSOR(S) is the only owner. If the client, SPOUSE, OR SPONSOR(S) has the right to dispose of the property, the actual value less encumbrances of the property is determined and counted as a resource;
2. Shared ownership, in which the property is owned by the client, SPOUSE, OR SPONSOR(S) and one or more individuals. The actual value less encumbrances is determined and charged in proportion to the client's, CLIENT’S SPOUSE, OR SPONSOR(S)’S share of ownership. There are two kinds of shared ownership:
a. Joint ownership or ownership in common, in which the property's actual value less encumbrances is divided equally among the owners; and,
b. Tenancy in common, in which the property's actual value less encumbrances is divided by the number of owners in proportion to their stated interest (which may not necessarily be equal).
C. Negotiability and, if applicable, the client's ability to sell the property interest at a reasonable price must be determined. Negotiability refers to the client's, CLIENT’S SPOUSE, OR SPONSOR(S)’S legal right to dispose of an ownership interest; ability to sell refers to a THE CLIENT, CLIENT’S SPOUSE. OR SPONSOR(S) legal ability to sell. Reasonable price is determined to be two-thirds of the actual value.
1. Negotiability - there may be legal reasons why a client, CLIENT’S SPOUSE, OR SPONSOR(S) may not be able to sell the client's property interest, such as when the estate is in probate or there is a lawsuit pending against the property. The refusal of co-owners to consent to the sale of a property interest is not a legal restriction of the client's, CLIENT’S SPOUSE, OR SPONSOR(S)’S right to sell.
2. If the co-owner of the property uses the property as the principal place of residence and sale of the property would cause undue hardship, the client's, CLIENT’S SPOUSE, OR SPONSOR(S)’S equity in the property shall be exempted, UNLESS THE CO-OWNER IS THE SPOUSE OR SPONSOR(S). Undue hardship for this purpose is defined as:
a. The co-owner uses the property as his OR /her primary residence; and,
b. The co-owner would have to move as a result of the sale of the property; and,
c. The co-owner has no other available housing, including relatives or income to rent at fair market value; and,
d. The co-owner documents, in writing, his OR /her undue hardship allegations; and,
e. Using prudent person principle, the county department determines the undue hardship allegations to be reasonable.
3. If the client, CLIENT’S SPOUSE OR SPONSOR(S) cannot sell the property for two-thirds of the actual value, the property shall be exempted provided that the client THERE continues TO BE reasonable efforts to sell the property such as listing the property with an agency or by advertising in the local media.
a. The county department shall verify on a quarterly basis that a reasonable effort is being made to sell the property.
b. The property shall not be exempted if the county department, using prudent person principle, determines the client, CLIENT’S SPOUSE, OR SPONSOR(S) is not making a reasonable effort to sell.
c. If the client, CLIENT’S SPOUSE, OR SPONSOR(S) rejects an offer to purchase the property that is at least two-thirds the actual value of the property, the entire equity value of the property shall be considered a countable resource.
4. If the property interest cannot be disposed of because of legal technicalities, the client's, CLIENT’S SPOUSE, OR SPONSOR(S)’S equity value is not a countable resource. The county department shall verify any limitations that prevent the disposition of the property and document those limitations in the statewide automated system case comments.
3.520.742 Personal Property [Eff. 3/2/14]
A. The actual value of any personal property which is assessed for taxation, such as a mobile home, house trailer, or property used in a trade or business, is determined by using the actual value reported by a county assessor or by obtaining a copy of the most recent property assessment notice. If the actual value is not on the assessment notice, the value may be determined by:
1. Verifying the actual valuation from a copy of the most recent property assessment notice or with the county assessor's office on the Internet, by phone, BY other personal contact, or in writing; or,
2. When personal property valuation is necessary, and the usual means of valuation is not possible, the county department shall use available local resources or the classified ad section of the local or other state newspaper or THE IInternet to determine and verify the actual value.
3. To determine the equity value of personal property, first determine the actual value; then subtract encumbrances.
B. The actual value of any personal property which is not assessed for taxation is determined by obtaining the appraised value less liabilities, i.e., VEHICLES, farm equipment and livestock or inventories of merchandise and materials, such as art, jewelry or valuable collections, as appraised by a verifiable, industry recognized source.
1. The actual value of automobiles and trucks is determined by using the trade-in fair condition value as provided by an auto valuation company, such as Kelly Blue Book or NADA guides. A greater or lesser value shall be used if verified by a statement from a reliable source, such as a car dealer, collector car expert, or scrap yard professional. UNLESS QUESTIONABLE, IT SHALL BE PRESUMED THAT THE VALUE OF THE VEHICLE IS FOUR HUNDRED DOLLARS ($400) WHEN THE INFORMATION IS NOT FOUND IN KELLY BLUE BOOK OR NADA GUIDES.
2. For personal property which has not been assessed for taxation and vehicles which are not listed by an auto valuation company, the client shall submit verification of the appraised value based on written statements received from the following:
a. Assessment standards obtained from the state or county motor vehicle office or county assessor's office; or,
b. Valuation obtained from a local merchant, dealer, THE IInternet or other reliable source.
C. The fair market value of stocks, mutual fund shares, municipal, corporate or government bonds, and other securities is based on the price as of the opening of the market on the date their value is determined by the county department. The market price is obtained from the published quotations on the Internet or by contacting a local securities firm.
1. The value of stocks traded over-the-counter is expressed on a “bid” and “asked” basis. In such cases, the bid price is used to determine the market value.
2. When stocks or other securities have no locally determinable value, the market value is requested from the issuing company. The Office of the Secretary of State in each state will supply the address of the issuing company and information as to whether the stock is still on the market.
D. The current cash value of U.S. Savings Bonds, Treasury Notes, and similar investment vehicles is determined from the value tables appearing on the bonds themselves, THROUGH THE ONLINE TREASURY DIRECT SYSTEM, or by contacting a financial institution.
E. Personal property may be exempted if the client, CLIENT’S SPOUSE, OR SPONSOR(S) has made an attempt to sell and has been unable to do so.
1. Failure to sell personal property at the asking price or for a reasonable value SHALL NOT EXEMPT, the resource FROM THE CLIENT’S COUNTABLE RESOURCES shall not be exempt. Under such circumstances, the county department shall determine whether the property could be sold for two-thirds of the actual value.
2. If the client, CLIENT’S SPOUSE, OR SPONSOR(S) receives an offer for at least two-thirds of the actual value and refuses to sell the property, the property shall not be exempted.
3. If the client, CLIENT’S SPOUSE, OR SPONSOR(S) cannot sell the property for two-thirds of the actual value, the property shall be exempted provided that the client THERE continues TO BE reasonable efforts to sell the property, such as by listing the property with an agency or by advertising in the local media.
a. The county department shall verify on a quarterly basis that a reasonable effort is being made to sell the property.
b. The property shall not be exempted if the county department, using prudent person principle, determines the client, CLIENT’S SPOUSE, OR SPONSOR(S) is not making a reasonable effort to sell.
c. If the client, CLIENT’S SPOUSE, OR SPONSOR(S) rejects an offer to purchase the property that is at least two-thirds the actual value of the property, the entire equity value of the property shall be considered a countable resource.
F. The equity value of mining claims and oil, mineral or water rights, if assessed separately from land, is determined by using the equity value established by the current market value.
G. The client, CLIENT’S SPOUSE, OR SPONSOR(S) shall have the right to submit evidence establishing a lesser property value. Such value may be established AS to be zero. The county department shall evaluate the evidence and determine the property value.
3.520.75 Life Insurance [Eff. 3/2/14]
A. Life insurance policies owned by the client, CLIENT’S SPOUSE, OR SPONSOR(S) that have a cash surrender value available (CSV) to the client must be evaluated for THE original face value at the time of purchase and for THE current CSV cash surrender value.
B. Term life insurance policies should be reviewed to determine if a CSV cash surrender value exists.
C. The county department shall obtain the most recent documentation related to the policyIES, to include active status, liens or encumbrances, and current CSV cash surrender value, AND ANNUAL DIVIDEND STATEMENTS.
D. If the total face value of all life insurance policies owned by a client AND HIS OR HER SPOUSE is equal to $1,500 or less, the full CSV cash surrender value of all policies is exempt. SPONSOR(S) ARE ALLOWED THE SAME EXEMPTION.
E. For OAP only, if the total face value of all life insurance policies owned by a client AND HIS OR HER SPOUSE is equal to more than $1,500 and the CSV cash surrender value of all policies combined is $250,000 $100,000 or less, then the following applies:
1. If all policies were purchased more than forty-eight (48) months prior to the eligibility determination date, and no further contributions or payments to the policies have been made in the past 48 months, all CSV cash surrender value is exempt.; OR,
2. If THERE HAVE BEEN the client has contributed additional monies CONTRIBUTED or made payments MADE to any of the policies within 48 months of THE eligibility determination date, those additional monies contributed are counted toward the resource limit; the original cash value amount prior to the 48 month period remains exempt.; OR,
3. If any of the policies were purchased within the 48 months prior to eligibility determination date, the total CSV cash surrender value is a countable resource.; AND,
4. SPONSOR(S) ARE ALLOWED THE SAME EXEMPTIONS.
F. For OAP only, if the total face value of all life insurance policies owned by a client AND HIS OR HER SPOUSE is equal to more than $1,500 and CSV cash surrender value of all policies combined is more than $250,000 $100,000, then the following applies:
1. If all policies were purchased more than 48 months prior to eligibility determination date, and no further contributions or payments to the policies have been made in the past 48 months, the CSV cash surrender value over $250,000 $100,000 is countable; the first $250,000 $100,000 is exempt.; OR,
2. If THERE HAVE BEEN the client has contributed additional monies CONTRIBUTED or made payments MADE to any of the policies within 48 months of eligibility determination date, those additional monies contributed are counted toward the resource limit and the CSV cash surrender value over $250,000 $100,000 is countable; the original cash value amount prior to the 48 month period remains exempt.; OR,
3. If any of the policies were purchased within the 48 months prior to eligibility determination date, the total CSV cash surrender value is a countable resource.; AND,
4. SPONSOR(S) ARE ALLOWED THE SAME EXEMPTIONS.
G. The original face value of a policy may be increased because of dividends and reinvestment of dividends. This increased face value shall not be used to determine eligibility. The original face value of the policy shall be used to determine whether the CSV cash surrender value of the policy is exempt.
H. USE THE FOLLOWING CHART TO ESTIMATE A LIFE INSURANCE POLICY'S CSV IF NOT AVAILABLE FROM THE CLIENT, CLIENT’S SPOUSE, OR SPONSOR(S):
|YEARS LIFE INSURANCE POLICY HAS BEEN IN EFFECT |ESTIMATED CSV IS THIS PERCENTAGE OF FACE VALUE: |
|20 OR MORE |60% |
|15-19 |50% |
|11-14 |45% |
|6-10 |30% |
|4-5 |20% |
|3 |10% |
|2 |5% |
|1 |0% |
3.520.76 Transfers Without Fair Consideration (TWFC) [Eff. 3/2/14]
A. A Transfer Without Fair Consideration (TWFC) is a transfer of any resource to another person at a price that is below fair market value. TRANSFERS OF RESOURCE OWNERSHIP MAY OCCUR THROUGH TRANSACTIONS SUCH AS SALE OF PROPERTY; TRADE OR EXCHANGE OF ONE PROPERTY FOR ANOTHER; SPEND-DOWN OF CASH; GIVING AWAY CASH; TRANSFERRING ANY FINANCIAL INSTRUMENT (E.G., STOCKS, BONDS); OR, GIVING AWAY PROPERTY (INCLUDING ADDING ANOTHER PERSON'S NAME AS AN OWNER OF THE PROPERTY). A transfer of a resource shall be considered a TWFC if the transfer was:
1. Voluntary; and,
2. Without fair and valuable consideration, and,
3. Made within thirty-six (36) months prior to the application date; OR WHILE RECEIVING ADULT FINANCIAL PROGRAM GRANT PAYMENTS; and,
4. For the purpose of rendering the client eligible for assistance. THE COUNTY WILL EVALUATE EVIDENCE PROVIDED BY THE CLIENT TO DETERMINE IF THE TRANSFER OF RESOURCES WAS EXCLUSIVELY FOR A PURPOSE OTHER THAN TO QUALIFY FOR BENEFITS.; or,
5. Made while receiving Adult Financial program benefits.
a. The county department shall make a rebuttable presumption that the transaction was made for the purpose of becoming or remaining eligible for Adult Financial program benefits when the transfer was made any time during the thirty-six (36) month period immediately prior to the filing of application for assistance or during such time that assistance was being received.
b. A client shall be given the opportunity to disprove the presumption. The presumption shall be nullified if the client can demonstrate WITH EVIDENCE to the county department that the transfer was for another purpose.
1) The client's primary purpose cannot be to acquire money or profit from the transaction; and,
2) The client shall provide written documentation of any agreement made in relation to the transfer of property, that was created at the time of the agreement to transfer property; and,
3) The county department shall weigh the evidence and use THE prudent person principle to determine whether there is sufficient evidence to disprove the presumption.
B. Circumstances at the time of the transaction may indicate a reasonable rationale for a client's willingness to accept a sum which is less than a fair consideration based on a hardship just prior to the transaction. Hardships include:
1. A period of unemployment resulting in an inability to meet monthly bills, and costs of subsistence; or,
2. An accident or severe illness resulting in a need of funds to meet large expenditures for medical care and services; or,
3. Other hardship deemed reasonable by the county department using THE prudent person principle.
C. A documented involuntary transfer of a resource shall not affect eligibility. Transfers that would be considered involuntary are:
1. Loss of property through fraud, provided that the client can demonstrate that every reasonable effort has been made to recover the property by court action or other procedures as indicated; or,
2. Loss of property through legal action such as judgment, foreclosure, delinquent tax sale; or,
3. Other involuntary transfer identified and determined reasonable by the county department using THE prudent person principle.
D. Transfers of up to a fifty percent (50%) share of the equity value of a resource between the client and the client's spouse, while legally married, shall not be a transfer without fair consideration.
DE. The county department shall determine the eligibility penalty as a result of a TWFC as follows:
1. Determine the actual value of the resource less encumbrances and subtract the amount the client received for the resource from the determined actual value. This is the uncompensated value.
2. Determine the current Adult Financial pProgram grant standard and add to the Adult Financial program grant standard any monthly medical costs, including health insurance premiums, for which the client is responsible to pay. This is the TWFC monthly penalty value.
3. Divide the uncompensated value by the TWFC monthly penalty value and round down to the nearest whole number.
4. This equals the number of months of ineligibility for Adult Financial Pprogram GRANT PAYMENTS benefits.
5. THE PENALTY PERIOD BEGINS THE MONTH FOLLOWING THE DATE OF TRANSFER. IF THERE ARE MULTIPLE TRANSFERS, THE PERIOD OF INELIGIBILITY WOULD BEGIN THE MONTH FOLLOWING THE END DATE OF THE FIRST TRANSFER’S PERIOD OF INELIGIBILITY.
6. IF THE CLIENT TRANSFERS A RESOURCE AND THE ENTIRE RESOURCE IS RETURNED IN THE SAME MONTH, THE PERIOD OF INELIGIBILITY DOES NOT APPLY.
A. IF THE CLIENT TRANSFERS A RESOURCE AND THE ENTIRE RESOURCE IS RETURNED IN A SUBSEQUENT MONTH, THE PERIOD OF INELIGIBILITY CONTINUES THROUGH THE MONTH THE RESOURCE IS RETURNED (EVEN IF THE RESOURCE IS RETURNED ON THE FIRST DAY OF THE MONTH). THE PERIOD OF INELIGIBILITY DUE TO THE TRANSFER ENDS AS OF THE MONTH FOLLOWING THE MONTH THE RESOURCE IS RETURNED. IN THAT MONTH, THE RETURNED RESOURCE IS COUNTED TOWARDS THE CLIENT'S RESOURCE LIMIT.
B. IF THE ENTIRE RESOURCE IS NOT RETURNED, THE PERIOD OF INELIGIBILITY DOES NOT END. INSTEAD, RECOMPUTE THE UNCOMPENSATED VALUE BASED ON HOW MUCH OF THE RESOURCE WAS NOT RETURNED. THEN, RECOMPUTE THE PERIOD OF INELIGIBILITY BASED ON THE ADJUSTED UNCOMPENSATED VALUE. IF ADDITIONAL FUNDS ARE SUBSEQUENTLY RETURNED, IT WILL BE NECESSARY TO RECOMPUTE THE UNCOMPENSATED VALUE AGAIN.
EF. A PERIOD OF INELIGIBILITY CAN BE FROM 1 MONTH UP TO A MAXIMUM OF 36 MONTHS DEPENDING ON THE AMOUNT OF THE UNCOMPENSATED VALUE FOR EACH RESOURCE TRANSFERRED. A PERIOD OF INELIGIBILITY CANNOT EXCEED 36 MONTHS REGARDLESS OF THE UNCOMPENSATED VALUE OF THE TRANSFER. MONTHS IN THE PERIOD OF INELIGIBILITY CAN COINCIDE WITH MONTHS OF INELIGIBILITY FOR OTHER REASONS. Upon the request of the client, the county department shall re-calculate the penalty when there is a subsequent increase in the Adult Financial program grant standard or in the client's monthly medical care costs. The county shall notify the client of any change in the period of ineligibility.
G. A life estate established on the residence by the client and/or the client's spouse within thirty-six (36) months from the date of application or while receiving Adult Financial program benefits shall be a TWFC.
H. The amount to be considered as a TWFC on a life estate shall be calculated by using equity value of the property and applying it to the life estate table pursuant to the “Social Security Program Operations Manual System (POMS)”, 26 CFR 20.2031-7, 49 Federal Register Vol. 49 No. 93/5-11-84, herein incorporated by reference. This rule does not contain any later amendments or editions. Copies of these federal laws are available from the Colorado Department of Human Services, Director of the Employment and Benefits Division, 1575 Sherman Street, Denver, Colorado, 80203, or at any state publications library contained in these rules as follows:
1. Determine the equity value of the property at the time the life estate was established. The equity value of the residential property shall be determined by obtaining the actual value and subtracting encumbrances.
2. Multiply the equity value of the property by the “Remainder” factor from the life estate table that corresponds to the client's age at the time the life estate was established. The result is the amount to be considered as a transfer of assets without fair consideration and is the uncompensated value.
a. When a life estate is established on the residence held by spouses in joint tenancy, the age of the younger spouse shall be used.
b. Once the uncompensated value is calculated, the penalty period is determined by using the steps outlined in Section 3.520.76, E, 2-4.
3.520.77 Exempt Resources [Eff. 3/2/14]
Resources that shall be exempt and not counted toward the resource limit for an individual or married couple include:
A. One vehicle regardless of its value, if it is used for the transportation of the client or a member of the household.
B. Household goods and personal effects FOUND IN OR ON THE PRIMARY RESIDENCE, THAT THE CLIENT USES ON A REGULAR BASIS. THE CLIENT NEEDS HOUSEHOLD GOODS FOR MAINTENANCE, USE, AND OCCUPANCY OF THE PREMISES AS A HOME. THIS ALSO INCLUDES PERSONAL EFFECTS WHICH ARE ORDINARILY WORN OR CARRIED BY THE CLIENT, OR ITEMS THAT HAVE AN INTIMATE RELATION TO THE CLIENT. THIS DOES NOT INCLUDE EFFECTS THAT THE CLIENT HOLDS BECAUSE OF THE VALUE OR AS AN INVESTMENT, WHICH ARE COUNTABLE AS PERSONAL PROPERTY AS OUTLINED IN SECTION 3.520.742. such as furnishings, appliances, and clothing.
C. A home in which a client and his OR /her spouse have an ownership interest and that serves as the client's principal place of residence. This property includes the shelter in which the client resides, the land on which the residence is located, and related outbuildings.
1. The home is not a countable resource regardless of its value. However, when there is an income producing property located on or adjacent to the home property, the income producing resource shall not qualify under the home exemption unless assessed collectively with the principal home.
2. When a client or his OR /her spouse requires long-term medical care that is outside the client's county of residence, the home continues to be exempt so long as there is intent for the client and/or spouse to return to the home at the conclusion of medical treatment.
3. When a client requires care in a long-term care facility, the home continues to be exempt so long as there is intent for the client to return to the home.
a. This intent to return home applies to the home in which the client or spouse was living prior to being admitted to the facility or to the replacement home. Such intent is documented by the following:
1) A written statement from the client indicating the intent to return home for any reason; or,
2) A written statement from the client's spouse, legal fiduciary, doctor, or authorized representative indicating the client's intent to return home.
b. An arrangement by the client for occupancy of the home by another person, either on a rental basis, rent free, or in exchange for home maintenance, during a period of temporary absence shall not affect the home property exemption.
4. The home of an OAP-C client, AS DEFINED IN SECTION 3.530.1, shall be exempt as a resource during the period of commitment.
5. If a client's home can no longer be excluded due to a change in his OR /her principal place of residence, the equity value of the property shall count as a resource.
D. Part or all of the value of property may be exempt if it is essential to the self-support of the client. To determine whether property is producing income or being used in a trade or business, the county department shall obtain a copy of the most recent tax returns from the client. If a return has not yet been filed, obtain a current estimate of income and a copy of the previous year's return. Property used for self-support activities include:
1. Property used in self-employment.
a. To be considered a valid trade or business as self-employment, the activity shall be:
1) Currently ongoing rather than in the stage of preparation or inactivity; and,
2) Intended to make a profit.
b. The liquid resources (e.g., cash, funds in a checking account) considered necessary for use in the trade or business shall BE EXCLUDED. not exceed three times the average monthly cash expenditure for operating the business, unless there is good cause, as determined and documented by the county department using the prudent person principle.
c. If property has been but is not currently in use, the exemption for such property shall continue for twelve (12) months if there is a reasonable expectation that the use of the property will resume within that time. The exemption is for twenty-four (24) months where non-use is due to a disabling condition.
2. Property owned by the client that is necessary to perform a job for wages, such as tools, safety equipment, or uniforms. If property has been but is not currently in use the exemption for such property shall continue for twelve (12) months if there is a reasonable expectation that the use of the property will resume within that time. The exemption is for twenty-four (24) months where non-use is due to a disabling condition.
3. Non-business property used to produce goods necessary for the client's daily activities.
a. A maximum of six thousand dollars ($6,000) of the equity value of such property shall be exempt as a resource. Any equity value in excess of $6,000 shall be a countable resource.
b. Examples of this type of property include land which is used to produce vegetables or livestock only for personal consumption in the client's household, and personal property necessary to perform that function (e.g., a garden tractor, A BOAT USED FOR SUBSISTENCE FISHING), but do not include motor vehicles, boats USED FOR LEISURE OR RECREATION, or other special vehicles.
c. If property has been but is not currently in use, the exemption for such property shall continue for twelve (12) months if there is a reasonable expectation that the use of the property will resume within that time. The exemption period shall be twenty-four (24) months where nonuse is due to a disabling condition.
4. Non-business, income-producing property shall be exempt, but the income shall be countable.
a. If a client owns non-business, income-producing property, a maximum of six thousand dollars ($6,000) of the equity value of such property is an exempt resource, as long as the property produces a net annual income of at least six percent (6%) of the excluded equity. If the equity value of such income-producing, non-business property exceeds $6,000, only the equity value above $6,000 will be counted as a resource. If there is more than one potentially exempt property, the rate-of-return requirement applies individually to each. However, the total combined exemption for all such properties shall not exceed $6,000.
b. “Non-business” means that the property is not used in a trade or business as defined in Section 3.520.76. Non-business, income-producing property may include but is not limited to houses or apartments for rent and land other than home property.
c. If non-business, income-producing property is not producing net income of at least six percent (6%) of the excluded equity, the entire equity value is counted as a resource. However, the exemption for up to $6,000 of the property's equity may continue if the property is earning less than 6% due to circumstances beyond the client's control (e.g., crop failure, illness, etc.), and there is a reasonable expectation that, within twenty-four (24) months, the property will again produce a 6% return.
5. A permit, license, or other similar authority granted by a governmental agency to engage in an income-producing activity is not a countable resource.
E. Proceeds from fire or casualty insurance shall be considered exempt to the extent that they are used to restore or replace an exempt resource. This exemption shall be allowed for up to three (3) months for restoration or replacement of exempt personal property and six (6) months for restoration or replacement of exempt real property from the date the client receives such sums.
1. Establishing eligibility for the duration of the replacement exemption requires:
a. Obtaining appropriate documentation to verify the amount of proceeds and date they were received; and,
b. Obtaining the client's signed statement verifying that the proceeds will be used for restoration or replacement of exempt property.
2. The COUNTY DEPARTMENT MUST CONTACT THE client must be contacted upon the expiration of the allowable time period to verify that restoration or replacement has occurred. Restoration or replacement shall be considered to occur when payment for such is made or contracted in writing to be made.
3. When the allowable time period ends, proceeds in excess of payments made or contracted to be made must be counted as a resource in the month following the month in which the time period expired, unless good cause for an extension is determined by the county department using the prudent person principle.
F. Proceeds from sale of the home property, relocation payments, or condemnation awards from a governmental agency shall be considered exempt to the extent that they are used to purchase or build a replacement home. This exemption is allowed for up to six (6) months from the date the client receives such sums. Proceeds of a home sale are the net payments received by the seller after satisfaction of all actual encumbrances and sales expenses.
1. Establishing eligibility for and the duration of the replacement exemption requires:
a. Obtaining appropriate documentation to verify the amount of proceeds and date they were received; and,
b. Obtaining the client's signed statement verifying that the proceeds will be used for restoration or replacement of exempt property.
2. The client must be contacted upon the expiration of the allowable time period to verify that restoration or replacement has occurred. Restoration or rReplacement shall be considered to occur when payment for such is made or contracted in writing to be made.
3. When the allowable time period ends, proceeds in excess of payments made or contracted to be made must be counted as a resource in the month following the month in which the time period expired, unless good cause for an extension is determined by the county department using the prudent person principle.
G. BURIAL TRUSTS ARE CONSIDERED AS FOLLOWS: An irrevocable trust or prepaid contract for burial expense. Irrevocable means that the contract cannot be terminated, sold, or transferred.
1. FOR ALL TRUSTS, THE AGREEMENT DOES NOT HAVE TO BE PREEXISTING AND NEED NOT HAVE BEEN PURCHASED IN COLORADO.
2. AN IRREVOCABLE BURIAL TRUST cannot be terminated, sold, or transferred. AN IRREVOCABLE BURIAL TRUST PLUS ANY ACCRUED INTEREST IS EXEMPT IF ALL OF THE FOLLOWING CRITERIA ARE MET:
A. THE TRUST IS MADE WITH A FEDERALLY INSURED BANK OR SAVINGS AND LOAN ASSOCIATION, OR WITH A TRUST COMPANY UNDER SUPERVISION OF THE STATE BANKING COMMISSIONER;
B. THE TRUST IS IRREVOCABLE DURING THE LIFETIME OF THE CLIENT AND IS TO BE PAID BY THE TRUSTEE ONLY UPON DEATH OF THE CLIENT FOR THE PURPOSE OF BURIAL EXPENSE;
C. THE TRUST PROVIDES FOR PAYMENT OF THE TRUST FUNDS WITHOUT LIMITATION AS TO PLACE OF BURIAL OR PROVIDER OF RELATED SERVICES. IN ANY CASE, HOWEVER, THE CLIENT IS NOT PRECLUDED FROM INDICATING A PREFERENCE AS TO PLACE OF BURIAL OR PROVIDER OF RELATED SERVICES; AND
D. THE TRUSTOR AND THE BENEFICIARY OF THE TRUST CANNOT BE ONE AND THE SAME. IF HE OR SHE IS BOTH THE TRUSTOR AND THE BENEFICIARY, THE VALUE EXCEEDING $1500 IS A COUNTABLE RESOURCE.
3. A REVOCABLE BURIAL TRUST CAN BE TERMINATED, SOLD, OR TRANSFERRED. A REVOCABLE BURIAL TRUST IS EXEMPT IF THE VALUE OF THE TRUST DOES NOT EXCEED ONE THOUSAND FIVE HUNDRED DOLLARS ($1,500). ANY INTEREST ON THE EXEMPT $1,500 IS ALSO EXEMPT. ANY AMOUNT OVER $1,500 IS A COUNTABLE RESOURCE.
H. PREPAID BURIAL CONTRACTS ARE EXEMPT A revocable trust if ANY OF the following conditions are met:
1. THE PREPAID BURIAL CONTRACT IS IRREVOCABLE. Revocable means that the contract can be terminated, sold, or transferred.
2. THE PREPAID BURIAL CONTRACT IS The burial prepaid contract is exempt if it is revocable and does not exceed one thousand five hundred dollars ($1,500). ANY AMOUNT IN EXCESS OF $1,500 SHALL BE A COUNTABLE RESOURCE.
a. To evaluate a prepaid revocable burial contract, the following shall apply:
1) Only the paid-up amount of the contract, not the face value, is taken into consideration;
B. ANY INTEREST ON THE EXEMPT $1500 IS ALSO EXEMPT.
2) The interest on the exempt $1,500 is also exempt;
b. To evaluate a trust deposit for burial expense, the $1,500 exemption applies only when the trust:
1) Is made with a federally insured bank or savings and loan association, or with a trust company under supervision of the State Banking Commissioner;
2) Is revocable during the lifetime of the client and is to be paid by the trustee only upon death of the client for the purpose of burial expense; and,
3) Provides for payment of the trust funds without limitation as to place of burial or provider of related services unless the trust was established prior to November 1966. In any case, however, the client is not precluded from indicating a preference as to place of burial or provider of related services.
I. The value of burial spaces required to meet the burial needs of the immediate family AS WELL AS BROTHERS, SISTERS, AND SPOUSES OF THOSE PERSONS, even if not living in the home. The immediate family includes the client's spouse, minor and adult children, stepchildren, adopted children, brothers, sisters, parents, adoptive parents, and the spouses of those persons. A BURIAL SPACE INCLUDES:
1. BURIAL PLOT;
2. GRAVESITE;
3. CRYPT;
4. MAUSOLEUM;
5. CASKET;
6. URN;
7. NICHE;
8. OTHER REPOSITORY CUSTOMARILY AND TRADITIONALLY USED FOR THE DECEDENT'S BODILY REMAINS;
9. VAULTS;
10. HEADSTONES, MARKERS, OR PLAQUES;
11. ARRANGEMENTS FOR THE OPENING AND CLOSING OF THE GRAVESITE; AND,
12. CONTRACTS FOR CARE AND MAINTENANCE OF THE GRAVESITE.
J. Any retroactive SSI or Social Security retirement or disability benefits still remaining after the month of receipt shall be exempt as a resource for nine months following the month they are received.
K. An income tax refund, INCLUDING THE PROPERTY TAX/RENT/HEAT CREDIT (PTC) REBATE, shall be exempt in the month received. Any remaining balance shall be counted as a resource after twelve (12) months.
L. Monies from a bona fide loan are exempt in the month received. Any remaining balance shall be counted as a resource in the following month(s).
M. MONIES SPECIFICALLY PLACED IN AN ACHIEVING A BETTER LIFE EXPERIENCE (ABLE) ACCOUNT, AS DESCRIBED IN THE ACHIEVING A BETTER LIFE EXPERIENCE ACT OF 2014, 26 U.S.C. SECTION 529A (2018).
3.520.78 Types of Income [Eff. 3/2/14]
3.520.781 Income [Eff. 3/2/14]
A. If a client's TOTAL COUNTABLE income equals or exceeds the Adult Financial program grant standard, the client shall not be eligible for that specific Adult Financial program.
B. Income eligibility determination utilizes four types of income:
1. Earned income;
2. In-kind earned income;
3. Unearned income; and,
4. In-kind unearned income.
C. Certain income shall be exempt and shall not be considered as countable income, in part or in whole, as outlined in Section 3.520.786.
D. Certain income shall have deductions, herein termed as income “disregards,” applied before determining final TOTAL countable income as outlined in Sections 3.533, 3.544, or 3.549.
E. CERTAIN INCOME SHALL BE DEEMED FROM THE CLIENT’S SPOUSE, PARENT, AND/OR SPONSOR TO DETERMINE THE CLIENT’S TOTAL COUNTABLE INCOME AS OUTLINED IN SECTIONS 3.534, 3.544 OR 3.549. The income of a spouse who is not receiving public assistance benefits, SSI benefits, or Medicaid assistance; and the income of the sponsor(s) shall be countable, herein termed as “deemed,” to the client as outlined in Section 3.534.
F. The total countable income of the client shall be deducted from the AND or OAP grant standard to determine the GRANT payment amount.
G. All income shall be countable in the month it is actually received or legally becomes available, whichever comes first, with the following exceptions:
1. Income that can be anticipated with reasonable certainty concerning the amount and the month it is expected to be received shall be counted in the month anticipated.
2. The anticipated monthly income shall be based on the income received in the previous month, except when the previous month does not provide an accurate indication of anticipated income, or under other circumstances as specified below:
a. For new or changed income, a period shorter than a month may be used to project a monthly amount;
b. For contract employment, such as in some school systems, where the employees derive their annual income in a period shorter than a year, the income shall be prorated over the term of the contract, provided that the income from the contract is not earned on an hourly or piecework basis;
c. For regularly received self-employment income, net earnings will usually be prorated and counted as received in a three (3) month period, except for farm income. For further information see Section 3.520.783.
d. For all other cases where receipt of income is reasonably certain but the monthly amount is expected to fluctuate, a period of twelve (12) months shall be used to arrive at an average monthly amount;
e. Income from rental property shall be considered self-employment income provided the client actively manages the property at least an average of twenty (20) hours per week.
1) Income from rental property shall be considered unearned income if the client is not actively managing the property an average of at least 20 hours per week.
2) Rental income, as self-employment or as unearned income, shall be averaged over a twelve month period to determine monthly income.
3) Income from jointly owned property must be considered as a percentage at least equal to the percentage of ownership or, if receiving more than percentage of ownership, the actual amount received.
f. For cases where a change in the monthly income amount can be anticipated with reasonable certainty, such as with Social Security cost of living adjustments (COLA), or other similar benefit increases, the expected amount shall be considered in determining a countable monthly income for the month received.
3.520.782 Earned Income [Eff. 3/2/14]
A. Earned income is GROSS monetary wages received by the client for services performed as an employee or as profit from self-employment.
B. In-kind earned income is non-monetary benefits received by the client for services performed as an employee or as self-employment profit, such as shelter as payment for building maintenance or babysitting or other barter goods in exchange for services.
1. In-kind income received in exchange for employment is employment income and shall have the appropriate earned income disregards applied to the total value of the income.
2. The amount considered as earned income when the client, CLIENT’S SPOUSE, OR SPONSOR(S) is paid in-kind shall be the value of the item supplied. The current market value of the item is used if the value of the item is not provided.
3.520.783 Self-Employment Income [Eff. 3/2/14]
A. An individual involved in a profit making activity shall be classified as self-employed.
B. To determine the net profit of a self-employed client, CLIENT’S SPOUSE, OR SPONSOR(S), deduct the cost of doing business from the gross income.
1. Cost of doing business expenses include, but are not limited to, the rent of business premises, wholesale cost of merchandise, utilities, interest, taxes, labor, and upkeep of necessary equipment.
2. Depreciation of equipment shall not be considered as a business expense.
3. The cost of and payments on the principal of loans for capital assets or durable goods shall not be considered as a business expense.
4. Personal expenses such as personal income tax payments, meals, and transportation to and from work are not business expenses.
C. Some types of self-employment income shall be calculated using a method specific to the type of self-employment, as follows:
1. Farm income shall be considered on a yearly basis. Net income for the prior year shall be determined and averaged for the succeeding year and counted as earned income. When a client, CLIENT’S SPOUSE, OR SPONSOR(S) ceases to farm, the income is no longer deducted from the grant standard.
2. Rental income shall be considered as follows:
a. When the client, CLIENT’S SPOUSE, OR SPONSOR(S) actively manages a self-owned rental property at least twenty (20) hours a week, treat rental income as self-employment income. Average the rental income over a twelve (12) month period to determine monthly earned income.
b. Board (to provide a person with regular meals only) payments to the client, CLIENT’S SPOUSE, OR SPONSOR(S) shall be considered earned income in the month received. For each boarder, calculate documentable expenses directly related to provision of board. Subtract the result from the board payment to determine the countable earned income.
c. Room (to provide a person with lodging only) payments to the client, CLIENT’S SPOUSE, OR SPONSOR(S) shall be considered earned income in the month received. For each boarder calculate the documentable expenses directly related to the provision of the room. Subtract the result from the room payment to determine the countable earned income.
d. Room and board (to provide a person regular meals and lodging) payments shall be considered earned income in the month received. For each boarder, calculate the documentable expenses directly related to the provision of room and board. Subtract the result from the room and board payment to determine the countable earned income.
3. Appropriate allowances for cost of doing business for A clients, CLIENT’S SPOUSE, OR SPONSOR(S) who IS/ARE A are licensed child care providers are:
a. For the first child for whom day care is provided, deduct $55; and,
b. For each additional child deduct $22.
c. Subtract the total allowances from the documented expenses to determine the earned income.
d. If the client, CLIENT’S SPOUSE, OR SPONSOR(S) can document a cost of doing business that is greater than the amounts above, the procedure, described in Section 3.520.783.B, shall be used to calculate earned income.
D. The net profit amount, secured after the appropriate deductions, is earned income.
E. SELF-EMPLOYMENT VERIFICATION MAY CONSIST OF TAX DOCUMENTS, SELF-EMPLOYMENT LEDGERS, RECEIPTS, OR OTHER DOCUMENTS USED FOR VERIFYING AND DOCUMENTING THE SELF-EMPLOYMENT INCOME AND EXPENSES. IF, AT THE TIME OF THE COUNTY DEPARTMENT’S ELIGIBILITY DETERMINATION, A CLIENT IS RECENTLY SELF-EMPLOYED OR DOES NOT HAVE ADEQUATE DOCUMENTATION OF THE SELF-EMPLOYMENT INCOME AND EXPENSES, THE COUNTY DEPARTMENT SHALL USE THE BEST INFORMATION AVAILABLE TO DETERMINE THE MONTHLY INCOME. THE CLIENT SHALL BE ENCOURAGED TO KEEP RECORDS OF INCOME AND EXPENSES FOR SUBSEQUENT CERTIFICATIONS. NO SPECIFIC VERIFICATION SHALL BE REQUIRED AND THE DOCUMENTATION PROVIDED BY THE CLIENT SHALL BE ACCEPTED UNLESS QUESTIONABLE.
F. ALL SELF-EMPLOYMENT INCOME SHALL BE CONSIDERED INCOME IN THE MONTH RECEIVED. IF RECEIPT OF SELF-EMPLOYMENT INCOME IS IRREGULAR, IT SHALL BE AVERAGED OVER A TWELVE-MONTH PERIOD. THE TWELVE-MONTH PERIOD CAN EITHER BE THE PREVIOUS TAX YEAR (JANUARY TO DECEMBER) OR THE MOST RECENT TWELVE-MONTHS PRIOR TO THE APPLICATION DATE.
3.520.784 Donated Work Hours and Volunteerism [Eff. 3/2/14]
A. Work hours or personal services, for which monetary compensation is not realized, provided to a business, to a person who is self-employed, or to any other person or business in need of a regular, temporary, or non-traditional employee, such as a seasonal worker, shall be considered countable earned income when the work:
1. Is regular and scheduled; and,
2. Is a necessary service; and,
3. If not performed by the client, CLIENT’S SPOUSE, OR SPONSOR(S) someone would have to be hired to perform the work; and,
4. Is greater than five (5) hours per week.
B. If donated work hours or personal services meet these requirements, the value of these hours is determined by:
1. The going rate in the community for similar work; or,
2. The current minimum wage standard, whichever is greater.
C. Volunteerism for the betterment of the community less than an average of thirty (30) hours per week shall not be considered income. Volunteerism for the betterment of the community includes but is not limited to:
1. Visiting persons in nursing homes, hospitals, etc.;
2. Delivering meals to homebound persons;
3. Providing limited transportation to medical appointments for disabled or aging persons; or,
4. Other opportunities deemed volunteerism for the betterment of the community by the county department using the prudent person principle.
3.520.785 Unearned Income [Eff. 3/2/14]
A. Unearned income is monetary benefits not earned through employment or self-employment, such as Social Security or other retirement benefits, interest, or investment income.
B. Countable unearned income includes the following and any other payments that could be construed to be a gain or benefit to the client, CLIENT’S SPOUSE, OR SPONSOR(S) and which are not earned income.
1. Benefits issued by the SSA. Social Security Administration, such as Social Security retirement, Social Security Disability Insurance (SSDI), or Supplemental Security Income (SSI).
a. Lump sum payments shall be counted as income in the month received. Any unspent amount will be treated as a resource after nine (9) months.
b. A recovery of Adult Financial program benefits shall be established if the lump sum payment is received too late in the month to adjust the Adult Financial program grant paid to the client.
c. If the Social Security Administration (SSA) is recovering any portion of the SSI payment from the client, CLIENT’S SPOUSE, OR SPONSOR(S) due to an overpayment of benefits, Adult Financial program GRANT PAYMENTS shall be calculated based on the gross SSI payment, not the received amount.
2. Pension or retirement payments made by a former employer or from any insurance or other public or private fund. If a lump sum payment for the value of the pension or retirement is an option, the client shall pursue the lump sum payment.
3. Disability or survivor's benefits made by an employer or from any insurance or other public or private fund.
4. Veteran compensation and pension based on service in the armed forces. Such payments may be made by the U.S. Veterans Administration (VA), another country, a state or local government, or other organization. Any portion of a VA pension paid to a veteran for support of a dependent shall be considered countable unearned income to the dependent rather than to the veteran.
5. Railroad retirement payments, such as sick pay, annuities, pensions, and unemployment insurance benefits, which are paid by the Railroad Retirement Board (RRB) to a client, CLIENT’S SPOUSE, OR SPONSOR(S) who is or was a railroad worker, or to such worker's dependents or survivors.
6. Unemployment Compensation.
7. Union strike benefits.
8. Amounts withheld from unearned income because of a garnishment.
9. Workers' Compensation payments awarded under federal and state law to an injured employee. Payments for medical, legal, or related expenses incurred by the client, CLIENT’S SPOUSE, OR SPONSOR(S) in connection with such claim are deducted prior to determining the amount of countable unearned income.
10. Dividends and interest received on financial accounts, savings bonds, leases, etc.
11. Annuity payments. If a lump sum payment for the value of the annuity is an option, the client shall pursue the lump sum payment. PAYMENTS SHOULD BE ACCEPTED AS FREQUENTLY AS POSSIBLE, E.G. MONTHLY, QUARTERLY, OR ANNUALLY. A LUMP SUM SHOULD ONLY BE ACCEPTED IF THE PREVIOUSLY IDENTIFIED INCREMENTS ARE UNAVAILABLE.
12. Inheritance.
13. Gifts and prizes.
14. Proceeds of a life insurance policy to the extent that they exceed the amount expended by the beneficiary for the purpose of the insured recipient's last illness and burial which are not covered by other benefits.
15. Proceeds of a health insurance policy or personal injury lawsuit to the extent that they exceed the amount to be expended or are required to be expended for medical care.
16. VA educational assistance (G.I. Bill) payments or other military or veterans benefits, which are conditional upon school attendance, are income to the extent that they exceed expenses necessary for school attendance.
17. Income from jointly owned property in a percentage at least equal to the percentage of ownership or, if receiving more than percentage of ownership, the actual amount received.
18. Lease bonuses (oil or mineral) received by the lessor as an inducement to lease land for exploration are income in the month received.
19. Oil or mineral royalties verified through tax documents such as the 1099 from the prior year shall be considered averagable income.
20. Income from rental property is considered as unearned income when the client is not actively managing the property on an average of at least twenty (20) hours a week. Rental income is countable to the extent it exceeds allowable expenses. Allowable expenses are maintenance, taxes, management fees, interest on mortgage, and utilities paid, and do not include the purchase of the rental property and payments on the principal of loans for the rental property.
21. Income derived from monies (or other property acquired with such monies) received pursuant to the “Civil Liberties Act of 1988” (by eligible persons of Japanese ancestry or certain specified survivors, and certain eligible Aleuts), P.L. 100-383, AS OF AUGUST 10, 1988 AND ARE herein incorporated by reference. This rule does not contain any later amendments or editions. THESE REGULATIONS ARE AVAILABLE IN PERSON AT THE OFFICE OF FEDERAL REGISTER, 800 NORTH CAPITOL STREET NW., SUITE 700 , WASHINGTON,DC 20002 DURING REGULAR BUSINESS HOURS OR BY MAIL AT THE OFFICE OF FEDERAL REGISTER, THE NATIONAL ARCHIVES AND RECORDS ADMINISTRATION, 8601 ADELPHI ROAD, COLLEGE PARK, MD 20740-6001 OR AT . THESE REGULATIONS ARE AVAILABLE FOR PUBLIC INSPECTION AND CCopYINGies of these federal laws are available from AT the Colorado Department of Human Services, Director of the Employment and Benefits Division, 1575 Sherman Street, Denver, Colorado, 80203, or at any state publications library.
22. PAYMENTS RECEIVED FROM Trusts. SUCH PAYMENTS CAN BE ON BEHALF OF, OR TO OR FOR THE BENEFIT OF THE CLIENT, CLIENT’S SPOUSE, OR SPONSOR(S), EXCLUDING MEDICAL OR PERSONAL ATTENDANT CARE.
23. ALIMONY AND SPOUSAL SUPPORT.
24. MINIMUM MONTHLY MAINTENANCE NEEDS ALLOWANCE (MMMNA) RETAINED FROM AN INSTITUTIONALIZED SPOUSE’S INCOME.
3.520.786 Exempt Income [Eff. 3/2/14]
CERTAIN Earned and unearned income that is not countable to the client, CLIENT’S SPOUSE, OR SPONSOR(S) in whole or in part is exempt. SUCH EXEMPT INCOME IS LIMITED TO THE FOLLOWING, including:
A. Income tax refunds, INCLUDING THE PROPERTY TAX/RENT/HEAT CREDIT (PTC) REBATE, in the month received. Any remaining funds shall be a countable resource after twelve (12) months.
B. The value of any third party payment for medical care paid on behalf of the client. This exemption also applies to room and board furnished during medical confinement and paid for by a third party.
C. Home energy assistance granted to the client by a private non-profit organization or home energy supplier, whether in-kind or by voucher or vendor payment.
D. Emergency or general assistance, other than home energy assistance, received on a one time basis in-cash or in-kind from the county department or other agencies.
E. Personal care or home care allowance grants paid to the client from a federal, state or local government program to purchase in-home supportive services shall be exempt as income. However, if the non-recipient spouse is the provider and receives the payment from the client for in-home services it shall be classified as employment income and is subject to deeming.
F. VA Aid and Attendance is exempt income to the client if used for medical supplies and medical or attendant care not covered by Medicare, Medicaid, or other health insurance programs. The remainder is countable and deducted from the assistance grant.
G. Educational loans and grants.
H. Work study income that exceeds the need-based grant shall be earned income in the month received.
I. Wages received by persons fifty-five (55) years of age and older under the Senior Community Service Employment Program (SCSEP) under Title V of the Older Americans Act;.
IJ. Income and resources set aside as part of a Plan to Achieve Self Support (PASS) approved by the Social Security Administration.
JK. Compensation received by the client pursuant to the Colorado Crime Victims Compensation Act IN ARTICLE 4.1 OF TITLE 24, C.R.S.; and,
KL. Certain uUnearned income as defined in the Social Security Program Operations Manual System (POMS), Section SI 00830.099 Guide to Unearned Income Exclusions (EFFECTIVE JANUARY 20, 2011) AND CONSISTENT WITH THE PROVISIONS OF FEDERAL REGULATIONS FOUND AT 20 CFR 416.1124 (EFFECTIVE SEPTEMBER 7, 2010), WHICH ARE HEREIN INCORPORATED BY REFERENCE. THIS RULE DOES NOT CONTAIN ANY LATER AMENDMENTS OR EDITIONS. THESE GUIDELINES ARE AVAILABLE FOR NO COST AT (POMS); WHILE THE REGULATIONS ARE AVAILABLE FOR NO COST AT . THESE GUIDELINES AND REGULATIONS ARE ALSO AVAILABLE FOR PUBLIC INSPECTION AND COPYING AT THE COLORADO DEPARTMENT OF HUMAN SERVICES, DIRECTOR OF THE EMPLOYMENT AND BENEFITS DIVISION, 1575 SHERMAN STREET, DENVER, COLORADO, 80203, OR AT ANY STATE PUBLICATIONS LIBRARY DURING REGULAR BUSINESS HOURS.
LM. Reverse mortgage loan payments.
M. PAYMENTS RECEIVED FOR PROVIDING FOSTER CARE. ANY AMOUNT PAID TO A PROVIDER OF FOSTER CARE IN EXCESS OF THE FOSTER CARE PAYMENT NOT INTENDED FOR THE CARE OF THE CHILD IS COUNTABLE INCOME TO THE PROVIDER.
N. CHILD SUPPORT PAYMENTS MADE TO THE CLIENT, CLIENT’S SPOUSE, OR SPONSOR(S). THESE PAYMENTS CAN EITHER BE CURRENT OR ARREARAGE PAYMENTS.
O. INFREQUENT OR IRREGULAR INCOME OF LESS THAN $60 IN A CALENDAR QUARTER.
3.520.79 In-Kind Support and Maintenance (ISM) FOR OAP and AND-CS Only [Eff. 3/2/14]
A. For certain clients who are not paying their fair share of SHELTERhousing costs, an In-kind Support and Maintenance (ISM) amount shall be determined and counted as unearned income.
B. The ISM calculation does not apply to a client:
1. WHO IS RResiding in and owning his OR /her primary residence; OR,
2. WHO IS RECEIVING Residing in subsidized housing; OR,
3. Who is homeless; OR,
4. Who is paying his OR /her fair share of shelter COSTS when shelter costs are market value or greater, even if the fair share is less than the current ISM amount.
a. Fair share is calculated by totaling SHELTER rent and utility costs and dividing by the number of people living in the household.
b. Market value is the amount a landlord or property manager would charge if the dwelling were rented on the open market. Rent may include heating fuel, gas, electricity, water, sewage and garbage collection; or,
5. Who is paying shelter costs in an amount equal to or greater than the current maximum ISM amount established for the shelter component, whether or not the costs are the client's fair share or market value.; UNLESS,
6. A CLIENT IS RECEIVING SSI AND BEING CHARGED AN ISM BY THE SOCIAL SECURITY ADMINISTRATION (SSA). THE CLIENT SHALL BE CHARGED A MATCHING ISM FOR ADULT FINANCIAL PROGRAMS, UNLESS GOOD CAUSE IS PROVIDED DUE TO SSA BACKLOG.
A. THE CLIENT SHALL BE INSTRUCTED TO WORK WITH THE SSA TO REMOVE OR REDUCE THE ISM ONCE THE CLIENT IS PAYING HIS OR HER FAIR SHARE OF SHELTER COSTS.
B. ONCE THE SSA REMOVES OR REDUCES THE ISM, THE CLIENT SHALL REPORT THE CHANGE IN ORDER TO HAVE THE ADULT FINANCIAL ISM REMOVED OR REDUCED.
C. If the client's DECLARED monthly shelter costs are less than the current maximum ISM amount established for the shelter component and the client is not paying his OR /her fair share, the county department shall determine the ISM amount to be applied, as follows:
1. If the client's shelter costs are less than the current market value, then the amount the client is actually paying is subtracted from the current maximum ISM amount. The result is counted as in-kind unearned income to the client.
2. If the shelter costs are market value but the client is paying less than his OR /her fair share, then the amount the client is actually paying is subtracted from the client's fair share amount or the current maximum ISM amount, whichever is less. The result is counted as in-kind unearned income to the client.
3. If the client is paying no shelter costs, and all shelter costs are supplied in full, then the current maximum ISM amount is counted as in-kind unearned income to the client.
D. A client receiving SSI and being charged an ISM by the Social Security Administration (SSA) shall be charged a matching ISM for Adult Financial programs.
1. The client shall be instructed to work with the SSA to remove or reduce the ISM once the client is paying a fair share of his/her shelter costs.
2. Once the SSA removes or reduces the ISM, the county department shall remove or reduce the Adult Financial programs ISM.
DE. If the client has an established life estate and THE client's shelter COSTS ARE is being provided in full, AN ISM SHALL BE CALCULATED the shelter component shall be deducted from the Adult Financial programs grant.
F. A client may purchase occupancy in a non-profit congregate home for the aged or in an individual private owner home. If all or part of the client's shelter is being provided in such an arrangement, an ISM shall be calculated.
G. If the client receives an educational grant or loan that provides for the client's shelter in full an ISM deduction shall be applied.
EH. The Adult Financial programs maximum shelter in-kind support and maintenance (ISM) shall be determined as follows:
1. The ISM includes shelter COSTS and utilities.
2. The ISM is calculated by multiplying the current SSI grant BENEFIT standard, AS DEFINED IN SECTION 3.510, by 33.33%, then adding a $20.00 disregard and rounding to the nearest whole dollar.
3.530 OLD AGE PENSION (OAP) PROGRAM [Emergency rev eff. 1/1/15]
The Old Age Pension (OAP) program provides financial assistance and may provide health care benefits for low-income Colorado residents who are sixty (60) years of age or older who meet ALL FINANCIAL AND NON-FINANCIAL basic eligibility requirements.
A. The total monthly OAP grant standard, as set by the State Board of Human Services, is $80921.00, effective January 1, 201920.
B. Effective January 1, 201920, the maximum monthly In-Kind Support and Maintenance (ISM) deduction amount for shelter COSTS, including utilities, is $28177.00.
3.530.1 DEFINITIONS [Eff. 3/2/14]
“OAP A” is a program for a client sixty-five (65) years of age or older.
“OAP B” is a program for a client sixty (60) years of age or older to sixty-four (60-64) years of age.
“OAP-C” is a program for a client age sixty (60) or older who has been committed to the Colorado Mental Health Institute or to a Regional Center by order of the district or probate court.
3.531 DETERMINATION [Eff. 3/2/14]
A. The county department shall enter all client, resource, and income information into the statewide automated system.
1. The county department shall determine eligibility.
2. If the client is missing any verification, the county department shall request additional and/or required verifications from the client. The request shall include:
a. A specific list of verifications necessary to determine eligibility;
b. The due date for when the verifications must be returned, which shall be ten (10) calendar days from the date the verification was requested in writing; and,
c. Notification that if the client fails to return the verifications by the due date, the county department shall process the application without those verifications, which may lead to a denial of benefits.
B. The client shall be advised that a collateral contact or home visit may be used to confirm questionable evidence, to investigate potential fraud, or when documentary evidence is insufficient to make a determination of eligibility or benefit level or cannot otherwise be obtained.
1. A collateral contact is a verbal or written confirmation of a client's circumstances by a person outside of the household. The county department shall:
a. Request the name of an appropriate collateral contact from the client; or,
b. Independently determine an appropriate collateral contact; or,
c. Substitute a home visit when an appropriate collateral contact cannot be identified.
2. An application may be denied if a collateral contact refuses to provide documentation of essential verifications and the applicant is unwilling to cooperate in obtaining such information personally.
a. Authorization of the release of such information alone does not constitute cooperation if the county department requests further assistance from the applicant. Documentation of lack of cooperation must be entered in the case record.
b. However, if the applicant is willing to cooperate but unable to obtain the information, no denial or delayed action shall be taken. The county shall assist the participant in gaining the information required to make a determination of eligibility.
3. Client confidentiality shall be maintained to the greatest extent possible when using a collateral contact for verification.
C. Each verification document shall be date-stamped with the date it was received in the county department office.
D. Upon timely receipt of the required verifications, the county department shall enter verifications into the statewide automated system. When all verifications have been entered, the county department shall review the results, verify accuracy, and determine eligibility. If a client fails to return verifications, the case will be denied.
E. If a client returns the required verifications late, the county department shall enter verifications into the statewide automated system. When all verifications have been entered, the county department shall review the results, verify accuracy, determine if good cause exists, and determine eligibility. If the client does not have good cause and informs the county department that he/she is requesting benefits, the client shall be required to reapply for benefits.
F. If a client believes that the value used for income or resource calculation was incorrect, the client shall provide supporting documentation. If such documentation confirms an incorrect calculation, the county department shall correct the case.
G. The county department shall send the client a notice explaining the eligibility determination results and the client's appeal rights as outlined ins Section 3.850, et seq. (9 C.C.R. 2503-8).
BH. The client shall have the right to decide how to spend his OR /her OAP GRANT PAYMENT benefit.
I. The county department shall promptly act to make changes in food assistance eligibility and other public assistance benefits as necessary in all instances where a client or mass change in OAP eligibility or payment occurs.
C. THE GRANT STANDARD FOR OAP, AS LISTED IN SECTION 3.530.A, SHALL BE ADJUSTED TO REMAIN WITHIN AVAILABLE APPROPRIATIONS. APPEALS SHALL NOT BE ALLOWED FOR GRANT STANDARD ADJUSTMENTS NECESSARY TO STAY WITHIN AVAILABLE APPROPRIATIONS.
D. IN ADDITION TO THE REGULAR MONTHLY OAP GRANT PAYMENTS, SUPPLEMENTAL PAYMENTS NECESSARY TO COMPLY WITH THE FEDERAL MAINTENANCE OF EFFORT (MOE) REQUIREMENTS MAY BE PROVIDED. THESE PAYMENTS ARE SUPPLEMENTS TO REGULAR GRANT PAYMENTS, ARE NOT ENTITLEMENTS, AND DO NOT AFFECT GRANT STANDARDS. APPEALS SHALL NOT BE ALLOWED FOR MOE PAYMENT ADJUSTMENTS. THE FEDERAL MOE IS LOCATED IN FEDERAL REGULATIONS FOUND AT 45 CFR 1321.49 (EFFECTIVE AS OF 1988 AND CURRENT THROUGH NOVEMBER 7, 2019), WHICH ARE HEREIN INCORPORATED BY REFERENCE. THIS RULE DOES NOT CONTAIN ANY LATER AMENDMENTS OR EDITIONS. THESE REGULATIONS ARE AVAILABLE AT NO COST AT . THESE REGULATIONS ARE ALSO AVAILABLE FOR PUBLIC INSPECTION AND COPYING AT THE COLORADO DEPARTMENT OF HUMAN SERVICES, DIRECTOR OF THE EMPLOYMENT AND BENEFITS DIVISION, 1575 SHERMAN STREET, DENVER, COLORADO, 80203, OR AT ANY STATE PUBLICATIONS LIBRARY DURING REGULAR BUSINESS HOURS.
3.532 GRANT PAYMENT DETERMINATION [Rev. eff. 1/22/15]
A. OAP grants PAYMENTS shall be calculated on an individual basis, with just one client per case.
B. When a client has been found eligible based upon eligibility rules as outlined in Sections 3.520.6 and 3.520.71, the amount of the client's authorized OAP GRANT PAYMENT benefit shall be determined by deducting the client's total countable income from the OAP grant standard LISTED IN SECTION 3.530.A.
1. If determined eligible on the first of the month, the client shall receive his OR /her authorized GRANT PAYMENT benefit in the initial and subsequent months.
2. If determined eligible on any other day of the month, the client's first month GRANT PAYMENT benefit shall be prorated according to the number of days remaining in the month; the client shall receive their authorized GRANT PAYMENTS benefit in subsequent months.
3. If a client is receiving services in another Adult Financial (AF) program in the month he OR /she turns sixty (60) years of age and is otherwise eligible for OAP, the client shall transition from the other AF program to OAP effective the first day of the client's birth month, and receive his OR /her authorized GRANT PAYMENT benefits for the birthday month and subsequent months.
C. If found eligible, the client's eligibility date shall be determined as follows:
1. If the client returns all verifications within the forty-five (45) day processing time frame, the eligibility date shall be the application date.
2. If the client returns all verifications after the forty-five (45) day processing time frame, but within sixty (60) calendar days of the original application date, the eligibility date shall be the date the verifications were returned.
3. If the client returns all verifications after sixty (60) days from the original application date, the client shall be required to re-apply for benefits.
D. If a client is actively attempting to sell, liquidate, or legally acquire a resource or secure available income, the county department shall not delay action on an application.
1. OAP shall be continued without adjustment until the resource or income is available. The county department is urged to monitor the attempts to access the resource or income.
2. If the client refuses or fails to make a reasonable effort to secure a potential resource or income, such resource or income shall be considered as if available, and timely and adequate notice shall be given regarding a proposed action to deny, reduce, or terminate assistance.
3. If the client secures the potential resource or income prior to the effective action date identified in the notice, the proposed action to deny, reduce, or terminate assistance shall be withdrawn by the county, and the case shall be corrected. Benefits may still be denied, reduced, or discontinued due to a change in income or resources.
CE. The OAP GRANT PAYMENT benefit shall be made VIA ELECTRONIC BENEFITS TRANSFER, DIRECT DEPOSIT, OR WARRANT directly to the client, TO A FACILITY DESIGNATED BY THE CLIENT, or to a legally designated person, such as a representative payee, fiduciary, or conservator.
For OAP-C clients, the financial officer of the facility or the client's guardian shall establish a reserve for the client in the amount of the current Personal Needs Allowance (PNA) grant standard for the client's personal needs.
DF. The client shall be eligible only for a monthly Ppersonal Nneeds Aallowance when program requirements are met and the client is a resident FOR of a facility at least thirty (30) consecutive days, IN ONE OF THE FOLLOWING FACILITIES as follows:
1. In a general medical and surgical hospital.;
2. In a nursing home, assisted living residence, or, intermediate care facility, group home, host home, or other long-term care facility, OR ADULT FINANCIAL APPROVED SETTING; OR.
3. In a psychiatric facility when sixty-five (65) years of age or older.
EG. The following persons are not eligible for a Ppersonal Nneeds Aallowance or OAP GRANT PAYMENTS benefit:
1. Inmates in a penal institution; or,
2. Residents in an unlicensed private or uncertified public facility.
FH. For every full calendar month that the client is a resident in an approved A facility LISTED IN SECTION 3.532.D, the OAP Ppersonal Nneeds Aallowance maximum shall be seventy-nine dollars ($79), effective October 1, 2016.
3.533 INCOME DISREGARDS [Eff. 3/2/14]
Disregards shall BE APPLIED BEFORE DETERMINING A CLIENT’S TOTAL COUNTABLE INCOME. not be applied iIf a client's total COUNTABLE income equals or exceeds the OAP grant standard AFTER THE DISREGARDS ARE APPLIED, HE OR SHE SHALL BE DENIED OR DISCONTINUED FOLLOWING THE POLICIES OUTLINED IN SECTION 3.554.
A. If the CLIENT HAS INCOME client's gross earnings are less than the OAP grant standard, apply the following income disregards:
1. To determine countable earned income:
a. Deduct $65 from the gross earned income; and,
b. Divide the remainder by two (2).
c. The result is the countable earned income.
2. To determine countable unearned income:
a. A client who receives SSI only, and does not receive any other unearned income, does not receive an unearned income disregard.
b. An OAP client living in an Adult Foster Care facility is not eligible to receive an unearned income disregard.
c. To determine countable unearned income of a client who does not receive SSI or who receives SSI and has other unearned income:
1) Deduct $20 from the gross unearned income;
2) The result is the countable unearned income.
3) If the client's unearned income is less than $20, the difference between the gross unearned income and the $20 deduction shall be applied to the earned income calculation if applicable.
TO DETERMINE COUNTABLE UNEARNED INCOME:
A. DETERMINE THE CLIENT'S GROSS UNEARNED INCOME FROM ALL SOURCES.
B. SUBTRACT ANY AMOUNT RECEIVED FROM SSI.
C. DEDUCT $20.00 FROM THE REMAINDER.
1. IF THE CLIENT IS MARRIED, THE $20.00 DISREGARD SHALL BE SPLIT EQUALLY BETWEEN THE CLIENT AND THE CLIENT’S SPOUSE SO THAT NO MORE THAN A $20.00 DISREGARD IS APPLIED FOR THE MARRIED COUPLE.
2. A CLIENT WHO RECEIVES SSI ONLY, AND DOES NOT RECEIVE ANY OTHER UNEARNED INCOME, DOES NOT RECEIVE AN UNEARNED INCOME DISREGARD.
D. ADD THE FULL SSI INCOME BACK TO THE REMAINDER.
E. THE REMAINDER IS COUNTABLE UNEARNED INCOME.
F. IF THE CLIENT'S GROSS UNEARNED INCOME IS LESS THAN $20.00, THE DIFFERENCE BETWEEN THE GROSS UNEARNED INCOME AND THE $20.00 DEDUCTION SHALL BE APPLIED TO THE EARNED INCOME CALCULATION, IF APPLICABLE.
d. Only one $20 unearned income disregard is allowed per couple and is divided equally between the two spouses.
B. Subtract the countable earned and countable unearned income from the OAP grant standard to determine the GRANT PAYMENT benefit amount.
3.534 DEEMING INCOME [Eff. 3/2/14]
A. To determine the amount of income to deem TO A CLIENT from a THE CLIENT’S SPOUSE WHO DOES NOT MEET THE CRITERIA DESCRIBED BELOW IN ‘C’, non-recipient spouse to a recipient spouse calculate the countable earned income of the non-recipient spouse as follows:
1. Deduct $65 from the CLIENT’S non-recipient spouse's gross earned income; and,
2. Divide the remainder by two (2); and,
3. The RESULT remainder is the amount of earned income deemed to the client.
4. The deemed earned income shall be considered income to the client and shall be deducted, together with any other income, from the grant of the client.
5. Wages being garnished by the court are countable earned income.
B. To determine the amount of unearned income to deem TO A CLIENT from a THE CLIENT’S SPOUSE WHO DOES NOT MEET THE CRITERIA AS DESCRIBED BELOW IN ‘C’, non-recipient spouse to a recipient spouse, calculate the countable unearned income of the non-recipient spouse as follows:
1. Calculate the total amount of unearned income of the non-recipient spouse;
2. Deduct the OAP grant standard from the total unearned income of the non-recipient spouse;
3. Deduct an amount to meet the needs of each dependent child LIVING IN THE HOUSEHOLD of the non-recipient spouse equal to half the maximum SSI grant BENEFIT standard, AS DEFINED IN SECTION 3.510, less the dependent child's own income;
4. Deduct any medical care payments by the non-recipient spouse for his OR /her dependents who are not covered by Medicare, Medicaid, or other health programs;
5. Deduct any amount of obligation of the non-recipient spouse due to orders of judgment or for support by a court, unless there is a garnishment. Income being garnished by the court is countable as unearned income.
6. The remainder is the amount of unearned income deemed to the client.
7. The deemed unearned income shall be considered income to the client and shall be deducted, together with any other income, from the grant of the client.
C. IF A CLIENT’S SPOUSE IS RECEIVING ADULT FINANCIAL GRANT PAYMENTS, SSI BENEFITS, OR MEDICAID ASSISTANCE AND HAS INCOME NO GREATER THAN THE OAP LIMIT, HIS OR HER INCOME SHALL NOT BE CONSIDERED AS AVAILABLE TO THE CLIENT AND SHALL NOT BE DEEMED. IF A CLIENT’S SPOUSE IS INSTITUTIONALIZED AND THE CLIENT HAS RETAINED THE MINIMUM MONTHLY MAINTENANCE NEEDS ALLOWANCE (MMMNA), THE MMMNA SHALL BE DEDUCTED FROM THE INSTITUTIONALIZED SPOUSE’S TOTAL INCOME. A sponsor's income can only be deemed towards the non-citizen they sponsor. To determine the amount of earned and unearned income to deem from a sponsor(s) to a client, calculate, as follows:
1. The total earned and unearned income of the sponsor are added together.
2. The following deductions are subtracted from the total income of the sponsor:
a. A deduction for the sponsor equal to the current SSI benefit standard for an individual for the month in which eligibility is being determined; plus,
b. A deduction for the sponsor's spouse living in the same household with the sponsor, equal to one-half the current SSI benefit standard for an individual; or a deduction for the sponsor's spouse, who is also a co-sponsor of the non-citizen, equal to the current SSI benefit standard for an individual; plus,
c. A deduction equal to one-half the SSI benefit standard for an individual for each person who is a dependent of the sponsor (other than the non-citizen and the non-citizen's spouse).
3. The difference between the total income and the total deductions is deemed as unearned income to the non-citizen. This deemed income is added to the non-citizen's own income to determine the total countable income.
4. Compare the non-citizen's countable income to the income standard of the Adult Financial program for which the non-citizen is applying to determine eligibility and/or the benefit amount.
5. If more than one non-citizen has the same sponsor, deem all of the sponsor's income to each non-citizen. Do not divide the sponsor's income among the non-citizens.
D. A SPONSOR'S INCOME CAN ONLY BE DEEMED TO THE NON-CITIZEN CLIENT HE OR SHE SPONSORS. THE AMOUNT OF EARNED AND UNEARNED INCOME TO DEEM FROM A SPONSOR(S) TO A NON-CITIZEN CLIENT IS CALCULATED AS FOLLOWS:
1. THE TOTAL GROSS EARNED AND UNEARNED INCOME OF THE SPONSOR ARE ADDED TOGETHER.
2. THE FOLLOWING DEDUCTIONS ARE SUBTRACTED FROM THE TOTAL GROSS INCOME OF THE SPONSOR:
A. A DEDUCTION FOR THE SPONSOR EQUAL TO THE CURRENT SSI BENEFIT STANDARD, AS DEFINED IN SECTION 3.510, FOR AN INDIVIDUAL FOR THE MONTH IN WHICH ELIGIBILITY IS BEING DETERMINED; PLUS,
B. A DEDUCTION FOR THE SPONSOR'S SPOUSE LIVING IN THE SAME HOUSEHOLD WITH THE SPONSOR, EQUAL TO ONE-HALF THE CURRENT SSI BENEFIT STANDARD. AS DEFINED IN SECTION 3.510, FOR AN INDIVIDUAL; OR A DEDUCTION FOR THE SPONSOR'S SPOUSE, WHO IS ALSO A CO-SPONSOR OF THE NON-CITIZEN, EQUAL TO THE CURRENT SSI BENEFIT STANDARD FOR AN INDIVIDUAL; PLUS,
C. A DEDUCTION EQUAL TO ONE-HALF THE SSI BENEFIT STANDARD, AS DEFINED IN SECTION 3.510, FOR AN INDIVIDUAL FOR EACH PERSON WHO IS A DEPENDENT OF THE SPONSOR (OTHER THAN THE NON-CITIZEN CLIENT AND THE NON-CITIZEN CLIENT'S SPOUSE), AS DEFINED IN SECTION 3.520.68.B.2.B.1.
3. THE DIFFERENCE BETWEEN THE TOTAL INCOME AND THE TOTAL DEDUCTIONS IS DEEMED AS UNEARNED INCOME TO THE NON-CITIZEN CLIENT. THIS DEEMED INCOME IS ADDED TO THE NON-CITIZEN CLIENT'S OWN INCOME TO DETERMINE THE TOTAL COUNTABLE INCOME.
4. THE NON-CITIZEN CLIENT'S COUNTABLE INCOME IS COMPARED TO THE INCOME STANDARD OF THE ADULT FINANCIAL PROGRAM FOR WHICH THE NON-CITIZEN CLIENT IS APPLYING TO DETERMINE ELIGIBILITY AND/OR THE GRANT PAYMENT AMOUNT.
5. IF MORE THAN ONE NON-CITIZEN CLIENT HAS THE SAME SPONSOR, ALL OF THE SPONSOR'S INCOME IS DEEMED TO EACH NON-CITIZEN CLIENT. DO NOT DIVIDE THE SPONSOR'S INCOME AMONG THE NON-CITIZEN CLIENTS.
3.540 AID TO THE NEEDY DISABLED STATE ONLY (AND-SO) PROGRAMS [Emergency rev. eff. 1/1/15]
The Aid to the Needy Disabled State Only (AND-SO) program provides interim assistance to clients age eighteen (18) through fifty-nine (59) years of age (unless diagnosed with blindness, then age zero (0) through 59 years of age); who are disabled or blind but have not been approved for Supplemental Security Income (SSI) or Social Security Disability Insurance (SSDI). INDIVIDUALS ARE REQUIRED TO MEET THE TOTAL DISABILITY REQUIREMENTS IDENTIFIED IN THIS SECTION, IN ADDITION TO THE NON-FINANCIAL AND FINANCIAL ELIGIBILITY REQUIREMENTS. INDIVIDUALS WHO ARE PARTIALLY DISABLED OR HAVE A SHORT-TERM DISABILITY ARE NOT ELIGIBLE. The AND-Colorado Supplement (AND-CS) program provides a supplemental payment for client's age zero (0) to 59 who are receiving SSI due to a disability or blindness, but are not receiving the full SSI grant standard.
A. The total AND-SO grant standard is $217.00, effective September 1, 2018.
B. The total AND-CS grant standard is $771.00, effective January 1, 2019.
BC. The grant standards for AND-SO and AND-CS shall be adjusted as needed to remain within available appropriations. Appeals shall not be allowed for grant standard adjustments necessary to stay within available appropriations.
D. In addition to the regular monthly AND-CS grant payments, supplemental payments necessary to comply with the federal Maintenance of Effort (MOE) requirements may be provided. These payments are supplements to regular grant payments, are not entitlements, and do not affect grant standards. Appeals shall not be allowed for MOE payment adjustments.
E. Effective January 1, 2019, the maximum ISM amount for shelter, including utilities, is $277.00.
3.540.1 DEFINITIONS [Eff. 3/2/14]
“Administrative error” means the county department incorrectly applied the disability certification, as documented on the medical certification form, and/or incorrectly applied the social factors used to determine the client's residual functional capacity.
“Aid to the Needy Disabled (AND)” includes the Aid to the Needy Disabled-State Only (AND-SO) , which include persons disabled due to blindness, and the Aid to the Needy Disabled-Colorado Supplement (AND-CS) programs.
“Blind or blindness” means central visual acuity of 20/200 or less in the better eye with the use of a correcting lens. An eye which has a limitation in the field of vision such that the widest diameter of the visual field subtends an angle no greater than 20 degrees shall be considered as having a central visual acuity of 20/200 or less.
“Disability” means a physical or mental impairment that is disabling and combined with other factors impacting the client's residual functional capacity substantially precludes the client from engaging in a useful occupation in any employment in the community for which he /she has competence as a wage earner or through self-employment. Disability also means blindness, as defined in this Section.
“Disability determination error” means the prior determination of disability was incorrect, based on documented evidence.
“Employment which exists in the community” means there are jobs for which the client has competence located within an area where the client might reasonably be expected to commute (see definition of “reasonable commute”). It does not mean that there are actual job vacancies that the client could fill or that the client would be hired to fill a job vacancy.
“Improvement” related to the client's medical condition means that in comparison to the most recent medical certification, the physical or mental impairment(s) which prevented the client from engaging in a SGAuseful occupation has decreased to the point that the client is able to engage in a SGA useful occupation or the client's residual functional capacity has increased to the point that the client is able to engage in a SGA useful occupation.
“Medical provider” means a Colorado licensed physician, psychiatrist, licensed psychologist, licensed clinical social worker, licensed professional counselor, physician's assistant, advanced practice nurse, or registered nurse. The physician may be a general practitioner or a specialist. A medical provider determining blindness shall be an ophthalmologist licensed in Colorado. A medical provider may be licensed in a bordering state when the nearest Colorado provider is more than one hour from the client's home and the provider in the bordering state is closer.
“Reasonable commute” means a commute no further than one hour one way.
“Residual functional capacity” means the client's MAXIMUM remaining ability to perform work of any type ON A REGULAR AND CONTINUING BASIS despite some disabling limitations.
“Self-supporting” means a job or self-employment that provides wages or income in an amount greater than the AND-SO grant standard.
“Semi-skilled work” means sufficient knowledge and ability is required to complete a job. The job tasks are not so specialized as to be labeled “skilled” work, but some specialized training is required. A semi-skilled employee can work with a moderate level of supervision.
“Skilled work” means special knowledge, expertise, or ability is required to complete the job. This may be learned in higher education or in a technical school. The skill could also be learned via on-the-job or other vocational education. A skilled employee is capable of working independently and accurately.
“SUBSTANTIAL GAINFUL ACTIVITY (SGA)” MEANS THE PERFORMANCE OF SIGNIFICANT PHYSICAL AND/OR MENTAL ACTIVITIES IN WORK FOR PAY OR PROFIT, OR IN WORK OF A TYPE GENERALLY PERFORMED FOR PAY OR PROFIT, REGARDLESS OF THE LEGALITY OF THE WORK. “SIGNIFICANT ACTIVITIES” ARE USEFUL IN THE ACCOMPLISHMENT OF A JOB OR THE OPERATION OF A BUSINESS, AND HAVE ECONOMIC VALUE. WORK MAY BE SUBSTANTIAL EVEN IF IT IS PERFORMED ON A PART-TIME BASIS, OR EVEN IF THE INDIVIDUAL DOES LESS, IS PAID LESS, OR HAS LESS RESPONSIBILITY THAN IN PREVIOUS WORK. WORK ACTIVITY IS GAINFUL IF IT IS THE KIND OF WORK USUALLY DONE FOR PAY, WHETHER IN CASH OR IN KIND, OR FOR PROFIT, WHETHER OR NOT A PROFIT IS REALIZED. ACTIVITIES INVOLVING SELF-CARE, HOUSEHOLD TASKS, UNPAID TRAINING, HOBBIES, THERAPY, SCHOOL ATTENDANCE, CLUBS, SOCIAL PROGRAMS, ETC., ARE NOT GENERALLY CONSIDERED TO BE SGA.
“TOTAL DISABILITY” MEANS A PHYSICAL OR MENTAL IMPAIRMENT WHICH IS DISABLING AND WHICH, BECAUSE OF OTHER FACTORS SUCH AS AGE, TRAINING, EXPERIENCE, AND SOCIAL SETTING, SUBSTANTIALLY PRECLUDES THE PERSON HAVING SUCH DISABILITY FROM ENGAGING IN A USEFUL OCCUPATION AS A HOMEMAKER OR AS A WAGE EARNER IN ANY EMPLOYMENT WHICH EXISTS IN THE COMMUNITY FOR WHICH HE OR SHE HAS COMPETENCE, AS DEFINED IN SECTION 26-2-103(14)(A), C.R.S.
“Unskilled work” means a job that requires little or no special training or experience and involves performing simple duties. Little or no independent judgment is required to be made by the employee and a moderate to heavy level of supervision in the job is required.
“Useful occupation” means any occupation which can be considered as self-supporting. Protected employment, such as a sheltered workshop or enclave, shall not be considered a useful occupation.
3.541 DISABILITY REQUIREMENTS [Eff. 3/2/14]
A. TO QUALIFY FOR AND-SO, THE CLIENT MUST MEET BOTH THE NON-FINANCIAL AND FINANCIAL ELIGIBILITY REQUIREMENTS AND HAVE A TOTAL DISABILITY AS DEFINED IN SECTION 3.540.1 AND PURSUANT TO SECTIONS 26-2-103(14)(A) AND 26-2-111(4)(A), C.R.S.
A. To meet the disability eligibility requirement for AND-CS, the client must be approved for Supplemental Security Income (SSI) due to a disability or blindness. The county department shall verify SSI eligibility through SVES and document in the statewide automated system case comments.
B. 1. To meet the TOTAL disability requirement for AND-SO, the client shall be certified by a medical professional as defined by Section 3.541.1., under one of the following categories:
1. Disabled due to substance abuse, as outlined in Section 3.541.3; or,
2. Totally disabled, as outlined in Section 3.541.BC; or,
3. With a medical disability that prevents the client from working in his OR /her usual occupation and when the disability is combined with additional functional deficits related to certain social factors, the client's residual functional capacity to work in any type of employment is severely disabling, as outlined in Section 3.541.C-ED-G.
C. 2. To be determined totally disabled tThe client shall MUST meet the criteria below ANDor have A other PHYSICAL OR MENTAL IMPAIRMENT THAT IS disabling AS conditions identified by the Social Security Administration (SSA): IN THE LISTING OF IMPAIRMENTS AND CONSISTENT WITH FEDERAL REGULATIONS FOUND AT 20 CFR, APPENDIX 1 TO SUBPART P OF PART 404 (SEPTEMBER 24, 2019), WHICH ARE HEREIN INCORPORATED BY REFERENCE. THIS RULE DOES NOT CONTAIN ANY LATER AMENDMENTS OR EDITIONS. THESE REGULATIONS ARE AVAILABLE AT NO COST AT . THESE REGULATIONS ARE ALSO AVAILABLE FOR PUBLIC INSPECTION AND COPYING AT THE COLORADO DEPARTMENT OF HUMAN SERVICES, DIRECTOR OF THE EMPLOYMENT AND BENEFITS DIVISION, 1575 SHERMAN STREET, DENVER, COLORADO, 80203, OR AT ANY STATE PUBLICATIONS LIBRARY DURING REGULAR BUSINESS HOURS.
3. THE TOTAL DISABILITY MUST BE EXPECTED TO LAST SIX (6) MONTHS OR LONGER.
1. Be blind or have a physical or mental impairment that is severely disabling. These conditions are generally permanent, fully debilitating, and may be expected to result in death. These impairments include:
a. Respiratory disorders, such as cystic fibrosis, chronic persistent lung infections, or chronic pulmonary insufficiency;
b. Cardiovascular disorders, such as chronic heart failure despite medication, congenital heart disease, or recurrent arrhythmias not related to a reversible cause;
c. Digestive disorders, such as liver dysfunction or gastrointestinal hemorrhage;
d. Genitourinary disorders, such as chronic renal failure resulting in chronic hemodialysis;
e. Hematological disorders, such as sickle-cell disease, hemophilia, or aplastic anemia;
f. Congenital disorders, such as fragile X syndrome or phenylketonuria (PKU);
g. Neurological disorders, such as multiple sclerosis, muscular dystrophy, head trauma, or cerebral palsy;
h. Disorders of speech or other senses, such as blindness, tinnitus in combination with progressive hearing loss, or loss of speech;
i. Musculoskeletal disorders, such as a gross anatomical deformity, spinal stenosis or other spinal disorder resulting in nerve root compression, or amputation of both hands;
j. Mental or cognitive disorders, such as schizophrenia, affective disorders, personality disorders, intellectual and developmental disabilities, or substance abuse to the extent that the disorder results in at least two of the following activities:
1) Marked restriction of activities of daily living; or,
2) Marked difficulties in maintaining social functioning; or,
3) Marked difficulties in maintaining concentration, persistence, or pace; or,
4) Repeated episodes of decompensation, each of extended duration.
2. Have an impairment or blindness that is expected to last twelve (12) months or more; and,
3. Must be completely unable to participate in a substantial gainful activity. Substantial gainful activity (SGA) means a level of work activity and earnings that is both substantial and gainful. The activity involves performance of significant physical or mental activities, or a combination of both. For a work activity to be considered substantial it does not need to equal full time. If impairment is anything other than blindness, earnings averaging over the current AND grant standard a month generally demonstrates a SGA. Gainful work activity is:
a. Work performed for pay or profit; or,
b. Work generally performed for pay or profit; or,
c. Work intended for profit, whether or not a profit is realized.
D. The client shall be considered disabled due to a lack of residual functional capacity when the client haVEs a medical disability that, is moderately to severely disabling and when combined with additional functional deficits due to social factors, such as age, training, experience, and social setting, severely limits the client's residual functional capacity .if he /she:
1. Is blind or has a physical or mental impairment that is disabling; and,
2. Has an impairment or blindness that is expected to last six (6) months or longer, as documented on the medical certification form; and,
3. Has additional functional deficits related to certain social factors that create a barrier to employment to the extent that the client is unable to work or learn skills necessary to work as a wage earner in any type of employment that exists in the community.
BE. To determine if the client's DISABILITY residual functional capacity would preclude him/her from employment, or from learning skills necessary for employment, the county department shall REVIEW AND document other medical data. and functional strengths and deficits, as follows:
1. THE COUNTY DEPARTMENT SHALL RReview STATE PRESCRIBED medical CERTIFICATION FORM(S) AND/OR ANY MEDICAID DISABILITY DETERMINATION records from licensed medical personnel; and,
2. Review disability assessments performed by other disability specialists; and,
3. THE COUNTY DEPARTMENT SShall weigh more heavily: A DISABILITY DETERMINATION COMPLETED THROUGH A MEDICAID DISABILITY DETERMINATION PROCESS THAN A MEDICAL CERTIFICATION FORM COMPLETED BY A MEDICAL PROVIDER.
A. A medical certification form completed by the client's usual doctor than a form completed by a doctor who has had no previous history with the client, unless the doctor with no known history is a specialist in the field of medicine pertaining to the client's disability, if there is more than one form provided by the applicant.
B. A disability determination completed through a Medicaid disability determination process than a medical certification form completed by a medical provider.
C.F. The county department shall review all documentation collected to determine if THE CLIENT IS ELIGIBLE FOR AND-SO certain social factors combined with a medical disability reasonably prevent the client from working or from learning new skills.
3.541.1 MEDICAL CERTIFICATION FORM [Eff. 3/2/14]
A. Medical certification shall be completed on the State Department's prescribed medical CERTIFICATION report form.
1. The county department shall provide the form to the client or the medical provider at the time of application or interview and PRIOR TO THE at each re-examination DUE date. The client shall arrange for the medical exam with an appropriate medical provider of his OR /her choosing.
a. It is the county department's responsibility to provide the medical form to the client or the client's provider of choice within ten (10) calendar days of application.
b. If the client fails to make arrangement for or submit to the required medical examination within thirty (30) calendar days following the interview, the client has failed to comply with the requirements for eligibility and the CLIENT’S PARTICIPATION IN THE program will be denied or discontinued FOLLOWING THE POLICIES OUTLINED IN SECTION 3.554. The county department shall provide a notice of adverse action to the client.
c. If the client requests a second opinion, the subsequent medical examination shall be at the client's expense. The county department shall not be obligated to pay for more than one medical exam per client per application or medical certification period.
d. If the county department requests a second opinion, the subsequent medical examination shall be at the county department's expense.
e. The county department shall review the medical certification form for completeness and to determine whether the information submitted is in conflict with other medical data, records, documentation, and information and/or observations received from the client, family, friends, professionals, community members, or the county department. The county department shall:
1) Ensure any incomplete forms are returned to the provider to be completed; and,
2) Consult and verify with the provider any questionable or contradictory information.
2. The medical certification shall be completed and signed by a MEDICAL PROVIDER AS DEFINED IN SECTION 3.540.1 Colorado licensed physician, psychiatrist, licensed psychologist, licensed clinical social worker, licensed professional counselor, physician's assistant, an advanced practice nurse, or a registered nurse. The physician may be a general practitioner or a specialist. Medical certification for blindness shall be completed only by an ophthalmologist licensed in Colorado.
a. The client shall be allowed to choose a medical provider licensed in a bordering state when the nearest Colorado provider is more than one hour from the client's home.
b. No other health care or counseling professionals shall be allowed to complete the medical form.THE MEDICAL CERTIFICATION MUST BE DATED NO EARLIER THAN NINETY (90) DAYS BEFORE THE APPLICATION OR RECERTIFICATION.
3. The medical certification form shall contain the disability limitations, including the length and scope of the disability, if any; and,
4. The medical re-examination date shall be based upon the date of the APPLICATION OR REDETERMINATION initial exam and the length of the disability, as documented by the medical provider, but shall not exceed twelve (12) months. However, if the client has been determined disabled by the State disability review contractor, the medical re-examination date shall be established by the review contractor.
B. THE MEDICAL EXAMINATION DETERMINING THE CLIENT’S DISABILITY AND COMPLETION OF THE MEDICAL CERTIFICATION FORM SHALL BE COMPLETED BY A MEDICAL PROVIDER THAT ACCEPTS MEDICAID WHENEVER POSSIBLE WHEN THE CLIENT IS RECEIVING MEDICAID. IF THE CLIENT’S PRIMARY MEDICAL PROVIDER DOES NOT ACCEPT MEDICAID OR THE CLIENT IS NOT RECEIVING MEDICAID, TThe county department shall authorize payment for examinations for AND-SO medical certification examinations.
1. Fees and costs shall be reimbursed to the county department using the 80% state share, 20% county share reimbursement methodology DESCRIBED IN SECTION 26-1-122(3)(B), C.R.S.
2. The county department shall set the provider fee and shall make such payments in a timely manner.
3. Providers shall accept fees for services as negotiated as payment in full. No client shall be assessed any additional or supplementary fee.
4. Providers may be excluded from completing medical certification examinations if there is adequate documentation that the provider:
a. Is not completing a thorough examination on which to base his OR /her decision; or,
b. Falsified a medical certification form.
C. A determination of medical eligibility shall be completed by each medical re-examination date. The county department shall be allowed to request the client submit a medical re-examination at the time of financial redetermination or when the county has information that the client's medical condition may have changed.
1. PRIOR TO THE At the time of medical re-examination DUE DATE, the county department shall SEND A NEW MEDICAL CERTIFICATION FORM obtain a release of information from the client and send the prior medical certification forms to the client or the medical provider.
2. The provider shall be required to indicate on the form whether there has been any improvement in the client's medical condition since the last medical certification.
3. If the client fails to make arrangement for or submit the required medical re-examination BY THE REDETERMINATION DUE DATE within ten (10) calendar days of the request, the county department shall terminate assistance FOLLOWING THE POLICIES OUTLINED IN SECTION 3.554and provide notice of adverse action to the client.
3.541.2 DENIAL AND DISCONTINUATION RELATED TO DISABILITY [Eff. 3/2/14]
A. FOLLOWING THE POLICIES OUTLINED IN SECTION 3.554, The county department shall deny or discontinue AND-SO assistance when:
1. There was an administrative or disability determination error in the prior disability determination. The county department shall gather more information on the discrepancies before taking a negative action on the case.; or,
2. There has been improvement in the client's medical condition and the client is no longer TOTALLY disabled, as outlined DEFINED in Section 3.540.1. Improvement may be demonstrated by:
a. Observations, symptoms, or other findings which demonstrate positive changes in the client's medical condition; or,
b. Observations, symptoms, or other findings which demonstrate that the effect of the medical impairment(s) on the client has decreased.
c. New medical evidence which shows that while the client's underlying condition may not have changed, advances in medical therapy or technology have reduced or eliminated the adverse effect of the condition on the client; or,
d. New or improved diagnostic techniques or other medical evaluations show that the client's previously determined medical condition is not as serious as previously indicated; or,
e. There has been a change in prognosis; or,
f. The client has compensated or adjusted to the medical condition which now enables the client to engage in SGA a useful occupation; or,
g. The client's medical condition is correctable and the client refuses, without good cause, to obtain prescribed medical treatment to correct the condition. Good cause may include, but is not limited to:
1) Treatment is contrary to the established teachings of the client's religion, provided the client can establish he OR SHE observes his OR /her religion; or,
2) Surgery has previously been performed with unsuccessful results and the same surgery is again being recommended for the same impairment; or,
3) The treatment because of its magnitude (e.g., open heart surgery or organ transplant that has less than a 50% chance of improving the client's condition) or unusual nature (e.g., experimental procedures) is very risky; or,
4) The cost of treatment is prohibitive or cannot be obtained; or,
3. There has been improvement in the client's residual functional capacity and the client is not TOTALLY disabled, as outlined DEFINED in Section 3.540.1. Improvement may be demonstrated by:
a. Observations, symptoms, or other findings which demonstrate positive changes in the client's residual functional capacity; or,
b. Observations, symptoms, or other findings which demonstrate that the effect of the social factors impacting residual functional capacity on the client has decreased; or,
c. New evidence shows that while the client's underlying condition may not have changed, the client's vocational abilities and/or residual functional capacity has so improved that the client is able to engage in SGA a useful occupation; or,
d. Vocational opportunities for which the client has competence have become available in the community; or,
e. The client has compensated or adjusted to the social factors impacting residual functional capacity and the client is able to engage in SGA a useful occupation; or,
f. Residual functional capacity is not a barrier to employment in some type of employment that exists in the community.
B. If the county department has documented evidence that a client is working AND RECEIVING more than five (5) hours per week EARNINGS EXCEEDING THE AND-SO GRANT STANDARD AFTER APPLICABLE DISREGARDS as an employee, engaged in self-employment with earnings exceeding the grant standard, or donating services or work hours without pay as defined in Section 3.520.784, the county department shall deny or discontinue the client from AND-SO GRANT PAYMENTS benefits FOLLOWING THE POLICIES OUTLINED IN SECTION 3.554.
3.541.3 DISABILITY DUE TO SUBSTANCE ABUSE [Eff. 3/2/14]
For the purpose of AND-SO, when the client's primary diagnosis is alcoholism or controlled substance addiction, the following criteria shall apply PURSUANT TO SECTION 26-2-111(4)(E), C.R.S.:
A. The client shall only be eligible for twelve (12) cumulative months in a lifetime when substance abuse is identified on the medical certification form.
B. The client shall agree to treatment for addiction to be eligible for AND-SO. Upon consent, the county department shall refer the client to aN designated assessment/treatment agency of LICENSED BY the STATE DEPARTMENT’S Office of Behavioral Health.
C. The client shall agree to a defined treatment program by the designated LICENSED agency.
D. If the client fails to comply with treatment, the following steps shall be followed:
1. The treatment center shall contact the county department within twenty-four (24) hours of the client's termination from treatment; and,
2. The county department shall discontinue the client's State AND-SO assistance immediately upon termination from treatment EFFECTIVE THE FOLLOWING MONTH WITH TIMELY NOTICE PROVIDED.
E. The client shall submit to random testing BY THE LICENSED AGENCY to ensure the client remains free of alcohol OR/controlled substance(s).
F. Any time a client tests positive for alcohol or controlled substance(s), the client shall be warned by the treatment center in writing. A COPY OF THE WWritten warnings shall BE have a copy placed in the client's file and noted as either mailed or hand delivered. If a client tests positive for alcohol or controlled substance(s) twice in any three-month period, the county department shall be notified and the client shall be terminated from AND-SO IMMEDIATELY EFFECTIVE THE FOLLOWING MONTH WITH TIMELY NOTICE PROVIDED using the five (5) day notice for non-compliance.
G. The initial partial month is not counted toward the twelve-month maximum allowed. However, if a client is discontinued and subsequently reapplies and is approved, partial months after re-approval will count as a full month toward the twelve-month maximum allowed.
3.542 DETERMINATION OF ELIGIBILITY [Eff. 3/2/14]
A. The county department shall enter all client, resource, and income information into the statewide automated system.
1. The county department shall determine eligibility.
2. If the client is missing any verification, the statewide automated system or the county department shall send a check list of required verifications to the client. The verification check list shall include:
a. A specific list of verifications necessary to determine eligibility;
b. The due date for when the verifications must be returned, which shall be ten (10) calendar days from the date of the verification checklist; and,
c. Notification that if the client fails to return the verifications by the due date, the county department shall process the application without those verifications, which may lead to a denial of benefits.
B. The client shall be advised that a collateral contact or home visit may be used to confirm questionable evidence, to investigate potential fraud, or when documentary evidence is insufficient to make a determination of eligibility or benefit level or cannot otherwise be obtained.
1. A collateral contact is a verbal or written confirmation of a client's circumstances by a person outside of the household. The county department shall:
a. Request the name of an appropriate collateral contact from the client; or,
b. Independently determine an appropriate collateral contact; or,
c. Substitute a home visit when an appropriate collateral contact cannot be identified.
2. An application may be denied if a collateral contact refuses to provide documentation of essential verifications and the applicant is unwilling to cooperate in obtaining such information personally.
a. Authorization of the release of such information alone does not constitute cooperation if the county department requests further assistance from the applicant. Documentation of lack of cooperation must be entered in the case record.
b. However, if the applicant is willing to cooperate but unable to obtain the information, no denial or delayed action shall be taken. The county shall assist the participant in gaining the information required to make a determination of eligibility.
3. Client confidentiality shall be maintained to the greatest extent possible when using a collateral contact for verification.
C. Each verification document shall be date-stamped with the date it was received in the county department office.
D. Upon timely receipt of the required verifications, the county department shall enter verifications into the statewide automated system. When all verifications have been entered, the county department shall review the results, verify accuracy, and determine eligibility. If a client fails to return verifications, the case will be denied.
E. If a client returns the required verifications late, the county department shall enter verifications into the statewide automated system. When all verifications have been entered, the county department shall review the results, verify accuracy, determine if good cause exists, and determine eligibility. If the client does not have good cause and informs the county department that he/she is requesting benefits, the client shall be required to reapply for benefits.
F. If a client believes that an income or resource has been attributed incorrectly, the client shall provide documentation that the value used for the computation was incorrect. If such documentation confirms an incorrect computation has been made, the county department shall correct the case.
G. The county department shall send the client a notice explaining the eligibility determination results and the client's appeal rights as outlined in Section 3.850, et seq. (9 C.C.R. 2503-8).
H. The client shall have the right to decide how to spend his/her AND-SO benefit.
I. The county department shall promptly act to make changes in food assistance eligibility and other public assistance benefits as necessary in all instances where a client or mass change in AND-SO eligibility or payment occurs.
BJ. Eligibility shall begin with the date of application or the date the client meets all eligibility requirements, whichever is later. In the case of AND-SO, if the client is delayed in completing the paperwork and appointment process for SSI and/or the medical exam through no fault of their own or if he/she is working with a Disability Benefits Guide, the date of application shall be used as the date of eligibility.
K. If a client is terminated from SSI, the client shall lose eligibility for the AND-CS program. The client may apply for AND-SO.
3.543 GRANT PAYMENT DETERMINATION [Rev. eff. 1/22/15]
A. AND-SO grants PAYMENTS shall be calculated on an individual basis with just one client per case.
B. When a client has been found eligible based upon eligibility rules as outlined in Sections 3.520.6 and 3.520.71, 3.520.72, and 3.520.73, the amount of the client's authorized AND-SO GRANT PAYMENT benefit shall be determined by deducting the client's total countable income from the AND-SO grant standard.
1. If determined eligible on the first of the month, the client shall receive his OR /her authorized GRANT PAYMENT benefit in the initial and subsequent months.
2. If determined eligible on any other day of the month, the client's first month GRANT PAYMENT benefit shall be prorated according to the number of days remaining in the month; the client shall receive their FULL authorized GRANT PAYMENT benefit in subsequent months.
C. If found eligible, the client's eligibility date shall be determined as follows:
1. If the client returns all verifications within the sixty (60) day processing time frame, the eligibility date shall be the application date.
2. If the client returns all verifications after the sixty (60) day processing time frame, but within 90 days of the original application date, the eligibility date shall be the date the verifications were returned.
3. If the client returns all verifications after ninety (90) days from the original application date, the client shall be required to re-apply for benefits.
D. If a client is actively attempting to sell, liquidate, or legally acquire a resource or secure available income, the county department shall not delay action on an application.
1. AND-SO shall be continued without adjustment until the resource or income is available. The county department is urged to monitor the attempts to access the resource or income.
2. If the client refuses or fails to make a reasonable effort to secure a potential resource or income, such resource or income shall be considered as if available, unless the client can show good cause. Timely and adequate notice shall be given regarding a proposed action to deny, reduce, or terminate assistance.
3. If upon receipt of the prior notice, the client secures the potential resource or income prior to the effective action date, the proposed action to deny, reduce, or terminate assistance shall be withdrawn, and the case shall be corrected. Benefits may still be denied, reduced, or discontinued due to a change in income or resources.
CE. Except as specified below, the AND-SO benefit shall be made directly to the client. THE AND-SO GRANT PAYMENT SHALL BE MADE VIA ELECTRONIC BENEFITS TRANSFER, DIRECT DEPOSIT, OR WARRANT TO THE CLIENT, TO A FACILITY, OR TO A LEGALLY DESIGNATED PERSON, SUCH AS A REPRESENTATIVE PAYEE, FIDUCIARY, OR CONSERVATOR.
F. When the client lives in a facility or has a payee, legal fiduciary, or authorized representative, the payment shall be made to the payee, fiduciary, authorized representative, or facility on behalf of the client.
DG. The client shall be eligible only for a monthly Ppersonal Nneeds Aallowance when program requirements are met and the client is a resident of a facility at least thirty (30) consecutive days, as follows:
1. In a general medical and surgical hospital;
2. In a nursing home, assisted living residence, or, intermediate care facility, group home, host home, or other long-term care facility, OR ADULT FINANCIAL APPROVED SETTING.
EH. The following persons are not eligible for a Ppersonal Nneeds Aallowance or AND-SO GRANT PAYMENTS benefit:
1. Inmates in a penal institution; or,
2. Residents in an unlicensed private or uncertified public facility.
FI. For every full calendar month that the client is a resident in an approved facility, the AND-SO Ppersonal Nneeds Aallowance maximum shall be seventy nine dollars ($79) effective October 1, 2016.
J. If the Social Security Administration (SSA) is recovering any portion of the client's SSI payment due to an overpayment of benefits, AND-CS shall be calculated based on the gross SSI payment and not the received amount.
3.544 AND-SO INCOME DISREGARDS AND DEEMED INCOME [Eff. 3/2/14]
DISREGARDS SHALL BE APPLIED BEFORE CALCULATING A CLIENT’S TOTAL COUNTABLE INCOME. IF A CLIENT'S TOTAL COUNTABLE INCOME EQUALS OR EXCEEDS THE AND-SO GRANT STANDARD AFTER THE DISREGARDS ARE APPLIED, HE OR SHE SHALL BE DENIED FOLLOWING THE POLICIES OUTLINED IN SECTION 3.554.
A. The earned and unearned income for an AND-SO client shall be counted dollar for dollar, with no disregards.
A. IF THE CLIENT HAS EARNED INCOME, APPLY THE FOLLOWING INCOME DISREGARDS:
1. DEDUCT $65 FROM THE GROSS EARNED INCOME; AND,
2. DIVIDE THE REMAINDER BY TWO (2).
3. THE RESULT IS THE COUNTABLE EARNED INCOME.
B. IF THE CLIENT HAS UNEARNED INCOME, APPLY THE FOLLOWING INCOME DISREGARDS:
1. DETERMINE THE CLIENT'S GROSS UNEARNED INCOME FROM ALL SOURCES.
2. DEDUCT $20.00. IF THE CLIENT IS MARRIED, THE $20.00 DISREGARD SHALL BE SPLIT BETWEEN THE CLIENT AND THE SPOUSE SO THAT NO MORE THAN A $20.00 DISREGARD IS APPLIED.
3. THE RESULT IS COUNTABLE UNEARNED INCOME.
C. SUBTRACT THE COUNTABLE EARNED AND COUNTABLE UNEARNED INCOME FROM THE AND-SO GRANT STANDARD TO DETERMINE THE GRANT PAYMENT AMOUNT.
DB. A portion of the earned income of the AND-SO client's spouse shall be deemed to the client, as follows:
1. Determine the spouse's monthly gross earnings.
2. Deduct $20.00.
3. From the remainder, deduct fifty percent (50%) but no more than $30.00.
4. From the remainder, subtract federal and state income tax, Medicare withholdings, and Social Security withholdings.
5. From the remainder, deduct $30.00 or the actual documented expenses of employment as allowed under Internal Revenue Services (IRS) deductions, whichever is greater.
6. The remainder is the amount of income deemed to the client.
1. DEDUCT SIXTY FIVE DOLLARS ($65) FROM THE SPOUSE'S GROSS EARNED INCOME; AND,
2. DIVIDE THE REMAINDER BY TWO (2); AND,
3. THE RESULT IS THE AMOUNT OF EARNED INCOME DEEMED TO THE CLIENT.
4. THE DEEMED EARNED INCOME SHALL BE CONSIDERED INCOME TO THE CLIENT AND SHALL BE DEDUCTED, TOGETHER WITH ANY OTHER INCOME, FROM THE GRANT OF THE CLIENT.
5. WAGES BEING GARNISHED BY THE COURT ARE COUNTABLE EARNED INCOME.
EC. A portion of the unearned income of the AND-SO client's spouse shall be deemed to the client, as follows:
1. Determine the spouse's unearned monthly gross income.
2. Deduct $20.00 UNLESS THE CLIENT ALSO HAS UNEARNED INCOME. THE $20.00 DISREGARD SHALL BE SPLIT BETWEEN THE CLIENT AND THE CLIENT’S SPOUSE SO THAT NO MORE THAN A $20.00 DISREGARD IS APPLIED.
3. The RESULTremainder is deemed to the client.
F. IF A CLIENT’S SPOUSE IS RECEIVING ADULT FINANCIAL GRANT PAYMENTS, SSI BENEFITS, OR MEDICAID ASSISTANCE AND HAS INCOME NO GREATER THAN THE SSI LIMIT, THEIR INCOME SHALL NOT BE CONSIDERED AS AVAILABLE TO THE CLIENT AND SHALL NOT BE DEEMED. IF A CLIENT’S SPOUSE IS INSTITUTIONALIZED AND THE CLIENT HAS RETAINED THE MINIMUM MONTHLY MAINTENANCE NEEDS ALLOWANCE (MMMNA), THE MMMNA SHALL BE DEDUCTED FROM THE INSTITUTIONALIZED SPOUSE’S TOTAL INCOME.
G. A SPONSOR'S INCOME CAN ONLY BE DEEMED TO THE NON-CITIZEN CLIENT HE OR SHE SPONSORS. THE AMOUNT OF EARNED AND UNEARNED INCOME TO DEEM FROM A SPONSOR(S) TO A NON-CITIZEN CLIENT IS CALCULATED AS FOLLOWS:
1. THE TOTAL GROSS EARNED AND UNEARNED INCOME OF THE SPONSOR ARE ADDED TOGETHER.
2. THE FOLLOWING DEDUCTIONS ARE SUBTRACTED FROM THE TOTAL INCOME OF THE SPONSOR:
A. A DEDUCTION FOR THE SPONSOR EQUAL TO THE CURRENT SSI BENEFIT STANDARD FOR AN INDIVIDUAL, AS DEFINED IN SECTION 3.510; PLUS
B. A DEDUCTION FOR THE SPONSOR'S SPOUSE LIVING IN THE SAME HOUSEHOLD WITH THE SPONSOR, EQUAL TO ONE-HALF THE CURRENT SSI BENEFIT STANDARD FOR AN INDIVIDUAL, AS DEFINED IN SECTION 3.510; OR A DEDUCTION FOR THE SPONSOR'S SPOUSE, WHO IS ALSO A CO-SPONSOR OF THE NON-CITIZEN, EQUAL TO THE CURRENT SSI BENEFIT STANDARD FOR AN INDIVIDUAL; PLUS
C. A DEDUCTION EQUAL TO ONE-HALF THE SSI BENEFIT STANDARD FOR AN INDIVIDUAL, AS DEFINED IN SECTION 3.510, FOR EACH PERSON WHO IS A DEPENDENT OF THE SPONSOR (OTHER THAN THE NON-CITIZEN CLIENT AND THE NON-CITIZEN CLIENT'S SPOUSE).
3. THE DIFFERENCE BETWEEN THE TOTAL INCOME AND THE TOTAL DEDUCTIONS IS DEEMED AS UNEARNED INCOME TO THE NON-CITIZEN CLIENT. THIS DEEMED INCOME IS ADDED TO THE NON-CITIZEN CLIENT'S OWN INCOME TO DETERMINE THE TOTAL COUNTABLE INCOME.
4. THE NON-CITIZEN CLIENT'S COUNTABLE INCOME IS COMPARED TO THE INCOME STANDARD OF THE ADULT FINANCIAL PROGRAM FOR WHICH THE NON-CITIZEN CLIENT IS APPLYING TO DETERMINE ELIGIBILITY AND/OR THE GRANT PAYMENT AMOUNT.
5. IF MORE THAN ONE NON-CITIZEN CLIENT HAS THE SAME SPONSOR, ALL OF THE SPONSOR'S INCOME IS DEEMED TO EACH NON-CITIZEN CLIENT. DO NOT DIVIDE THE SPONSOR'S INCOME AMONG THE NON-CITIZEN CLIENTS.
H. THE COUNTY DEPARTMENT SHALL DETERMINE ALL COUNTABLE EARNED AND UNEARNED INCOME AVAILABLE FROM THE CLIENT, THE SPOUSE, AND THE SPONSOR(S). THE TOTAL SHALL BE DEDUCTED FROM THE AND-SO GRANT TO DETERMINE THE CLIENT'S GRANT PAYMENT AMOUNT.
3.545 AND-CS INCOME DISREGARDS AND DEEMED INCOME [Eff. 3/2/14]
A. A portion of the earned income of an AND-CS client's spouse shall be deemed to the client, as follows:
1. Determine the spouse's monthly gross income.
2. Deduct $65.00.
3. Divide the remainder in half.
4. The result is the amount deemed to the client.
B. A portion of the unearned income for an AND-CS client who receives SSI and other unearned income shall be disregarded and shall not be countable income, as follows:
1. Determine the client's unearned income from all sources except SSI.
2. Deduct $20.00. If the client is married, the $20.00 disregard shall be split between the client and the spouse so that no more than a $20.00 disregard is applied.
3. The remainder is countable unearned income.
4. If the client's unearned income is less than $20, the difference between the gross unearned income and the $20 deduction shall be applied to the earned income calculation, if applicable.
C. A portion of the unearned income for AND-CS client's spouse shall be deemed to the client, as follows:
1. Determine the spouse's monthly gross unearned income.
2. Deduct any remaining unearned income disregard remaining from the client or $20.00, whichever is less. A couple shall be allowed a combined $20.00 disregard, which is split between the client and the spouse.
3. The remainder is countable unearned income and is deemed to the client.
D. An AND-CS client who does not receive another source of unearned income other than SSI such as an Adult Foster Care allowance does not receive the $20.00 unearned income disregard.
E. When the AND-CS client is an unemancipated child under eighteen (18) years of age, the earned and unearned income of the child and the child's parents shall be subject to disregards and deeming, as outlined above. The parents' income shall be deemed using the same calculations as a spouse.
F. If a spouse or parent is receiving assistance under another category of public assistance, SSI benefits, or medical assistance, the income from those benefits shall not be considered as available to the client.
G. A sponsor's income can only be deemed towards the non-citizen they sponsor. To determine the amount of earned and unearned income to deem from a sponsor(s) to a client, calculate, as follows:
1. The total earned and unearned income of the sponsor are added together.
2. The following deductions are subtracted from the total income of the sponsor:
a. A deduction for the sponsor equal to the current SSI benefit standard for an individual for the month in which eligibility is being determined; plus
b. A deduction for the sponsor's spouse living in the same household with the sponsor, equal to one-half the current SSI benefit standard for an individual; or a deduction for the sponsor's spouse, who is also a co-sponsor of the non-citizen, equal to the current SSI benefit standard for an individual; plus
c. A deduction equal to one-half the SSI benefit standard for an individual for each person who is a dependent of the sponsor (other than the non-citizen and the non-citizen's spouse).
3. The difference between the total income and the total deductions is deemed as unearned income to the non-citizen. This deemed income is added to the non-citizen's own income to determine the total countable income.
4. Compare the non-citizen's countable income to the income standard of the Adult Financial program for which the non-citizen is applying to determine eligibility and/or the benefit amount.
5. If more than one non-citizen has the same sponsor, deem all of the sponsor's income to each non-citizen. Do not divide the sponsor's income among the non-citizens.
H. The county department shall determine all countable earned and unearned income available from the client, the spouse, and the sponsor(s). The total shall be deducted from the AND grant to determine the client's benefit amount.
3.545 3.546 INTERIM ASSISTANCE REIMBURSEMENT (IAR) [Eff. 3/2/14]
A. AND-SO payments made while an SSI claim is pending, in suspense, terminated, or in appeal shall be classified as interim assistance. At the time of application, the SSI payment procedure shall be explained to the client.
1. All AND-SO payments made to the client are recoverable upon approval for SSI benefits. IF THE FIRST RETROACTIVE SSI PAYMENT IS SENT TO THE CLIENT, RATHER THAN THE COUNTY DEPARTMENT, HE OR SHE IS REQUIRED TO REPAY ANY AND-SO GRANT PAYMENTS FROM SUCH LUMP SUM FOR MONTHS HE OR SHE WAS DETERMINED ELIGIBLE FOR SSI.
2. As a condition of eligibility for AND-SO the client shall be required to sign the “Authorization for Reimbursement of Interim Assistance” (IM-14), AS DEFINED IN SECTION 3.510, AT APPLICATION AND AT LEAST annually allowing recovery of the funds from the first retroactive SSI payment. THIS FORM MUST ALSO BE COMPLETED AT EVERY REDETERMINATION AND WHENEVER THE CLIENT’S CASE IS TRANSFERRED TO ANOTHER COUNTY. THE FORM MUST INCLUDE THE SELECTION OF ONE PAYMENT DESIGNATION; CLIENT’S SIGNATURE AND DATE; A COUNTY REPRESENTATIVE’S SIGNATURE AND DATE, WHICH SHALL NOT PREDATE THE CLIENT’S SIGNATURE AND DATE; AND ALL REQUIREMENTS FOR THE INTERIM ASSISTANCE AGREEMENT INCLUDING THE APPLICABLE COUNTY SOCIAL SECURITY GRANT REIMBURSEMENT (GR) CODE AS DESCRIBED IN THE SSA INTERIM ASSISTANCE REIMBURSEMENT STATE HANDBOOK, SECTION 4 (NOVEMBER 30, 2018) WHICH IS HEREIN INCORPORATED BY REFERENCE. THIS RULE DOES NOT CONTAIN ANY LATER AMENDMENTS OR EDITIONS. THIS HANDBOOK IS AVAILABLE FOR NO COST AT . THIS HANDBOOK IS ALSO AVAILABLE FOR PUBLIC INSPECTION AND COPYING AT THE COLORADO DEPARTMENT OF HUMAN SERVICES, DIRECTOR OF THE EMPLOYMENT AND BENEFITS DIVISION, 1575 SHERMAN STREET, DENVER, COLORADO, 80203, OR AT ANY STATE PUBLICATIONS LIBRARY DURING REGULAR BUSINESS HOURS.
A. THE COUNTY SHALL NOTIFY THE SSA WITHIN 30 CALENDAR DAYS OF OBTAINING A VALID IM-14, AS DEFINED IN SECTION 3.510, IF THE NOTIFICATION EXCEEDS 30 CALENDAR DAYS, THE COUNTY DEPARTMENT SHALL BE REQUIRED TO OBTAIN A NEW VALID IM-14 FROM THE CLIENT.
B. THE COUNTY DEPARTMENT SHALL BE REQUIRED TO REVIEW THE “IAR TRANSACTIONS REJECTED BY SSA REPORT” IN THE STATEWIDE AUTOMATED SYSTEM, COGNOS REPORT PLATFORM, AND SHALL TAKE ALL NECESSARY ACTIONS TO RESOLVE ANY DISCREPANCIES WITHIN THIRTY (30) CALENDAR DAYS OF THE ORIGINAL TRANSMISSION DATE.
3. The client shall be required to give signed authorization for recovery directly from the client in the event that the first retroactive SSI payment is sent to the client rather than to the county department.
4. The authorization shall be effective for a maximum of one (1) year from the date it was signed by the client. The county department shall ensure that a new “Authorization for Reimbursement of Interim Assistance” (IM-14) is signed prior to the expiration of the previous IM-14 form.
B. Within ten (10) working days of receipt of the REIMBURSEMENT FROM SSA initial SSI retroactive payment, the county department shall complete and send to the client the apportionment notice (IM-19), AS DEFINED IN SECTION 3.510, to include the amount of the interim assistance payments made, by month, for all counties that provided AND-SO payments to the client. IF THE COUNTY DEPARTMENT RECOVERS EXCESS IAR FUNDS FROM THE INITIAL SSI RETROACTIVE PAYMENT, THE COUNTY MUST REIMBURSE THE SOCIAL SECURITY ADMINISTRATION UTILIZING THE STATE PRESCRIBED FORM, WITHIN THREE (3) BUSINESS DAYS OF THE MAILING OF THE IM-19.
C. The accounting of payments made shall be entered in the federal SSA eIAR data system. THE FEDERAL SSA EIAR DATA SYSTEM RECORDS THE ACCOUNTING OF PAYMENTS MADE. AFTER PROCESSING THIS INFORMATION, IT ISSUES PAYMENTS TO THE COUNTY DEPARTMENT AND DISTRIBUTES THE REMAINDER, IF ANY. SSA shall process the information and make a payment to the county department. SSA distributes the remainder, if any, to the client. Recoveries directly from a retroactive SSI payment can only be made from the first such payment.
D. When the SSI payment is received by the client, the county department shall consider the payment as income in the month received.
E. In the event that a client receives the initial retroactive SSI payment directly, the county department shall establish a recovery from the client.
1. The county department may agree to recover interim payments by periodic payments or through a lump sum recovery.
2. Any such recovery(ies) made shall be coded as Interim Assistance Reimbursement (IAR) Recovery(ies).
3. Any amount recovered in the same month as the month in which the retroactive payment was received shall not be counted as income.
F. The county department shall not pay any portion of its share of the federal SSI lump sum payment to the client or to any third party for legal, professional, or other fees incurred by the client in securing SSI benefits. All of the IAR payment shall be used to reimburse the AND-SO program for GRANT PAYMENTS benefits paid to the client as interim assistance in accordance with the agreement between the Colorado Department of Human Services and the Social Security Administration. The client is not required to obtain legal or other third party representation in order to apply for and/or obtain SSI benefits, and the client is solely responsible for any fees incurred in this process.
G. If an SSI client's SSI payment is suspended or terminated, the client may apply for AND-SO and complete the “Authorization for Reimbursement of Interim Assistance” (IM-14), AS DEFINED IN SECTION 3.510.
H. The county department that filed the original “Authorization for Reimbursement of Interim Assistance” (IM-14), AS DEFINED IN SECTION 3.510, for an AND-SO client shall be the County of Record. The County of Record acting as an agent of the state shall:
1. Collect and apportion all AND-SO GRANT payments for all county departments that may have provided AND-SO GRANT PAYMENTSbenefits; and,
2. Account for all AND-SO payments to the Social Security Administration (SSA) timely; and,
3. Make an accounting in the statewide automated system for any reimbursement received. Non-system determined claims (NSDC) shall not be entered for IARs without State Department approval.
I. THE COUNTY DEPARTMENT SHALL MAINTAIN RECORDS OF THE IAR CASE FOR FOUR (4) YEARS FROM THE END OF THE FEDERAL FISCAL YEAR IN WHICH THE IAR WAS PROCESSED.
J. THE COUNTY DEPARTMENT SHALL COMPLY WITH OTHER REGULATIONS THAT THE STATE DEPARTMENT FINDS NECESSARY TO ADMINISTER THE INTERIM ASSISTANCE PROVISIONS.
3.546 AID TO THE NEEDY DISABLED-COLORADO SUPPLEMENT (AND-CS) PROGRAM
THE AID TO THE NEEDY DISABLED-COLORADO SUPPLEMENT (AND-CS) PROGRAM PROVIDES A SUPPLEMENTAL PAYMENT FOR CLIENT'S AGE ZERO (0) TO FIFTY-NINE (59) WHO ARE RECEIVING SSI DUE TO A DISABILITY OR BLINDNESS, BUT ARE NOT RECEIVING THE FULL SSI BENEFIT STANDARD, AS DEFINED IN SECTION 3.510.
A. THE TOTAL AND-CS GRANT STANDARD IS $783.00, EFFECTIVE JANUARY 1, 2020.
B. THE GRANT STANDARD FOR AND-CS SHALL BE ADJUSTED AS NEEDED TO REMAIN WITHIN AVAILABLE APPROPRIATIONS. APPEALS SHALL NOT BE ALLOWED FOR GRANT STANDARD ADJUSTMENTS NECESSARY TO STAY WITHIN AVAILABLE APPROPRIATIONS.
C. IN ADDITION TO THE REGULAR MONTHLY AND-CS GRANT PAYMENTS, SUPPLEMENTAL PAYMENTS NECESSARY TO COMPLY WITH THE FEDERAL MOE REQUIREMENTS, AS INCORPORATED BY REFERENCE IN SECTION 3.531.D, MAY BE PROVIDED. THESE PAYMENTS ARE SUPPLEMENTS TO REGULAR GRANT PAYMENTS, ARE NOT ENTITLEMENTS, AND DO NOT AFFECT GRANT STANDARDS. APPEALS SHALL NOT BE ALLOWED FOR MOE PAYMENT ADJUSTMENTS.
D. EFFECTIVE JANUARY 1, 2020, THE MAXIMUM ISM AMOUNT FOR SHELTER COSTS IS $281.00.
3.547 DETERMINATION
A. TO MEET THE DISABILITY ELIGIBILITY REQUIREMENT FOR AND-CS, THE CLIENT MUST BE APPROVED FOR SSI DUE TO A DISABILITY OR BLINDNESS. THE COUNTY DEPARTMENT SHALL VERIFY SSI ELIGIBILITY THROUGH SVES OR SDX AND DOCUMENT IN THE STATEWIDE AUTOMATED SYSTEM CASE COMMENTS.
B. THE COUNTY DEPARTMENT SHALL ENTER ALL CLIENT, RESOURCE, AND INCOME INFORMATION INTO THE STATEWIDE AUTOMATED SYSTEM.
C. THE CLIENT SHALL HAVE THE RIGHT TO DECIDE HOW TO SPEND HIS OR HER AND-CS GRANT PAYMENT.
D. IF A CLIENT IS TERMINATED FROM SSI, THE CLIENT SHALL LOSE ELIGIBILITY FOR THE AND-CS PROGRAM.
3.548 GRANT DETERMINATION
A. AND-CS GRANTS SHALL BE CALCULATED ON AN INDIVIDUAL BASIS WITH JUST ONE CLIENT PER CASE.
B. WHEN A CLIENT HAS BEEN FOUND ELIGIBLE THE AMOUNT OF THE CLIENT'S AUTHORIZED AND-CS GRANT PAYMENT SHALL BE DETERMINED BY DEDUCTING THE CLIENT'S TOTAL COUNTABLE INCOME FROM THE AND-CS GRANT STANDARD.
1. IF DETERMINED ELIGIBLE ON THE FIRST OF THE MONTH, THE CLIENT SHALL RECEIVE HIS OR HER AUTHORIZED GRANT PAYMENT IN THE INITIAL AND SUBSEQUENT MONTHS.
2. IF DETERMINED ELIGIBLE ON ANY OTHER DAY OF THE MONTH, THE CLIENT'S FIRST MONTH GRANT PAYMENT SHALL BE PRORATED ACCORDING TO THE NUMBER OF DAYS REMAINING IN THE MONTH; THE CLIENT SHALL RECEIVE THEIR AUTHORIZED GRANT PAYMENT IN SUBSEQUENT MONTHS.
C. THE AND-CS GRANT PAYMENT SHALL BE MADE VIA ELECTRONIC BENEFITS TRANSFER, DIRECT DEPOSIT, OR WARRANT TO THE CLIENT, TO A FACILITY, OR TO A LEGALLY DESIGNATED PERSON, SUCH AS A REPRESENTATIVE PAYEE, FIDUCIARY, OR CONSERVATOR.
D. THE CLIENT SHALL ONLY BE ELIGIBLE FOR A MONTHLY PERSONAL NEEDS ALLOWANCE (PNA) WHEN PROGRAM REQUIREMENTS ARE MET AND THE CLIENT IS A RESIDENT OF A FACILITY FOR AT LEAST THIRTY (30) CONSECUTIVE DAYS, AS FOLLOWS:
1. IN A GENERAL MEDICAL AND SURGICAL HOSPITAL;
2. IN A NURSING HOME, ASSISTED LIVING RESIDENCE, OR, INTERMEDIATE CARE FACILITY, GROUP HOME, HOST HOME, OTHER LONG-TERM CARE FACILITY, OR ADULT FINANCIAL APPROVED SETTING.
E. THE FOLLOWING PERSONS ARE NOT ELIGIBLE FOR A PNA OR AND-CS GRANT PAYMENTS:
1. INMATES IN A PENAL INSTITUTION; OR,
2. RESIDENTS IN AN UNLICENSED PRIVATE OR UNCERTIFIED PUBLIC FACILITY.
F. THE AND-CS PERSONAL NEEDS ALLOWANCE MAXIMUM SHALL BE SEVENTY-NINE DOLLARS ($79) EFFECTIVE OCTOBER 1, 2016. THE AND-CS GRANT SHALL NOT BE REDUCED UNTIL THE MONTH FOLLOWING THE FIRST FULL CALENDAR MONTH THAT THE CLIENT IS A RESIDENT IN AN APPROVED FACILITY.
G. IF THE SOCIAL SECURITY ADMINISTRATION (SSA) IS RECOVERING ANY PORTION OF THE CLIENT'S SSI PAYMENT DUE TO AN OVERPAYMENT OF BENEFITS, AND-CS SHALL BE CALCULATED BASED ON THE GROSS SSI PAYMENT AND NOT THE RECEIVED AMOUNT.
3.549 AND-CS INCOME DISREGARDS AND DEEMED INCOME
A. IF THE CLIENT HAS INCOME, APPLY THE FOLLOWING INCOME DISREGARDS:
1. TO DETERMINE COUNTABLE EARNED INCOME:
A. DEDUCT $65 FROM THE MONTHLY GROSS INCOME; AND,
B. DIVIDE THE REMAINDER BY TWO (2).
C. THE RESULT IS THE COUNTABLE EARNED INCOME.
2. TO DETERMINE COUNTABLE UNEARNED INCOME:
A. DETERMINE THE CLIENT'S UNEARNED INCOME FROM ALL SOURCES.
B. SUBTRACT ANY AMOUNT RECEIVED FROM SSI.
C. DEDUCT $20 FROM THE REMAINDER.
1. IF THE CLIENT IS MARRIED, THE $20 DISREGARD SHALL BE SPLIT BETWEEN THE CLIENT AND THE SPOUSE SO THAT NO MORE THAN A $20.00 DISREGARD IS APPLIED FOR THE MARRIED COUPLE.
2. A CLIENT WHO RECEIVES SSI ONLY, AND DOES NOT RECEIVE ANY OTHER UNEARNED INCOME, DOES NOT RECEIVE AN UNEARNED INCOME DISREGARD.
D. ADD THE FULL SSI INCOME BACK TO THE REMAINDER.
E. THE RESULT IS THE COUNTABLE UNEARNED INCOME.
F. IF THE CLIENT'S UNEARNED INCOME IS LESS THAN $20.00, THE DIFFERENCE BETWEEN THE GROSS UNEARNED INCOME AND THE $20.00 DEDUCTION SHALL BE APPLIED TO THE EARNED INCOME CALCULATION, IF APPLICABLE.
B. SUBTRACT THE COUNTABLE EARNED AND COUNTABLE UNEARNED INCOME FROM THE AND-CS GRANT STANDARD TO DETERMINE THE GRANT PAYMENT AMOUNT.
C. A PORTION OF THE EARNED INCOME OF AN AND-CS CLIENT'S SPOUSE SHALL BE DEEMED TO THE CLIENT, AS FOLLOWS:
1. DETERMINE THE SPOUSE'S MONTHLY GROSS INCOME.
2. DEDUCT $65.00 FROM THE MONTHLY GROSS INCOME; AND,
3. DIVIDE THE REMAINDER BY TWO (2).
4. THE RESULT IS THE AMOUNT DEEMED TO THE CLIENT.
D. A PORTION OF THE UNEARNED INCOME FOR THE AND-CS CLIENT'S SPOUSE SHALL BE DEEMED TO THE CLIENT, AS FOLLOWS:
1. DETERMINE THE SPOUSE'S MONTHLY GROSS UNEARNED INCOME.
2. DEDUCT ANY REMAINING UNEARNED INCOME DISREGARD REMAINING FROM THE CLIENT OR $20.00, WHICHEVER IS LESS. A COUPLE SHALL BE ALLOWED A COMBINED $20.00 DISREGARD, WHICH IS SPLIT BETWEEN THE CLIENT AND THE SPOUSE.
3. THE RESULT IS COUNTABLE UNEARNED INCOME AND IS DEEMED TO THE CLIENT.
E. WHEN THE AND-CS CLIENT IS AN UNEMANCIPATED CHILD UNDER EIGHTEEN (18) YEARS OF AGE, THE EARNED AND UNEARNED INCOME OF THE CHILD AND THE CHILD'S PARENTS SHALL BE SUBJECT TO DISREGARDS AND DEEMING, AS OUTLINED ABOVE. THE PARENTS' INCOME SHALL BE DEEMED USING THE SAME CALCULATIONS AS A SPOUSE.
F. IF A SPOUSE OR PARENT IS RECEIVING ADULT FINANCIAL GRANT PAYMENTS, SSI BENEFITS, OR MEDICAID ASSISTANCE AND HAS INCOME NO GREATER THAN THE SSI LIMIT, THEIR INCOME SHALL NOT BE CONSIDERED AS AVAILABLE TO THE AND-CS CLIENT AND SHALL NOT BE DEEMED. IF A SPOUSE IS INSTITUTIONALIZED AND THE CLIENT HAS RETAINED THE MMMNA, THE MMMNA SHALL BE DEDUCTED FROM THE INSTITUTIONALIZED SPOUSE’S TOTAL INCOME.
G. A SPONSOR'S INCOME CAN ONLY BE DEEMED TOWARDS THE NON-CITIZEN CLIENT HE OR SHE SPONSORS. THE AMOUNT OF EARNED AND UNEARNED INCOME TO DEEM FROM A SPONSOR(S) TO A CLIENT IS CALCULATED AS FOLLOWS:
1. THE TOTAL GROSS EARNED AND UNEARNED INCOME OF THE SPONSOR ARE ADDED TOGETHER.
2. THE FOLLOWING DEDUCTIONS ARE SUBTRACTED FROM THE TOTAL INCOME OF THE SPONSOR:
A. A DEDUCTION FOR THE SPONSOR EQUAL TO THE CURRENT SSI BENEFIT STANDARD, AS DEFINED IN SECTION 3.510, FOR AN INDIVIDUAL FOR THE MONTH IN WHICH ELIGIBILITY IS BEING DETERMINED; PLUS
B. A DEDUCTION FOR THE SPONSOR'S SPOUSE LIVING IN THE SAME HOUSEHOLD WITH THE SPONSOR, EQUAL TO ONE-HALF THE CURRENT SSI BENEFIT STANDARD, AS DEFINED IN SECTION 3.510, FOR AN INDIVIDUAL; OR A DEDUCTION FOR THE SPONSOR'S SPOUSE, WHO IS ALSO A CO-SPONSOR OF THE NON-CITIZEN CLIENT, EQUAL TO THE CURRENT SSI BENEFIT STANDARD FOR AN INDIVIDUAL; PLUS
C. A DEDUCTION EQUAL TO ONE-HALF THE SSI BENEFIT STANDARD, AS DEFINED IN SECTION 3.510, FOR AN INDIVIDUAL FOR EACH PERSON WHO IS A DEPENDENT OF THE SPONSOR (OTHER THAN THE NON-CITIZEN CLIENT AND THE NON-CITIZEN CLIENT'S SPOUSE).
3. THE DIFFERENCE BETWEEN THE TOTAL INCOME AND THE TOTAL DEDUCTIONS IS DEEMED AS UNEARNED INCOME TO THE NON-CITIZEN CLIENT. THIS DEEMED INCOME IS ADDED TO THE NON-CITIZEN CLIENT'S OWN INCOME TO DETERMINE THE TOTAL COUNTABLE INCOME.
4. COMPARE THE NON-CITIZEN CLIENT'S COUNTABLE INCOME TO THE INCOME STANDARD OF THE ADULT FINANCIAL PROGRAM FOR WHICH THE NON-CITIZEN CLIENT IS APPLYING TO DETERMINE ELIGIBILITY AND/OR THE GRANT PAYMENT AMOUNT.
5. IF MORE THAN ONE NON-CITIZEN CLIENT HAS THE SAME SPONSOR, ALL OF THE SPONSOR'S INCOME IS DEEMED TO EACH NON-CITIZEN CLIENT. DO NOT DIVIDE THE SPONSOR'S INCOME AMONG THE NON-CITIZEN CLIENTS.
H. THE COUNTY DEPARTMENT SHALL DETERMINE ALL COUNTABLE EARNED AND UNEARNED INCOME AVAILABLE FROM THE CLIENT, THE SPOUSE/PARENTS, AND THE SPONSOR(S). THE TOTAL SHALL BE DEDUCTED FROM THE AND-CS GRANT STANDARD TO DETERMINE THE CLIENT'S GRANT PAYMENT AMOUNT.
3.550 FINANCIAL REDETERMINATION [Eff. 3/2/14]
A. A redetermination of eligibility shall mean a case review/determination of necessary information and verifications to determine ongoing eligibility every twelve (12) to twenty-four (24) months for OAP and AT LEAST every twelve (12) months for AND. The eligibility period for OAP shall be determined by the statewide automated system based on the following factors:
1. OAP cases shall be redetermined, at a minimum, every twenty-four (24) months when:
a. There is no earned income; and,
b. The value of the client's countable resources are at least two hundred dollars ($200) under the client's resource limit, as defined in Section 3.520.72.A.
2. All other OAP cases shall be redetermined every twelve (12) months, at a minimum.
B. Clients shall file their redetermination with the county DEPARTMENT by the fifteenth (15th) of the month as specified in the redetermination packet.
1. A client's failure to file a RRR REDETERMINATION timely may delay the determination of benefits AND GRANT PAYMENTS.
2. THE COUNTY DEPARTMENT MUST MAKE AN ELIGIBILITY DECISION ON CComplete, TIMELY-RECEIVED forms ON OR BEFORE received timely must be acted upon by the county department by the last day of the month IN WHICH THE FORMS WERE DUE.
3. Complete forms received between the 16th and the last day of the month the redetermination is due must be approved or denied as soon as possible. but no later than the tenth (10th) calendar day in the following month. THE COUNTY DEPARTMENT WILL HAVE TEN (10) DAYS TO ACT ON SUCH REDETERMINATIONS, TO INCLUDE SCHEDULING AND CONDUCTING THE INTERVIEW AND REQUESTING ANY NECESSARY VERIFICATION. THE COUNTY MUST MAKE AN ELIGIBILITY DECISION ON REDETERMINATION FORMS RECEIVED BETWEEN THE 16TH AND LAST DAY OF THE MONTH WITHIN THIRTY (30) DAYS FROM RECEIPT OF SUCH REDETERMINATION.
C. The county department shall schedule AND CONDUCT an interview with the client at each redetermination.
1. THE CLIENT SHALL BE OFFERED The interview shall be an in-person interview if the county department has not had an in-person interview with the client within three (3) years of the RRR due date.
a. Exception to this rule is allowed if there is good cause, as outlined in Section 3.510 3.520.4, C; or,
b. If the client resides in a long-term care facility and the county department is able to verify information through the facility administration; or,
c. Has regular monitoring (to include face-to-face visits) by a Single Entry Point case manager.
2. IF THE CLIENT DOES NOT ELECT AN IN-PERSON INTERVIEW, THE COUNTY SHALL SCHEDULE A PHONE INTERVIEW. The interview may be a phone interview if the county department has had an in-person interview with the client within the past three years.
3. THE CLIENT SHALL BE PROVIDED WRITTEN NOTICE AT LEAST FOUR (4) DAYS IN ADVANCE OF THE SCHEDULED INTERVIEW. THE CLIENT MAY PROVIDE A WRITTEN OR VERBAL WAIVER THAT WRITTEN NOTICE OF THE SCHEDULED INTERVIEW IS NOT NECESSARY WHEN THE COUNTY DEPARTMENT IS ABLE TO CONDUCT THE INTERVIEW DURING REDETERMINATION PROCESSING. When a redetermination interview is scheduled, the client shall be notified at least ten (10) calendar days in advance, in writing, of: WRITTEN NOTICE SHALL INCLUDE:
a. The date and time for the interview;
b. IDENTIFICATION OF AAny documentation that may be needed; AND including, but not limited to:
1) Non-financial eligibility requirements, as outlined in Section 3.520.6; and,
2) Resources, as outlined in Section 3.520.72; and,
3) Income, as outlined in Section 3.520.78.
c. The opportunity to reschedule the appointment or make other arrangements in the event of good cause.
4. When the client does not keep the INTERVIEW appointment and does not request an alternate time or arrangement, AS DESCRIBED IN SECTION 3.520.4.C, GRANT PAYMENTSbenefits will be discontinued FOLLOWING THE POLICIES OUTLINED IN SECTION 3.554.
D. To redetermine eligibility a case review must be conducted and necessary verification must be received to determine ongoing eligibility.
1. If the client is approved and is receiving SSI benefits and has no other earned or unearned income, the income and resources received through the federal State Data Exchange (SDX) OR THE FEDERAL STATE VERIFICATION ELIGIBILITY SYSTEM (SVES) interface shall be considered verified upon receipt.
a. The county department shall verify REVIEW non-financial eligibility AND VERIFY ANY CHANGES; and,
b. If the county department has obtained or received information related to income, resources, or non-financial eligibility requirements that is contrary to the SDX OR SVES interfaceS, the county department shall independently verify the information; and,
c. The county department shall forward such contrary information to the local Social Security Administration office.
2. During the redetermination process AND PRIOR TO ELIGIBILITY DETERMINATION, the county worker shall:
a. Conduct an interview;
b. Explain the purpose of the interview and the use of the information supplied by the client on the redetermination form and any additional required forms;
c. Inform the client in writing that Social Security Numbers will be used to request and exchange information with other agencies as part of the eligibility process, including the Department of Labor and Employment (state wage and unemployment data), AND THE Social Security Administration, and Internal Revenue Service;
d. Have the client complete the form(s) or PROVIDE ASSISTANCE TO THE CLIENT IN COMPLETING complete the form(S) on behalf of the client;
e. Explain the appeal rights to the client as outlined in Section 3.587 3.850, et seq. (9 C.C.R. 2503-8);
f. Witness the signature of the client and sign as a person who helped complete the form(S), when applicable;
g. Review documents, verifications, and any other information supplied by the client with the client in order to obtain clarification if needed;.
h. Request updated verifications for all income, resources, and non-financial eligibility requirements WHICH HAVE CHANGED. THIS MAY to include, but IS not limited to:
1) Newly declared, such as a new vehicle;
2) Previously declared, such as a change in marital status; AND,
3) Changes from the previous RRR REDETERMINATION, such as closure of a bank account.; and,
4) Changes in value, such as an increase in the cash surrender value of life insurance policies.
E. Any time while receiving Adult Financial program GRANT PAYMENTSbenefits, if there is questionable information regarding the circumstances of a household OR THE COUNTY DEPARTMENT RECEIVES INFORMATION ABOUT CHANGES IN A HOUSEHOLD’S CIRCUMSTANCES BUT CANNOT DETERMINE THE EFFECT OF THOSE CHANGES ON GRANT PAYMENTS, the county worker can request a CONTACT redetermination. THE COUNTY DEPARTMENT SHALL SEND A REQUEST FOR CONTACT NOTICE REQUESTING THE CLIENT ATTEND AN INTERVIEW APPOINTMENT. THE INTERVIEW SHOULD BE IN-PERSON UNLESS GOOD CAUSE APPLIES WHICH WOULD ALLOW FOR A PHONE INTERVIEW IN LIEU OF THE IN-PERSON INTERVIEW. IF THE CLIENT DOES NOT ATTEND THE INTERVIEW APPOINTMENT OR REQUEST AN ALTERNATE TIME OR ARRANGEMENT, AS SPECIFIED IN SECTION 3.520.4.C., THE CASE SHALL BE DISCONTINUED. The county department shall MAKE A REQUEST FOR CONTACT generate an intermittent redetermination when:
1. It receives information that would contradict eligibility or that is questionable; or,
2. It suspects possible fraud; or,
3. It receives direction to do so from the State Department; or,
4. IT IS OOtherwise reasonable TO DO SO under the prudent person principle.
F. Forms that the client is required to complete shall be mailed to the client at least thirty (30) calendar days prior to the first of the month in which the eligibility redetermination is due. This is considered the prior notice period. A review of the case record will indicate the forms required based on individual case circumstances. The following procedures relate to Mmail-out redeterminations SHALL BE CONDUCTED AS FOLLOWS:
1. A redetermination form shall be mailed to the client;
2. Form(s) shall be completed, signed by the client, and returned to the county department no later than redetermination due date; and,
3. When the client is unable to complete the form(s) due to physical, mental, or emotional disabilities, and has no one to help, the county department shall assist the client to complete the form(s), unless there is another available legal or other resource that is willing and able to assist the client.
4. When the client is unable to complete the redetermination packet in a timely manner due to good cause, the county department shall extend the due date up to thirty (30) calendar days. The assistance or referral action of the county department shall be recorded in the case record.
G. When the county department receives the completed RRR REDETERMINATION packet, it shall:
1. Date stamp the redetermination form(s) and corresponding verification.
2. Thoroughly review the RRR REDETERMINATION packet for completeness, accuracy, and consistency. All factors shall be evaluated as to their effect on eligibility and payment.
a. If the client failed to sign the RRR REDETERMINATION PACKET, the RRR REDETERMINATION packet shall be returned to the client for signature with instructions to return the signed packet before the end of the client's eligibility period. AN UNSIGNED REDETERMINATION PACKET SHALL BE CONSIDERED INCOMPLETE AND SHALL NOT BE PROCESSED BY THE COUNTY DEPARTMENT.
b. If the RRR REDETERMINATION PACKET is incomplete, the county department shall ask ADDITIONAL CLARIFYING QUESTIONS AND REQUEST for all necessary verification.
3. Review the RRR REDETERMINATION packet for changes to:
a. Non-financial eligibility requirements, as outlined in Section 3.520.6; and,
b. Resources, as outlined in Section 3.520.72; and,
c. Income, as outlined in Section 3.520.78.
4. Document verifications in the case file, UTILIZING THE PROCESS DESCRIBED IN SECTION 3.520.4.D. The case file shall be used as a checklist in the redetermination process, and shall be used to keep track of matters requiring further action. When additional information is needed:
a. Due to incomplete form(s) or lack of verification, a notice shall be mailed to the client. The notice shall specify the items that are required for a redetermination to be completed in order to determine eligibility and/or payment;
b. Due to inaccurate or inconsistent data, the client may be contacted by telephone or be requested to make an office visit, to secure the proper information. COLLATERAL CONTACTS AND INTERFACES SHALL BE USED TO GATHER INFORMATION WHENEVER POSSIBLE.
c. Complete forms must be acted upon promptly by the county.
H. If the redetermination form is TIMELY RECEIVED BUT IS received by the first filing deadline, but it is incomplete, a correction notice shall be sent to the client advising the client that the redetermination form is incomplete and must be corrected by the LAST DAY OF THE MONTH IN WHICH THE FORMS WERE DUE correction deadline to avoid termination and/or the county department shall work with the client to complete the form.
I. When the information provided on the redetermination form, or otherwise provided by the client, is the basis for reduction in the amount of assistance or in termination of assistance FOLLOW THE POLICIES OUTLINED IN SECTION 3.554., such actions shall be taken after adequate notice is given.
3.551 LATE REDETERMINATIONS [Eff. 3/2/14]
When a client fails to return his OR /her redetermination packet BY prior to the last day of the month of the expiring eligibility period, the client's case shall be discontinued FOLLOWING THE POLICIES OUTLINED IN SECTION 3.554.
A. If the client returns the redetermination packet within thirty (30) calendar days after discontinuation, the following processing requirements shall be implemented:
1. If the client has good cause, the client's GRANT PAYMENTSbenefits shall be reinstated. There shall be no break in the client's GRANT PAYMENTSbenefit. THE COUNTY DEPARTMENT WILL HAVE TEN (10) DAYS TO ACT ON SUCH REDETERMINATIONS, TO INCLUDE SCHEDULING AND CONDUCTING THE INTERVIEW AND REQUESTING ANY NECESSARY VERIFICATION. THE COUNTY MUST MAKE AN ELIGIBILITY DECISION ON REDETERMINATION FORMS RECEIVED WITHIN THIRTY (30) CALENDAR DAYS AFTER DISCONTINUATION WITHIN THIRTY (30) DAYS FROM RECEIPT OF SUCH REDETERMINATION.
2. If the client does not have good cause, the county department shall use the redetermination packet as a new application. The date of the new application shall be the date the county department received the redetermination packet. There shall be a break in the client's GRANT PAYMENTSbenefit.
B. If the client returns the redetermination packet thirty-one (31) or more days after the discontinuation, the county department shall require the client to complete a new application. This will result in a break in the client's GRANT PAYMENTSbenefit.
3.552 REPORTING CHANGES
A. WHEN A CLIENT IS CERTIFIED FOR ADULT FINANCIAL GRANT PAYMENTS, A CERTIFICATION PERIOD IS ASSIGNED. DURING THE CERTIFICATION PERIOD, THE CLIENT IS REQUIRED TO REPORT AND PROVIDE VERIFICATION OF CHANGES APPLICABLE TO ELIGIBILITY. EXAMPLES OF CHANGES INCLUDE, BUT ARE NOT LIMITED TO, INCOME, MARITAL STATUS, HOUSEHOLD COMPOSITION, SHELTER COSTS, RESOURCES, AND CITIZENSHIP STATUS. IF A CLIENT DOES NOT REPORT CHANGES AS REQUIRED AND AS A RESULT IS OVERPAID GRANT PAYMENTS, THE CLIENT WILL BE HELD LIABLE FOR REPAYING ANY GRANT PAYMENTS HE OR SHE WAS NOT ELIGIBLE TO RECEIVE.
B. SOME CHANGES MAY BE REPORTED DIRECTLY TO THE COUNTY DEPARTMENT THROUGH INTERFACES. UNLESS OTHERWISE SPECIFIED IN SECTION 3.520.5, INFORMATION THAT IS RECEIVED THROUGH INTERFACES IS CONSIDERED VERIFIED UPON RECEIPT AND IS NOT SUBJECT TO ADDITIONAL VERIFICATION BY THE CLIENT. THE DATE OF THE CHANGE FOR THIS INFORMATION SHALL BE CONSIDERED THE DATE THE INFORMATION IS REPORTED TO THE COUNTY THROUGH AN INTERFACE. THE COUNTY DEPARTMENT SHALL ACT ON THESE CHANGES WITHIN TEN (10) CALENDAR DAYS OF THE DATE OF THE CHANGE, UNLESS OTHERWISE PRESCRIBED IN SECTION 3.520.5.
C. CLIENTS SHALL BE REQUIRED TO REPORT AND PROVIDE VERIFICATION OF CHANGES IN CIRCUMSTANCES BY THE 10TH OF THE MONTH FOLLOWING THE MONTH IN WHICH THE CHANGE OCCURRED. THE COUNTY DEPARTMENT HAS UP TO TEN (10) CALENDAR DAYS TO ACT ON THE INFORMATION FROM THE DATE THE CHANGE IS REPORTED AND VERIFIED, AS OUTLINED IN SECTION 3.553.
D. THE CLIENT SHALL BE ALLOWED TO REPORT CHANGES IN PERSON, BY TELEPHONE, IN WRITING, OR ELECTRONICALLY. CHANGES REPORTED BY THE CLIENT BY TELEPHONE, ELECTRONICALLY, OR IN PERSON SHALL BE ACTED UPON IN THE SAME MANNER AS THOSE REPORTED IN WRITING. IF REPORTING BY MAIL, CLIENTS WILL HAVE MET THE REPORTING REQUIREMENT PROVIDED THE ENVELOPE IS POSTMARKED BY THE 10TH OF THE MONTH FOLLOWING THE MONTH IN WHICH THE CHANGE OCCURRED.
E. IF ADDITIONAL VERIFICATION IS REQUIRED TO PROCESS THE REPORTED CHANGE, THE CLIENT SHALL BE NOTIFIED OF THE VERIFICATION NEEDED AND THE DEADLINE FOR SUBMITTING REQUIRED VERIFICATION TO THE COUNTY DEPARTMENT, UTILIZING THE PROCESS DESCRIBED IN SECTION 3.520.4.D. THE NOTICE SHALL INFORM THE CLIENT THAT THE CHANGE MUST BE VERIFIED PRIOR TO ACTION BEING TAKEN BY THE COUNTY DEPARTMENT IF GRANT PAYMENTS ARE TO BE INCREASED.
F. WHEN A CHANGE IN CLIENT CIRCUMSTANCES OCCURS AND THE COUNTY DEPARTMENT HAS DETERMINED THAT A CLIENT HAS FAILED TO COOPERATE IN PROVIDING VERIFICATION NECESSARY TO DETERMINE ELIGIBILITY. THE CLIENT'S ELIGIBILITY SHALL BE TERMINATED FOLLOWING WRITTEN TIMELY NOTICE. CLIENTS EXPERIENCING DIFFICULTY IN OBTAINING NECESSARY VERIFICATION SHALL BE ASSISTED BY THE COUNTY DEPARTMENT EITHER IN OBTAINING THE DOCUMENTARY EVIDENCE OR BY MAKING A COLLATERAL CONTACT. THE COUNTY DEPARTMENT MUST ENSURE THAT THE CLIENT WAS NOTIFIED OF THE NEEDED VERIFICATION AND AT LEAST ELEVEN (11) CALENDAR DAYS WAS ALLOWED TO OBTAIN THE VERIFICATION.
3.553 ACTION ON CHANGES
A. A CHANGE SHALL BE CONSIDERED TO BE REPORTED AS OF THE DATE THE COUNTY DEPARTMENT IS NOTIFIED OF THE CHANGE. A CHANGE SHALL BE CONSIDERED VERIFIED AS OF THE DATE THE COUNTY DEPARTMENT RECEIVES VERIFICATION OF THE CHANGE. IF A CHANGE IS REPORTED AND VERIFIED BY THE TENTH (10TH) OF THE MONTH FOLLOWING THE DATE OF THE CHANGE, THE CHANGE SHALL BE CONSIDERED TIMELY REPORTED BY THE CLIENT.
B. THE COUNTY DEPARTMENT SHALL PROCESS THE CHANGE WITHIN TEN (10) CALENDAR DAYS FROM THE DATE THE CHANGE WAS VERIFIED, TO BE CONSIDERED TIMELY PROCESSED BY THE COUNTY DEPARTMENT. CHANGES REPORTED BY CLIENTS SHALL BE DOCUMENTED IN THE CASE RECORD TO INDICATE THE CHANGE, THE DATE THE CHANGE WAS REPORTED, AND THE DATE THE CHANGE WAS VERIFIED. IF THE CHANGE CAUSES A CHANGE TO THE CLIENT’S GRANT, A NOTICE OF ACTION FORM SHALL BE ISSUED TO INFORM THE CLIENT OF THE CHANGE.
C. CHANGES SHALL BE ACTED UPON AS FOLLOWS:
1. CHANGES THAT RESULT IN AN INCREASE IN GRANT PAYMENTS SHALL TAKE EFFECT THE MONTH FOLLOWING THE MONTH THE CHANGE WAS VERIFIED BY THE CLIENT. DUE TO THE TIME REQUIRED FOR PROCESSING BY THE COUNTY DEPARTMENT, RECEIPT OF ANY INCREASE IN GRANT PAYMENTS MAY BE DELAYED BEYOND THE MONTH FOLLOWING THE MONTH OF THE CHANGE.
2. CHANGES THAT RESULT IN A DECREASE IN GRANT PAYMENTS OR TOTAL INELIGIBILITY SHALL AFFECT A CASE FOLLOWING THE POLICIES OUTLINED IN SECTION 3.554.
D. IF GRANT PAYMENTS ARE OVER-PAID BECAUSE A CLIENT FAILS TO TIMELY REPORT AND/OR TIMELY VERIFY CHANGES IN CIRCUMSTANCES OR INCOME AS REQUIRED, A CLAIM SHALL BE ESTABLISHED AND A NOTICE OF OVERPAYMENT AND A PUBLIC ASSISTANCE REPAYMENT AGREEMENT FORM REFERENCED IN SECTION 3.582.B.4. WILL BE MAILED. IF THE OVER-PAYMENT IS DISCOVERED WITHIN THE CERTIFICATION PERIOD, THE CLIENT MUST BE GIVEN WRITTEN TIMELY NOTICE IF GRANT PAYMENTS ARE TO BE REDUCED.
3.554 TIMELY AND ADEQUATE NOTICE
A. THE COUNTY DEPARTMENT AND/OR THE SINGLE ENTRY POINT (SEP) SHALL NOTIFY A CLIENT OF ANY CHANGE FROM HIS OR HER PRIOR GRANT PAYMENT AMOUNT, THE REASON FOR THE ACTION, AND THE DATE THE ACTION BECOMES EFFECTIVE IN WRITING.
B. CLIENTS SHALL RECEIVE WRITTEN TIMELY NOTICE, GIVING AT LEAST ELEVEN (11) CALENDAR DAYS ADVANCE NOTICE BEFORE ANY ADVERSE ACTION, SUCH AS A GRANT PAYMENT REDUCTION, SUSPENSION, TERMINATION OR DENIAL, BECOMES EFFECTIVE DURING THE CERTIFICATION PERIOD, EXCEPT AS SPECIFIED IN SECTION 3.554.C. THE NOTICE SHALL EXPLAIN THE REASON FOR THE PROPOSED ACTION AND THE DATE THE ACTION BECOMES EFFECTIVE.
1. WHEN ACTING ON A CHANGE IN ACCORDANCE WITH SECTION 3.553, IF THE ELEVEN (11) CALENDAR DAY TIMELY NOTICE PERIOD CAN BE GIVEN WITHIN THE MONTH THE WRITTEN TIMELY NOTICE IS SENT, THE CHANGE WILL BECOME EFFECTIVE THE FIRST DAY OF THE FOLLOWING MONTH.
2. IF THE 11 CALENDAR DAY TIMELY NOTICE PERIOD CONCLUDES IN THE FOLLOWING MONTH, THE CHANGE SHALL BECOME EFFECTIVE THE FIRST DAY OF THE MONTH AFTER WHICH THE TIMELY NOTICE PERIOD CONCLUDED.
3. IF THE TIMELY NOTICE PERIOD ENDS ON A WEEKEND OR HOLIDAY AND A REQUEST FOR A STATE LEVEL FAIR HEARING AND CONTINUATION OF GRANT PAYMENTS IS RECEIVED THE FIRST BUSINESS DAY AFTER THE TIMELY NOTICE PERIOD, THE REQUEST SHALL BE CONSIDERED TIMELY RECEIVED.
C. ADEQUATE NOTICE, NOT TIMELY NOTICE, IS REQUIRED IN THE FOLLOWING SITUATIONS:
1. WHEN FACTS INDICATE AN OVERPAYMENT BECAUSE OF PROBABLE FRAUD OR AN INTENTIONAL PROGRAM VIOLATION AND SUCH FACTS HAVE BEEN VERIFIED TO THE EXTENT POSSIBLE, PRIOR NOTICE SHALL BE MAILED AT LEAST FIVE (5) CALENDAR DAYS BEFORE THE PROPOSED EFFECTIVE DATE.
2. THE COUNTY DEPARTMENT HAS DETERMINED THAT THE STATE PRESCRIBED MEDICAL CERTIFICATION HAS EXPIRED.
3. THE COUNTY DEPARTMENT AND/OR SEP HAS DETERMINED THAT THE CLIENT HAS STOPPED RECEIVING HOME CARE ALLOWANCE (HCA) AND IS NOW RECEIVING HOME AND COMMUNITY BASED SERVICES (HCBS).
4. THE CLIENT HAS DIED.
5. THE CLIENT HAS PROVIDED A CLEAR STATEMENT WHICH STATES THAT HE OR SHE NO LONGER WISHES TO RECEIVE ASSISTANCE/SERVICES.
6. THE CLIENT BEGINS RECEIVING SSI OR SSDI. A CLAIM TO RECOVER THE AND-SO OR COLORADO SUPPLEMENT GRANT PAYMENTS THAT ARE ISSUED IN THE SAME MONTH THAT THE SSI OR SSDI BENEFITS ARE RECEIVED SHALL BE CREATED AND THE CLIENT SHALL BE LIABLE TO REPAY THE AND-SO OR COLORADO SUPPLEMENT GRANT PAYMENTS THAT WERE ISSUED.
7. AT APPLICATION OR REDETERMINATION, WHEN A CERTIFICATION PERIOD HAS NOT YET BEEN SET.
D. IF THE CHANGE IN CIRCUMSTANCES REQUIRES A REDUCTION OR TERMINATION OF GRANT PAYMENTS, THE FOLLOWING ACTION WILL BE REQUIRED:
1. SEND A WRITTEN TIMELY NOTICE.
2. IF A CLIENT REQUESTS A COUNTY CONFERENCE, CONDUCT THE COUNTY CONFERENCE AS SPECIFIED IN SECTION 3.586. IF A CLIENT IS DISSATISFIED WITH THE RESULTS OF THE COUNTY CONFERENCE AND REQUESTS A STATE LEVEL FAIR HEARING BEFORE AN ADMINISTRATIVE LAW JUDGE, SUCH A REQUEST SHALL BE IN ACCORDANCE WITH SECTION 3.587.
IF A CLIENT DOES NOT REQUEST A COUNTY CONFERENCE AND ONLY REQUESTS A STATE LEVEL FAIR HEARING ANY TIME PRIOR TO THE EFFECTIVE DATE OF THE TIMELY NOTICE, AND THE CERTIFICATION PERIOD HAS NOT EXPIRED, THE CLIENT'S GRANT PAYMENTS SHALL BE CONTINUED ON THE BASIS AUTHORIZED IMMEDIATELY PRIOR TO THE TIMELY NOTICE. CONTINUED GRANT PAYMENTS SHALL NOT BE ISSUED FOR A PERIOD BEYOND THE END OF THE CURRENT CERTIFICATION PERIOD. GRANT PAYMENTS SHALL BE CONTINUED UNTIL A FINAL DECISION HAS BEEN MADE BY THE OFFICE OF APPEALS OR UNTIL THE CERTIFICATION PERIOD ENDS, WHICHEVER OCCURS FIRST. THE COUNTY DEPARTMENT SHALL EXPLAIN TO THE CLIENT THAT REPAYMENT WILL BE REQUIRED FOR THE AMOUNT OF ANY GRANT PAYMENTS DETERMINED BY THE HEARING OFFICER TO HAVE BEEN OVER-PAID OR THE CONTINUED GRANT PAYMENTS TO WHICH THE CLIENT WAS NOT ELIGIBLE TO RECEIVE.
3. IF THE CERTIFICATION PERIOD EXPIRES BEFORE THE HEARING PROCESS IS COMPLETED, THE CLIENT MAY REAPPLY FOR BENEFITS.
4. IF THE CLIENT DOES NOT APPEAL THE TIMELY NOTICE TO DECREASE OR TERMINATE GRANT PAYMENTS WITHIN THE TIMELY NOTICE PERIOD, THE CHANGES SHALL BE MADE IN ACCORDANCE WITH TIMEFRAMES OUTLINED IN SECTION 3.553, C.
3.560 CASE TRANSFERS [Eff. 3/2/14]
A. If the client's eligibility has been discontinued and he OR /she reports a change of address after the discontinuation, the client shall be required to complete a new application for benefits in the new county department of residence. This will result in a break in the client's GRANT PAYMENTSbenefits.
B. If the client notifies a county department of a change in address while the client's case is approved, the following steps shall be completed:
1. The case transfer shall be completed OR ADDITIONAL VERIFICATION SHALL BE REQUESTED within three (3) working days if no additional verification is needed. VERIFICATION WILL BE ACTED ON BY THE TRANSFERRING COUNTY PRIOR TO TRANSFERRING IN ACCORDANCE WITH TIMELINESS REQUIREMENTS OUTLINED IN SECTION 3.553.
2. Prior to transferring an ongoing case to the new county department, the originating county department shall update the case to address any unresolved IEVS, discrepancies, claims, and any unworked case changes.
3. The new county department may choose to pull a case from the originating county department.
a. If the new county department chooses to pull the case, it is responsible for addressing any unresolved IEVS, notifying the originating county department that the case has been transferred, and requesting from the originating county department any unworked changes so the new county department can process the changes.
b. The originating county department shall be responsible for researching and documenting any discrepancies and claims.
C. If the client notifies the county department of a change of address during his OR /her RRR REDETERMINATION certification period, the following apply:
1. The county department receiving the change of address notice shall:
a. Notify the client of the RRR REDETERMINATION due date and the affected benefit month; and,
b. Determine whether the client has received the RRR REDETERMINATION packet.
1) If yes, the client shall be instructed to complete and return the RRR REDETERMINATION packet to the new county department.
2) If no, the new county department shall mail an RRR REDETERMINATION packet to the client's new address, ask the client to come to the office to complete an RRR REDETERMINATION, or ask the client to complete the RRR REDETERMINATION through the online application process.
2. If a client submits their RRR REDETERMINATION packet to the originating county department prior to the end of the eligibility period and subsequently submits a new application in the client's new county department of residence before the RRR REDETERMINATION is processed, the date of the RRR REDETERMINATION shall be the date of application. The new county department may process the RRR REDETERMINATION at the same time the new application is processed.
3. When the client's RRR REDETERMINATION packet has been mailed and then the client reports a change in address, the following shall apply:
a. If the client reports the change of address and returns the RRR REDETERMINATION packet to the originating county department, the originating county department shall process the RRR REDETERMINATION and then transfer the case to the new county department.
b. If the client reports the change of address to the new county department prior to returning his OR /her RRR REDETERMINATION packet to the originating county department, the originating county department shall instruct the client to return their RRR REDETERMINATION to the new county department for processing.
c. If the client reports the change of address to the new county department after returning his OR /her RRR REDETERMINATION packet to the original county department, the RRR REDETERMINATION shall be processed by the original county department and then transferred to the new county department.
4. When the client's RRR REDETERMINATION packet has not been mailed and the client reports the change in address during the recertification timeframe, the county department receiving the change of address shall:
a. Update the client's address in the statewide automated system to ensure the RRR REDETERMINATION is mailed to the client's new address when it is generated by the statewide automated system;
b. Inform the client that his OR /her case shall be transferred to the new county department; and,
c. Provide the client with the name and address of the new county department office; and,
d. The originating county department shall transfer the case.
D. For AND-SO cases, if the medical certification form is expiring within thirty (30) calendar days of the reported change of address, the originating county department is strongly encouraged to send the medical certification form to the client immediately.
1. If the form is returned to the originating county department, the originating county department shall process the medical RRR.
2. If the form is returned to the new county department, the new county department shall process the medical RRR.
3. If the form was not provided to the client at the time of the reported change of address, the new county department shall provide the client with the form and process the medical RRR.
3.570 HOME CARE ALLOWANCE, SPECIAL POPULATIONS HOME CARE ALLOWANCE, ADULT FOSTER CARE, AND BURIAL
3.570.1 HOME CARE ALLOWANCE [Eff. 3/2/14]
3.570.11 Purpose of Program [Eff. 3/2/14]
A. Home Care Allowance (HCA) is a special cash payment made to a client, FIVE (5) YEARS OF AGE OR OLDER for the purpose of securing in-home, personal care services.
1. HCA is a non-entitlement program; and,
2. HCA CCannot be received while receiving Home and Community Based Services or Adult Foster Care; and,
3. HCA is designed to serve clients with the lowest functional abilities and the greatest need for paid care.
B. Effective September 1, 2018, the HCA grant standard maximums are as follows:
1. Tier 1 - $330.00
2. Tier 2 - $472.00
3. Tier 3 - $605.00
C. The tier grant standard maximums shall be lower for certain clients who have income greater than program limits, as defined in Section 3.570.13, B, or for clients with special circumstances, as defined in Section 3.570.13, D.
D. The HCA grant is not taxable income to the client. The payment made to the care provider using the HCA grant received by the client is income to the care provider and subject to taxation under State and Federal laws.
E. The HCA grant standards shall be adjusted to stay within available appropriations. Appeals shall not be granted for these adjustments.
F. In addition to the regular monthly HCA grant payments, supplemental payments necessary to comply with the federal Maintenance of Effort (MOE) requirements, AS INCORPORATED IN SECTION 3.531.D., may be provided. These payments are supplements to regular grant payments, are not entitlements, and do not affect grant standards. Appeals shall not be allowed for MOE payment adjustments.
3.570.12 Definitions [Eff. 3/2/14]
“Activities of daily living” (ADL) means physical transfers, bladder care, bowel care, mobility, dressing, bathing, hygiene, and eating.
“Authorized representative” means an individual OR ORGANIZATION designated by the client, or by the parent or guardian of the client, if appropriate, to assist in acquiring or utilizing Home Care Allowance (HCA). The extent of the authorized representative's involvement shall be determined upon designation.
“BUS” means the Benefits Utilization System, the data system used to document case management activities for Home Care Allowance (HCA) clients.
“Care planning” means identifying client goals and choices for the care needed, services needed, appropriate service providers, and knowledge of the client and of community resources. The care plan shall be documented on the State Department prescribed care plan tool.
“Case management” means the assessment of a client's long-term care needs, development and implementation of a care plan, coordination and monitoring of the long-term care service delivery, evaluation of service effectiveness, and periodic reassessment of client needs.
“Client” means a current or past applicant or a current or past recipient of benefits under the HCA program.
“County department” means the county department of human/social services.
“Functional assessment” means the comprehensive evaluation of the client's ability to manage his OR /her activities of daily living and to determine the level of assistance the client requires to complete his OR /her activities of daily living.
“Home” means a non-facility residence. A HOME CANNOT INCLUDE A HOMELESS SHELTER OR OTHER TEMPORARY SETTING.
“Intake/screening/referral” means the initial contact with clients by the Single Entry Point (SEP) and shall include, but not be limited to, a preliminary screening of: the client's need for long term care services, the client's need for referral to other programs or services, eligibility for financial and program assistance, and the need for a comprehensive assessment.
“Medical leave” means the absence of the client from their home for more than twenty-four (24) hours due to admittance to a hospital or other facility, upon physician's order with the presumption on the part of the physician that the client will be returning to their home. Medical leave may be planned or unplanned.
“Non-medical leave” means the absence of the client from their home for more than twenty-four (24) hours for non-medical reasons that are not part of a client's care plan. Non-medical leave may be planned or unplanned.
“NON-SKILLED CARE” MEANS CARE PROVIDED BY LICENSED AND UNLICENSED NON-MEDICAL PERSONNEL, INCLUDING CAREGIVERS WHO ASSIST OR HELP THE INDIVIDUAL WITH DAILY TASKS SUCH AS BATHING, EATING, CLEANING THE HOME, AND PREPARING MEALS.
“Ongoing case management” means the evaluation of the effectiveness and appropriateness of services, on an ongoing basis, through contacts with the client, appropriate collaterals CONTACTS, and service providers.
“Reassessment” means a comprehensive re-evaluation by the case manager with the client and appropriate collaterals (such as family members, friends and/or caregivers) to determine the client's level of functioning, service needs, available resources, potential funding resources, and necessity for paid care. The reassessment of functional need shall be documented on the State Department prescribed assessment tool.
“Single Entry Point (“SEP”) agency” means the agency selected by HCPF the Colorado Department of Health Care Policy and Financing to provide case management functions for persons in need of long term care services within specific demographic areas, pursuant to Section 25.5-6-106, C.R.S.
“Skilled personal care” means some exceptions to personal care for activities of daily living that, because of the severe or complex nature of the client's need, requires a person with specialized training and skill to complete the task. Skilled personal care is not a paid service of the Home Care Allowance (HCA) program. See Section 8.489.30 (10 C.C.R. 2505-10) of the HCPF Colorado Department of Health Care Policy and Financing's rules for the definitions of personal care and the skilled exceptions to personal care.
“State Department” means the Colorado Department of Human Services.
3.570.13 Eligibility [Eff. 3/2/14]
A. Eligibility for HCA shall be based on both financial need and the client's functional needs. The client shall meet eligibility for both financial and functional requirements to be approved for an HCA payment.
B. To be financially eligible, the client shall:
1. Be approved for Supplemental Security Income (SSI) benefits and be receiving at least one dollar ($1) SSI payment; or,
2. Meet all eligibility criteria required for Aid to the Needy Disabled – State Only (AND-SO) program; or,
3. Have been receiving both Old Age Pension (OAP) GRANT PAYMENTSbenefits and HCA as of December 31, 2013 and remain continuously eligible for both benefits.
C. To be functionally eligible, the client shall have an HCA eligible functional assessment score. The functional assessment score is calculated by determining the client's functional capacity score and need for paid care score, as follows:
1. Functional Capacity: determined by assessing the client's ability to complete all activities of daily living (ADLs) and applying a score to his OR /her ability to complete the ADLs using the functional impairment scale; and,
2. Need for Paid Care: determined by identifying the unmet need for paid care and applying a score to the unmet need using the need for paid care scale, as outlined in Section 3.570.14; and,
3. Combining the functional capacity score and the need for paid care score to determine whether the client meets the minimum scores for eligibility and, if eligible, the tier of GRANT PAYMENTSbenefits to be approved, as follows:
|TIER |CAPACITY SCORE |NEED FOR PAID CARE SCORE |
|1 |21 or Higher |1 to 23 |
|2 |21 or Higher |24 to 37 |
|3 |21 or Higher |38 to 51 |
D. The SEP shall not approve the maximum authorized HCA amount for the tier if:
1. The client's needs can be fully or partially met through other paid or unpaid sources (excluding family and friends); or,
2. The HCA provider is able to provide the authorized services for less than the maximum authorized amount; or,
3. The client is unwilling or unable to use the maximum authorized amount.
E. Each client who meets the minimum functional assessment scoring requirements for the HCA program shall be functionally eligible for an HCA grant.
1. The authorization by the SEP shall be forwarded to the county department to determine financial eligibility.
2. Clients shall not be approved for HCA if financially ineligible, even if the client is functionally eligible.
3. Clients shall not be approved for HCA if functionally ineligible, even if the client is financially eligible.
F. If financially and functionally eligible for HCA, payment of the HCA authorized grant PAYMENT shall begin on the first day of the month following the month in which the HCA is approved OR THE PAYMENT EFFECTIVE DATE FROM THE STATE APPROVED FORM COMPLETED BY THE SEP, WHICHEVER DATE IS LATER. There shall be no retroactive HCA payments.
G. IF A CLIENT IS ASSESSED AND DOES NOT MEET THE FUNCTIONAL ASSESSMENT SCORING REQUIREMENTS, THE COUNTY DEPARTMENT AND SEP SHALL REFER THE CLIENT TO OTHER AGENCIES OR SERVICES AVAILABLE IN THE COMMUNITY, SUCH AS AREA AGENCIES ON AGING (AAA), AGING AND DISABILITY RESOURCES FOR COLORADO (ADRC), CENTERS FOR INDEPENDENT LIVING, AND/OR OTHER LOCAL COMMUNITY RESOURCES TO HELP WITH ANY IDENTIFIED NEEDS.
3.570.14 Functional Assessment Scoring [Eff. 3/2/14]
A. The need for skilled personal care shall not be included in the scoring of the need for paid care.
B. In order to be eligible for the Home Care Allowance program, each client shall score a minimum of twenty one (21) points when assessed for the ability to complete the activities of daily living (ADLs) using the following functional impairment scale:
1. Independent: score zero (0) if the client is physically able to perform all essential components of the ADL, with or without an assistive device.
2. Low: score one (1) if the client REQUIRES OCCASIONAL OR INTERMITTENT SUPERVISION OR STAND-BY ASSISTANCE IN A LIMITED NUMBER OF THE COMPONENTS OF THE ACTIVITY SUCH AS HE OR SHE is able to perform all essential components of the function, but impairment of function exists even with an assistive device. The client requires occasional or intermittent supervision or physical assistance in a limited number of the components of the activity.
a. Occasional or intermittent means the client does not need assistance daily, but may need assistance a few times a month or up to two (2) times per week.
b. Supervision or assistance means verbal prompting, cueing, and reminders, and means stand-by assistance or monitoring to help the client if he OR /she needs physical assistance up to two (2) times per week.
C. STAND-BY ASSISTANCE MEANS ASSISTANCE OR MONITORING TO HELP THE CLIENT IF HE OR SHE NEEDS PHYSICAL ASSISTANCE UP TO TWO (2) TIMES PER WEEK.
3. Moderate: score two (2) if the client is unable to perform the majority of the essential components of the function even with an assistive device, and the client requires hands-on and frequent assistance to accomplish the activity.
a. Frequent means the client needs assistance at least three (3) times per week and up to daily.
b. Hands-on assistance means the care provider must physically assist the client in completing the task.
4. Severe: score three (3) if the client is totally unable to perform the function and requires someone to perform the task, or the client requires constant supervision for the task.
C. The need for paid care score shall be based on the frequency of the client's unmet need for paid care and shall be modified by the following factors:
1. Need for paid care shall be scored as zero (0) when those services are provided through another program, agency, or individual.
2. For clients living with others, the need for paid care shall be scored only on the client's needs that are greater than and differentiated from typical household routine and the typical expectation of assistance by family members living in the home.
D. For children age FIVE (5) zero (0) through eighteen (18) years, functional capacity and need for paid care shall be scored according to age appropriate criteria. CHILDREN UNDER THE AGE OF 5 SHALL NOT BE SCORED AND ARE NOT ELIGIBLE TO RECEIVE HOME CARE ALLOWANCE.
E. The need for paid care scale is as follows:
|SCORE |FREQUENCY |DEFINITION OF FREQUENCY |
|0 |None |Client's needs are met. No need for paid care. |
|1 |Weekly |Client needs paid care up to and including once a week. |
|2 |Daily |Client needs paid care more than once a week and up to once a day, seven days |
| | |a week. |
|3 |Twice Daily |Client needs paid care two or more times per day at least five days per week. |
F. The functional assessment shall be scored on the State Department prescribed form, which shall list each activity of daily living, the functional capacity score and the need for paid care score for each ADL.
3.570.15 Activities of Daily Living [Eff. 3/2/14]
A. Activities of daily living (ADLs) shall be scored using the functional capacity impairment scale and the need for paid care scale.
B. The activities of daily living are:
1. Critical ADLs
a. Transfers: the ability to move between surfaces, such as getting in and out of bed; transferring from a bed to a chair, wheelchair, or walker; moving from a chair or wheelchair to a walker or to a standing position; and the ability to use assistive devices, including prosthetics. A child age 0 to 48 months shall not be scored for any transfers, including positioning. A child age 0 to 60 months shall not be scored for car seat, highchair, or crib transfers.
b. Bladder care: the extent to which the client has control of his OR /her bladder functions and the ability of the client to accomplish the tasks of toileting, including catheterizing, getting on and off the toilet, changing incontinence products, and cleaning him/herself. A child age 0 to 36 months shall not be scored for bladder incontinence or care.
c. Bowel care: the extent to which the client has control of his OR /her bowel functions and the ability of the client to accomplish the tasks of toileting, including getting on and off the toilet, changing incontinence products, and cleaning him/herself. A child age 0 to 36 months shall not be scored for bowel incontinence or care.
2. Basic ADLs
a. Mobility: the ability of the client to ambulate around the home and around essential places outside the home, with or without assistive devices. A child age 0 to 36 months shall not be scored for mobility.
b. Dressing: the ability of the client to accomplish all phases of the activities of dressing and undressing, including getting, putting on, fastening, and taking off all items of clothing, braces, and artificial limbs. A child age 0 to 60 months shall not be scored for dressing.
c. Bathing: the ability of the client to safely accomplish the task of washing body parts including getting into bathing waters, with or without assistive devices or whether the client requires stand by or hands-on assistance from another person. A child age 0 to 60 months shall not be scored for bathing.
d. Hygiene: the ability of the client to maintain personal hygiene other than bathing, including combing hair, brushing teeth, and clipping nails. A child age 0 to 60 months shall not be scored for hygiene.
e. Eating: the ability to cut food into manageable size pieces, chew, and swallow food, with or without assistive devices. A child age 0 to 48 months shall not be scored for eating.
3. Instrumental ADLs
a. Meals: the ability to safely prepare food to meet the basic nutritional requirements of the client, including cutting food, transferring food to cooking vessels and/or dishes, utilizing utensils, using a stove or microwave, and implementing special dietary needs. A child age 50 to 1814 years shall not be scored for meals.
b. Housekeeping: the ability to maintain the interior of the client's residence for the purpose of health and safety, such as wiping surfaces, cleaning floors, making a bed, and cleaning dishes. A child age 50 to 1812 years shall not be scored for housekeeping.
c. Laundry: the ability to gather and wash soiled clothing and linens; use washing machines and dryers; hang, fold, and put away clean clothing and linens. A child age 50 to 1812 years shall not be scored for laundry.
d. Shopping: the ability to purchase goods that are necessary for health and safety. Activities include the ability to make needs known, to make a list, reach for the needed items at the store, ability to estimate or determine the cost of the item, and to move items into the home and put them away. A child age 50 to 1815 years shall not be scored for shopping.
4. Supportive ADLs
a. Medicine: the ability to manage medications, including knowing the name of the medication, knowing the amount, frequency, and how to take the medicine, understanding the reason for taking it, and understanding possible side effects. A child age 50 to 14 years shall not be scored for medicine.
b. Appointment: the ability to schedule or make an appointment for essential activities, such as doctor visits, meetings with caseworkers, and transportation. A child age 50 to 1816 years shall not be scored for appointments.
c. Money: the ability to manage money, such as balancing a check book, writing checks or paying a bill electronically, and ability to understand financial decisions. A child age 50 to 1816 years shall not be scored for money.
d. Access: the ability to access resources or services in the community, such as locating the resource/service and completing the process necessary to receive the resource or service. A child age 50 to 1816 years shall not be scored for access.
e. Telephone: the ability to use the telephone to communicate essential needs, such as answering the phone in a reasonable time, speaking clearly and loudly enough to be understood, dialing the phone, initiating a conversation, hearing the caller, and placing a call in an emergency. A child age 50 to 12 years shall not be scored for telephone.
3.570.16 Care Planning and Case Management [Eff. 3/2/14]
A. Home Care Allowance may be used to purchase:
1. Non-skilled assistance with activities of daily living, as defined in Section 3.570.15; and;
2. Electronic monitoring, such as an emergency alert button; and,
3. One-time deep cleaning if a referral is initiated by Adult Protective Services and determined necessary by the SEP.
B. The SEP shall develop a care plan on the State Department prescribed form within ten (10) working days after program eligibility has been determined and prior to the arrangement for services.
1. The care plan shall be:
a. Signed by the client, SEP, and the service provider; AND,
b. Reviewed and updated at least once every twelve months; and,
c. Reviewed sooner if there is a change in the client's needs; and,
d. Provided to all parties.
2. Care planning shall include, but not be limited to, the following tasks:
a. IdentifyING and documentING care plan goals and client choices.
b. IdentifyING and documentING services, including type, duration and frequency.
c. ArrangINGe for services through a service provider, family member, or other provider of the client's choosing.
1) Providers shall be at least eighteen (18) years of age or older and have the ability to provide appropriate services. The SEP shall assist the client in finding an appropriate service provider, if needed.
2) The SEP shall negotiate with the client and care provider to arrive at the total number of paid care hours to be provided monthly.
3) The HCA payments shall be made directly to the client or authorized representative who shall pay the provider the agreed upon, authorized amount monthly.
4) No portion of the authorized HCA amount shall be withheld by the client for personal use. The entire HCA authorized amount shall be spent for HCA allowable services.
d. CoordinatINGe service delivery, negotiatINGe with the service provider and the client regarding service provision, and formalizINGe the provider agreement.
e. CompletINGe program requirements for the authorization of services.
f. ReferRING the client to community resources, as needed, and attemptING to develop resources for the client if a resource is not available within the client's community.
g. ExplainING the complaint procedures to the client, as listed on the care plan document.
h. ExplainING the client's right to appeal any decision.
3. The SEP shall meet the client's needs, with consideration of the client's choices, using the most cost effective methods available.
a. When services are available to the client at no cost from family, friends, volunteers, or others, these services shall be utilized before the purchase of services, providing these services adequately meet the client's needs.
b. When public dollars must be used to purchase services, the SEP shall ASSIST THE CLIENT IN COMPARING THE COST encourage the client to select the lowest cost provider of serviceS when quality of service is comparable.
c. The SEP shall ENSUREassure there is no duplication in services provided by any other public or privately funded services.
D. THE SEP SHALL DISCUSS WITH THE CLIENT IF OTHER WAIVERS AND/OR SERVICES ARE MORE APPROPRIATE OR BENEFICIAL TO THE CLIENT AND ASSESS AS NEEDED.
C. The SEP shall provide ongoing case management, as follows:
1. MonitorING the quality of care provided to THE clients.
2. ContactING service providers concerning service coordination, effectiveness, and appropriateness.
3. ReviewING the client's assessment, care plan, and service agreements to include changes in client functioning, service effectiveness, appropriateness, and cost-effectiveness that may require a reassessment or a change in the care plan.
4. MakINGe changes in care plans as appropriate to client needs and/or referRING the client to community resources, if appropriate.
5. ProvidINGe conflict resolution and/or crisis intervention, as needed.
6. IdentifyING, AND contactING appropriate individuals, and resolvINGe any problems or complaints raised by the client or others regarding service delivery.
7. NotifyING the appropriate law enforcement and/or CHILD/Adult Protective Services agency of suspected abuse, neglect or exploitation, as required by SECTIONS 18-6.5-101108, 19-3-304 and 26-3.1-102, C.R.S.
D. The SEP shall complete a review of the client's current assessment or reassessment and the care plan with the client six months following the assessment or reassessment.
1. The review shall be conducted by telephone, at the client's place of residence, at the place of service, or other appropriate setting as determined by the client's needs.
2. AN IN-PERSON face-to-face home visit shall be completed when significant changes in the client's condition are identified.
E. The SEP shall complete AN IN-PERSONface-to-face functional reassessment within twelve (12) months of the initial functional assessment and every twelve months thereafter. A reassessment shall be completed sooner if the client's condition changes.
F. Reassessment shall include the following tasks:
1. ReviewING the care plan, service agreement, and provider contract or agreement.
2. EvaluatINGe service effectiveness, quality of care, and appropriateness of services.
3. VerifyING continuing financial and program eligibility.
4. Annually, or more often if indicated, completINGe a new care plan and service agreement.
5. ReferRING the client to community resources, as needed.; AND
6. Determine continued appropriateness of placement. DISCUSSING WITH THE CLIENT IF A HCPF WAIVER AND/OR SERVICE IS MORE APPROPRIATE OR BENEFICIAL AND ASSESS AS NEEDED.
G. The SEP shall update the information provided at the previous assessment or reassessment, utilizing the State Department prescribed FORM functional assessment tool and the HCPF PRESCRIBED SYSTEM Benefits Utilization System. When a new functional assessment is completed a copy shall be sent to the county department within ten (10) working days of the reassessment.
3.570.17 Denials, Discontinuations, and Case Transfers [Eff. 3/2/14]
A. The responsibility of the SEP is to determine the functional eligibility of the client. The SEP shall deny or discontinue the client from the HCA program if he OR /she is determined functionally ineligible AND PROVIDE TIMELY OR ADEQUATE NOTICE AS REQUIRED BY SECTION 3.554.
1. The client shall be informed of his OR /her appeal rights in accordance with rules under Section 3.850, et seq AS OUTLINED IN SECTION 3.587.
2. The client shall be provided appropriate referrals to other community resources within one (1) working day of discontinuation or denial.
3. IF THE DISCONTINUATION OR DENIAL IS DUE TO FUNCTIONAL ELIGIBILITY, The SEP shall notify THE CLIENT THAT HE OR SHE MUST NOTIFY THE providers on the care plan within one (1) working day of RECEIVING NOTICE FROM THE COUNTY DEPARTMENTdiscontinuation.
4. IF THE DISCONTINUATION OR DENIAL IS DUE TO FINANCIAL ELIGIBILITY, THE SEP SHALL NOTIFY THE CLIENT THAT HE OR SHE MUST NOTIFY ALL PROVIDERS ON THE CARE PLAN WITHIN ONE (1) WORKING DAY OF RECEIVING NOTICE FROM THE COUNTY DEPARTMENT.
54. The SEP shall notify the county department within FIVE (5) one (1) working dayS of discontinuation.
65. The SEP shall prepare for and defend at the STATE LEVEL FAIR hearing any appeal related to functional denial or discontinuation. The SEP may request assistance and/or testimony from the county department.
B. The responsibility of the county department is to determine the financial eligibility of the client. The county department shall deny or discontinue the client from the HCA program if he OR /she is determined financially ineligible AND PROVIDE TIMELY OR ADEQUATE NOTICE AS REQUIRED BY SECTION 3.554.
1. The client shall be informed of his OR /her appeal rights in accordance with rules under Section 3.850, et seq AS OUTLINED IN SECTION 3.587.
2. The client shall be provided appropriate referrals to other community resources within one (1) working day of discontinuation or denial.
3. The county department shall notify all providers on the care plan within one (1) working day of discontinuation.
34. The county department shall notify the SEP within FIVE (5) one (1) working dayS of discontinuation.
45. The county department shall prepare for and defend at the STATE LEVEL FAIR hearing any appeal related to financial denial or discontinuation. The county department may request assistance and/or testimony from the SEP.
C. FOLLOWING THE NOTICE PROCEDURES OUTLINED IN SECTION 3.554, DDenial and/or discontinuation from the HCA program shall occur for the following reasons:
1. Financial and Functional Eligibility: The SEP or county department shall deny or discontinue a client if the client is not financially eligible and/or is not functionally eligible for HCA.
2. Level of Care: The SEP shall deny or discontinue when the client:
a. Does not meet functional capacity score minimum requirements; or,
b. Does not meet need for paid care score criteria.
3. Receipt of Services: The SEP or county department shall deny or discontinue when the client:
a. Has not received services for one month;
b. Has twice refused to schedule an appointment for an initial assessment, six (6)-month review, or reassessment within a thirty (30) consecutive DAY period;
c. Has failed to keep three (3) scheduled appointments within a thirty (30) consecutive day period;
d. Has refused to schedule an appointment for a required visit after the client's case has been transferred to a new SEP or county department;
e. Refuses to use the HCA payment to pay for services or uses the payment for services not identified in the service agreement; or,
f. Refuses to sign the intake form, care plan, or other documents and forms required to receive services.
4. Facility Status: The SEP or county department shall deny or discontinue when the client:
a. Is a resident of a nursing facility, hospital, or any other long-term care facility; or,
b. Enters a hospital or other long-term care facility for treatment, hospitalization, or rehabilitation that continues for thirty (30) CALENDAR days or more.
5. Service Limitations Related to Safety: The SEP or county department shall deny or discontinue when the client cannot be safely served given the type and/or amount of services available. Evidence of safety concerns include, but are not limited to:
a. The results of an Adult Protective Services assessment that substantiates ongoing risk.
b. A statement from the client's physician attesting to diminished cognitive capacity, debilitating mental health concerns, or ongoing risk.
c. Lack of available and/or appropriate service providers.
d. A functional assessment score indicating a level of need for services in excess of those available under the HCA program.
e. Other available information or evidence that will support the determination that the client's safety is at risk.
6. Service Limitations Related to Cost Effectiveness: The SEP or county department shall deny or discontinue when other more cost effective alternatives are available to meet the client's needs.
7. Living Arrangements: The SEP or county department shall deny or discontinue when the client is residing anywhere other than his OR /her home.
a. The SEP may continue to authorize services while a resident is on medical or non-medical leave.
b. Combined leave shall not exceed a total of forty-two (42) days in a twelve (12) month period beginning with the date the client was approved for the HCA program.
8. Move Out of State: The SEP or county department shall deny or discontinue when the client has moved out of state.
a. Discontinuation shall be effective the day after the date of the move.
b. Clients who leave the state on a temporary basis with the intent to return to Colorado within thirty (30) calendar days shall not be discontinued. If the client fails to return to Colorado the client shall be discontinued on day thirty one (31).
9. Voluntary Withdrawal from the Program: The SEP or county shall deny or discontinue when the client requests withdrawal from the HCA program.
10. Death: The SEP or county shall discontinue the HCA program effective the day after the client's date of death. No notice of discontinuation shall be sent.
D. The SEP shall complete the following procedures to transfer an HCA client to a new county department:
1. THE SEP SHALL NNotify the county department of the client's plans to relocate to another county and the date of transfer.
2. If the client's current service providers do not provide services in the area where the client is relocating, THE SEP SHALL make arrangements, in consultation with the client, for new service providers.
E. The SEP shall complete the following procedures to transfer an HCA client to a new SEP:
1. The transferring SEP shall contact the receiving SEP by telephone or email to give notification that the client is planning to transfer, to negotiate a transfer date, and to provide information.
2. The transferring SEP shall forward copies of the client's case records, including forms required for the HCA program, to the receiving SEP prior to the relocation, if possible, but in no case later than five (5) working days after the client's relocation.
3. The receiving SEP shall complete aN IN-PERSONface-to-face meeting with the client and an assessment and case summary update within ten (10) working days after notification of the client's relocation.
4. The receiving SEP shall review the care plan and the assessment tool, revise as necessary, and coordinate services and providers.
3.570.18 County Department and Single Entry Point (SEP) Requirements and Responsibilities [Eff. 3/2/14]
A. The county department shall:
1. Ensure all requirements of the county department are implemented, as appropriate for the HCA program, related to:
a. General county requirements, as outlined in Section 3.520; and,
b. OLD AGE PENSION Documentation, as outlined in Section 3.530 3.520.2; and,
c. AID TO THE NEEDY DISABLED STATE ONLY AND COLORADO SUPPLEMENTProgram review and oversight, as outlined in Section 3.540 AND 3.546.3.520.3; and,
d. FINANCIAL REDETERMINATION Application processing, as outlined in Section 3.550 3.520.4.
2. The county department shall Ddetermine financial eligibility for HCA in the statewide automated system and update any changes in the case record.
3. The county department shall Nnotify the SEP in writing:
a. Within five (5) working days of determining HCA eligibility.
b. Within five (5) working days after the eligibility worker determines that the client is no longer financially eligible for HCA.
c. Within one (1) working day when the client has filed a written appeal with the county department.
d. Within one (1) working day when the client has withdrawn the appeal or a final agency decision has been entered.
4. The county department shall Rrespond to requests for information from the SEP within ten (10) working days.
B. The SEP shall:
1. Provide intake, screening, and referral activities, as follows:
a. Determine of the appropriateness of a referral for a client assessment.
1) If appropriate, complete intake activities within two (2) working days of the referral.
2) Obtain the client's or client's authorized representative's signature on the intake form.
3) Complete the HCA functional assessment within thirty (30) calendar days of referral.
b. Provide the client information and referral to other agencies, as needed.
2. The SEP shall Iidentify potential payment source(s), including the availability of private funding:
a. Refer the client to the county department to complete an application; or,
b. Refer the client to another community resource that can assist in completing the application; or,
c. Verify the client's ability to private pay for services.
3. The SEP shall Ccomplete a functional assessment when the county department provides written notification that the client has requested HCA and is receiving or has submitted an application for Old Age Pension (OAP), Aid to the Needy Disabled Colorado Supplement (AND-CS), Aid to the Needy Disabled State Only (AND-SO), or the client is receiving Supplemental Security Income (SSI).
a. If the client is being discharged from a hospital or nursing facility, the SEP shall complete the functional assessment regardless of whether AN the Medicaid application date FOR STATE ASSISTANCE OR MEDICAID has been provided by the county department.
b. The SEP shall complete the functional assessment within two (2) working days after notification when a client is being transferred from a hospital to the HCA program.
c. The SEP shall complete the functional assessment within five (5) working days after notification when a client who is being transferred from a nursing facility to the HCA program.
d. The SEP shall complete the functional assessment within ten (10) working days after notification for all other clients. However, the SEP shall have a procedure for prioritizing urgent referrals.
4. The SEP shall Ddocument all case information.
a. Documentation of contacts and case management activities shall be entered into the HCPF PRESCRIBED SYSTEM Benefits Utilization System (BUS) within five (5) working days of the contact or activity.
b. All information related to intake, assessment, and care planning shall be thoroughly documented within ten (10) working days of the intake, assessment or care planning using State Department prescribed forms and the HCPF PRESCRIBED SYSTEM BUS.
c. Additional documentation that cannot be entered into the HCPF PRESCRIBED SYSTEM BUS shall be maintained in the case file.
5. The SEP shall Nnotify clients of their program status using the State Department prescribed form at the time of initial eligibility, when there is a significant change in the client's payment or services, when an adverse action is taken, or at the time of discontinuation.
6. The SEP shall Nnotify the county department in writing:
a. Within five (5) working days of determining HCA functional eligibility.
b. Within five (5) working days after the SEP determines that the client is no longer functionally eligible for HCA.
c. Within one (1) working day when the client has filed a written appeal with the SEP.
d. Within one (1) working day when the client has withdrawn the appeal or a final agency decision has been entered.
7. The SEP shall Rrespond to requests for information from the county department within ten (10) working days.
8. The SEP shall Nnotify the client, at the time of his or her application and at the time of reassessment or discontinuation of the right to request a STATE LEVEL fair hearing before an Administrative Law Judge AS OUTLINED IN SECTION 3.587, in accordance with Section 3.850 (9 C.C.R. 2503-8), and to appeal adverse actions of the SEP or county department.
9. The SEP shall Iinform the client's Adult Protective Services caseworker, if applicable, of the client's status. The case manager shall participate in mutual staffing of the client's case.
10. The SEP shall IMMEDIATELY report to the Colorado Department of Public Health and Environment any congregate facility, with three (3) or more residents, that is not licensed.
11. The SEP shall Iimmediately report to the county department any information that indicates an overpayment, incorrect payment, or misuse of any HCA benefit, and shall cooperate with the county department in any subsequent recovery process.
12. The SEP shall Bbe subject to routine quality control, program monitoring, and contract management to minimally include:
a. Targeted review of the HCPF PRESCRIBED SYSTEM BUS documentation;
b. Case file review;
c. Targeted program review conducted via phone, email, or survey;
d. Onsite program review;
e. A performance improvement plan to correct areas of identified non-compliance; and,
f. Contract sanctions when the SEP fails to implement a performance improvement plan.
3.570.2 SPECIAL POPULATIONS HOME CARE ALLOWANCE (SP-HCA) [Eff. 3/2/14]
3.570.21 Purpose of Program [Eff. 3/2/14]
A. Special Populations Home Care Allowance (SP-HCA) is a special cash payment made to a client for the purpose of securing in-home, personal care services.
1. SP-HCA is a non-entitlement program; and,
2. Cannot be received while receiving benefits from a Home and Community Based Services waiver other than Supportive Living Services (HCBS-SLS) or Children's Extensive Supports (HCBS-CES); and,
3. Is for clients that received Home Care Allowance (HCA) and HCBS-SLS or HCBS-CES services for at least one month between September 2011 and December 2011.
B. Effective September 1, 2018, the SP-HCA grant standard maximums are as follows:
1. Tier 1 - $330.00
2. Tier 2 - $472.00
3. Tier 3 - $605.00
C. The SP-HCA grant is not taxable income to the client. The payment made to the care provider using the SP-HCA grant received by the client is income to the care provider and subject to taxation under State and Federal laws.
D. The SP-HCA grant standards shall be adjusted to stay within available appropriations. Appeals shall not be granted for these adjustments.
E. In addition to the regular monthly SP-HCA grant payments, supplemental payments necessary to comply with the federal Maintenance of Effort (MOE) requirements may be provided. These payments are supplements to regular grant payments, are not entitlements, and do not affect grant standards. Appeals shall not be allowed for MOE payment adjustments.
3.570.22 Definitions [Eff. 3/2/14]
“Activities of daily living” means physical transfers, bladder care, bowel care, mobility, dressing, bathing, hygiene, and eating.
“Authorized representative” means an individual designated by the client, or by the parent or guardian of the client, if appropriate, to assist in acquiring or utilizing Special Populations Home Care Allowance (SP-HCA). The extent of the authorized representative's involvement shall be determined upon designation.
“BUS” means the Benefits Utilization System, the data system used to document case management activities for Special Populations Home Care Allowance (SP-HCA) clients.
“Care planning” means identifying client goals and choices for the care needed, services needed, appropriate service providers, and knowledge of the client and of community resources. The care plan shall be documented on the State prescribed care plan tool.
“Case management” means the assessment of a client's long-term care needs, development and implementation of a care plan, coordination and monitoring of the long-term care service delivery, evaluation of service effectiveness, and periodic reassessment of client needs.
“Client” means any person identified by the State Department as meeting the minimal eligibility criteria to apply for a Special Populations Home Care Allowance (SP-HCA) program grant as outlined at Section 3.570.23, or any person approved for a SP-HCA program grant.
“Functional Assessment” means a comprehensive evaluation by the case manager with the client and appropriate collaterals (such as family members, friends and/or caregivers) to determine the client's level of functioning, service needs, available resources, and necessity for paid care.
“Home” means a non-facility residence.
“Medical leave” means the absence of the client from their home for more than twenty-four (24) hours due to admittance to a hospital or other facility, upon physician's order with the presumption on the part of the physician that the client will be returning to their home. Medical leave may be planned or unplanned.
“Non-medical leave” means the absence of the client from their home for more than twenty-four (24) hours for non-medical reasons that are not part of a client's care plan. Non-medical leave may be planned or unplanned.
“Ongoing case management” means the evaluation of the effectiveness and appropriateness of services, on an ongoing basis, through contacts with the client, appropriate collaterals, and service providers.
“Reassessment” means a comprehensive re-evaluation by the case manager with the client and appropriate collaterals (such as family members, friends and/or caregivers) to determine the client's level of functioning, service needs, available resources, potential funding resources, and necessity for paid care. The reassessment of functional needs shall be documented on the State prescribed assessment tool.
“Service Plan Authorization Limit” (SPAL) means an annual upper payment limit of total funds available to purchase services to meet the client's ongoing needs. Purchase of services not subject to the SPAL are in accordance with the Colorado Department of Health Care Policy and Financing rules in Section 8.500.102, B (10 C.C.R. 2505-10). A specific limit is assigned to each of the six (6) support levels in the HCBS-SLS waiver. The SPAL is determined by the Department based on the annual appropriation for the HCBS-SLS waiver, the number of clients in each level, and projected utilization.
“Spending Limitation” means an annual maximum limit of funds available to purchase services to meet the client's needs under the Home and Community Based Services Children's Extensive Support (HCBS-CES) waiver.
“Single Entry Point (“SEP”) agency” means the agency selected by the Colorado Department of Health Care Policy and Financing to provide case management functions for persons in need of long term care services within specific demographic areas, pursuant to Section 25.5-6-106, C.R.S.
“Skilled personal care” means some exceptions to personal care for activities of daily living that, because of the severe or complex nature of the client's need, requires a person with specialized training and skill to complete the task. Skilled personal care is not a paid service of the Special Populations Home Care Allowance (SP-HCA) program. See the Colorado Department of Health Care Policy and Financing rules in Section 8.489.30 (10 C.C.R. 2505-10) for the definitions of personal care and the skilled exceptions to personal care.
“State Department” means the Colorado Department of Human Services (CDHS).
3.570.23 Application Process and Eligibility Determination [Eff. 3/2/14]
A. Eligibility for SP-HCA shall be based on financial need, the client's functional needs, and SP-HCA special eligibility criteria. The client shall meet eligibility for financial, functional, and special requirements to be approved for an SP-HCA payment.
B. The State Department shall identify persons eligible to apply for SP-HCA as potential clients through a review of the statewide automated system for eligibility determination, the data system for the Division for Developmental Disabilities, and review of the Single Entry Point (SEP) case file. Persons identified as potential clients for a SP-HCA grant minimally shall have been:
1. Approved for Supplemental Security Income (SSI) benefits and been receiving at least a one dollar ($1.00) SSI payment at least one month between September 2011 and December 2011; or,
2. Eligible for a Home Care Allowance (HCA) grant under criteria for the Old Age Pension (OAP) or Aid to the Needy Disabled/Aid to the Blind – State Only (AND/AB-SO) programs as outlined in Sections 3.500 (9 C.C.R. 2503-5), et seq., at least one month between September 2011 and December 2011; and,
3. Receiving a Home Care Allowance (HCA) grant at least one month between September 2011 and December 2011; and,
4. Receiving Home and Community Based Services Supported Living Services (HCBS-SLS) or Home and Community Based Services Children's Extensive Support (HCBS-CES) services at least one month between September 2011 and December 2011; and,
5. One thousand dollars ($1,000) or less from the maximum Service Plan Authorization Limit (SPAL) or Spending Limitation for his/her functional level of need within the HCBS-SLS or HCBS-CES waiver between September 2011 and December 2011.
C. Persons identified by the State Department in March 2012 as potential clients as outlined in Section 3.570.23, B, shall be provided a one-time-only opportunity to apply for SP-HCA.
1. The application process to determine eligibility for the SP-HCA grant shall be initiated no later than March 23, 2012.
2. An application packet for SP-HCA shall be sent to the identified clients. The application packet shall include:
a. A cover letter outlining the SP-HCA grant, the application process, and other necessary information; and,
b. The application; and,
c. Any other forms or documents deemed necessary by the State Department to determine eligibility and process grant payments.
3. No additional persons shall be identified as potential clients after March 2012. Appeals shall not be granted to persons wishing to apply for SP-HCA who were not identified as potential clients at the inception of the SP-HCA program in March 2012.
D. Persons identified by the State Department as potential clients who wish to apply for an SP-HCA grant shall return the application packet and all supporting documentation so it arrives in the State Department office no later than June 1, 2012.
1. Applications may be returned via email, fax, or mail service.
2. Clients whose application is received in the State Department office after June 1, 2012 shall be determined permanently ineligible for SP-HCA. An appeal of this decision must be filed no later than thirty (30) calendar days after the denial.
E. Each application that was returned timely shall be reviewed within forty five (45) calendar days of receipt of the application to determine eligibility and grant award, to include:
1. Completeness of the application.
a. Incomplete and/or unsigned applications shall be returned to the client immediately.
b. If an incomplete application is received between April 15 and June 1, 2012, the State Department may grant a waiver, at its discretion, for the client to return the completed application after the June 1, 2012 program deadline for application.
2. Financial eligibility determination.
a. A client receiving at least one dollar ($1.00) in SSI benefits shall be determined financially eligible.
b. A client not receiving at least $1.00 in SSI benefits shall meet eligibility under either the Old Age Pension (OAP) or Aid to the Needy Disabled-State Only (AND-SO) program requirements, as outlined in Sections 3.530 and 3.540 to be determined financially eligible.
1) A secondary application to collect income and resource information shall be sent to the client immediately.
2) The client shall return the completed secondary application along with all verifications of income and resources within twenty (20) working days.
3) A phone interview shall be scheduled with the client or authorized representative to review the secondary application and verifications.
4) If the client or authorized representative refuses to consent to the interview, fails to return the secondary application, or fails to provide required verification the client shall be permanently ineligible for the SP-HCA program. An appeal of this decision must be filed no later than thirty (30) calendar days after the denial.
3. Functional eligibility determination.
a. If the client's most recent functional assessment (FA), care plan (CP), and provider agreement (PA) were completed ten (10) or more months prior to the application date, the State Department shall refer the client to the appropriate SEP for a new FA, CP, and PA prior to determining eligibility.
1) The SEP shall complete the FA, CP, and PA no later than fifteen (15) working days from the date of referral by the State Department.
2) The SEP shall email the State Department with the completed FA, CP, and PA within one (1) working day of completion.
b. If the client's most recent FA, CP, and PA were completed less than ten (10) months prior to the application date, the State Department shall review for functional eligibility.
c. To be functionally eligible, the client shall have an SP-HCA eligible functional assessment score as outlined in Section 3.570.24. The functional assessment score is calculated by determining the client's functional capacity score and need for paid care score, as follows:
1) Functional Capacity: determined by assessing the client's ability to complete all activities of daily living (ADLs) and applying a score to their ability to complete the ADLs using the functional impairment scale, as outlined in Section 3.570.24; and,
2) Need for Paid Care: determined by identifying the unmet need for paid care and applying a score to the unmet need using the need for paid care scale as outlined in Section 3.570.24; and,
3) Combining the functional capacity score and the need for paid care score to determine whether the client meets the minimum scores for eligibility and, if eligible, the tier of benefits to be approved, as follows:
|TIER |CAPACITY SCORE |NEED FOR PAID CARE SCORE |
|1 |21 or Higher |1 to 23 |
|2 |21 or Higher |24 to 37 |
|3 |21 or Higher |38 to 51 |
d. The SEP shall not approve the maximum authorized SP-HCA amount for the tier if:
1) The client's needs can be fully or partially met through other paid or unpaid sources (excluding family and friends); or,
2) The SP-HCA provider is able to provide the authorized services for less than the maximum authorized amount, or,
3) The client is unwilling or unable to use the maximum authorized amount.
e. Each client who meets the minimum functional assessment scoring requirements for the SP-HCA program shall be functionally eligible for an SP-HCA grant.
1) The authorization by the SEP shall be forwarded to the State Department to determine financial eligibility and SP-HCA special eligibility, as outlined in Sections 3.570.23, E, 2 and 3.570.23, E, 4.
2) Clients shall not be approved for SP-HCA if financially ineligible and/or do not meet SP-HCA special eligibility criteria, even if the client is functionally eligible.
3) Clients shall not be approved for SP-HCA if functionally ineligible, even if the client is financially eligible and/or meets SP-HCA special eligibility criteria.
4. SP-HCA special eligibility criteria.
a. A client must have received a Home Care Allowance (HCA) program payment at least one month between September 2011 and December 2011.
b. A client must have received HCBS-SLS or HCBS-CES waiver services at least one month between September 2011 and December 2011.
c. A client must have been $1,000 or less from his/her SPAL in HCBS-SLS or Spending Limitation in HCBS-CES at least one month between September 2011 and December 2011.
d. All applications will be reviewed for eligibility retroactive to January 2012, provided the client was still a resident of Colorado on January 1, 2012.
F. All eligible clients shall be approved for an SP-HCA program grant.
1. The SP-HCA program approval shall be retroactive to January 2012 for all months that the client is eligible.
2. The client's grant amount shall be based on the SP-HCA tier of payment as determined by the functional assessment conducted by the SEP.
3. Grants shall be for one full month and shall not be prorated based on a partial month of services.
G. Notice shall be provided to the client of approval for or denial of an SP-HCA grant no later than ten (10) working days after completing the eligibility determination.
1. The notice shall contain the eligibility result and appropriate rule citations; and,
2. The date when the grant will be effective, if approved; or,
3. The date and reason for denial and the appeal process, if denied.
H. Monthly payments shall be processed on the 20th of the month.
1. The client or authorized representative shall report any changes related to income, resources, functional assessment, HCBS waiver status, or any other change that might affect eligibility to the State Department or SEP within five (5) working days of the change.
2. Failure to report a change shall be grounds for discontinuation from the program and any payments made after the change shall be subject to recovery and/or fraud investigation and possible prosecution, as outlined in Section 3.800, et seq. (9 C.C.R. 2503-8).
I. Ongoing review of the client's eligibility beginning February 2012 and thereafter shall be conducted in coordination with the SEP, Division for Developmental Disabilities, and State Department. To remain eligible for a SP-HCA grant, the client shall continually:
1. Be approved for Supplemental Security Income (SSI) benefits and be receiving at least a one dollar ($1.00) SSI monthly payment; or, meet all eligibility criteria for the Aid to the Needy Disabled – State Only (AND-SO) programs; or, were receiving both Old Age Pension (OAP) benefits and SP-HCA as of December 31, 2013 and remain continuously eligible for both benefits; and,
2. Be receiving HCBS-SLS or HCBS-CES services and SP-HCA; and,
3. Remain one thousand dollars ($1,000) or less from the maximum SPAL or Spending Limitation for his/her functional level of need within the HCBS-SLS or HCBS-CES waiver; and,
4. Meet the SP-HCA eligible functional capacity score and need for paid care score as outlined in Section 3.570.24.
J. Annual reassessment and redetermination shall be conducted.
1. A new functional assessment shall be conducted by the SEP.
2. A new financial and SP-HCA eligibility determination shall be conducted.
3. The client or authorized representative shall compete and timely return the redetermination application and any other required documentation required to process the redetermination.
4. Notice of continued eligibility and grant amount shall be provided, if the client is determined eligible for SP-HCA.
K. If during ongoing review or at the time of annual redetermination the client is no longer eligible for SP-HCA, notice of discontinuation and appeal rights, as outlined in Section 3.850, et seq. (9 C.C.R. 2503-8) shall be provided within ten (10) working days.
1. The notice shall include the reason for the discontinuation, the appropriate rule citations, and information on the appeal process.
2. The appeal process shall be as outlined in Section 3.850, with the following exceptions:
a. Requirements of the county department shall be changed to requirements of the State Department and/or SEP and requests for a county level conference shall be a State Department level conference.
b. Appeals shall be granted for specific SP-HCA requirements only within thirty (30) days of denial or discontinuation.
L. No hardship exceptions shall apply to SP-HCA grants.
3.570.24 Functional Assessment and Need for Paid Care Score [Eff. 3/2/14]
A. The need for skilled personal care shall not be included in the scoring of the need for paid care.
B. The Single Entry Point (SEP) agency shall complete a functional assessment for each client as follows:
1. Upon referral by the State Department to determine initial eligibility for the SP-HCA program; or,
2. Immediately whenever the SEP, during ordinary case management services and in his/her professional opinion, identifies a significant change in the client's ability to perform activities of daily living; or,
3. Immediately whenever the client or authorized representative reports a significant change in the client's ability to perform activities of daily living; or,
4. Annually, at a minimum. The annual functional assessment shall be completed no earlier than forty-five (45) calendar days prior to and no later than the client's reassessment due date. The assessment shall include, but may not be limited to:
a. A new functional assessment during a face-to-face visit at the client's place of residence;
b. Evaluation of the appropriateness of services, service effectiveness, and quality of care over the past year; and,
c. Completion of an updated care plan and provider agreement.
C. In order to be eligible for the SP-HCA program, each client shall score a minimum of twenty-one (21) points when assessed for the ability to complete the activities of daily living (ADL) using the following functional impairment scale:
1. Independent: score zero (0) if the client is physically able to perform all essential components of the ADL, with or without an assistive device.
2. Low: score one (1) if the client is able to perform all essential components of the function, but impairment of function exists even with an assistive device, or the client requires occasional or intermittent supervision or physical assistance in a limited number of the components of the activity.
a. Occasional or intermittent means the client does not need assistance daily, but may need assistance a few times a month or up to two (2) times per week.
b. Supervision or assistance means verbal prompting, cueing, and reminders, and means stand-by assistance or monitoring to help the client if he/she needs physical assistance up to two (2) times per week.
3. Moderate: score two (2) if the client is unable to perform the majority of the essential components of the function even with an assistive device, and the client requires hands-on and frequent assistance to accomplish the activity.
a. Frequent means the client needs assistance at least three (3) times per week and up to daily.
b. Hands-on assistance means the care provider must physically assist the client in completing the task.
4. Severe: score three (3) if the client is totally unable to perform the function and requires someone to perform the task, or the client requires constant supervision for the task.
D. The need for paid care score shall be based on the frequency of the client's unmet need for paid care and shall be modified by the following factors:
1. Need for paid care shall be scored as zero (0) when those services are provided through another program, agency, or individual.
2. For clients living with others, the need for paid care shall be scored only on the client's needs that are greater than and differentiated from typical household routine and the typical expectation of assistance by family members living in the home.
3. Need for paid care shall be scored only on the client's needs that are greater than and differentiated from services received through the Medicaid Home and Community Based Services Supportive Living Services (HCBS-SLS) or Children's Extensive Support (HCBS-CES) waiver.
E. For children age zero (0) through eighteen (18) years, functional capacity and need for paid care shall be scored according to age appropriate criteria.
F. The need for paid care scale is as follows:
|SCORE |FREQUENCY |DEFINITION OF FREQUENCY |
|0 |None |Client's needs are met. No need for paid care. |
|1 |Weekly |Client needs paid care up to and including once a week. |
|2 |Daily |Client needs paid care more than once a week and up to once a day, seven days |
| | |a week. |
|3 |Twice Daily |Client needs paid care two or more times per day at least five days per week. |
G. The functional assessment shall be scored on the State Department prescribed form, which shall list each activity of daily living, the functional capacity score, and the need for paid care score for each ADL.
3.570.25 Activities of Daily Living [Eff. 3/2/14]
A. Activities of daily living (ADLs) shall be scored using the functional capacity impairment scale and the need for paid care scale outlined in Section 3.570.24.
B. The activities of daily living are:
1. Critical ADLs
a. Transfers: the ability to move between surfaces, such as getting in and out of bed; transferring from a bed to a chair, wheelchair, or walker; moving from a chair or wheelchair to a walker or to a standing position; and the ability to use assistive devices, including prosthetics. A child age 0 to 48 months shall not be scored for any transfers, including positioning. A child age 0 to 60 months shall not be scored for car seat, highchair, or crib transfers.
b. Bladder care: the extent to which the client has control of his/her bladder functions and the ability of the client to accomplish the tasks of toileting, including catheterizing, getting on and off the toilet, changing incontinence products, and cleaning him/herself. A child age 0 to 36 months shall not be scored for bladder incontinence or care.
c. Bowel care: the extent to which the client has control of his/her bowel functions and the ability of the client to accomplish the tasks of toileting, including getting on and off the toilet, changing incontinence products, and cleaning him/herself. A child age 0 to 36 months shall not be scored for bowel incontinence or care.
2. Basic ADLs
a. Mobility: the ability of the client to ambulate around the home and around essential places outside the home, with or without assistive devices. A child age 0 to 36 months shall not be scored for mobility.
b. Dressing: the ability of the client to accomplish all phases of the activities of dressing and undressing, including getting, putting on, fastening, and taking off all items of clothing, braces, and artificial limbs. A child age 0 to 60 months shall not be scored for dressing.
c. Bathing: the ability of the client to safely accomplish the task of washing body parts including getting into bathing waters, with or without assistive devices or whether the client requires stand by or hands-on assistance from another person. A child age 0 to 60 months shall not be scored for bathing.
d. Hygiene: the ability of the client to maintain personal hygiene other than bathing, including combing hair, brushing teeth, and clipping nails. A child age 0 to 60 months shall not be scored for hygiene.
e. Eating: the ability to cut food into manageable size pieces, chew, and swallow food, with or without assistive devices. A child age 0 to 48 months shall not be scored for eating.
3. Instrumental ADLs
a. Meals: the ability to safely prepare food to meet the basic nutritional requirements of the individual, including cutting food, transferring food to cooking vessels and/or dishes, utilizing utensils, using a stove or microwave, and implementing special dietary needs. A child age 0 to 14 years shall not be scored for meals.
b. Housekeeping: the ability to maintain the interior of the client's residence for the purpose of health and safety, such as wiping surfaces, cleaning floors, making a bed, and cleaning dishes. A child age 0 to 12 years shall not be scored for housekeeping.
c. Laundry: the ability to gather and wash soiled clothing and linens; use washing machines and dryers; hang, fold, and put away clean clothing and linens. A child age 0 to 12 years shall not be scored for laundry.
d. Shopping: the ability to purchase goods that are necessary for health and safety. Activities include ability to make needs known, to make a list, reach for the needed items at the store, ability to estimate or determine the cost of the item, and to move items into the home and put them away. A child age 0 to 15 years shall not be scored for shopping.
4. Supportive ADLs
a. Medicine: the ability to manage medications, including knowing the name of the medication, knowing the amount, frequency, and how to take the medicine, understanding the reason for taking it, and understanding possible side effects. A child age 0 to 14 years shall not be scored for medicine.
b. Appointment: the ability to schedule or make an appointment for essential activities, such as doctor visits, meetings with caseworkers, and transportation. A child age 0 to 16 years shall not be scored for appointments.
c. Money: the ability to manage money, such as balancing a check book, writing checks or paying a bill electronically, and ability to understand financial decisions. A child age 0 to 16 years shall not be scored for money.
d. Access: the ability to access resources or services in the community, such as locating the resource/service and completing the process necessary to receive the resource or service. A child age 0 to 16 years shall not be scored for access.
e. Telephone: the ability to use the telephone to communicate essential needs, such as answering the phone in a reasonable time, speaking clearly and loudly enough to be understood, dialing the phone, initiating a conversation, hearing the caller, and placing a call in an emergency. A child age 0 to 12 years shall not be scored for telephone.
3.570.26 Care Planning And Case Management [Eff. 3/2/14]
A. Special Populations Home Care Allowance may be used to purchase:
1. Non-skilled assistance with activities of daily living, as defined in Section 3.570.25; and;
2. Electronic monitoring, such as an emergency alert button; and,
3. One-time deep cleaning if a referral is initiated by Adult Protective Services and determined necessary by the SEP.
B. The SEP shall develop a care plan on the State Department prescribed form within ten (10) working days after program eligibility has been determined and prior to the arrangement for services.
1. The care plan shall be:
a. Signed by the client, SEP, and the service provider.
b. Reviewed and updated at least once every twelve (12) months; and,
c. Reviewed sooner if there is a change in the client's needs; and,
d. Provided to all parties.
2. Care planning shall include, but not be limited to, the following tasks:
a. Identify and document care plan goals and client choices.
b. Identify and document services, including type, duration and frequency.
c. Arrange for services through a service provider, family member, or other provider of the client's choosing.
1) Providers shall be at least eighteen (18) years of age or older and have the ability to provide appropriate services. The SEP shall assist the client in finding an appropriate service provider, if needed.
2) The SEP shall negotiate with the client and care provider to arrive at the total number of paid care hours to be provided monthly.
3) The SP-HCA payments shall be made directly to the client or authorized representative who shall pay the provider the agreed upon, authorized amount monthly.
4) No portion of the authorized SP-HCA amount shall be withheld by the client for personal use. The entire SP-HCA authorized amount shall be spent for SP-HCA allowable services.
d. Coordinate service delivery, negotiate with the service provider and the client regarding service provision, and formalize the provider agreement.
e. Complete program requirements for the authorization of services.
f. Refer the client to community resources, as needed, and attempt to develop resources for a client if a resource is not available within the client's community.
g. Explain the complaint procedures to the client, as listed on the care plan document.
h. Explain the client's right to appeal any decision.
3. The SEP shall meet the client's needs, with consideration of the client's choices, using the most cost effective methods available.
a. When services are available to the client at no cost from family, friends, volunteers, or others, these services shall be utilized before the purchase of services, providing these services adequately meet the client's needs.
b. When public dollars must be used to purchase services, the SEP shall encourage the client to select the lowest cost provider of service when quality of service is comparable.
c. The SEP shall assure there is no duplication in services provided by any other public or privately funded services.
4. The SEP shall notify the client in writing of the outcome of the functional assessment no later than ten (10) working days from the date of the functional assessment. The notice shall contain:
a. The functional eligibility result and appropriate rule citations.
b. The authorized grant amount, if the functional assessment determines the client has a functional need for paid care:
1) The authorized grant amount shall be the tier grant standard based on the client's overall functional capacity and need for paid care score; or,
2) An amount less than the tier grant standard based on the client's overall functional capacity score if the care provider has agreed to provide all services outlined in the care plan for the lesser amount.
c. The reason for denial and the appeal process, if denied.
C. The SEP shall provide ongoing case management, as follows:
1. Monitor the quality of care provided to clients.
a. Contact service providers concerning service coordination, effectiveness and appropriateness.
b. Review the client's assessment, care plan, and service agreements to include changes in client functioning, service effectiveness, appropriateness, and cost-effectiveness that may require a reassessment or a change in the care plan.
c. Make changes in service plans as appropriate to client needs and/or refer the client to community resources, if appropriate.
d. Provide conflict resolution and/or crisis intervention, as needed.
e. Identify and contact appropriate individuals, and resolve any problems or complaints raised by the client or others regarding service delivery.
f. Notify the appropriate law enforcement and/or Adult Protective Services agency of suspected abuse, neglect, or exploitation, as required by Sections 18-6.5-101 and 26-3.1-102, C.R.S.
D. The SEP shall complete a review of the client's current assessment or reassessment and the care plan with the client six (6) months following the assessment or reassessment.
1. The review shall be conducted by telephone, at the client's place of residence, at the place of service, or in another appropriate setting as determined by the client's needs.
2. A face-to-face home visit shall be completed when significant changes in the client's condition are identified.
E. The SEP shall complete a face-to-face functional reassessment within twelve (12) months of the initial functional assessment and every 12 months thereafter. A reassessment shall be completed sooner if the client's condition changes.
F. Reassessment shall include the following tasks:
1. Review the care plan, service agreement, and provider contract or agreement.
2. Evaluate service effectiveness, quality of care, and appropriateness of services.
3. Verify continuing functional and program eligibility.
4. Annually, or more often if indicated, complete a new care plan and service agreement.
5. Refer the client to community resources, as needed.
G. The SEP shall update the information provided at the previous assessment or reassessment, utilizing the State Department prescribed functional assessment tool and the BUS. When a new functional assessment is completed a copy shall be sent to the State Department within ten (10) working days of the reassessment.
3.570.27 Denials, Discontinuations, and Case Transfers [Eff. 3/2/14]
A. A client shall meet all eligibility requirements outlined in Sections 3.570.23 and 3.570.24 each month to continue to be eligible for the SP-HCA program.
B. Clients shall be denied or discontinued from the SP-HCA program if he/she is determined ineligible. The client shall be informed of the adverse action and appeal rights in accordance with rules under Sections 3.570.23, K, and 3.850.
C. Clients that are denied and/or are discontinued from the SP-HCA program are permanently disqualified from the program and shall not be eligible to apply for or be approved for benefits in subsequent months or years.
1. To ease the eligibility process for the SP-HCA program, the following provisions shall apply:
a. Clients originally approved for the SP-HCA program and then subsequently discontinued from SP-HCA on or before June 30, 2013, may reapply for reinstatement of benefits.
b. Application must be received no later than July 12, 2013, for reinstatement of benefits.
c. The application shall be reviewed to determine if between January 1, 2012 and June 30, 2013, the client again met SP-HCA eligibility criteria following the most recent discontinuation.
d. If the client is determined to meet SP-HCA eligibility criteria again following the most recent discontinuation, but still on or before June 30, 2013, benefits shall be retroactive to the new eligibility date.
2. Clients originally approved for the SP-HCA program and then subsequently discontinued from SP-HCA on or after July 1, 2013, shall be permanently discontinued from receiving SP-HCA benefits.
D. The SEP and/or CCB shall notify the State Department when the agency has knowledge that any of the following occurs. The State Department shall notify the client of discontinuation from SP-HCA when it has information from the SEP, CCB, program data systems, or any other source that any of the following has occurred:
1. The client no longer receives services under the HCBS-SLS or HCBS-CES waiver.
2. The client's needs changed and his/her level of service need is no longer within one thousand dollars ($1,000) of the SPAL or Spending Limitation for HCBS-SLS or HCBS-CES.
3. The client no longer meets financial eligibility criteria.
4. The client no longer meets the functional capacity and need for paid care scores necessary to be approved for SP-HCA.
5. The client has not received services for thirty (30) or more consecutive days.
6. The client or authorized representative has refused to schedule an appointment with the SEP, CCB, or State Department or refuses to allow for a home visit, an initial assessment, six (6)-month review, reassessment, or other review.
7. The client or authorized representative has failed to keep two (2) scheduled appointments.
8. The client or authorized representative refuses to sign the application, the care plan, or other documents and forms required to receive services or in any other way refuses to cooperate with the requirements of the SP-HCA program.
9. The client or authorized representative refuses to use the SP-HCA grant to pay for services, uses the grant for services not identified in the care plan and provider agreement, or uses the grant to purchase household expenses including, but not limited to, shelter costs, utilities, food, toiletries, clothing, home furnishings or other items not authorized by the SP-HCA care plan.
10. The client is a resident of a nursing facility, hospital, alternative care facility, group home, licensed or unlicensed long-term care facility.
11. The client enters a hospital or other long-term care facility for treatment or rehabilitation that continues for thirty (30) or more consecutive days.
a. SP-HCA benefits shall be temporarily discontinued while the client remains in the hospital or long-term care facility for treatment or rehabilitation.
b. SP-HCA benefits shall be permanently discontinued if the client remains in the hospital or long-term care facility for treatment or rehabilitation for one hundred eighty (180) or more consecutive days.
12. The client cannot be safely served given the type and/or amount of services available. To support a denial or discontinuation for safety reasons related to service limitations, the SEP shall document the limitations and evidence of safety concerns, when available, including, but not limited to:
a. The results of an adult protective services assessment;
b. A statement from the client's physician attesting to diminished cognitive capacity, debilitating mental health concerns, or increased medical or physical care needs;
c. Lack of available services and/or providers;
d. An assessment score indicating a level of need for services in excess of those available under the SP-HCA program; and/or,
e. Other available information or evidence that will support the determination that the client's safety is at risk.
13. The level of service need is not cost effective under the SP-HCA program. To support a denial or discontinuation due to cost effectiveness the SEP shall document the level of service need and more cost effective alternatives.
14. The client has moved out of the state or country or has or been out of the state or country for more than thirty (30) consecutive days. Discontinuation shall be effective the day after the date of the move or on day thirty-one (31) of the absence from the state or country.
15. The client or authorized representative requests withdrawal from the program.
16. The client or authorized representative has failed to report a change in circumstances that potentially affects eligibility for SP-HCA.
17. The client has died. Discontinuation shall be effective the day after the client's death. No notice of discontinuation shall be sent.
E. The notice of adverse action shall include the reason for denial or discontinuation, the appropriate rule cite, and appeal rights as outlined in Section 3.850, et seq. (9 C.C.R. 2503-8).
F. In the event of denial or discontinuation, the SEP shall:
1. Provide appropriate referrals to other community resources, as needed, within one (1) working day of discontinuation.
2. Notify all providers on the care plan within one (1) working day of discontinuation.
3. Notify the State Department within one (1) working day of discontinuation.
4. Attend the appeal hearing to defend the denial or discontinuation.
3.570.28 State Department and SEP Requirements and Responsibilities [Eff. 3/2/14]
A. The State Department shall:
1. Determine eligibility for SP-HCA and update any changes in the case record.
2. Notify the SEP in writing:
a. Within five (5) working days of determining SP-HCA eligibility.
b. Within five (5) working days after the State Department determines that the client is no longer financially eligible for SP-HCA.
c. Within one (1) working day when the client has filed a written appeal with the State Department.
d. Within one (1) working day when the client has withdrawn the appeal or a final agency decision has been entered.
3. Respond to requests for information from the SEP within ten (10) working days.
B. The SEP shall:
1. Provide intake, screening, and referral activities, as follows:
a. Complete intake activities within two (2) working days of the referral.
b. Obtain the client's or client's authorized representative's signature on the intake form.
c. Complete the SP-HCA functional assessment within thirty (30) calendar days of referral.
d. Provide the client information and referral to other agencies, as needed.
2. Complete a functional assessment when the State Department provides written notification that the client has requested SP-HCA and is receiving or has submitted an application for Old Age Pension (OAP), Aid to the Needy Disabled State Only (AND-SO), or the client is receiving Supplemental Security Income (SSI).
a. If the client is being discharged from a hospital or nursing facility, the SEP shall complete the functional assessment regardless of whether the Medicaid application date has been provided by the county department.
b. The SEP shall complete the functional assessment within two (2) working days after notification when a client is being transferred from a hospital to the SP-HCA program.
c. The SEP shall complete the functional assessment within five (5) working days after notification when a client who is being transferred from a nursing facility to the SP-HCA program.
d. The SEP shall complete the functional assessment within ten (10) working days after notification for all other clients. However, the SEP shall have a procedure for prioritizing urgent referrals.
3. Document all case information.
a. Documentation of contacts and case management activities shall be entered into the BUS within five (5) working days of the contact or activity.
b. All information related to intake, assessment, and care planning shall be thoroughly documented within ten (10) working days of the intake, assessment or care planning using forms and the BUS.
c. Additional documentation that cannot be entered into the BUS shall be maintained in the case file.
4. Notify clients of their program status using the State Department prescribed form at the time of initial eligibility, when there is a significant change in the client's payment or services, when an adverse action is taken, or at the time of discontinuation.
5. Notify the State Department in writing:
a. Within five (5) working days of determining SP-HCA functional eligibility.
b. Within five (5) working days after the SEP determines that the client is no longer functionally eligible for SP-HCA.
c. Within one (1) working day when the client has filed a written appeal with the SEP.
d. Within one (1) working day when the client has withdrawn the appeal or a final agency decision has been entered.
6. Respond to requests for information from the State Department within ten (10) working days.
7. Notify the client, at the time of his or her application and at the time of reassessment or discontinuation of the right to request a fair hearing before an Administrative Law Judge in accordance with Section 3.850, and to appeal adverse actions of the SEP or State Department.
8. Inform the client's Adult Protective Services caseworker, if applicable, of the client's status. The case manager shall participate in mutual staffing of the client's case.
9. Report to the Colorado Department of Public Health and Environment any congregate facility, with three (3) or more residents that is not licensed.
10. Report immediately to the State Department any information that indicates an overpayment, incorrect payment, or misuse of any SP-HCA benefit, and shall cooperate with the county department in any subsequent recovery process.
11. Be subject to routine quality control, program monitoring, and contract management to minimally include:
a. Targeted review of the BUS documentation; and,
b. Case file review; and,
c. Targeted program review conducted via phone, email, or survey; and,
d. Onsite program review; and,
e. A performance improvement plan to correct areas of identified non-compliance; and,
f. Contract sanctions when the SEP fails to implement a performance improvement plan.
3.570.4 BURIAL ASSISTANCE PROGRAM
3.570.41 PURPOSE OF PROGRAM
BURIAL BENEFITS ARE AVAILABLE TO ELIGIBLE CLIENTS TO COVER REASONABLE AND NECESSARY COSTS FOR BURIAL SERVICES.
3.570.42 DEFINITIONS
“BURIAL BENEFIT” MEANS THE STATE DEPARTMENT PROGRAM TO PAY ALL OR A PORTION OF THE COST OF FUNERAL, BURIAL, OR CREMATION SERVICES FOR CERTAIN DECEASED CLIENTS.
“BURIAL FUNDS” MEANS THE FUNDS AUTHORIZED BY THE COUNTY DEPARTMENT UNDER THE BURIAL BENEFIT.
“BURIAL PLOT” MEANS THE CLIENT'S FINAL RESTING PLACE, WHETHER A CEMETERY PLOT, VAULT, OR CREMATORIUM NICHE.
“BURIAL SERVICES” MEANS THOSE SERVICES PROVIDED AS PART OF FUNERAL, BURIAL, OR CREMATION SERVICES, INCLUDING:
A. TRANSPORTATION OF THE BODY FROM THE PLACE OF DEATH TO A FUNERAL HOME OR OTHER STORAGE FACILITY, AND/OR FROM THE FUNERAL HOME TO THE FUNERAL/MEMORIAL SITE, AND/OR TO THE BURIAL PLOT;
B. STORAGE OF THE BODY PRIOR TO FINAL DISPOSITION AND/OR STORAGE OF THE CREMATED REMAINS FOR NO MORE THAN ONE HUNDRED TWENTY (120) DAYS, IN THOSE CASES WHERE THE REMAINS ARE NOT BURIED AND ARE NOT CLAIMED BY THE CLIENT'S FAMILY OR FRIENDS;
C. EMBALMING, WHERE NECESSARY FOR PRESERVATION OF THE BODY AND/OR PREPARATION OF THE BODY FOR THE CASKET OR FOR CREMATION;
D. PURCHASE OF A CASKET OR OF AN URN OR OTHER RECEPTACLE FOR THE CREMATED REMAINS;
E. PURCHASE OF A GRAVESITE, VAULT, VAULT LINER, OR CREMATORIUM NICHE;
F. PURCHASE AND PLACEMENT OF THE GRAVE MARKER AND/OR OF PERPETUAL CARE OF THE GRAVESITE, VAULT, OR CREMATORIUM NICHE;
G. FUNERAL OR MEMORIAL SERVICE;
H. CREMATION OF THE BODY;
I. BURIAL OR INTERNMENT OF THE BODY OR CREMATED REMAINS IN A BURIAL PLOT, VAULT, OR CREMATORIUM NICHE;
J. ANY OTHER ITEMS THAT ARE INCIDENTAL TO BURIAL SERVICES.
“CONTRIBUTIONS” MEANS ANY MONETARY PAYMENT OR DONATION MADE DIRECTLY TO THE SERVICE PROVIDER(S) BY A NON-RESPONSIBLE PERSON TO DEFRAY THE EXPENSES OF A deceased public assistance or medical assistance recipient’s funeral, cremAtion, or burial, or any combination thereof.
“LEGALLY RESPONSIBLE PERSON(S)” MEANS A PERSON WHO IS THE DECEDENT’S SPOUSE OR THE DECEDENT’S PARENT IF THE DECEDENT IS AN UNEMANCIPATED MINOR WHO IS UNDER THE AGE OF EIGHTEEN; AND BEARS LEGAL RESPONSIBILITY FOR THE CHARGES ASSOCIATED WITH THE DECEDENT’S FUNERAL, CREAMATION, OR BURIAL EXPENSES.
“NONRESPONSIBLE PERSON” MEANS ONE OF THE FOLLOWING WHO MAKES A CONTRIBUTION TO THE CHARGES FOR BURIAL SERVICES:
A. A RELATIVE OF THE DECEDENT WHO IS NOT A LEGALLY RESPONSIBLE PERSON; OR,
B. ANY OTHER PERSON OR PARTY.
3.570.43 ELIGIBILITY AND DETERMINATION FOR BURIAL ASSISTANCE
A. A BURIAL BENEFIT SHALL BE AVAILABLE TO COVER ALL OR PART OF REASONABLE AND NECESSARY COSTS FOR BURIAL SERVICES WHEN:
1. A DECEASED CLIENT WAS RECEIVING OLD AGE PENSION (OAP), AID TO THE NEEDY DISABLED (AND-SO OR AND-CS), HOME CARE ALLOWANCE, AND/OR COLORADO MEDICAID ASSISTANCE AT THE TIME OF DEATH; AND,
2. THE DECEASED CLIENT'S ESTATE IS INSUFFICIENT TO PAY ALL OR PART OF THE BURIAL SERVICES; AND,
3. THE RESOURCES OF THE LEGALLY RESPONSIBLE PERSON(S) FOR THE SUPPORT OF THE DECEASED CLIENT ARE INSUFFICIENT, EVEN WITH CONTRIBUTIONS FROM THE CLIENT'S ESTATE, TO ENABLE THE LEGALLY RESPONSIBLE PERSON(S) TO PAY ALL OR PART OF SUCH EXPENSES; AND,
4. THE TOTAL COST FOR ALL BURIAL SERVICES DOES NOT TOTAL MORE THAN TWO THOUSAND FIVE HUNDRED DOLLARS ($2,500), EXCEPT THAT THE COST OF A BURIAL PLOT SHALL NOT BE INCLUDED IN THE $2,500 MAXIMUM COST LIMIT WHEN:
A. THE CLIENT HAS A PREPAID BURIAL PLOT VALUED AT TWO THOUSAND DOLLARS ($2,000) OR LESS AT THE TIME OF PURCHASE; OR,
B. A BURIAL PLOT WAS PURCHASED BY SOMEONE OTHER THAN THE DECEASED CLIENT AND DONATED TO THE DECEASED CLIENT; AND,
B. THE TOTAL BURIAL BENEFIT SHALL NOT EXCEED THE CURRENT BURIAL BENEFIT RATE.
1. EFFECTIVE MARCH 1, 2020, THE BURIAL BENEFIT SHALL NOT EXCEED ONE THOUSAND FIVE HUNDRED DOLLARS ($1,500).
2. THE REIMBURSEMENT RATE SHALL BE ADJUSTED BY THE STATE DEPARTMENT AS NEEDED TO STAY WITHIN THE AVAILABLE APPROPRIATIONS. THERE SHALL BE NO APPEAL GRANTED FOR THIS ADJUSTMENT.
C. WHEN ASSISTANCE FOR FUNERAL, BURIAL, OR CREMATION SERVICES IS REQUESTED WITHIN THIRTY (30) DAYS FROM THE DATE OF DEATH ON BEHALF OF A DECEASED CLIENT AS DESCRIBED IN SECTION 3.570.43.A, BY ANY INTERESTED PARTY; AN APPLICATION REQUESTING A BURIAL BENEFIT SHALL BE COMPLETED AND SUBMITTED TO THE COUNTY DEPARTMENT FOR ELIGIBILITY DETERMINATION. REQUESTS MADE AFTER 30 DAYS SHALL BE EVALUATED BY THE COUNTY DEPARTMENT AND AN EXTENSION MAY BE GIVEN IF GOOD CAUSE EXISTS, NOT TO EXCEED ONE (1) YEAR FROM THE DATE OF DEATH. GOOD CAUSE SHALL EXIST FOR ANY APPLICATION FILED WITHIN ONE YEAR OF THE DATE OF DEATH OF THE CLIENT, IF THE CLIENT’S DATE OF DEATH PRECEDED THE EFFECTIVE DATE OF THIS RULE. THE CLIENT'S FAMILY OR FRIENDS, OR THE COUNTY DEPARTMENT WHEN THERE ARE NO KNOWN FAMILY OR FRIENDS, SHALL MAKE ARRANGEMENTS FOR DISPOSITION OF THE CLIENT'S BODY IN A REASONABLE, DIGNIFIED MANNER WHICH APPROXIMATES THE WISHES AND THE RELIGIOUS AND CULTURAL PREFERENCES OF THE CLIENT OR FAMILY, TO THE EXTENT POSSIBLE WITHIN THE BURIAL BENEFIT RULES AND BURIAL GRANT PAYMENT FUNDS.
1. THE COUNTY DEPARTMENT SHALL ENSURE THAT A CHOICE OF DISPOSITION BY THE CLIENT IS MADE IN WRITING. THE CHOICE OF DISPOSITION MAY BE MADE ON THE CLIENT'S MOST RECENT APPLICATION FOR BENEFITS, IN THE CLIENT'S WILL, OR BY ANY OTHER DOCUMENT WHICH THE COUNTY DEPARTMENT DEEMS CREDIBLE. IF THERE ARE CONFLICTING DOCUMENTS EXPRESSING THE CLIENT’S CHOICE OF DISPOSITION, THE COUNTY DEPARTMENT SHALL UTILIZE THE MOST RECENT DOCUMENT CONTAINING THE CLIENT’S CHOICE. IF THE CLIENT HAS NOT EXPRESSED A CHOICE OF DISPOSITION, THE CLIENT’S DISPOSITION SHALL BE DETERMINED RESPECTIVELY BY THE CLIENT’S SPOUSE, ADULT CHILDREN, PARENTS, OR SIBLINGS.
2. THE COUNTY DEPARTMENT SHALL COORDINATE WITH THE CLIENT'S FAMILY OR INTERESTED PARTIES TO EXPLAIN THE BURIAL BENEFIT RULES, INCLUDING:
A. OPTIONS IN THE EVENT THE CLIENT'S OR FAMILY'S BURIAL PREFERENCES CANNOT BE MET WITHIN THE LIMITATIONS OF THE BURIAL RULES OR BURIAL GRANT PAYMENT MAXIMUM; AND,
B. IF THE FAMILY'S BURIAL PREFERENCE IS IN OPPOSITION TO THE CLIENT'S PREFERENCE, AS NOTED ON THE CLIENT'S MOST RECENT APPLICATION FOR BENEFITS OR OTHER DOCUMENTATION, THE BURIAL GRANT PAYMENT SHALL BE USED TO MEET THE CLIENT'S PREFERENCE, UNLESS ALL OPTIONS FOR MEETING THAT PREFERENCE HAVE BEEN EXHAUSTED WITHIN THE LIMITATIONS OF THE BURIAL GRANT PAYMENT; AND,
C. THE LEGALLY RESPONSIBLE PERSON'S RESPONSIBILITY TO PAY THE COST OF BURIAL SERVICES THAT EXCEED THE APPROVED BURIAL GRANT PAYMENT; AND,
D. THAT VOLUNTARY CONTRIBUTIONS FROM FAMILY, FRIENDS, OR OTHER INTERESTED PARTIES, MAY BE USED TO COVER SOME OR ALL OF THE LEGALLY RESPONSIBLE PERSON'S COSTS THAT EXCEED THE APPROVED BURIAL GRANT PAYMENT UP TO THE MAXIMUM COST LIMIT.
3. THE COUNTY DEPARTMENT SHALL USE THE FOLLOWING PROCEDURES WHEN THE DECEASED CLIENT'S BURIAL PREFERENCES ARE UNKNOWN AND A FAMILY MEMBER CANNOT BE LOCATED:
A. IF A FAMILY MEMBER HAS NOT BEEN LOCATED WITHIN TWENTY-FOUR HOURS AFTER THE CLIENT DIES, THE COUNTY DEPARTMENT SHALL HAVE THE BODY REFRIGERATED OR EMBALMED.
B. IF A FAMILY MEMBER HAS NOT BEEN LOCATED WITHIN SEVEN (7) DAYS, THE COUNTY DEPARTMENT SHALL MAKE THE DETERMINATION TO BURY OR CREMATE THE BODY BASED ON THE BEST OPTION AVAILABLE.
C. THE COUNTY DEPARTMENT SHALL COMPLETE AND SEND WRITTEN AUTHORIZATION TO THE APPROPRIATE FUNERAL HOME OR CREMATORIUM.
D. THE COUNTY DEPARTMENT SHALL REDUCE THE BURIAL GRANT PAYMENT BY APPLYING THE FOLLOWING MONIES TOWARD THE FULL BURIAL COSTS IN THE ORDER LISTED:
1. FIRST, SUBTRACT MONIES DUE FROM ANY INSURANCE POLICY OF THE DECEASED CLIENT TO A LEGALLY RESPONSIBLE PERSON OR ANY OTHER PERSON WHO MAKES A CONTRIBUTION TO BURIAL SERVICES AND IS NAMED AS BENEFICIARY OR A JOINT BENEFICIARY; THEN IF COSTS REMAIN,
2. SUBTRACT THE VALUE OF THE DECEASED CLIENT'S ESTATE AS OF THE DATE OF DEATH THAT ARE AVAILABLE, INCLUDING ANY CASH OR PROPERTY OF ANY KIND WHICH THE DECEASED CLIENT OWNED OR PROPORTIONATE SHARE OF RESOURCES HELD IN JOINT OWNERSHIP AT THE TIME OF DEATH; THEN IF COSTS REMAIN,
3. SUBTRACT MONIES FROM THE LEGALLY RESPONSIBLE PERSON(S) FOR THE CLIENT, AS FOLLOWS:
A. SOCIAL SECURITY LUMP SUM DEATH BENEFITS PAYABLE TO A LEGALLY RESPONSIBLE PERSON SHALL BE EXEMPT.
B. IF THE LEGALLY RESPONSIBLE PERSON(S) HAS RESOURCES BELOW THE SSI RESOURCE LIMIT OF $2,000 FOR AN INDIVIDUAL OR $3,000 FOR A COUPLE ANY RESOURCES WOULD NOT BE USED TO REDUCE THE BURIAL GRANT PAYMENT. THESE LIMITS ARE CONSISTENT WITH THE PROVISIONS OF FEDERAL REGULATIONS FOUND AT 20 CFR 416.1205 (2019), WHICH ARE HEREIN INCORPORATED BY REFERENCE. THIS RULE DOES NOT CONTAIN ANY LATER AMENDMENTS OR EDITIONS. THESE REGULATIONS ARE AVAILABLE FOR NO COST AT . THESE REGULATIONS ARE ALSO AVAILABLE FOR PUBLIC INSPECTION AND COPYING AT THE COLORADO DEPARTMENT OF HUMAN SERVICES, DIRECTOR OF THE EMPLOYMENT AND BENEFITS DIVISION, 1575 SHERMAN STREET, DENVER, COLORADO, 80203, OR AT ANY STATE PUBLICATIONS LIBRARY DURING REGULAR BUSINESS HOURS.
1) IF THE LEGALLY RESPONSIBLE PERSON IS THE WIDOW(ER), THE INDIVIDUAL RESOURCE LIMIT SHALL APPLY.
2) THE LEGALLY RESPONSIBLE PERSON(S) MAY VOLUNTARILY CONTRIBUTE MONIES TOWARD THE COST OF THE BURIAL SERVICES.
C. IF THE LEGALLY RESPONSIBLE PERSON(S) HAS RESOURCES OVER THE SSI LIMIT, THE AMOUNT OF RESOURCES OVER THE LIMIT SHALL BE USED TO REDUCE THE BURIAL GRANT PAYMENT; THEN IF COSTS REMAIN,
4. THE COUNTY DEPARTMENT SHALL ISSUE A WRITTEN AUTHORIZATION FOR THE AMOUNT OF THE BURIAL GRANT PAYMENT, UP TO THE BURIAL GRANT PAYMENT LIMIT, AS SET FORTH IN SECTION 3.570.43.B.1.
E. ONCE THE APPLICATION AND CHOICE OF BURIAL SERVICES IS DETERMINED, THE FAMILY OR COUNTY DEPARTMENT SHALL CONTACT THE APPROPRIATE PROVIDER(S) TO OBTAIN A WRITTEN ESTIMATE OF THE PROVIDER'S PROPOSED CHARGES FOR BURIAL SERVICES. IF MORE THAN ONE PROVIDER IS INVOLVED, A SEPARATE WRITTEN ESTIMATE FROM EACH PROVIDER SHALL BE OBTAINED.
F. ONCE THE PROPOSAL(S) FROM THE PROVIDER(S) IS RECEIVED, THE COUNTY DEPARTMENT SHALL DETERMINE IF A BURIAL GRANT PAYMENT IS APPROPRIATE.
1. IF THE COMBINED CHARGES FROM THE PROVIDER(S) EXCEED TWO THOUSAND FIVE HUNDRED DOLLARS ($2,500), NO BURIAL GRANT PAYMENT SHALL BE PAID.
2. THE COUNTY DEPARTMENT SHALL ALLOW THE PROVIDER(S) TO RESUBMIT A WRITTEN ESTIMATE WITHIN TEN (10) CALENDAR DAYS OF NOTIFICATION THAT THE CHARGES EXCEEDED THE BURIAL GRANT PAYMENT MAXIMUM.
G. ALL PAYMENTS FROM A DECEDENT'S ESTATE, PAYMENTS FROM LEGALLY RESPONSIBLE PERSONS, AND CONTRIBUTIONS FROM ANY OTHER PERSON PERSONS WHO MAKE A CONTRIBUTION TO BURIAL SERVICES SHALL BE PAID DIRECTLY TO THE PROVIDER(S) OF SERVICES. AFTER THE PROVISION OF ALL SERVICES, THE PROVIDERS SHALL BILL THE COUNTY DEPARTMENT DIRECTLY FOR REIMBURSEMENT FOR APPROPRIATE COSTS THAT HAVE NOT BEEN COVERED BY THE RESOURCES FROM OR CONTRIBUTIONS MADE BY THE DECEDENT'S ESTATE, LEGALLY RESPONSIBLE PERSONS, OR ANY OTHER PERSON PERSONS WHO MAKE A CONTRIBUTION TO BURIAL SERVICES. THE COUNTY DEPARTMENT SHALL REIMBURSE THE APPROPRIATE PROVIDERS DIRECTLY, BASED UPON THE STATEMENT OF AGREEMENT.
H. THE COUNTY DEPARTMENT OF RESIDENCE OF THE DECEASED CLIENT SHALL AUTHORIZE THE APPROVED BURIAL GRANT PAYMENT THROUGH THE STATEWIDE AUTOMATED SYSTEM. THE BURIAL GRANT PAYMENT SHALL BE PAID DIRECTLY TO THE PROVIDER(S). THE BURIAL APPLICATION MUST BE PROCESSED AS SOON AS POSSIBLE BUT NO LATER THAN THIRTY (30) DAYS FROM SUBMISSION.
I. THE COUNTY DEPARTMENT SHALL HAVE A STATEMENT OF AGREEMENT BETWEEN THE PROVIDERS, WHICH ENSURES THAT THE DISTRIBUTION OF BURIAL GRANT PAYMENT IS PROPORTIONAL TO BURIAL SERVICES PROVIDED OR AS THE PROVIDERS OTHERWISE DETERMINE. THE AGREEMENT SHALL BE SIGNED BY ALL PROVIDER(S) AND SHALL BE APPROVED AND SIGNED BY THE COUNTY DEPARTMENT BEFORE THE BURIAL GRANT PAYMENT IS AUTHORIZED IN THE STATEWIDE AUTOMATED SYSTEM.
J. THE COUNTY DEPARTMENT WILL SEEK RECOVERY OF RESOURCES IF:
1. THE RESOURCE WAS REPORTED TO THE FUNERAL DIRECTOR AFTER THE DEADLINE DATE, AND THE FUNERAL DIRECTOR DOES NOT COLLECT FROM THEM.
2. THE RESOURCE BECOMES AVAILABLE ONLY AFTER THE COUNTY DEPARTMENT HAS PAID FOR BURIAL SERVICES.
3.580 ADULT FOSTER CARE (AFC)
3.581 PURPOSE OF PROGRAM [Emergency rev. eff. 1/1/15]
A. The AFC program provides twenty-four (24) hour care and supervision for frail elderly or physically or emotionally disabled adults, age eighteen (18) or older, who do not require twenty-four (24) hour medical care but who cannot return to their home and need twenty-four (24) hour non-medical supervision.
B. Effective January 1, 2019, the maximum AFC grant standard is $1,403.00, determined as follows:
1. Deduct the client's income, from the AFC grant standard; and,
2. Deduct the client's OAP or AND-CS grant and any Supplemental Security Income (SSI) benefits; and,
3. The remainder is the AFC benefit.
C. The AFC maximum grant standard shall be adjusted to stay within available appropriations. Appeals shall not be granted for these adjustments.
D. The AFC grant is not taxable income to the client.
E. In addition to the regular monthly AFC grant payments, supplemental payments necessary to comply with the federal Maintenance of Effort (MOE) requirements may be provided. These payments are supplements to regular grant payments, are not entitlements, and do not affect grant standards. Appeals shall not be allowed for MOE payment adjustments.
3.582 DEFINITIONS [Eff. 3/2/14]
“Adult Foster Care (AFC) Facility” means a Colorado Department of Public Health and Environment (CDPHE) licensed assisted living residence (ALR) that shall provide:
A. Twenty-four hour residential care for no more than sixteen (16) residents;
B. An environment that is sanitary and safe from physical harm;
C. Adequate sleeping and living areas; and,
D. Appropriate AFC services.
“Adult Foster Care (AFC) Services” means services provided for each AFC client including, but not limited to:
A. Availability of three (3) balanced meals per day with provision for special diets when those diets have been prescribed as part of a medical plan;
B. Assistance with transportation;
C. Protective oversight;
D. Assistance with basic personal tasks, such as bathing, hair care, and dressing;
E. Supervision of self-administration of medications;
F. Housekeeping services such as changing of bed linen, cleaning of living areas, and rearrangement of furniture as needed to promote freer mobility;
G. Laundering of resident's clothing and bedding; and,
H. Opportunities for structured recreational activities and socializing.
“Appropriateness of placement” means the determination of whether a client would be appropriate for an AFC facility and/or the AFC program.
“BUS” means the Benefits Utilization System used to document case management services conducted by the Single Entry Point agencies.
“Client” means a current or past applicant or a current or past recipient of benefits under the AFC program.
“County department” means the county department of human/social services.
“Medical leave” means the absence of the client from the Adult Foster Care (AFC) facility for more than twenty-four (24) hours due to admittance to a hospital or other facility, upon physician's order with the presumption on the part of the physician that the client will be returning to the AFC facility. Medical leave may be planned or unplanned.
“Non-medical leave” means the absence of the client from the Adult Foster Care (AFC) facility for more than twenty-four (24) hours for non-medical reasons that are not part of a client's care plan. Non-medical leave may be planned or unplanned.
“Operator” means any person who owns an Adult Foster Care (AFC) facility or an individual with authority delegated by the owner who manages, controls, or performs the day-to-day tasks for operating an AFC facility.
“Protective Oversight” means guidance of an Adult Foster Care (AFC) client, as required by the needs of the client or as reasonably requested by the client, including the following:
A. Knowing the client's general whereabouts, although the client may travel independently in the community;
B. Monitoring the activities of the client while on the premises to ensure the health, safety, and well-being of the client, including monitoring of prescribed medications;
C. Reminding the client to carry out activities of daily living; and,
D. Reminding the client of any important activities, including appointments.
“Single Entry Point (“SEP”) agency” means the agency selected by the Colorado Department of Health Care Policy and Financing (HCPF) to provide case management services for persons in need of long term care services within specific demographic areas, pursuant to Section 25.5-6-106, C.R.S.
“Staff” means a paid employee of the Adult Foster Care (AFC) facility.
“Substance Abuse” means the use of alcohol or drugs or any other mind or mood altering material in a manner that deviates from standard medical practice in the community, which acts to the detriment of the individual clients or the public.
“Universal Precautions” refers to a system of infection control, which assumes that every direct contact with body fluids is potentially infectious including skin, eye, mucous membrane, blood, blood-tinged body fluids, or other potentially infectious materials.
3.583 ELIGIBILITY [Rev. eff. 1/22/15]
A. The AFC program provides twenty-four (24) hour care and supervision for clients who are:
1. Frail elderly or physically or emotionally disabled adults age eighteen (18) or older who do not require twenty-four (24) hour medical care but who cannot return to their home and need twenty-four (24) hour non-medical supervision; and,
2. Living in a non-medical facility of no more than sixteen (16) clients that is licensed by the Colorado Department of Public Health And Environment (CDPHE); and,
3. Receiving or eligible to receive Old Age Pension (OAP), Aid to the Needy Disabled-Colorado Supplement (AND-CS), or Supplemental Security Income (SSI).
B. AFC shall not be available to persons:
1. Receiving home care allowance; or,
2. With a developmental disability, as defined in 27-10.5-102, C.R.S.; or,
3. Receiving or eligible to receive behavioral or mental health services pursuant to any provision in Title 27, C.R.S.
C. Eligibility for the Adult Foster Care program shall be based on:
1. Financial eligibility; and,
2. Functional eligibility that includes the client's functional assessment, the client's need for twenty-four (24) hour supervision and assistance, and the client's appropriateness for the AFC program.
D. The county department shall determine financial eligibility for AFC.
1. The client's application shall be processed to determine eligibility for OAP or AND-CS, or the county department shall determine whether the client is receiving SSI benefits.
2. If approved for OAP or AND-CS or the client is receiving SSI, deduct the client's income and the OAP or AND-CS grant standard from the AFC maximum grant standard to determine the client's AFC benefit.
3. If a client is receiving or eligible to receive Home Care Allowance (HCA) or a Home and Community Based Services (HCBS) waiver that provides services for any person receiving or eligible to receive services pursuant to any provision in Title 27, C.R.S., eligibility for AFC cannot begin until the first day of the month following the discontinuation of HCA OR HCBS.
4. The AFC benefit shall be paid to the client. The client shall:
a. Keep $79.00 of the payment for personal needs; and,
b. Use the remainder of the AFC payment to pay a portion of the fee charged by the AFC provider; and,
c. Pay the remainder of the AFC charges using his/her income from OAP, AND/CS, or SSI.
5. AFC facilities shall charge a standard rate of payment for all AFC clients.
a. The AFC rate charged by the AFC facility shall be no greater than the current maximum AFC grant standard less seventy seven dollars ($79), effective October 1, 2016, for the client's personal needs.
b. AFC facilities shall charge private pay clients an amount at least equal to that charged to clients receiving an AFC benefit.
E. The Single Entry Point (SEP) shall determine functional eligibility.
To be functionally eligible, the client shall have an AFC eligible functional assessment score as outlined in Section 3.584. The functional assessment score is calculated by determining the client's functional capacity score and need for paid care score, as follows:
1. Functional Capacity: determined by assessing the client's ability to complete all activities of daily living (ADLs) and applying a score to his/her ability to complete the ADLs using the functional impairment scale; and,
2. Determining the client's appropriateness of placement in an AFC facility.
F. When the client is determined functionally eligible for the AFC program, the Single Entry Point (SEP) shall notify the county department. The county department shall notify the SEP when the client has been determined financially eligible for the AFC program.
G. The AFC payment effective date shall be the date that the client was admitted to the AFC facility or the date he/she is determined to be financially eligible, whichever is later. If the client is receiving or eligible to receive Home and Community Based Services (HCBS) pursuant to any provision in Title 27, C.R.S, the effective date is the first day of the month following the discontinuation of HCBS.
3.584 FUNCTIONAL ASSESSMENT SCORING [Eff. 3/2/14]
A. The need for skilled personal care shall not be included in the scoring of the functional capacity or need for paid care. Skilled personal care is not a paid service of the AFC program.
B. In order to be eligible for the AFC, each client shall score a minimum of ten (10) points when assessed for the ability to complete the activities of daily living (ADL) using the following functional capacity impairment scale:
1. Independent: score zero (0) if the client is physically able to perform all essential components of the ADL, with or without an assistive device.
2. Low: score one (1) if the client is able to perform all essential components of the function, but impairment of function exists even with an assistive device. The client requires occasional or intermittent supervision or physical assistance in a limited number of the components of the activity.
a. Occasional or intermittent means the client does not need assistance daily, but may need assistance a few times a month or up to two (2) times per week.
b. Supervision or assistance means verbal prompting, cueing, and reminders, and means stand-by assistance or monitoring to help the client if he/she needs physical assistance up to two (2) times per week.
3. Moderate: score two (2) if the client is unable to perform the majority of the essential components of the function even with an assistive device, and the client requires hands-on and frequent assistance to accomplish the activity.
a. Frequent means the client needs assistance at least three (3) times per week and up to daily.
b. Hands-on assistance means the care provider must physically assist the client in completing the task.
4. Severe: score three (3) if the client is totally unable to perform the function and requires someone to perform the task, or the client requires constant supervision for the task.
C. The functional assessment shall be scored on the State Department prescribed form, which shall list each activity of daily living and the functional capacity score for each ADL.
3.585 ACTIVITIES OF DAILY LIVING [Eff. 3/2/14]
A. Activities of daily living (ADLs) shall be scored using the functional capacity impairment scale.
B. The activities of daily living are:
1. Critical ADLs
a. Transfers: the ability to move between surfaces, such as getting in and out of bed; transferring from a bed to a chair, wheelchair, or walker; moving from a chair or wheelchair to a walker or to a standing position; and the ability to use assistive devices, including prosthetics.
b. Bladder care: the extent to which the client has control of his/her bladder functions and the ability of the client to accomplish the tasks of toileting, including catheterizing, getting on and off the toilet, changing incontinence products, and cleaning him/herself.
c. Bowel care: the extent to which the client has control of his/her bowel functions and the ability of the client to accomplish the tasks of toileting, including getting on and off the toilet, changing incontinence products, and cleaning him/herself.
2. Basic ADLs
a. Mobility: the ability of the client to ambulate around the home and around essential places outside the home, with or without assistive devices.
b. Dressing: the ability of the client to accomplish all phases of the activities of dressing and undressing, including getting, putting on, fastening, and taking off all items of clothing, braces, and artificial limbs.
c. Bathing: the ability of the client to safely accomplish the task of washing body parts including getting into bathing waters, with or without assistive devices or whether the client requires stand by or hands-on assistance from another person.
d. Hygiene: the ability of the client to maintain personal hygiene other than bathing, including combing hair, brushing teeth, clipping nails, and shaving.
e. Eating: the ability to cut food into manageable size pieces, chew, and swallow food, with or without assistive devices.
3. Instrumental ADLs
a. Meals: the ability to safely prepare food to meet the basic nutritional requirements of the individual, including cutting food, transferring food to cooking vessels and/or dishes, utilizing utensils, using a stove or microwave, and implementing special dietary needs.
b. Housekeeping: the ability to maintain the interior of the client's residence for the purpose of health and safety, such as wiping surfaces, cleaning floors, making a bed, and cleaning dishes.
c. Laundry: the ability to gather and wash soiled clothing and linens; use washing machines and dryers; hang, fold, and put away clean clothing and linens.
d. Shopping: the ability to purchase goods that are necessary for health and safety. Activities include ability to make needs known, to make a list, reach for the needed items at the store, ability to estimate or determine the cost of the item, and to move items into the home and put them away.
4. Supportive ADLs
a. Medicine: the ability to manage medications, including knowing the name of the medication, knowing the amount, frequency, and how to take the medicine, understanding the reason for taking it, and understanding possible side effects.
b. Appointment: the ability to schedule or make an appointment for essential activities, such as doctor visits, meetings with caseworkers, and transportation.
c. Money: the ability to manage money, such as balancing a checkbook, writing checks or paying a bill electronically, and ability to understand financial decisions.
d. Access: the ability to access resources or services in the community, such as locating the resource/service and completing the process necessary to receive the resource or service.
e. Telephone: the ability to use the telephone to communicate essential needs, such as answering the phone in a reasonable time, speaking clearly and loudly enough to be understood, dialing the phone, initiating a conversation, hearing the caller, and placing a call in an emergency.
3.586 APPROPRIATENESS OF PLACEMENT [Eff. 3/2/14]
A. The appropriateness of placement shall be determined.
1. The appropriateness of placement shall be documented on the state prescribed form.
2. An AFC facility shall not admit or keep any client requiring a level of care or type of service that the facility does not provide or is unable to provide.
B. If a client meets one or more of the following disqualifying criteria for appropriateness of placement, he/she shall be ineligible for the AFC program, regardless of the functional assessment score or the client's financial eligibility. The client shall be ineligible for AFC when he/she:
1. Needs skilled care services more frequently than once per week. If skilled care services are provided, the services must be provided by a skilled care provider; or,
2. Is unable or unwilling to meet his/her own personal hygiene needs under supervision; or,
3. Has an acute physical illness which cannot be managed through medications or prescribed therapy; or,
4. Has a substance abuse problem, unless the substance abuse is no longer acute and a physician determines it to be manageable; or,
5. Has ambulation limitations, unless compensated for by an assistive device with minimal assistance from staff; or,
6. Has a reportable communicable or infectious disease, unless the transmittal of the disease can be managed through the use of universal precautions and appropriate medical and/or drug treatment; or,
7. Is consistently disoriented to time, person, and place to such a degree that he/she poses a danger to self or others; or,
8. Has a seizure disorder which is not adequately controlled by medications; or,
9. Exhibits behavior that poses a physical threat to self or others. Such behavior includes, but is not limited to, violent and disruptive behavior and/or any behavior which involves physical, sexual, or psychological force or intimidation; or,
10. Requires intravenous or tube feeding; or,
11. Is consistently unwilling to take medications prescribed by a physician or psychiatrist; or,
12. Is incapable of self-administration of medications. The client is not disqualified if the AFC facility has a staff member trained in medication administration, in accordance with Section 25-1.5-302, C.R.S., et seq., or who possesses all necessary licenses to administer medication; or,
13. Is a person whose physical safety cannot be assured in an AFC; or,
14. Is consistently, uncontrollably incontinent of bowel or bladder and it cannot be managed by the client with assistance from staff; or,
15. Needs restraints of any kind. “Restraint” for the purpose of this section means any physical or chemical device, application of force, or medication that is designed or used for the purpose of modifying, altering, or controlling behavior for the convenience of the facility and excludes medication prescribed by a physician as part of an on-going treatment plan or pursuant to a diagnosis; or,
16. Has a primary diagnosis of mental illness and is unwilling to comply with medications prescribed by the physician or psychiatrist; or,
17. Is receiving or is eligible to receive behavioral or mental health services, as defined in Title 27, C.R.S; or,
18. Has a developmental disability, as defined in Title 27, Article 10.5-102, C.R.S.
3.587 CARE PLANNING, PLACEMENT, AND CASE MANAGEMENT [Eff. 3/2/14]
A. When the client is determined eligible for the AFC program, the Single Entry Point (SEP) shall review available AFC facilities to determine if the client's needs can be met by any of the facilities. The review:
1. May require contact with AFC facilities outside of the client's county of residence.
2. Shall include a discussion of the client's needs with the AFC facility staff.
B. When an appropriate AFC facility(ies) has been located, the SEP shall:
1. Discuss the facility(ies) and with the client;
2. Arrange for the client to make an initial visit to the facility(ies); and,
3. Develop a care plan in conjunction with the client, family, SEP, and the AFC facility staff.
4. Ensure a signed provider agreement is in place prior to placement at the AFC facility. The agreement shall be:
a. Reviewed at least annually; and,
b. Be re-signed annually, contingent upon the AFC facility's ongoing appropriateness for the client and ongoing licensure as an assisted living residence by CDPHE.
C. A client shall not be placed in an AFC facility unless:
1. The competent client gives informed consent for placement; or,
2. The court-appointed guardian of the client requests placement; and,
3. The client or his/her legal representative understands and agrees to adhere to facility rules.
D. Any client admitted for respite care in an AFC shall meet the requirements for appropriate placement.
E. The SEP shall develop a care plan on the State Department prescribed form within ten (10) working days after program eligibility has been determined and prior to the arrangement for services.
1. The care plan shall be:
a. Signed by the client, SEP, and AFC facility staff.
b. Reviewed and updated at least once every twelve (12) months; and,
c. Reviewed sooner if there is a change in the client's needs; and,
d. Provided to all parties prior to admission to the facility.
2. Care planning shall include, but not be limited to, the following tasks:
a. Identify and document care plan goals and client choices.
b. Identify and document services, including type, duration and frequency.
c. Arrange for services through an AFC facility, coordinate service delivery, negotiate with the AFC facility and the client regarding service provision, and formalize the AFC agreement.
d. Complete program requirements for the authorization of services.
e. Refer the client to community resources, as needed, and attempt to develop resources for the client if a resource is not available within the client's community.
f. Explain the complaint procedures to the client, as listed on the care plan document.
g. Explain the client's right to appeal any decision.
F. The SEP shall provide ongoing case management, as follows:
Monitor the quality of care provided to clients.
1. Contact service providers concerning service coordination, effectiveness and appropriateness.
2. Review the client's assessment, care plan, and service agreements to include changes in client functioning, service effectiveness, appropriateness, and cost-effectiveness that may require a reassessment or a change in the care plan;
3. Make changes in service plans as appropriate to client needs and/or refer the client to community resources, if appropriate.
4. Provide conflict resolution and/or crisis intervention, as needed.
5. Identify and contact appropriate individuals, and resolve any problems or complaints raised by the client or others regarding service delivery, including corrective action processes, as appropriate.
6. Notify the appropriate law enforcement and/or Adult Protective Services agency of suspected abuse, neglect, or exploitation, as required by Sections 18-6.5-101 and 26-3.1-102, C.R.S.
G. The SEP shall complete a review of the client's current assessment or reassessment and the care plan with the client six (6) months following the assessment or reassessment.
1. The review shall be conducted by telephone, at the client's place of residence, at the place of service or other appropriate setting as determined by the client's needs.
2. A face-to-face home visit shall be completed when significant changes in the client's condition are identified.
H. The SEP shall complete a face-to-face functional reassessment within twelve (12) months of the initial functional assessment and every 12 months thereafter. A reassessment shall be completed sooner if the client's condition changes.
I. Reassessment shall include the following tasks:
1. Obtain diagnoses from the client's medical provider at least annually, or sooner if the client's condition changes.
2. Review the care plan, service agreement, and provider contract or agreement.
3. Evaluate service effectiveness, quality of care, and appropriateness of services.
4. Verify continuing financial and program eligibility.
5. Annually, or more often if indicated, complete a new care plan and service agreement.
6. Refer the client to community resources, as needed.
7. Determine continued appropriateness of placement.
J. The SEP shall update the information provided at the previous assessment or reassessment, utilizing the State Department prescribed functional assessment tool. When a new functional assessment is completed a copy shall be sent to the county department within thirty (30) days of the reassessment.
3.588 DENIALS, DISCONTINUATIONS, AND CASE TRANSFERS [Eff. 3/2/14]
A. The SEP shall deny or discontinue the client from the AFC program if he/she is determined functionally ineligible.
1. The client shall be informed of his/her appeal rights in accordance with rules under Section 3.850, et seq.
2. The client shall be provided appropriate referrals to other community resources within one (1) working day of discontinuation or denial.
3. The SEP shall notify all providers on the care plan within one (1) working day of discontinuation.
4. The SEP shall notify the county department within one (1) working day of discontinuation.
5. The SEP shall prepare for and defend at the hearing any appeal related to functional denial or discontinuation. The SEP may request assistance and/or testimony from the county department.
B. The county department shall deny or discontinue the client from the AFC program if he/she is determined financially ineligible.
1. The client shall be informed of his/her appeal rights in accordance with rules under Section 3.850, et seq.
2. The client shall be provided appropriate referrals to other community resources within one (1) working day of discontinuation or denial.
3. The county department shall notify all providers on the care plan within one (1) working day of discontinuation.
4. The county department shall notify the Single Entry Point (SEP) within one (1) working day of discontinuation.
5. The county department shall prepare for and defend at the hearing any appeal related to financial denial or discontinuation. The county department may request assistance and/or testimony from the SEP.
C. Denial and/or discontinuation from the AFC program shall occur for the following reasons:
1. Financial and Functional Eligibility: The SEP or county department shall deny or discontinue a client if the client is not financially eligible and/or is not functionally eligible for AFC.
2. Target population: The SEP or county department shall deny or discontinue when the client:
a. Has been diagnosed with a developmental disability, as defined in Section 27-10.5-102, C.R.S.; or,
b. Is receiving or eligible to receive behavioral or mental health services pursuant to any provision of Title 27, C.R.S.
3. Level of Care: The SEP shall deny or discontinue when the client:
a. Does not meet functional capacity score minimum requirements; or,
b. Does not meet appropriateness of placement criteria.
4. Receipt of Services: The SEP or county department shall deny or discontinue when the client:
a. Has not received services for one month;
b. Has twice refused to schedule an appointment for an initial assessment, six (6)-month review, or reassessment within a thirty (30) day consecutive period;
c. Has failed to keep three (3) scheduled appointments within a thirty (30) consecutive day period;
d. Has refused to schedule an appointment for a required visit after the client's case has been transferred to a new SEP or county department;
e. Refuses to use the AFC payment to pay for services or uses the payment for services not identified in the service agreement; or,
f. Refuses to sign the intake form, care plan, or other documents and forms required to receive services.
5. Facility Status: The SEP or county department shall deny or discontinue when the client:
a. Is a resident of a nursing facility, hospital, or other facility other than the approved AFC facility; or,
b. Enters a hospital for treatment and hospitalization that continues for thirty (30) days or more.
6. Service Limitations Related to Safety: The SEP or county department shall deny or discontinue when the client cannot be safely served given the type and/or amount of services available. Evidence of safety concerns include, but are not limited to:
a. The results of an Adult Protective Services assessment that substantiates ongoing risk.
b. A statement from the client's physician attesting to diminished cognitive capacity, debilitating mental illness, or ongoing risk.
c. Lack of available AFC facilities.
d. A functional assessment score indicating a level of need for services in excess of those available under the AFC program.
e. Other available information or evidence that will support the determination that the client's safety is at risk.
7. Service Limitations Related to Cost Effectiveness: The SEP or county department shall deny or discontinue when other more cost effective alternatives are available to meet the client's needs.
8. Living Arrangements: The SEP or county department shall deny or discontinue when the client is residing anywhere other than his/her approved AFC facility.
a. The SEP may continue to authorize services while a resident is on medical or non-medical leave.
b. Combined leave shall not exceed a total of forty-two (42) days in a twelve (12) month period beginning with the date the client was admitted into the AFC program.
9. Move Out of State: The SEP or county department shall deny or discontinue when the client has moved out of state.
a. Discontinuation shall be effective the day after the date of the move.
b. Clients who leave the state on a temporary basis with the intent to return to Colorado within thirty (30) calendar days shall not be discontinued. If the client fails to return to Colorado the client shall be discontinued on day thirty-one (31).
10. Voluntary Withdrawal from the Program: The SEP or county shall deny or discontinue when the client requests withdrawal from the AFC program.
11. Death: The SEP or county shall discontinue the AFC program effective the day after the client's date of death. No notice of discontinuation shall be sent.
D. The SEP shall complete the following procedures to transfer an AFC client to a new county department:
1. Notify the county department of the client's plans to relocate to another county and the date of transfer.
2. If the client's current service providers do not provide services in the area where the client is relocating make arrangements, in consultation with the client, for new service providers.
3. If the client is moving from one county to another county to enter a new facility, forward copies of the following client records to the facility prior to the client's admission to the facility:
a. Current client assessment;
b. Verification of financial eligibility status.
E. The SEP shall complete the following procedures to transfer an AFC client to a new SEP:
1. The transferring SEP shall contact the receiving SEP by email or telephone to give notification that the client is planning to transfer, to negotiate a transfer date, and to provide information.
2. The transferring SEP shall forward copies of the client's case records, including forms required for the AFC program, to the receiving SEP prior to the relocation, if possible, but in no case later than five (5) working days after the client's relocation.
3. If the client is moving to enter a new Adult Foster Care facility, the transferring SEP shall forward copies of the following client records to the facility prior to the client's admission to the facility:
a. Current client assessment;
b. Verification of financial eligibility status.
4. The receiving SEP shall complete a face-to-face meeting with the client and an assessment and case summary update within ten (10) working days after notification of the client's relocation.
5. The receiving SEP shall review the care plan and the assessment tool, revise as necessary, and coordinate services and providers.
3.589 COUNTY DEPARTMENT AND SEP REQUIREMENTS AND RESPONSIBILITIES [Eff. 3/2/14]
A. The AFC facility shall:
1. Be licensed by the Colorado Department of Public Health and Environment (CDPHE) and shall operate in compliance with the rules concerning “Standards for Hospitals and Health Facilities: Chapter VII: Assisted Living Residences” (6 C.C.R. 1011-1), including operator and staff qualifications, training, records, reporting, and resident rights.
2. AFC facilities shall provide all AFC services and protective oversight as outlined in Section 3.582.
3. AFC facilities shall coordinate client care with the SEP as follows:
a. Have a copy of the AFC's current license from the CDPHE available for annual inspection.
b. Notify the SEP of any AFC facility license revocation or suspension or of any violation of codes or ordinances within twenty-four (24) hours of occurrence.
c. Notify the SEP of a potential crisis situation where intervention from the SEP may be necessary.
d. Notify the SEP of any client's death, acute illness, or accident requiring medical attention.
e. Provide updates or cooperate in periodic conferences relating to the client.
f. Immediately notify the SEP of any AFC client's planned or unplanned medical or non-medical leave of more than twenty-four (24) hours.
B. The county department shall:
1. Ensure all requirements of the county department are implemented, as appropriate for the AFC program, related to:
a. General county requirements, as outlined in Section 3.520; and,
b. Documentation, as outlined in Section 3.520.2; and,
c. Program review and oversight, as outlined in Section 3.520.3; and,
d. Application processing, as outlined in Section 3.520.4.
2. The county department shall determine financial eligibility for AFC in the statewide automated system and update any changes in the case record.
3. The county shall notify the SEP in writing:
a. Within five (5) working days of determining AFC eligibility.
b. Within five (5) working days after the eligibility worker determines that the client is no longer financially eligible for AFC.
c. Within one (1) working day when the client has filed a written appeal with the county department.
d. Within one (1) working day when the client has withdrawn the appeal or a final agency decision has been entered.
4. The county shall respond to requests for information from the SEP within ten (10) working days.
C. The SEP shall:
1. Provide intake, screening, and referral activities, as follows:
a. Determine of the appropriateness of a referral for a client assessment.
1) If appropriate, complete intake activities within two (2) working days of the referral.
2) Obtain the client's or client's authorized representative's signature on the intake form.
3) Complete the AFC functional assessment within thirty (30) calendar days of referral.
b. Provide the client information and referral to other agencies, as needed.
2. The SEP shall identify potential payment source(s), including the availability of private funding:
a. Refer the client to the county department to complete an application; or,
b. Refer the client to another community resource that can assist in completing the application; or,
c. Verify the client's ability to private pay for services.
3. The SEP shall complete a functional assessment when the county department provides written notification that the client has requested AFC and is receiving or has submitted an application for Old Age Pension (OAP), Aid to the Needy Disabled Colorado Supplement (AND-CS), or the client is receiving Supplemental Security Income (SSI).
a. If the client is being discharged from a hospital or nursing facility, the SEP shall complete the functional assessment regardless of whether the Medicaid application date has been provided by the county department.
b. The SEP shall complete the functional assessment within two (2) working days after notification when a client is being transferred from a hospital to the AFC program.
c. The SEP shall complete the functional assessment within five (5) working days after notification when a client who is being transferred from a nursing facility to the AFC program.
d. The SEP shall complete the functional assessment within ten (10) working days after notification for all other clients. However, the SEP shall have a procedure for prioritizing urgent referrals.
4. The SEP shall document all case information.
a. Documentation of contacts and case management activities shall be entered into the BUS within five (5) working days of the contact or activity.
b. All information related to intake, assessment, and care planning shall be thoroughly documented within ten (10) working days of the intake, assessment or care planning using State Department prescribed forms and the BUS.
c. Additional documentation that cannot be entered into the BUS shall be maintained in the case file.
5. The SEP shall notify clients of their program status using the State Department prescribed form at the time of initial eligibility, when there is a significant change in the client's payment or services, when an adverse action is taken, or at the time of discontinuation.
6. The SEP shall notify the county department in writing:
a. Within five (5) working days of determining AFC functional eligibility.
b. Within five (5) working days after the SEP determines that the client is no longer functionally eligible for AFC.
c. Within one (1) working day when the client has filed a written appeal with the SEP.
d. Within one (1) working day when the client has withdrawn the appeal or a final agency decision has been entered.
7. The SEP shall respond to requests for information from the county department within ten (10) working days.
8. The SEP shall notify the client, at the time of his or her application and at the time of reassessment or discontinuation of the right to request a fair hearing before an Administrative Law Judge in accordance with Section 3.850, and to appeal adverse actions of the SEP or county department.
9. The SEP shall inform the client's Adult Protective Services caseworker, if applicable, of the client's status. The case manager shall participate in mutual staffing of the client's case.
10. The SEP shall report to the Colorado Department of Public Health and Environment any congregate facility, with three (3) or more residents, that is not licensed.
11. The SEP shall immediately report to the county department any information that indicates an overpayment, incorrect payment, or misuse of any AFC benefit, and shall cooperate with the county department in any subsequent recovery process.
12. The SEP shall be subject to routine quality control, program monitoring, and contract management to minimally include:
a. Targeted review of the BUS documentation;
b. Case file review;
c. Targeted program review conducted via phone, email, or survey; and,
d. Onsite program review;
e. A performance improvement plan to correct areas of identified non-compliance; and,
f. Contract sanctions when the SEP fails to implement a performance improvement plan.
3.590 BURIAL ASSISTANCE PROGRAM
3.591 PURPOSE OF PROGRAM [Eff. 3/2/14]
Burial benefits are available to eligible clients to cover reasonable and necessary costs for burial services.
3.592 DEFINITIONS [Eff. 3/2/14]
“Burial benefit” means the State Department program to pay all or a portion of the cost of funeral, burial, or cremation services for certain deceased clients.
“Burial funds” means the funds authorized by the county department under the burial benefit.
“Burial plot” means the client's final resting place, whether a cemetery plot, vault, or crematorium.
“Burial services” means those services provided as part of funeral, burial, or cremation services, including:
A. Transportation of the body from the place of death to a funeral home or other storage facility, and/or from the funeral home to the funeral/memorial site, and/or to the burial plot;
B. Storage of the body prior to final disposition and/or storage of the cremated remains for no more than one hundred twenty (120) days, in those cases where the remains are not buried and are not claimed by the client's family or friends;
C. Embalming, where necessary for preservation of the body and/or preparation of the body for the casket or for cremation;
D. Purchase of a casket or of an urn or other receptacle for the cremated remains;
E. Purchase of a gravesite, vault, vault liner, or crematorium space;
F. Purchase and placement of the grave marker and/or of perpetual care of the gravesite, vault, or crematorium;
G. Funeral or memorial service;
H. Cremation of the body;
I. Burial or internment of the body or cremated remains in a burial plot, vault, or crematorium;
J. Any other items that are incidental to burial services.
“Contributions” means any monetary payment or donation made directly to the service provider(s) by a non-responsible person to defray the expenses of the client's burial services.
“Legally responsible person(s)” means the parent(s) of a deceased minor client or the spouse of the deceased client.
3.593 ELIGIBILITY AND DETERMINATION FOR BURIAL ASSISTANCE [Eff. 3/2/14]
A. A burial benefit shall be available to cover reasonable and necessary costs for burial services when:
1. A deceased client was receiving Old Age Pension (OAP), Aid to the Needy Disabled (AND-SO or AND-CS), and/or eligible Colorado Medicaid assistance at the time of death; and,
2. The deceased client's estate is insufficient to pay all or part of the burial services; and,
3. The resources of the legally responsible person(s) for the support of the deceased client are insufficient, even with contributions from the client's estate, to enable the legally responsible person(s) to pay all or part of such expenses; and,
4. The total cost for all burial services does not total more than two thousand five hundred dollars ($2,500), except that the cost of a burial plot shall not be included in the $2,500 maximum cost limit when:
a. The client has a prepaid burial plot valued at two thousand dollars ($2,000) or less at the time of purchase; or,
b. A burial plot was purchased by someone other than the deceased client and donated to the deceased client; and,
B. The total burial benefit shall not exceed the current burial benefit rate, as determined by the program of assistance the client was receiving at the time of death.
1. Effective January 1, 2014, the burial benefit shall not exceed one thousand five hundred dollars ($1,500) for clients who were receiving Old Age Pension (OAP), Colorado Medicaid programs for persons sixty (60) years of age and older, or Colorado Medicaid for families and children, including an adult who meets the modified adjusted gross income (MAGI) criterion as defined in the Department of Health Care Policy and Financing regulations 10 C.C.R. 2505-10 Section 8.100.4, at the time of death.
2. Effective January 1, 2014, the burial benefit shall not exceed one thousand dollars ($1,000) for clients who were receiving Aid to the Needy Disabled – State Only (AND-SO), Aid to the Needy Disabled – Colorado Supplement (AND-CS), or any other Colorado Medicaid program for clients under sixty (60) years of age at the time of death.
3. The reimbursement rate shall be adjusted by the State Department as needed to stay within the available appropriations. There shall be no appeal granted for this adjustment.
C. When assistance for funeral, burial, or cremation services is requested within one (1) year from the date of death on behalf of a deceased recipient of public or medical assistance by any interested party; an application requesting a burial benefit shall be completed and submitted to the county department for eligibility determination. The client's family or friends, or the county department when there are no known family or friends, shall make arrangements for disposition of the client's body in a reasonable, dignified manner which approximates the wishes and the religious and cultural preferences of the client or family, to the extent possible within the burial benefit rules and benefit funds.
1. The county department shall ensure that a choice of disposition by the client or a family member is made in writing. The choice of disposition may be made on the client's most recent application for benefits, in the client's will, on the application for burial benefits, or by any other document which the county department deems credible.
2. The county department shall coordinate with the client's family or interested parties to explain the burial benefit rules, including:
a. Options in the event the client's or family's burial preferences cannot be met within the limitations of the burial rules or benefit maximum; and,
b. If the family's burial preference is in opposition to the client's preference, as noted on the client's most recent application for benefits or other documentation, the burial benefit shall be used to meet the client's preference, unless all options for meeting that preference have been exhausted within the limitations of the burial benefit; and,
c. The legally responsible person's responsibility to pay the cost of burial services that exceed the approved burial benefit; and,
d. That voluntary contributions from family, friends, or other interested parties, may be used to cover some or all of the legally responsible person's costs that exceed the approved burial benefit.
3. The county department shall use the following procedures when the deceased client's burial preferences are unknown and a family member cannot be located:
a. If a family member has not been located within twenty-four hours after the client dies, the county department shall have the body refrigerated or embalmed.
b. If a family member has not been located within seven (7) days, the county department shall make the determination to bury or cremate the body based on the best option available.
c. Complete and send written authorization to the appropriate funeral home or crematorium.
D. The county department shall reduce the burial benefit by applying the following monies toward the full burial costs in the order listed:
1. First, subtract monies due from any insurance policy of the deceased client to a legally responsible person or non-responsible person who is named as beneficiary or a joint beneficiary; then if costs remain,
2. Subtract the value of the deceased client's estate as of the date of death, including any cash or property of any kind which the deceased client owned at the time of death; then if costs remain,
3. Subtract monies from the legally responsible person(s) for the client, as follows:
a. Social Security lump sum death benefits payable to a legally responsible person shall be exempt.
b. If the legally responsible person(s) has resources below the SSI resource limit of $2,000 for an individual or $3,000 for a couple.
1) If the legally responsible person is the widow(er), the individual resource limit shall apply.
2) The legally responsible person(s) may voluntarily contribute monies toward the cost of the burial services.
c. If the legally responsible person(s) has resources over the SSI limit, the amount of resources over the limit shall be used to reduce the burial benefit; then if costs remain,
4. The county department shall issue a written authorization for the amount of the burial benefit, up to the benefit limit, as outlined in Section 3.590.
E. Once the application and choice of burial services is determined, the family or county department shall contact the appropriate provider(s) to obtain a written estimate of the provider's proposed charges for burial services. If more than one provider is involved, a separate written estimate from each provider shall be obtained.
F. Once the proposal(s) from the provider(s) is received, the county department shall determine if a burial benefit is appropriate, as outlined in Section 3.590.
1. If the combined charges from the provider(s) exceed two thousand five hundred dollars ($2,500), no burial benefit shall be paid.
2. The county department shall allow the provider(s) to resubmit a written estimate within thirty (30) calendar days of notification that the charges exceeded the burial benefit maximum.
G. The county department of residence of the deceased individual shall authorize the approved burial benefit through the statewide automated system. The burial benefit shall be paid directly to the provider(s).
H. The county department shall have a statement of agreement between the providers, which ensures that the distribution of burial benefits is proportional to burial services provided or as the providers otherwise determine. The agreement shall be signed by all provider(s) and shall be approved and signed by the county department before the burial benefit is authorized in the statewide automated system.
3.580 PAYMENTS, OVERPAYMENTS, INTENTIONAL PROGRAM VIOLATIONS, FRAUDULENT ACTS, RECOVERY, DISPUTE RESOLUTION, APPEAL, AND STATE LEVEL FAIR HEARING
3.581 PAYMENTS
A. A CLIENT SHALL BE PLACED ON AN ISSUANCE SCHEDULE SO THAT HE OR SHE RECEIVES GRANT PAYMENTS ON OR ABOUT THE SAME DATE EACH MONTH ONCE A CERTIFICATION PERIOD IS ESTABLISHED. DUE TO THE EFFECTIVE DATE OF ELIGIBILITY, THE DATE ON WHICH A CLIENT RECEIVES HIS OR HER INITIAL PAYMENT NEED NOT BE THE DATE THAT THE CLIENT MUST RECEIVE ANY SUBSEQUENT PAYMENTS.
B. WHEN THE COUNTY DEPARTMENT DETERMINES THAT A CLIENT WAS INELIGIBLE FOR ALL OR A PART OF A GRANT PAYMENT THAT THE CLIENT HAS ALREADY RECEIVED, THE COUNTY DEPARTMENT SHALL, SUBJECT TO TIMELY NOTICE AND RECOVERY RULES, ESTABLISH A CLAIM, AND IF VALID, INITIATE A RECOVERY.
C. IF A CLIENT DIES, PAYMENTS TO THE CLIENT SHALL BE TREATED AS FOLLOWS:
1. A CLIENT’S ELIGIBILITY SHALL END ON THE DATE OF HIS OR HER DEATH.
2. IF A CLIENT OF ANY CATEGORY OF ASSISTANCE DIES BEFORE 12:00 A.M. ON THE FIRST DAY OF A MONTH, NO ELIGIBILITY FOR A GRANT PAYMENT FOR THE FOLLOWING MONTH EXISTS.
3. IF A CLIENT OF ANY CATEGORY OF ASSISTANCE DIES ON OR AFTER 12:00 A.M. ON THE FIRST DAY OF A MONTH, ANY PAYMENT TO WHICH THE PERSON WAS ELIGIBLE SHALL BE MAINTAINED FOR RELEASE TO THE CLIENT'S PERSONAL REPRESENTATIVE AS DEFINED IN SECTION 15-10-201(39), C.R.S., FOR A MAXIMUM OF THREE (3) MONTHS. THE FOLLOWING RULES APPLY WHEN A PERSONAL REPRESENTATIVE REQUESTS TO RECEIVE A DECEASED CLIENT’S LAST GRANT PAYMENT:
A. THE INDIVIDUAL CLAIMING TO BE THE PERSONAL REPRESENTATIVE OF THE DECEASED CLIENT MUST PROVIDE THE COURT-ISSUED LETTERS DESCRIBED IN SECTION 15-12-103, C.R.S. TO THE COUNTY DEPARTMENT IN ORDER TO RECEIVE THE DECEASED CLIENT’S LAST GRANT PAYMENT; OR
B. IF THE PERSONAL REPRESENTATIVE PRESENTS A COURT ORDER ORDERING THE COUNTY DEPARTMENT TO PAY THE DECEASED CLIENT’S LAST GRANT PAYMENT TO A SPECIFIC PERSON OR ENTITY, THE COUNTY DEPARTMENT SHALL MAKE THE LAST GRANT PAYMENT PAYABLE TO THE PERSON NAMED IN THE ORDER.
D. TO CALCULATE PARTIAL MONTH PAYMENTS:
1. DETERMINE THE CLIENT’S MONTHLY GRANT PAYMENT AMOUNT FOR THE PROGRAM ACCORDING TO PROGRAM RULES at 3.520.78, 3.533, 3.544, AND 3.549;
2. DETERMINE THE NUMBER OF DAYS FOR WHICH THE CLIENT IS ELIGIBLE FOR ASSISTANCE AND, BASED ON THE TABLE IN SUBSECTION 4 BELOW, FIND THE DECIMAL FIGURE CORRESPONDING TO THE NUMBER OF DAYS OF ELIGIBILITY;
3. MULTIPLY THE CLIENT’S MONTHLY GRANT PAYMENT AMOUNT FROM SUBSECTION 1 BY THE DECIMAL FIGURE IN THE TABLE IN SUBSECTION 4 TO DETERMINE THE GRANT PAYMENT AMOUNT FOR THE PARTIAL MONTH;
4. TO CALCULATE THE PARTIAL MONTH PAYMENTS, THE FOLLOWING TABLE SHALL BE USED:
DAYS STANDARD DAYS STANDARD DAYS STANDARD
1 .03288 11 .36164 21 .69041
2 .06575 12 .39452 22 .72329
3 .09863 13 .42739 23 .75617
4 .13151 14 .46027 24 .78904
5 .16439 15 .49315 25 .82192
6 .19726 16 .52603 26 .85480
7 .23014 17 .55890 27 .88768
8 .26302 18 .59178 28 .92054
9 .29590 19 .62466 29 .95342
10 .32876 20 .65754 30 .98630
E. ALL PAYMENTS, INCLUDING PARTIAL PAYMENTS, SHALL HAVE ANY CENTS DROPPED TO THE NEAREST DOLLAR, EXCEPT IN CASES WHERE SSI INCOME REDUCES THE GRANT.
F. COUNTY DEPARTMENTS SHALL NOT HOLD OR DELAY THE CLIENT’S GRANT PAYMENT BEYOND THE REGULAR ISSUANCE DATE EXCEPT WHEN:
1. A FINAL AGENCY DECISION HAS BEEN MADE AUTHORIZING THE ACTION.
2. IN CASES WHERE A CORRECTED PAYMENT IS TO BE ISSUED, THE CORRECTED PAYMENT SHALL BE ISSUED BY THE EFFECTIVE DATE OF THE ORIGINAL WARRANT AND THE INCORRECT PAYMENT SHALL BE CANCELLED.
3. WHEN THE COUNTY DEPARTMENT RECEIVES RELIABLE INFORMATION THAT THE CLIENT NO LONGER RESIDES AT THE LAST KNOWN ADDRESS AND ATTEMPTS TO LOCATE THE PERSON THROUGH THE POST OFFICE, RELATIVES, FRIENDS, ETC., HAVE BEEN UNSUCCESSFUL, THE CASE SHALL BE DISCONTINUED FOLLOWING THE POLICIES OUTLINED IN SECTION 3.554. IF THE CLIENT CONTACTS THE COUNTY DEPARTMENT BEFORE GRANT PAYMENTS ARE DISCONTINUED AND PROVIDES THE CURRENT ADDRESS AND ALL OTHER ELIGIBILITY CRITERION HAVE BEEN MET, THE CLIENT SHALL RECEIVE THE GRANT PAYMENTS THEY ARE ELIGIBLE FOR;
4. ANY GRANT PAYMENTS ISSUED TO AN ELECTRONIC BENEFIT TRANSFER (EBT) CARD AND NOT ACCESSED WITHIN THREE HUNDRED SIXTY-FIVE (365) DAYS OF ISSUANCE, SHALL BE EXPUNGED. THE COUNTY SHALL REISSUE GRANT PAYMENTS WITHIN 90 DAYS OF THE EXPUNGEMENT IF REQUESTED BY THE CLIENT VERBALLY, ELECTRONICALLY, IN PERSON, OR IN WRITING. THE COUNTY MAY REISSUE UP TO TWELVE (12) MONTHS OF EXPUNGED GRANT PAYMENTS.
G. THE COUNTY DEPARTMENT SHALL TAKE PROMPT ACTION TO CORRECT UNDERPAYMENTS TO CLIENTS OF ADULT FINANCIAL GRANT PAYMENTS. THERE ARE TWO TYPES OF UNDERPAYMENTS: 1) GRANT PAYMENT(S) RECEIVED BY OR FOR A CLIENT THAT IS LESS THAN THE AMOUNT WHICH THE CLIENT SHOULD HAVE RECEIVED, BUT NOT A DENIAL OR TERMINATION, OR 2) THE FAILURE OF THE COUNTY DEPARTMENT TO ISSUE A GRANT PAYMENT TO A CLIENT WHEN SUCH PAYMENT SHOULD HAVE BEEN ISSUED (I.E., DENIALS OR TERMINATION OF ADULT FINANCIAL GRANT PAYMENTS).
1. WHEN THE COUNTY DEPARTMENT BECOMES AWARE OF A POTENTIAL UNDERPAYMENT, THE COUNTY DEPARTMENT SHALL:
A. DETERMINE IF AN UNDERPAYMENT OCCURRED; AND,
B. RECORD THE FACTS AND BASIS OF ITS DETERMINATION IN THE CASE RECORD.
2. A COUNTY SHALL CORRECT ANY UNDERPAYMENTS BY THE MONTH FOLLOWING THE DISCOVERY OF SUCH UNDERPAYMENTS.
3. UNDERPAYMENTS SHALL BE USED TO PAY ANY VALIDATED CLAIMS AGAINST THE CLIENT UNLESS THE COUNTY DEPARTMENT HAS DETERMINED THIS ACTION WILL CAUSE AN UNDUE HARDSHIP TO THE CLIENT AS DETERMINED ON A CASE-BY-CASE BASIS. UNDERPAYMENTS WILL BE APPLIED TO CLAIMS USING THE FOLLOWING HIERARCHY:
A. FRAUD OR IPV CLAIMS FIRST (UNDUE HARDSHIP CANNOT BE GRANTED);
B. CLIENT ERROR CLAIMS SECOND; AND
C. ADMINISTRATIVE ERROR CLAIMS LAST. INSTANCES THAT MAY RESULT IN AN ADMINISTRATIVE ERROR CLAIM INCLUDE, BUT ARE NOT LIMITED TO, THE FOLLOWING:
1. THE COUNTY FAILED TO TAKE TIMELY ACTION ON A CHANGE REPORTED BY THE CLIENT.
2. THE COUNTY INCORRECTLY COMPUTED THE CLIENT’S INCOME, RESOURCES, OR OTHER INFORMATION, OR OTHERWISE GAVE AN INCORRECT GRANT PAYMENT.
3. ANY OTHER SITUATION NOT CAUSED BY WILLFUL WITHHOLDING OF INFORMATION ON THE PART OF THE CLIENT AND/OR THEIR AUTHORIZED REPRESENTATIVE.
4. IF AN UNDERPAYMENT IS DISCOVERED BY THE COUNTY DEPARTMENT, THE COUNTY DEPARTMENT SHALL NOTIFY THE CLIENT IN WRITING, OF ITS DETERMINATION OF THE UNDERPAYMENT.
5. PROMPT ACTION SHALL BE TAKEN TO CORRECT UNDERPAYMENTS THAT OCCURRED WITHIN THE PAST TWELVE (12) MONTHS FROM THE DISCOVERY DATE BY ISSUING A RETROACTIVE PAYMENT. RETROACTIVE PAYMENTS SHALL NOT BE MADE UNLESS THE AMOUNT IS ONE DOLLAR ($1.00) OR MORE.
H. THE COUNTY DEPARTMENT SHALL REISSUE A LOST OR STOLEN PAYMENT IF THE LOSS OR THEFT IS NOT QUESTIONABLE AND THE COUNTY DETERMINES THAT SUCH LOSS WAS BEYOND THE CLIENT'S CONTROL.
A LOSS WILL BE CONSIDERED WITHIN THE CLIENT’S CONTROL WHEN:
1. THE CLIENT HAS SHARED THE EBT PIN NUMBER OR WRITTEN THE PIN NUMBER ON THE EBT CARD ITSELF, OR
2. THE CLIENT HAS GIVEN HIS OR HER CARD TO ANOTHER PERSON FOR THAT PERSON’S USE.
I. A CLIENT IS PROHIBITED FROM USING OR ALLOWING THE USE OF HIS OR HER EBT CARD AT AUTOMATED TELLER MACHINES (ATMS) AND POINT OF SALE (POS) DEVICES LOCATED IN PROHIBITED ESTABLISHMENTS AS DESCRIBED IN SECTION 3.520.4.C.4.F.
A CLIENT’S EBT TRANSACTIONS SHALL BE MONITORED QUARTERLY. CLIENTS WHO USE PROHIBITED ATMS OR POS DEVICES SHALL BE CONTACTED BY THE COUNTY DEPARTMENT. INAPPROPRIATE USAGE SHALL RESULT IN:
1. A WRITTEN WARNING THAT THE USE OF THE EBT CARD IN PROHIBITED ESTABLISHMENTS WILL RESULT IN THE CARD BEING DISABLED. THE COUNTY DEPARTMENT SHALL PROVIDE EDUCATION ABOUT APPROPRIATE USE, ACCESS, AND ALTERNATIVES;
2. IF CONTINUED MISUSE OCCURS (IDENTIFIED ON THE QUARTERLY USAGE REPORT AFTER A WARNING HAS OCCURRED), THE CASH GRANT PAYMENT PORTION OF HIS OR HER EBT CARD SHALL BE DISABLED FOR ONE MONTH, REQUIRING THE COUNTY TO NOTIFY THE CLIENT OF ADDITIONAL OPTIONS FOR RECEIPT OF PAYMENT (DIRECT DEPOSIT OR COUNTY WARRANT) AS WELL AS NOTIFICATION OF DUE PROCESS IN ACCORDANCE WITH STATE RULES PURSUANT TO SECTIONS 3.520.1.H-I AND 3.554.
3. IF MISUSE CONTINUES, THE COUNTY DEPARTMENT SHALL DENY OR DISCONTINUE THE GRANT PAYMENTS AND IMPOSE A ONE MONTH INELIGIBILITY PERIOD. THE COUNTY SHALL REQUIRE THE CLIENT TO COMPLETE A NEW APPLICATION AFTER THE ONE MONTH INELIGIBILITY PERIOD IF HE OR SHE WANTS TO RECEIVE ADULT FINANCIAL ASSISTANCE. THE COUNTY DEPARTMENT SHALL NOT ACCEPT A NEW APPLICATION FROM THE CLIENT UNTIL THE ONE MONTH INELIGIBILITY PERIOD EXPIRES. THE COUNTY DEPARTMENT SHALL FOLLOW THE DUE PROCESS PROCEDURES PURSUANT TO SECTIONS 3.520.1.H-I AND 3.554; AND,
4. AFTER THE ONE MONTH INELIGIBILITY PERIOD FOR CONTINUED MISUSE, IF/WHEN THE CLIENT REAPPLIES, ANY FUTURE EBT CARD USAGE AT PROHIBITED ESTABLISHMENTS SHALL BE CONSIDERED CONTINUED MISUSE. SUCH SUBSEQUENT VIOLATIONS WILL RESULT IN THE ONE MONTH INELIGIBILITY PERIOD AND REAPPLICATION PROCESS REFERRED TO IN SUBSECTION 3, ABOVE.
3.582 OVERPAYMENTS
THE COUNTY DEPARTMENT SHALL ESTABLISH A CLAIM ON AN OVERPAYMENT BEFORE THE LAST DAY OF THE QUARTER FOLLOWING THE QUARTER IN WHICH THE OVERPAYMENT WAS DISCOVERED.
A. AN OVERPAYMENT SHALL BE ADJUSTED IF THERE IS A RECORD OF ANY UNDERPAYMENT(S) FOR A PRIOR PERIOD. THE HIERARCHY OF SUCH ADJUSTMENTS SHALL BE:
1. FRAUD OR IPV CLAIMS FIRST,
2. CLIENT ERROR CLAIMS SECOND; AND,
3. ADMINISTRATIVE ERROR CLAIMS LAST.
B. LIABILITY FOR AN OVERPAYMENT MUST BE LEGALLY ESTABLISHED. METHODS FOR LEGALLY ESTABLISHING AN OVERPAYMENT INCLUDE BUT ARE NOT LIMITED TO:
1. AN EXECUTED PROMISSORY NOTE;
2. A COURT JUDGMENT;
3. A FINAL AGENCY ACTION;
4. A SIGNED PUBLIC ASSISTANCE REPAYMENT AGREEMENT FORM.
C. FAILURE TO SIGN THE PUBLIC ASSISTANCE REPAYMENT AGREEMENT FORM SHALL BE HANDLED AS FOLLOWS:
1. IF THE CLIENT AGAINST WHOM A COLLECTION ACTION HAS BEEN INITIATED IS CURRENTLY PARTICIPATING IN ANY ADULT FINANCIAL PROGRAM AND DOES NOT RESPOND TO THE PUBLIC ASSISTANCE REPAYMENT AGREEMENT FORM WITHIN ELEVEN (11) CALENDAR DAYS OF THE DATE THE NOTICE IS MAILED, GRANT PAYMENT REDUCTION SHALL BEGIN WITH THE FIRST MONTH FOLLOWING THE TIMELY NOTICING PERIOD WITHOUT FURTHER NOTICE AS DESCRIBED IN SECTION 3.585.A.2.
2. IF THE CLIENT AGAINST WHOM A COLLECTION ACTION HAS BEEN INITIATED IS NOT PARTICIPATING IN THE PROGRAM WHEN A COLLECTION ACTION FOR A CLAIM IS INITIATED OR IF A COLLECTION ACTION HAS BEEN INITIATED FOR REPAYMENT OF A CLAIM AND NO RESPONSE IS MADE TO THE PUBLIC ASSISTANCE REPAYMENT AGREEMENT FORM WITHIN ELEVEN (11) CALENDAR DAYS OF THE DATE THE NOTICE IS MAILED, THE COUNTY DEPARTMENT SHALL PURSUE ALL LEGAL RECOVERY METHODS AS DESCRIBED IN SECTION 3.585 IN ORDER TO RECOVER THE OVERPAYMENT. LEGAL REMEDIES INCLUDE, BUT ARE NOT LIMITED TO, JUDGMENTS, GARNISHMENTS, CLAIMS ON ESTATES AND THE STATE INCOME TAX REFUND INTERCEPT PROCESS.
D. THE AMOUNT OF THE OVERPAYMENTS INVOLVING INCOME SHALL BE CALCULATED TO ALLOW FOR INCOME DISREGARDS DESCRIBED IN SECTIONS 3.533, 3.544, AND 3.549 BASED ON THE ADULT FINANCIAL PROGRAM FROM WHICH THE CLIENT RECEIVED GRANT PAYMENTS.
E. COMPUTATION OF THE OVERPAYMENT FOR ADULT FINANCIAL GRANT PAYMENTS IS BASED ON THE AMOUNT RECEIVED THAT A CLIENT WAS ORIGINALLY ELIGIBLE TO RECEIVE. ALL EARNED AND UNEARNED INCOME RECEIVED BY THE CLIENT AND ANY RESOURCES ARE TAKEN INTO CONSIDERATION IN THE COMPUTATION.
IN THE INSTANCES WHERE THE OVERPAYMENT IS THE DIRECT RESULT OF ACTIONS TIED TO THE DETERMINATION OF IPV AND/OR FRAUD, WHICH RESULTED IN RECEIPT OF GRANT PAYMENTS IN ERROR, OR GRANT PAYMENTS RECEIVED THAT THE CLIENT WAS NOT ELIGIBLE TO RECEIVE, THE OVERPAID GRANT PAYMENTS SHALL BE RECOVERED FROM THE CLIENT AND/OR A LIABLE INDIVIDUAL PURSUANT TO THE REQUIREMENTS OF 3.583.
F. THE CALCULATION OF OVERPAYMENT SHALL BEGIN IN THE MONTH THAT THE OVERPAYMENT OCCURRED.
1. START WITH THE AMOUNT ISSUED TO THE CLIENT;
2. DETERMINE THE CORRECT PAYMENT ACCORDING TO PROGRAM RULES AT SECTIONS 3.520.78, 3.533, 3.544, 3.549, AND 3.581.D.
3. COMPARE THE AMOUNT ISSUED TO THE CLIENT TO THE CORRECT PAYMENT AMOUNT.
A. IF THE AMOUNT ISSUED TO THE CLIENT IS GREATER THAN THE CORRECT PAYMENT AMOUNT, THE DIFFERENCE IS THE OVERPAYMENT AMOUNT.
B. IF THE AMOUNT ISSUED TO THE CLIENT IS LESS THAN THE CORRECT PAYMENT AMOUNT, THE DIFFERENCE IS THE UNDERPAYMENT AMOUNT, AS ADDRESSED IN SECTION 3.581.G.
4. IF THE CLIENT IS OVER THE RESOURCE LIMIT IN ANY MONTH, THE CLIENT IS TOTALLY INELIGIBLE FOR THAT MONTH. ANY PAYMENT RECEIVED IN SUCH MONTH(S) IS AN OVERPAYMENT.
5. IF A CLIENT DOES NOT MEET THE NON-FINANCIAL ELIGIBILITY REQUIREMENTS IN ANY MONTH, THE CLIENT IS TOTALLY INELIGIBILE FOR THE MONTH. ANY PAYMENT RECEIVED IN SUCH MONTH(S) IS AN OVERPAYMENT.
G. WHEN THE COUNTY DEPARTMENT HAS DETERMINED THAT A CLIENT HAS RECEIVED AN OVERPAYMENT, THE DEPARTMENT SHALL:
1. TAKE ACTION TO RESEARCH THE OVERPAYMENT AND DETERMINETHE AMOUNT OF THE OVERPAYMENT.
2. DETERMINE IF THE OVERPAYMENT IS TO BE RECOVERED AS DESCRIBED IN SECTION 3.585.
3. DOCUMENT THE FACTS AND SITUATION THAT PRODUCED THE OVERPAYMENT. DOCUMENT WHETHER THE OVERPAYMENT IS TO BE RECOVERED. RETAIN ALL ASSOCIATED DOCUMENTATION AND NOTICES UNTIL THE OVERPAYMENT IS REPAID IN FULL.
4. DETERMINE WHETHER THERE WAS WILLFUL WITHHOLDING OF INFORMATION, FRAUD, OR IPV AS DESCRIBED IN SECTIONS 3.583 AND 3.584.
5. PROVIDE THE CLIENT WITH TIMELY OR ADEQUATE NOTICE AS REQUIRED BY SECTION 3.554 OF THE AMOUNT DUE AND THE REASON FOR THE RECOVERY INCLUDING:
A. THE LIABLE INDIVIDUAL(S) RESPONSIBLE FOR THE REPAYMENT;
B. THE AMOUNT OF THE CLAIM;
C. THE PERIOD THE CLAIM IS FOR;
D. THE REASON FOR THE OVERPAYMENT INCLUDING WHETHER THE OVERPAYMENT IS A RESULT OF FRAUD/IPV, CLIENT ERROR, OR ADMINISTRATIVE ERROR;
E. THE CLIENT’S RIGHTS AND RESPONSIBILITIES;
F. THE METHOD OF REPAYMENT;
G. HOW TO OBTAIN FREE LEGAL ASSISTANCE; AND
H. THE APPLICABLE RULES CONCERNING THE OVERPAYMENT.
6. SEND QUARTERLY STATEMENTS WITH THE BALANCE DUE.
3.583 ADULT FINANCIAL INTENTIONAL PROGRAM VIOLATIONS (IPV)
A. ALL CLIENTS MUST BE PROVIDED WITH THEIR RIGHTS IN RELATION TO IPV AS FOLLOWS:
1. THE CLIENT HAS THE RIGHT TO AN ADMINISTRATIVE DISQUALIFICATION HEARING (ADH) BEFORE AN ADMINISTRATIVE LAW JUDGE (ALJ).
2. THE COUNTY DEPARTMENT MAY OFFER AN ADH AT THE COUNTY. THIS DOES NOT PRECLUDE THE CLIENT FROM REQUESTING THE ADH BE HELD BEFORE AN ALJ.
3. A CLIENT MAY WAIVE THE RIGHT TO AN ADH, EITHER BEFORE AN ALJ OR WITH THE COUNTY DEPARTMENT BY SIGNING A WAIVER OF ADH FORM. CLIENTS HAVE A RIGHT TO LOOK AT ALL THE EVIDENCE THAT WOULD BE USED AT AN ADH BEFORE DECIDING WHETHER TO WAIVE THE RIGHT TO AN ADH.
4. IF A CLIENT CHOOSES TO APPEAR AT THE ADH HE OR SHE WILL BE AFFORDED THE RIGHT TO REPRESENT HIM OR HERSELF OR TO BE REPRESENTED BY AN ATTORNEY AT HIS OR HER EXPENSE.
5. THE CLIENT MAY CHOOSE TO BE REPRESENTED BY ANY OTHER PERSON HE OR SHE CHOOSES PURSUANT TO SECTION 26-2-127(1)(A)(IV), C.R.S..
6. A CLIENT AND/OR HIS OR HER REPRESENTATIVE, UPON PROVIDING A SIGNED RELEASE, MAY LOOK AT HIS OR HER CASE FILE, INCLUDING ALL THE EVIDENCE THAT WILL BE USED AT THE ADH. THE CLIENT AND/OR HIS OR HER REPRESENTATIVE HAS THE RIGHT TO LOOK AT HIS OR HER CASE FILE BEFORE AND DURING THE ADH.
7. THE COUNTY DEPARTMENT SHALL PROVIDE A FREE COPY OF THE EVIDENCE TO BE UTILIZED DURING THE ADH TO THE CLIENT AT LEAST FIFTEEN (15) DAYS PRIOR TO AN ADH HEARD BY THE COUNTY. UPON REQUEST, THE COUNTY DEPARTMENT WILL PROVIDE A FREE COPY OF ANY OTHER PARTS OF THE CASE FILE THAT THE CLIENT DETERMINES IS NEEDED AT THE ADH.
8. A CLIENT MAY BRING WITNESSES TO SPEAK ON HIS OR HER BEHALF AT THE ADH.
9. THE CLIENT AND OR HIS OR HER REPRESENTATIVE HAS THE RIGHT TO QUESTION OR DENY ANY EVIDENCE OR STATEMENTS MADE AGAINST HIM OR HER AT THE ADH. THIS INCLUDES THE RIGHT TO ASK QUESTIONS OF PERSONS TESTIFYING AGAINST HIM OR HER.
10. THE CLIENT HAS THE RIGHT TO PRESENT ANY EVIDENCE THAT HE OR SHE FEELS IS IMPORTANT TO PROVE HIS OR HER CASE.
B. ALL CLIENTS FOR ADULT FINANCIAL PROGRAMS MUST BE PROVIDED WITH A WRITTEN NOTICE OF THE PENALTIES FOR AN IPV ON THE ADULT FINANCIAL APPLICATION FORM. ALL ADULT FINANCIAL CLIENTS SHALL BE NOTIFIED OF THE PENALTIES FOR AN IPV WHEN REPORTING CHANGES ON THE REDETERMINATION FORM.
C. A COUNTY DEPARTMENT IS REQUIRED TO REFER THE INVESTIGATION TO THE APPROPRIATE INVESTIGATORY AGENCY FOR ANY CLIENT OR REPRESENTATIVE PAYEE WHENEVER THERE IS AN ALLEGATION OR REASON TO BELIEVE THAT INDIVIDUAL HAS COMMITTED AN IPV AS DESCRIBED BELOW.
WHEN CONDUCTING AN INTERVIEW FOR IPV AND/OR FRAUD, THE COUNTY DEPARTMENT INVESTIGATOR OR REPRESENTATIVE HAS THE RESPONSIBILITY TO ENSURE THE FOLLOWING:
1. THAT AN EXPLANATION WAS GIVEN TO THE INDIVIDUAL REGARDING THE REASON THE INTERVIEW IS TAKING PLACE; AND,
2. THAT THE INDIVIDUAL’S RIGHTS HAVE BEEN PROVIDED TO HIM OR HER (SECTION 3.520.1.I); AND,
3. THAT THE INDIVIDUAL’S RIGHTS AND RESPONSIBILITIES INCLUDING CONFIDENTIALITY OF RECORDS AND INFORMATION, THE RIGHT TO NON-DISCRIMINATION PROVISIONS, THE RIGHT TO A COUNTY CONFERENCE, AND THE RIGHT TO A STATE LEVEL FAIR HEARING HAVE BEEN PROVIDED TO HIM OR HER; AND,
4. THAT THE RIGHTS AND RESPONSIBILITIES PRESENTED IN THE “WHAT I SHOULD KNOW” SECTION OF THE APPLICATION THAT THE CLIENT ACKNOWLEDGED WHEN HE OR SHE SIGNED THE APPLICATION FORM HAVE NOT BEEN VIOLATED; AND,
5. THAT THE COUNTY AND/OR REPRESENTATIVE OF THE COUNTY SHALL NOT THREATEN THE INDIVIDUAL OR ENGAGE IN ANY OTHER INTIMIDATION TACTICS TOWARD THE CLIENT.
D. IF THE COUNTY RECEIVES QUESTIONABLE INFORMATION THAT IS NECESSARY FOR DETERMINING A CLIENT’S ELIGIBILITY AND THE VERIFICATION REQUESTED BY THE COUNTY DEPARTMENT IS NOT SUPPLIED BY THE CLIENT AS REQUIRED BY THE COUNTY DEPARTMENT’S VERIFICATION REQUEST TIMEFRAMES, GRANT PAYMENTS MAY BE REDUCED AND/OR THE CASE CLOSED AND GRANT PAYMENTS TERMINATED FOR A CLIENT’S FAILURE TO PROVE ELIGIBILITY FOLLOWING THE POLICIES OUTLINED IN SECTION 3.554. THESE ACTIONS AND NOTIFICATION SHALL NOT BE USED AS AN INTIMIDATION TACTIC OR THREAT.
E. FOLLOWING AN INVESTIGATION, ACTION MUST BE TAKEN ON CASES WHERE DOCUMENTED EVIDENCE EXISTS TO SHOW A CLIENT HAS COMMITTED ONE OR MORE ACTS OF IPV. ACTION MUST BE TAKEN THROUGH:
1. OBTAINING A "WAIVER OF ADMINISTRATIVE DISQUALIFICATION HEARING"; OR,
2. AN ADMINISTRATIVE DISQUALIFICATION HEARING; OR,
3. REFERRAL FOR CIVIL OR CRIMINAL ACTION IN A COUNTY OR DISTRICT COURT; OR,
4. DOCUMENTING IN THE CASE FILE THE COUNTY DEPARTMENT’S DECISION TO TAKE NO ACTION TO PURSUE IPV USING DOCUMENTED EVIDENCE TO SUPPORT THE DECISION. THE COUNTY DEPARTMENT SHALL ESTABLISH A CLAIM IF APPROPRIATE.
F. IN PROCEEDING AGAINST SUCH A CLIENT, THE COUNTY DEPARTMENT MUST COORDINATE ANY ACTION WITH ACTIONS TAKEN UNDER THE FOOD ASSISTANCE PROGRAM WHERE THE FACTUAL ISSUES ARE THE SAME OR RELATED.
G. OVERPAYMENT ACTIONS SHALL BE INITIATED WITHIN TEN (10) CALENDAR DAYS OF THE INVESTIGATION’S CONCLUSION, UNLESS OTHERWISE SPECIFIED IN THE CASE FILE. THIS IS REQUIRED IN ALL CASES EVEN IF ADH PROCEDURES OR REFERRAL FOR PROSECUTION IS NOT INITIATED, EXCEPT IN INSTANCES WHERE NOTIFICATION OF OVERPAYMENTS MAY PREJUDICE THE ONGOING CRIMINAL CASE OR INVESTIGATION. IN THESE INSTANCES, THE COUNTY DEPARTMENT MAY MAKE THE DETERMINATION TO POSTPONE NOTIFICATION OF CLAIMS TO THE CLIENT IF THE OVERPAYMENT IS BEING REFERRED TO A COURT OF APPROPRIATE JURISDICTION. THE DETERMINATION TO POSTPONE NOTIFICATION MUST BE CLEARLY DOCUMENTED IN THE CASE FILE.
H. THE STATE DEPARTMENT WILL NOT CONDONE ANY ACTIONS OF THE COUNTY DEPARTMENT THAT COULD BE DETERMINED TO BE A VIOLATION OF STATE OR FEDERAL LAW. ANY ACTIONS TAKEN BY A COUNTY DEPARTMENT THAT IS DETERMINED TO BE IN VIOLATION OF STATE OR FEDERAL LAW MAY BE SUBJECT TO CORRECTIVE ACTION PER 9 C.C.R. 2501-1 SECTION 1.150 ET SEQ.
I. THESE RULES APPLY TO ALL CLIENTS WHO COMMIT AN IPV WHO ARE RECIPIENTS OR REPRESENTATIVE PAYEES OF GRANT PAYMENTS AND/OR SERVICES. THE DETERMINATION OF IPV SHALL BE BASED ON A PREPONDERANCE OF EVIDENCE THAT DEMONSTRATES INTENT TO COMMIT IPV.
J. SUPPORTING EVIDENCE WARRANTING THE PURSUIT OF AN IPV DISQUALIFICATION MUST BE DOCUMENTED WITH A SUPERVISORY REVIEW. IF THE COUNTY DEPARTMENT DETERMINES THERE IS EVIDENCE TO SUBSTANTIATE THAT A PERSON HAS COMMITTED AN IPV, THE PERSON HAS A RIGHT TO AN ADH. HOWEVER, THE COUNTY DEPARTMENT SHALL ALLOW THAT PERSON THE OPPORTUNITY TO WAIVE THE RIGHT TO AN ADH.
1. THE STATE APPROVED IPV FORMS SHALL BE PROVIDED TO THE INDIVIDUAL SUSPECTED OF AN IPV. THESE MAY BE OFFERED TO THE INDIVIDUAL DURING THE INVESTIGATION OR MAILED ONCE IT HAS BEEN SUSPECTED AN IPV HAS OCCURRED, BUT THERE IS NO PLAN TO PURSUE CRIMINAL CHARGES.
2. ONE OF THE STATE APPROVED FORMS AFFORDS THE INDIVIDUALTHE RIGHT TO WAIVE THE ADH. IF THE INDIVIDUAL CHOOSES TO WAIVE HIS OR HER RIGHT TO AN ADH, THE INDIVIDUAL SHALL HAVE FIFTEEN (15) CALENDAR DAYS FROM THE DATE THE IPV FORMS ARE PROVIDED BY THE COUNTY TO RETURN THE WAIVER. IF THE FORM IS NOT RETURNED, THE COUNTY DEPARTMENT SHALL PURSUE AN ADH.
3. THE COMPLETION OF THE WAIVER IS VOLUNTARY AND THE COUNTY DEPARTMENT MAY NOT REQUIRE, NOR BY ITS ACTIONS APPEAR TO REQUIRE, THE COMPLETION OF THE WAIVER.
K. AN IPV ADH MUST BE REQUESTED WHENEVER:
1. THE FACTS OF THE CASE DO NOT WARRANT CIVIL OR CRIMINAL PROSECUTION;
2. DOCUMENTARY EVIDENCE EXISTS TO SHOW AN INDIVIDUAL HAS COMMITTED ONE OR MORE ACTS OF IPV; AND
3. THE INDIVIDUAL HAS FAILED TO SIGN AND RETURN THE WAIVER OF ADH FORM.
L. AN ADH MAY BE REQUESTED AGAINST AN ACCUSED INDIVIDUAL WHOSE CASE IS CURRENTLY BEING REFERRED FOR PROSECUTION ON A CIVIL OR CRIMINAL ACTION IN COUNTY OR DISTRICT COURT.
M. A COUNTY DEPARTMENT MAY CONDUCT AN ADH OR MAY USE THE OFFICE OF ADMINISTRATIVE COURTS (OAC) TO CONDUCT THE ADH.
1. THE INDIVIDUAL MAY REQUEST VERBALLY, IN WRITING, ELECTRONICALLY, OR IN PERSON THAT THE OAC CONDUCT THE ADH IN LIEU OF A COUNTY ADH. SUCH AN ADH MUST BE REQUESTED TEN (10) CALENDAR DAYS BEFORE THE SCHEDULED DATE OF THE COUNTY ADH.
2. THE OAC OR THE COUNTY DEPARTMENT MUST MAIL BY CERTIFIED MAIL, RETURN RECEIPT REQUESTED, A NOTICE OF THE DATE OF THE ADH ON THE FORM PRESCRIBED BY THE STATE DEPARTMENT, TO THE INDIVIDUAL ALLEGED TO HAVE COMMITTED AN IPV. THE NOTICE MUST BE MAILED AT LEAST THIRTY (30) CALENDAR DAYS PRIOR TO THE ADH DATE, TO THE INDIVIDUAL’S LAST KNOWN ADDRESS. THE NOTICE FORM SHALL INCLUDE A STATEMENT THAT THE INDIVIDUAL MAY WAIVE THE RIGHT TO APPEAR AT AN ADH.
3. THE ALJ OR ADH OFFICER SHALL NOT ENTER A DEFAULT JUDGMENT AGAINST THE INDIVIDUAL FOR FAILURE TO FILE A WRITTEN ANSWER TO THE NOTICE OF HEARING OR FAILURE TO APPEAR AT THE ADH, BUT SHALL BASE THE INITIAL DECISION UPON THE EVIDENCE INTRODUCED AT THE ADH.
4. THE ADH MUST BE CONTINUED AT THE ACCUSED INDIVIDUAL'S REQUEST IF GOOD CAUSE IS SHOWN. THE REQUEST FOR CONTINUANCE MUST BE RECEIVED BY THE PRESIDING ALJ OR ADH OFFICER AT LEAST TEN (10) CALENDAR DAYS PRIOR TO THE ADH.
THE ADH SHALL NOT BE CONTINUED FOR MORE THAN A TOTAL OF THIRTY (30) CALENDAR DAYS FROM THE ORIGINAL ADH DATE. ONE ADDITIONAL CONTINUANCE IS PERMITTED AT THE ADH OFFICER OR ALJ'S DISCRETION. IF THE ADH OFFICER OR ALJ CONSIDERS IT NECESSARY, A MEDICAL ASSESSMENT MAY BE ORDERED TO SUBSTANTIATE OR DISPROVE A GOOD CAUSE STATEMENT OF AN ACCUSED INDIVIDUAL. SUCH ASSESSMENT SHALL BE OBTAINED AT THE AGENCY’S EXPENSE AND MADE PART OF THE RECORD.
N. DISQUALIFICATION FOR IPV SHALL BE AS FOLLOWS:
1. IF THE INDIVIDUAL SIGNS AND RETURNS THE REQUEST FOR WAIVER OF ADH WITHIN FIFTEEN (15) CALENDAR DAYS FROM THE DATE THE WAIVER IS SENT, THAT PERSON SHALL BE PROVIDED WITH A NOTICE OF THE PERIOD OF DISQUALIFICATION.
2. THE DISQUALIFICATION PERIOD SHALL BEGIN NO LATER THAN THE FIRST DAY OF THE FOLLOWING MONTH FROM THE DATE DETERMINED THROUGH THE ADH PROCESS OR, IF THE INDIVIDUAL SIGNED AN ADH WAIVER, THE DATE HE OR SHE SIGNED THE WAIVER.
A. ONCE THE DISQUALIFICATION IS IMPOSED IT SHALL CONTINUE WITHOUT INTERRUPTION. TO CONSIDER A DISQUALIFICATION PERIOD SERVED, THE CLIENT SHALL HAVE A BREAK IN GRANT PAYMENTS TOTALING THE TIME PERIOD OF THE DISQUALIFICATION. THE DISQUALIFICATION PERIOD SHALL REMAIN IN EFFECT UNLESS AND UNTIL THE FINDING IS REVERSED BY THE OFFICE OF APPEALS OR A COURT OF APPROPRIATE JURISDICTION OR UNTIL THE PERIOD OF DISQUALIFICATION IS SERVED PER SECTION C BELOW.
B. THE DISQUALIFICATION MAY BE IN ADDITION TO ANY OTHER PENALTIES WHICH MAY BE IMPOSED BY A COURT OF LAW FOR THE SAME OFFENSES (I.E. CRIMINAL OR CIVIL SANCTIONS).
C. THE DISQUALIFICATION SHALL BE IN EFFECT FOR TWELVE (12) MONTHS UPON THE FIRST OCCASION OF ANY SUCH OFFENSE; TWENTY-FOUR (24) MONTHS UPON THE SECOND OCCASION OF ANY SUCH OFFENSE AND PERMANENTLY UPON THE THIRD SUCH OFFENSE. ALL DISQUALIFICATIONS IMPOSED SHALL RUN AND BE SERVED CONSECUTIVELY.
D. IF THE CLIENT IS FOUND TO HAVE COMMITTED AN IPV IN ANY OTHER PUBLIC ASSISTANCE PROGRAM, THE CLIENT IS DISQUALIFIED FROM PARTICIPATION IN ADULT FINANCIAL PROGRAMS FOR THE PENALTY PERIODS ASCRIBED TO THOSE VIOLATIONS AND FOR THE SAME PERIOD OF TIME.
4. THE DISQUALIFICATION PENALIZES ONLY THE INDIVIDUAL(S) FOUND TO HAVE COMMITTED AN IPV. IF A CLIENT’S SPOUSE AND/OR SPONSOR(S) HAVE RECEIVED AN IPV ON HIS OR HER OWN CASE(S), THE SPOUSE’S AND/OR SPONSOR(S)’ INCOME AND RESOURCES, WHEN APPLICABLE, WILL BE CONSIDERED AVAILABLE TO THE CLIENT AND USED FOR DETERMINING ELIGIBILITY.
5. AN IPV DISQUALIFICATION IN ONE COUNTY IS VALID AND EFFECTIVE IN ALL OTHER COLORADO COUNTIES. A COUNTY DEPARTMENT SHALL CONSIDER A DISQUALIFICATION IMPOSED BY ANOTHER COUNTY DEPARTMENT WHEN DETERMINING THE APPROPRIATE DISQUALIFICATION PENALTY FOR THE DISQUALIFIED INDIVIDUAL WITHOUT AN ADDITIONAL ADH OR FURTHER RIGHT TO APPEAL.
O. IF, AS A RESULT OF THE ADH, THE COUNTY ADH OFFICER OR ALJ FINDS THE INDIVIDUAL HAS COMMITTED AN IPV, A WRITTEN NOTICE SHALL BE PROVIDED TO NOTIFY THE INDIVIDUAL OF THE DECISION. THE COUNTY HEARING DECISION NOTICE SHALL BE A STATE PRESCRIBED FORM, WHICH INCLUDES A STATEMENT THAT A STATE ADH AT THE OAC MAY BE REQUESTED.
1. IN AN ADH BEFORE AN ALJ, THE DETERMINATION OF IPV SHALL BE AN INITIAL DECISION, WHICH SHALL NOT BE IMPLEMENTED WHILE PENDING STATE DEPARTMENT REVIEW AND A FINAL AGENCY DECISION. THE INITIAL DECISION SHALL ADVISE THE CLIENT THAT FAILURE TO FILE EXCEPTIONS TO FINDINGS OF THE INITIAL DECISION WILL WAIVE THE RIGHT TO SEEK JUDICIAL REVIEW OF A FINAL AGENCY DECISION AFFIRMING THE INITIAL DECISION.
2. WHEN AN INDIVIDUAL WAIVES HIS OR HER RIGHT TO AN ADH, A WRITTEN NOTICE OF THE DISQUALIFICATION PENALTY SHALL BE MAILED TO THE INDIVIDUAL. THIS NOTICE SHALL BE ON A STATE PRESCRIBED NOTICE FORM.
3. IN THE EVENT THAT THE ADH WAS HEARD BY THE COUNTY, THE CLIENT MAY APPEAL THE DECISION OF THE COUNTY ADH TO THE OAC. AN APPEAL MUST BE RECEIVED BY THE COUNTY DEPARTMENT OR BY THE OAC WITHIN FIFTEEN (15) CALENDAR DAYS OF THE DATE THE COUNTY DEPARTMENT MAILS THE LOCAL ADH DECISION TO THE CLIENT. SEE SECTION 3.587 FOR RULES REGULATING THE APPEAL PROCESS.
4. A COPY OF THE COUNTY ADH DECISION SHALL BE FORWARDED TO THE STATE DEPARTMENT’S EMPLOYMENT AND BENEFITS DIVISION FOR REVIEW AT THE SAME TIME THE DECISION IS MAILED TO THE CLIENT.
3.584 FRAUDULENT ACT
A. WHEN THE COUNTY DEPARTMENT OR LOCAL SERVICE DELIVERY AGENCY DETERMINES THAT IT HAS PAID A CLIENT A GRANT PAYMENT AS A RESULT OF A FRAUDULENT ACT, THE FACTS USED IN THE DETERMINATION SHALL BE REVIEWED WITH THE DEPARTMENT’S LEGAL COUNSEL WITHIN THE ATTORNEY GENERAL’S OFFICE AND/OR A REPRESENTATIVE FROM THE DISTRICT ATTORNEY’S OFFICE. IF SUSPECTED FRAUD IS SUBSTANTIATED BY THE AVAILABLE EVIDENCE, THE CASE SHALL BE REFERRED TO THE DISTRICT ATTORNEY. ALL REFERRALS TO THE DISTRICT ATTORNEY SHALL BE MADE IN WRITING AND SHALL INCLUDE THE AMOUNT OF ASSISTANCE FRAUDULENTLY RECEIVED BY THE CLIENT.
B. IF ANY DEDUCTION IS BEING MADE FROM THE CLIENT’S ASSISTANCE PAYMENT IT MUST BE CONSISTENT WITH ANY COURT ORDER RESULTING FROM A PROSECUTION BY THE DISTRICT ATTORNEY. IF THE INDIVIDUAL BEING PROSECUTED IS NOT AN ADULT FINANCIAL PROGRAM CLIENT, ANOTHER METHOD OF RECOVERY SHALL BE USED TO COLLECT AMOUNTS DUE TO THE DEPARTMENT.
1. INTEREST SHALL BE CHARGED FROM THE MONTH IN WHICH THE OVERPAYMENT WAS RECEIVED UNTIL THE DATE THE OVERPAYMENT IS RECOVERED. INTEREST SHALL BE CALCULATED AT THE LEGAL RATE.
2. THE CLIENT MAY CHOOSE TO REPAY THE COUNTY DEPARTMENT THE ENTIRE AMOUNT OF THE OVERPAYMENT AT ONE TIME OR ESTABLISH A REPAYMENT PLAN. IN EITHER INSTANCE, THE FRAUD CHARGE SHOULD BE DISCUSSED WITH THE DISTRICT ATTORNEY OR APPROPRIATE INVESTIGATIVE AUTHORITY.
C. IF THE DISTRICT ATTORNEY DECLINES TO PROSECUTE, THE AMOUNT OF OVERPAYMENT DUE, AS ESTABLISHED BY THE DEPARTMENT, WILL CONTINUE TO BE RECOVERED BY DEDUCTION FROM SUBSEQUENT GRANT PAYMENTS OR OTHER METHOD OF RECOVERY IF THE INDIVIDUAL IS NOT A CLIENT OF ADULT FINANCIAL GRANT PAYMENTS.
3.585 RECOVERY
A. A COUNTY DEPARTMENT MUST TAKE ACTION TO RESEARCH AND DETERMINE IF RECOVERY SHOULD BE INITIATED WITHIN TEN (10) CALENDAR DAYS OF DISCOVERING A CLIENT RECEIVED AN OVERPAYMENT. THE RECOVERY OF VALID OVERPAYMENTS IS REQUIRED REGARDLESS OF WHEN THE OVERPAYMENT OCCURRED EXCEPT IN SITUATIONS AS DESCRIBED IN SECTION 3.585.H. OVERPAYMENTS MAY BE RECOVERED FROM THE CLIENT WHO WAS OVERPAID OR WHO FRAUDULENTLY RECEIVED THE ASSISTANCE PAYMENT OR ANOTHER LIABLE INDIVIDUAL.
IF A CLIENT IS DECEASED, OVERPAYMENTS SHALL BE RECOVERED FROM THE DECEASED CLIENT'S ESTATE.
B. THE FOLLOWING RULES DO NOT APPLY IN INSTANCES WHERE THE STATE OR COUNTY DEPARTMENT SEEKS RECOVERY IN A CASE THAT WAS TRANSFERRED TO THE DISTRICT ATTORNEY AND PROSECUTED THROUGH THE COURTS:
1. THE CLIENT SHALL BE NOTIFIED OF THE RECOVERY ACTION TO BE TAKEN, USING THE NOTICE RULES FOUND AT SECTION 3.554.C.;
2. WHEN THE OVERPAYMENT IS CAUSED BY AN UNINTENTIONAL ERROR, THE CLIENT'S WILLFUL WITHHOLDING OR AN ADMINISTRATIVE ERROR, SUCH OVERPAYMENT SHALL BE DEDUCTED, AFTER NOTICE HAS BEEN GIVEN PURSUANT TO SECTION 3.554, FROM SUBSEQUENT GRANT PAYMENTS WHILE THE CLIENT IS ACTIVELY RECEIVING ADULT FINANCIAL GRANT PAYMENTS.
A. THE CLIENT MAY CHOOSE TO REPAY THE COUNTY DEPARTMENT THE ENTIRE AMOUNT OF THE OVERPAYMENT AT ONE TIME. THE CLIENT SHALL WORK WITH THE COUNTY DEPARTMENT TO DETERMINE HOW A LUMP SUM REPAYMENT CAN BE MADE.
B. WHEN THE RECOVERY AMOUNT IS NOT TO BE REPAID IN A SINGLE PAYMENT PER SUBSECTION A ABOVE, AND THE CASE REMAINS ACTIVE, THE COUNTY DEPARTMENT SHALL ESTABLISH A MONTHLY RECOVERY DEDUCTION FROM SUBSEQUENT ASSISTANCE PAYMENTS. THE MONTHLY RATE OF RECOVERY SHALL BE TEN DOLLARS OR TEN PERCENT OF THE ASSISTANCE PAYMENT, WHICHEVER IS HIGHER.
THE FOLLOWING PROCEDURE SHALL BE USED TO ARRIVE AT THE MONTHLY RECOVERY DEDUCTION AMOUNT:
1. IF THE ERROR IS A RESULT OF AN AGENCY ERROR AND THE CLIENT DOES NOT MEET CRITERIA SET FORTH IN SECTION 3.585, COMPUTE TEN PERCENT (10%) OF THE ADULT FINANCIAL GRANT PAYMENT AMOUNT. IF THE RESULTING PERCENTAGE AMOUNT IS LESS THAN TEN DOLLARS ($10), THE DEDUCTION FROM THE GRANT PAYMENT AMOUNT SHALL BE TEN DOLLARS ($10).
2. DEDUCT THE PERCENTAGE AMOUNT OR TEN DOLLARS ($10), WHICHEVER IS HIGHER, FROM THE GRANT PAYMENT. THE RESULT SHALL BE ROUNDED TO THE NEXT LOWER WHOLE DOLLAR AMOUNT, IF NOT ALREADY A WHOLE DOLLAR AMOUNT. THIS ROUNDED AMOUNT IS THE FINAL PAYMENT AMOUNT.
3. WHEN THE AUTHORIZED PAYMENT AMOUNT IS LESS THAN TEN DOLLARS ($10), THE CASE IS CONSIDERED A “NO PAYMENT” CASE AND NO DEDUCTION SHALL BE MADE.
4. WHEN THE RECOVERY IS DUE TO A FRAUDULENT ACTION ON THE PART OF THE CLIENT AND INTEREST MAY BE ADDED THERETO IN ACCORDANCE WITH SECTION 3.584.B.1., THE INTEREST AMOUNT SHALL NOT BE INCLUDED IN THE GRANT PAYMENT DEDUCTION UNLESS THE CLIENT AGREES TO SUCH INCLUSION. IF THE CLIENT DOES NOT SO AGREE, THE INTEREST AMOUNT SHALL BE COLLECTED SEPARATELY.
5. THE AMOUNT OF THE GRANT PAYMENT DEDUCTION FOR RECOVERY SHALL BE RECORDED IN THE CLIENT'S CASE FILE AND COLLECTED VIA THE STATEWIDE AUTOMATED SYSTEM.
C. THE COUNTY DEPARTMENT SHALL NOT ESTABLISH A CLAIM UNLESS THE AMOUNT OF THE CLAIM IS GREATER THAN $200, EXCEPT IN THE FOLLOWING CIRCUMSTANCES:
1. THE OVERPAYMENT IS IDENTIFIED THROUGH A FEDERAL OR STATE LEVEL QUALITY CONTROL REVIEW; OR,
2. THE CLAIM IS BEING PURSUED AS AND RESULTS IN AN IPV.
3. WHEN THE OVERPAYMENT IS CAUSED BY THE CLIENT’S WILLFUL WITHHOLDING OF INFORMATION OR AN ADMINISTRATIVE ERROR, AND THE ADULT FINANCIAL CASE IS NO LONGER ACTIVE, RECOVERY OF SUCH OVERPAYMENT SHALL BE BASED UPON THE PUBLIC ASSISTANCE REPAYMENT AGREEMENT FORM OR OTHER METHODS OF RECOVERY.
A. THE COUNTY SHALL ESTABLISH A MONTHLY REPAYMENT AGREEMENT WITH A FORMER CLIENT. THE REPAYMENT AGREEMENT SHALL NOT EXCEED TWENTY-FIVE PERCENT (25%) OF AVAILABLE MONTHLY INCOME. DETERMINATION OF THE REPAYMENT AMOUNT MUST BE CLEARLY DOCUMENTED IN THE ELECTRONIC CASE FILE.
B. THE CLIENT MAY CHOOSE TO REPAY THE COUNTY DEPARTMENT THE ENTIRE AMOUNT OF THE OVERPAYMENT AT ONE TIME. THE CLIENT SHALL WORK WITH THE COUNTY DEPARTMENT TO DETERMINE HOW A LUMP SUM REPAYMENT CAN BE MADE.
C. THE COUNTY DEPARTMENT MAY WRITE-OFF UNPAID VALID CLAIMS AS FOLLOWS:
1. VALID ADMINISTRATIVE ERROR CLAIMS LESS THAN ONE HUNDRED TWENTY-FIVE DOLLARS ($125.00) CAN BE WRITTEN OFF NINETY (90) DAYS AFTER THE TERMINATION OF ALL PUBLIC ASSISTANCE.
2. VALID CLAIMS FOR CLIENT ERROR, FRAUD, AND IPV LESS THAN THREE HUNDRED DOLLARS ($300.00).
3. ANY UNPAID VALID CLAIM OF $125 OR MORE FOR AN INDIVIDUAL WHO WAS NOT CONVICTED OF AN IPV OR FRAUD SPECIFIC TO THE OVERPAYMENT, IS NO LONGER RECEIVING PUBLIC ASSISTANCE, AND THE OVERPAYMENT WAS ESTABLISHED SIX (6) OR MORE YEARS AGO, AND THE COUNTY DEPARTMENT HAS DETERMINED THAT IT IS NO LONGER COST EFFECTIVE TO PURSUE COLLECTION.
D. IF THE CLIENT BEGINS TO RECEIVE ADULT FINANCIAL GRANT PAYMENTS AGAIN AFTER THE OVERPAYMENT HAS BEEN ESTABLISHED AND STILL HAS A CLAIM BALANCE, THE DEDUCTION OF GRANT PAYMENTS SHALL OCCUR AS DESCRIBED IN SECTION 3.585.B.2.
C. THE CLIENT MAY ISSUE THE STATE A REFUND OF ANY OVERPAID GRANT PAYMENTS FROM HIS OR HER EXISTING BALANCE OF ADULT FINANCIAL GRANT PAYMENTS ON HIS OR HER ELECTRONIC BENEFITS TRANSFER (EBT) CARD BY CONTACTING THE COUNTY DEPARTMENT. THIS REQUIRES A WRITTEN STATEMENT FROM THE CLIENT.
D. CLIENTS ARE NOT ENTITLED TO GRANT PAYMENTS THAT WERE PAID IN ERROR OR MISTAKENLY PROVIDED TO THE CLIENT BASED ON A DATA ENTRY ERROR INTO THE STATEWIDE AUTOMATED SYSTEM OR AN ERROR RESULTING FROM THE STATEWIDE AUTOMATED SYSTEM. THE COUNTY SHALL CREATE A CLAIM AND MAY RETRIEVE THE GRANT PAYMENTS FROM THE CLIENT’S EBT CARD WITHIN TWENTY-FOUR (24) HOURS OF THE ISSUANCE WITHOUT PRIOR WRITTEN AUTHORIZATION BY THE CLIENT. THE CLIENT SHALL HAVE NO APPEAL RIGHTS IN RELATION TO THIS GRANT PAYMENT BECAUSE HE OR SHE WAS NOT ELIGIBLE FOR THE INITIAL RECEIPT OF THE GRANT PAYMENT(S) IN THE FIRST INSTANCE.
WHEN GRANT PAYMENTS ISSUED IN ERROR ARE NOT RETRIEVED FROM THE CLIENT’S EBT CARD WITHIN TWENTY-FOUR (24) HOURS, FUNDS SHALL NOT BE TAKEN FROM THE CARD USING THIS METHOD UNLESS PERMISSION IS GRANTED FROM THE CLIENT IN WRITING USING THE STATE PRESCRIBED FORM. IF PERMISSION IS NOT GRANTED, THE COUNTY DEPARTMENT SHALL PURSUE OTHER METHODS OF RECOVERY AS DESCRIBED IN SECTION 3.585.
E. THE CLIENT MAY REQUEST VOLUNTARY DEDUCTIONS BE APPLIED TO THE OVERPAYMENT. THESE ARE CONSIDERED TO BE AN AMOUNT IN ADDITION TO THE DEDUCTION FROM THE GRANT PAYMENT AS ESTABLISHED THROUGH THE RECOVERY CALCULATIONS IN SECTION 3.585.B. THE CLIENT SHALL BE PROVIDED WRITTEN CONFIRMATION OF THE AMOUNT TO BE DEDUCTED AND THAT HE OR SHE HAS THE RIGHT TO STOP THE VOLUNTARY DEDUCTION AT ANY TIME BY WRITTEN REQUEST.
F. A CLAIM MAY BE FILED AGAINST THE ESTATE OF A CLIENT FOR OVERPAYMENT. THIS INCLUDES CASES WHERE OVERPAYMENTS WERE MADE AND NOT RECOVERED. THE COUNTY DEPARTMENT'S LEGAL ADVISOR MUST BE CONSULTED IN DETERMINING THE AMOUNT OF ASSISTANCE PAYMENTS FOR WHICH A CLAIM IS TO BE FILED.
G. IN ACCORDANCE WITH SECTIONS 26-2-133 AND 39-21-108, C.R.S., THE STATE AND COUNTY DEPARTMENTS MAY RECOVER OVERPAYMENTS OF PUBLIC OR MEDICAL ASSISTANCE BENEFITS THROUGH THE OFFSET (INTERCEPT) OF A TAXPAYER'S STATE INCOME TAX REFUND. TAX REFUNDS SHALL NOT BE OFFSET IN INSTANCES WHERE THE TAXPAYER IS MAKING REGULAR, ONGOING PAYMENTS AS AGREED TO IN THE PUBLIC ASSISTANCE REPAYMENT AGREEMENT AND/OR BASED ON ARRANGEMENTS BETWEEN THE TAXPAYER AND THE COUNTY(IES). UNLESS AGREED TO BY THE CLIENT, THE COUNTY SHALL NOT OFFSET TAX REFUNDS DURING THE SAME MONTH THE CLIENT MAKES A PAYMENT ON A CLAIM IF THE PAYMENT AGREEMENT WAS ESTABLISHED PRIOR TO THE OFFSET. RENT REBATES ARE SUBJECT TO THE OFFSET PROCEDURE. THE OFFSET OF THE TAXPAYER STATE INCOME TAX REFUND AND/OR RENT REBATE MAY BE USED TO RECOVER OVERPAYMENTS THAT HAVE BEEN:
1. DETERMINED BY FINAL AGENCY ACTION; OR,
2. ORDERED BY A COURT AS RESTITUTION; OR,
3. REDUCED TO JUDGMENT.
H. PRIOR TO CERTIFYING THE TAXPAYER'S NAME AND OTHER INFORMATION TO THE COLORADO DEPARTMENT OF REVENUE, THE COLORADO DEPARTMENT OF HUMAN SERVICES SHALL NOTIFY THE TAXPAYER, IN WRITING AT HIS OR HER LAST-KNOWN ADDRESS, THAT THE STATE INTENDS TO USE THE TAX REFUND OFFSET TO RECOVER THE OVERPAYMENT. IN ADDITION TO THE REQUIREMENTS OF SECTION 26-2-133(2), C.R.S., THE PRE-OFFSET NOTICE SHALL INCLUDE THE NAME OF THE COUNTY DEPARTMENT CLAIMING THE OVERPAYMENT, THE PROGRAM THAT MADE THE OVERPAYMENT, AND THE CURRENT BALANCE OWED.
I. EFFECTIVE AUGUST 1, 1991, THE TAXPAYER IS ENTITLED TO OBJECT TO THE OFFSET BY FILING A REQUEST FOR A COUNTY CONFERENCE OR STATE LEVEL FAIR HEARING WITHIN THIRTY (30) CALENDAR DAYS FROM THE DATE THAT THE STATE DEPARTMENT MAILS ITS PRE-OFFSET NOTICE TO THE TAXPAYER. IN ALL OTHER RESPECTS, THE PROCEDURES APPLICABLE TO SUCH HEARINGS SHALL BE THOSE THAT ARE STATED IN SECTION 3.587. AT THE HEARING ON THE OFFSET, THE COUNTY DEPARTMENT OR ALJ SHALL NOT CONSIDER WHETHER AN OVERPAYMENT HAS OCCURRED BECAUSE OVERPAYMENT HAS ALREADY BEEN OTHERWISE LEGALLY ESTABLISHED, BUT MAY CONSIDER THE FOLLOWING ISSUES IF RAISED BY THE TAXPAYER IN HIS OR HER REQUEST FOR A HEARING:
1. WHETHER THE TAXPAYER WAS PROPERLY NOTIFIED OF THE OVERPAYMENT;
2. WHETHER THE TAXPAYER IS THE PERSON, WHO OWES THE OVERPAYMENT;
3. WHETHER THE AMOUNT OF THE OVERPAYMENT HAS BEEN PAID OR IS INCORRECT;
4. WHETHER THE DEBT CREATED BY THE OVERPAYMENT HAS BEEN DISCHARGED THROUGH BANKRUPTCY; OR,
5. WHETHER OTHER SPECIAL CIRCUMSTANCES EXIST INCLUDING, BUT NOT LIMITED TO, THE CIRCUMSTANCES DESCRIBED IN SECTION 3.585.H., (I.E., FACTS THAT SHOW THAT THE TAXPAYER WAS WITHOUT FAULT IN CREATING THE OVERPAYMENT AND WILL INCUR FINANCIAL HARDSHIP IF THE INCOME TAX REFUND IS OFFSET).
J. IF AN OFFSET IS ESTABLISHED, AN OVERPAYMENT SHALL NOT BE RECOVERED USING ANOTHER METHOD DESCRIBED IN SECTION 3.585 IN THE MONTH THE OFFSET OCCURS UNLESS PRIOR AUTHORIZATION IS RECEIVED FROM THE INDIVIDUAL MAKING THE RECOVERY PAYMENTS.
K. THE COUNTY DEPARTMENT IS REQUIRED TO PURSUE COLLECTION OF THE OVERPAYMENT FROM THE CLIENT/RESPONSIBLE PAYEE WHO MANAGED AND ADMINISTERED THE ADULT FINANCIAL FUNDS. THE COUNTY DEPARTMENT SHALL PURSUE ALL AVAILABLE OVERPAYMENT RECOVERY OPTIONS TO COLLECT THE OVERPAYMENT FROM THE CLIENT/RESPONSIBLE PAYEE FIRST AND THEN ANY OTHER LIABLE INDIVIDUALS LEGALLY RESPONSIBLE FOR OVERPAYMENTS, UNLESS OTHERWISE SPECIFIED.
1. IN INSTANCES WHERE A TRUSTEE HAS USED A CLIENT'S TRUST INCOME OR PROPERTY IN A MANNER CONTRARY TO THE TERMS OF THE TRUST:
A. DETERMINE WHETHER AN OVERPAYMENT OF ADULT FINANCIAL GRANT PAYMENTS HAS OCCURRED AS A RESULT OF THE CLIENT’S LOSS OF INCOME BASED ON THE TRUSTEE’S IMPROPER ACTIONS;
B. CONSULT WITH THE COUNTY ATTORNEY OR OTHER LEGAL RESOURCE TO DETERMINE HOW TO PURSUE ACTION AGAINST A TRUST/TRUSTEE;
C. ADVISE THE TRUSTEE OF THE OVERPAYMENT CIRCUMSTANCES; AND
D. IF THE TRUSTEE DISAGREES WITH SUCH CIRCUMSTANCES AND OVERPAYMENT, PURSUE THE RECOVERY ESTABLISHMENT AND COLLECTION THROUGH APPROPRIATE LEGAL MEANS; OR
E. TAKE APPROPRIATE STEPS TO SECURE REPAYMENT WITH THE COOPERATION OF THE TRUSTEE; OR,
F. REPORT SUCH BEHAVIOR OR ACTION BY THE TRUSTEE TO THE COUNTY ADULT PROTECTIVE SERVICES TO ENSURE THE PROTECTION OF THE CLIENT’S RIGHTS IN THE TRUST.
2. IN INSTANCES WHERE A POWER OF ATTORNEY HAS USED HIS OR HER LEGAL AUTHORITY FOR PURPOSES OTHER THAN FOR THE BENEFIT OF THE CLIENT:
A. DETERMINE WHETHER AN OVERPAYMENT OF ADULT FINANCIAL GRANT PAYMENTS HAS OCCURRED AS A RESULT OF THE POWER OF ATTORNEY’S IMPROPER ACTIONS;
B. CONSULT WITH THE COUNTY ATTORNEY OR OTHER LEGAL RESOURCE TO DETERMINE HOW TO PURSUE ACTION AGAINST A POWER OF ATTORNEY;
C. ADVISE THE HOLDER OF THE POWER OF ATTORNEY OF THE OVERPAYMENT CIRCUMSTANCES; AND,
D. IF THE HOLDER OF THE POWER OF ATTORNEY DISAGREES WITH SUCH CIRCUMSTANCES AND OVERPAYMENT, PURSUE THE RECOVERY ESTABLISHMENT AND COLLECTION THROUGH APPROPRIATE LEGAL MEANS; OR
E. TAKE APPROPRIATE STEPS TO SECURE REPAYMENT WITH THE COOPERATION OF THE HOLDER OF THE POWER OF ATTORNEY; OR
F. REPORT SUCH BEHAVIOR OR ACTION BY THE TRUSTEE TO THE COUNTY ADULT PROTECTIVE SERVICES TO ENSURE THE PROTECTION OF THE CLIENT’S RIGHTS AND BENEFITS.
L. IN ANY CASE IN WHICH AN OVERPAYMENT HAS BEEN MADE, THERE SHALL BE NO RECOVERY FROM ANY PERSON:
1. WHO IS WITHOUT FAULT IN THE CREATION OF THE OVERPAYMENT; AND,
2. WHO HAS REPORTED ANY INCREASE IN INCOME OR OTHER CIRCUMSTANCES AFFECTING THE CLIENT'S ELIGIBILITY WITHIN THE TIMELY REPORTING REQUIREMENTS FOR THE PROGRAM; AND,
3. IF SUCH RECOVERY WOULD DEPRIVE THE PERSON OF INCOME REQUIRED FOR ORDINARY AND NECESSARY LIVING EXPENSES AND WOULD BE AGAINST EQUITY AND GOOD CONSCIENCE. THE FACT THAT THE CLIENT IS RECEIVING PUBLIC ASSISTANCE SHALL NOT BE THE ONLY FACTOR IN MAKING A DETERMINATION THAT THE PERSON WOULD BE DEPRIVED OF INCOME REQUIRED FOR ORDINARY AND NECESSARY LIVING EXPENSES AND THAT EQUITY AND GOOD CONSCIENCE EXIST.
A. IF A CLIENT HAS TEN (10) PERCENT OR MORE OF INCOME REMAINING AFTER NECESSARY LIVING EXPENSES, HE OR SHE SHALL NOT BE CONSIDERED DEPRIVED OF INCOME.
B. IF A CLIENT’S EXPENSES EXCEED HIS OR HER INCOME, ADDITIONAL QUESTIONS MUST BE ASKED TO DETERMINE HOW HE OR SHE IS MEETING EXPENSES TO ASCERTAIN IF OTHER INCOME (I.E. GIFT, IN-KIND) NEEDS TO BE INCLUDED IN THE INCOME CALCULATION.
M. WHEN THE OVERPAYMENT RECOVERY IS NOT PURSUED, SUCH FACT, TOGETHER WITH THE REASON, SHALL BE DOCUMENTED IN THE STATEWIDE AUTOMATED SYSTEM. ALL INFORMATION PERTAINING TO THE REASON, ESTABLISHMENT, AND COLLECTION OF CLAIMS SHALL BE RETAINED IN THE CASE RECORD UNTIL THE CLAIM IS WRITTEN OFF OR PAID IN FULL.
3.586 DISPUTE RESOLUTION
THE DISPUTE RESOLUTION PROCESS IS AVAILABLE FOR DISPUTES CONCERNING COUNTY DEPARTMENT ACTIONS RELATED TO ELIGIBILITY, REDUCTION OF GRANT PAYMENT AMOUNTS, REDETERMINATION PROCEDURES, AND OTHER COUNTY ACTIONS THAT DO NOT INVOLVE ALLEGATIONS OF FRAUDULENT ACTS OR IPV ON THE PART OF THE CLIENT. IF THERE IS A DISPUTE REGARDING FRAUDULENT ACTIONS OR IPV, THAT DISPUTE MUST BE HANDLED ACCORDING TO SECTIONS 3.583 AND 3.584 REGARDING IPVS AND FRAUDULENT ACTS.
IN ORDER TO RESOLVE DISPUTES BETWEEN COUNTY DEPARTMENTS AND/OR THE LOCAL SERVICE DELIVERY AGENCY AND CLIENTS, COUNTY DEPARTMENTS AND LOCAL SERVICE DELIVERY AGENCIES SHALL ADOPT PROCEDURES FOR THE RESOLUTION OF DISPUTES CONSISTENT WITH THIS SECTION. THE PROCEDURES SHALL BE DESIGNED TO ESTABLISH A SIMPLE NON-ADVERSARIAL FORMAT FOR THE INFORMAL RESOLUTION OF DISPUTES.
A. THE COUNTY DEPARTMENT OR LOCAL SERVICE DELIVERY AGENCY, PRIOR TO TAKING ACTION TO DENY, TERMINATE, RECOVER, INITIATE VENDOR PAYMENTS OR MODIFY FINANCIAL ASSISTANCE PROVIDED UNDER THE ADULT FINANCIAL PROGRAM TO A CLIENT, SHALL, AT A MINIMUM, PROVIDE THE CLIENT AN OPPORTUNITY FOR A COUNTY CONFERENCE.
1. THE RIGHT OF A CLIENT TO A COUNTY CONFERENCE IS PRIMARILY TO ENSURE THAT THE PROPOSED ACTION IS VALID, TO PROTECT THE CLIENT AGAINST AN ERRONEOUS ACTION CONCERNING GRANT PAYMENTS, AND TO ENSURE REASONABLE PROMPTNESS OF COUNTY ACTION. THE CLIENT MAY CHOOSE, HOWEVER, TO BYPASS THE COUNTY CONFERENCE AND APPEAL DIRECTLY TO THE STATE OFFICE OF ADMINISTRATIVE COURTS, PURSUANT TO SECTION 3.587.
2. THE CLIENT IS ENTITLED TO:
A. REPRESENTATION BY AN AUTHORIZED REPRESENTATIVE RETAINED AT HIS OR HER OWN EXPENSE, SUCH AS LEGAL COUNSEL, RELATIVE, FRIEND, OR ANOTHER SPOKESPERSON, OR HE OR SHE MAY REPRESENT HIMSELF OR HERSELF;
B. EXAMINE THE CONTENTS OF THE CASE FILE AND ALL DOCUMENTS AND RECORDS USED BY THE COUNTY DEPARTMENT OR AGENCY IN MAKING ITS DECISION. EXAMINATION OF THE FILE IS AVAILABLE AT A REASONABLE TIME BEFORE THE CONFERENCE AND DURING THE CONFERENCE. HOWEVER, THE FILE SHALL NOT INCLUDE NAMES OF CONFIDENTIAL INFORMANTS, PRIVILEGED COMMUNICATIONS BETWEEN THE COUNTY DEPARTMENT AND ITS ATTORNEY, OR THE NATURE AND STATUS OF PENDING CRIMINAL PROSECUTIONS AND ANY OTHER INFORMATION THAT IS CONFIDENTIAL OR PRIVILEGED; AND
C. PRESENT NEW INFORMATION OR DOCUMENTATION TO SUPPORT REVERSAL OR MODIFICATION OF THE PROPOSED ADVERSE ACTION.
3. FAILURE OF THE CLIENT TO REQUEST A COUNTY CONFERENCE WITHIN NINETY (90) CALENDAR DAYS FROM THE DATE TIMELY NOTICE OF THE PROPOSED ACTION WAS MAILED TO THE CLIENT WITHOUT MAKING A REQUEST FOR POSTPONEMENT WITHIN THAT SAME NINETY (90) DAYS, SHALL CONSTITUTE ABANDONMENT OF THE RIGHT TO A CONFERENCE. THE CLIENT DOES NOT LOSE THE RIGHT TO APPEAL DIRECTLY TO THE OAC PURSUANT TO SECTION 3.587.
4. FAILURE OF THE CLIENT TO APPEAR AT THE SCHEDULED COUNTY CONFERENCE WITHOUT MAKING A REQUEST FOR POSTPONEMENT PRIOR TO THE SCHEDULED DATE OF THE CONFERENCE SHALL CONSTITUTE ABANDONMENT OF THE RIGHT TO A CONFERENCE UNLESS THE CLIENT CAN SHOW GOOD CAUSE FOR HIS OR HER FAILURE TO APPEAR. THE CLIENT DOES NOT LOSE THE RIGHT TO APPEAL DIREACTLY TO THE OAC PURSUANT TO SECTION 3.587.
B. THE COUNTY CONFERENCE SHALL BE HELD BEFORE A PERSON WHO WAS NOT DIRECTLY INVOLVED IN THE INITIAL DETERMINATION OF THE ACTION IN QUESTION IN THE COUNTY DEPARTMENT OR AGENCY WHERE THE PROPOSED DECISION IS PENDING. THE COUNTY WORKER OR CONTRACTOR WHO INITIATED THE ACTION IN DISPUTE SHALL NOT CONDUCT THE COUNTY CONFERENCE.
1. THE PERSON DESIGNATED TO CONDUCT THE CONFERENCE SHALL BE IN A POSITION WHICH, BASED ON KNOWLEDGE, EXPERIENCE, AND TRAINING, WOULD ENABLE HIM OR HER TO DETERMINE IF THE PROPOSED ACTION IS VALID. THIS COULD INCLUDE, BUT IS NOT LIMITED TO, A SUPERVISOR, QUALITY ASSURANCE PERSONNEL, OR A MANAGER WITH NO PREVIOUS KNOWLEDGE OF THE CASE.
2. TWO OR MORE COUNTY DEPARTMENTS/LOCAL SERVICE DELIVERY AGENCIES MAY SCHEDULE A JOINT COUNTY CONFERENCE RELATED TO THE SAME CLIENT. IF TWO OR MORE COUNTIES/LOCAL SERVICE DELIVERY AGENCIES SCHEDULE A JOINT COUNTY CONFERENCE, THE LOCATION OF THE CONFERENCE NEED NOT BE HELD IN THE COUNTY OR AGENCY TAKING THE ACTION, AND THE CONFERENCE LOCATION SHALL BE CONVENIENT TO THE CLIENT.
3. THE COUNTY CONFERENCE MAY BE CONDUCTED EITHER IN PERSON, BY TELEPHONE, OR VIDEO CONFERENCE. A TELEPHONIC OR VIDEO CONFERENCE MUST BE AGREED TO BY THE CLIENT.
4. THE COUNTY/AGENCY WORKER OR OTHER COUNTY OR DEPARTMENT EMPLOYEE OR CONTRACTOR SHALL ATTEND THE COUNTY CONFERENCE AND PRESENT THE FACTUAL BASIS FOR THE DISPUTED ACTION.
5. THE COUNTY CONFERENCE SHALL BE CONDUCTED ON AN INFORMAL BASIS. THE COUNTY DEPARTMENT/AGENCY MUST PROVIDE SPECIFIC REASONS FOR THE PROPOSED ACTION, AND THE APPLICABLE STATE DEPARTMENT'S RULES, OR COUNTY POLICY. IN THE EVENT THE CLIENT DOES NOT SPEAK ENGLISH, AN INTERPRETER SHALL BE PROVIDED BY THE COUNTY DEPARTMENT/AGENCY.
6. THE COUNTY/AGENCY SHALL HAVE AVAILABLE AT THE CONFERENCE ALL PERTINENT DOCUMENTS AND RECORDS IN THE CASE FILE RELEVANT TO THE SPECIFIC ACTION IN DISPUTE.
7. TO THE EXTENT POSSIBLE, THE COUNTY CONFERENCE SHALL BE SCHEDULED AND CONDUCTED PRIOR TO GRANT PAYMENTS BEING REDUCED OR TERMINATED.
8. THE COUNTY DEPARTMENT/LOCAL SERVICE AGENCY SHALL PROVIDE NOTICE TO THE CLIENT AT LEAST FOUR (4) DAYS PRIOR TO THE SCHEDULED TIME AND LOCATION FOR THE CONFERENCE, OR THE TIME OF THE SCHEDULED TELEPHONE OR VIDEO CONFERENCE. NOTICE SHOULD BE IN WRITING. THE CLIENT MAY PROVIDE A WRITTEN OR VERBAL WAIVER THAT WRITTEN NOTICE OF THE SCHEDULED CONFERENCE IS NOT NECESSARY WHEN THE COUNTY DEPARTMENT IS ABLE TO CONDUCT THE CONFERENCE WITHIN FOUR (4) DAYS.
9. THE COUNTY DEPARTMENT MAY CONSOLIDATE A CLIENT’S DISPUTES REGARDING THE ADULT FINANCIAL PROGRAM, THE FOOD ASSISTANCE PROGRAM, OR ANY OTHER PUBLIC ASSISTANCE PROGRAM IF THE FACTS ARE SIMILAR AND CONSOLIDATION WOULD FACILITATE RESOLUTION OF ALL DISPUTES.
10. THE GOAL OF THE COUNTY CONFERENCE IS TO REACH AN AGREEMENT BETWEEN THE CLIENT AND THE COUNTY DEPARTMENT AND/OR THE LOCAL SERVICE DELIVERY AGENCY.
C. AT THE CONCLUSION OF THE CONFERENCE, THE PERSON PRESIDING SHALL SUMMARIZE THE DISCUSSION IN WRITING. THE SUMMARY SHALL INCLUDE WHETHER THE ISSUE WAS RESOLVED AND INCLUDE THE CLIENT’S APPEAL RIGHTS AS DESCRIBED IN SECTION 3.587.A. A COPY OF THE WRITTEN SUMMARY SHALL BE PROVIDED TO THE CLIENT AND/OR HIS OR HER REPRESENTATIVE WITHIN ELEVEN (11) CALENDAR DAYS. A COPY OF THE SUMMARY WILL ALSO BE MAINTAINED IN THE CLIENT’S CASE FILE.
3.587 APPEAL AND STATE LEVEL FAIR HEARING
A. THESE RULES APPLY TO ALL STATE LEVEL FAIR HEARINGS OF COUNTY DEPARTMENT ACTIONS CONCERNING ASSISTANCE PAYMENTS AND ACTIONS TAKEN PURSUANT TO STATE RULES GOVERNING THE ADULT FINANCIAL PROGRAM. AN AFFECTED CLIENT WHO IS DISSATISFIED WITH A COUNTY DEPARTMENT OR LOCAL SERVICE DELIVERY AGENCY ACTION OR THE RESULT OF A COUNTY CONFERENCE OR FAILURE TO ACT CONCERNING GRANT PAYMENTS MAY APPEAL TO THE OFFICE OF ADMINISTRATIVE COURTS (OAC) FOR A STATE LEVEL FAIR HEARING BEFORE AN INDEPENDENT ADMINISTRATIVE LAW JUDGE (ALJ). THIS WILL BE A FULL EVIDENTIARY HEARING OF ALL RELEVANT AND PERTINENT FACTS TO REVIEW THE DECISION OF THE COUNTY DEPARTMENT OR LOCAL SERVICE DELIVERY AGENCY. THE TIME LIMITATIONS FOR SUBMITTING A REQUEST FOR AN APPEAL ARE:
1. WHEN THE CLIENT ELECTS TO AVAIL HIM OR HERSELF OF A COUNTY CONFERENCE, BUT IS DISSATISFIED WITH THAT DECISION, THE REQUEST MUST BE SUBMITTED IN WRITING AND MAILED OR DELIVERED AS DESCRIBED IN 3 BELOW WITHIN THE NINETY (90) DAY PERIOD SPECIFIED IN 2, BELOW;
2. WHEN THE CLIENT ELECTS NOT TO AVAIL HIM OR HERSELF OF A COUNTY CONFERENCE BUT WISHES TO APPEAL DIRECTLY TO THE STATE, A WRITTEN REQUEST FOR AN APPEAL MUST BE MAILED OR DELIVERED AS DESCRIBED IN 3 BELOW NO LATER THAN NINETY (90) CALENDAR DAYS FROM THE DATE TIMELY NOTICE OF THE PROPOSED ACTION WAS MAILED TO THE PERSON;
3. A REQUEST FOR AN APPEAL MUST BE MAILED OR DELIVERED TO THE OFFICE OF ADMINISTRATIVE COURTS. IF THE REQUEST FOR APPEAL IS SENT TO OR MADE WITH THE COUNTY DEPARTMENT, THE COUNTY SHALL FORWARD SUCH REQUEST TO THE OAC.
B. REQUESTS FOR STATE LEVEL FAIR HEARINGS MAY RESULT FROM SUCH REASONS AS:
1. THE OPPORTUNITY TO MAKE AN APPLICATION OR REAPPLICATION HAS BEEN DENIED;
2. AN APPLICATION FOR ASSISTANCE OR SERVICES HAS NOT BEEN ACTED UPON WITHIN THE MAXIMUM TIME PERIOD FOR THE CATEGORY OF ASSISTANCE;
3. THE APPLICATION FOR ASSISTANCE HAS BEEN DENIED; THE GRANT PAYMENT HAS BEEN MODIFIED OR DISCONTINUED; REQUESTED RECONSIDERATION OR A GRANT PAYMENT AMOUNT DEEMED INCORRECT HAS BEEN REFUSED OR DELAYED; GRANT PAYMENT HAS BEEN DELAYED THROUGH THE HOLDING OF PAYMENTS; THE COUNTY DEPARTMENT IS DEMANDING REPAYMENT FOR ANY PART OF A GRANT PAYMENT TO A CLIENT WHICH THE CLIENT DOES NOT BELIEVE IS JUSTIFIED; OR THE CLIENT DISAGREES WITH THE TYPE OR LEVEL OF BENEFITS OR SERVICES PROVIDED.
C. THE BASIC OBJECTIVES AND PURPOSES OF THE APPEAL AND STATE LEVEL FAIR HEARING PROCESS ARE:
1. TO SAFEGUARD THE INTERESTS OF THE CLIENT;
2. TO PROVIDE A PRACTICAL MEANS BY WHICH THE CLIENT IS AFFORDED A PROTECTION AGAINST INCORRECT ACTION ON THE PART OF THE COUNTY DEPARTMENT OR LOCAL SERVICE DELIVERY AGENCY;
3. TO BRING TO THE ATTENTION OF THE STATE DEPARTMENT AND COUNTY DEPARTMENT OR LOCAL SERVICE DELIVERY AGENCY INFORMATION THAT MAY INDICATE NEED FOR CLARIFICATION OR REVISION OF STATE AND COUNTY POLICIES AND PROCEDURES;
4. TO ASSURE EQUITABLE TREATMENT THROUGH THE ADMINISTRATIVE PROCESS WITHOUT RESORT TO LEGAL ACTION IN THE DISTRICT COURTS.
D. ANY CLEAR EXPRESSION VERBALLY OR IN WRITING BY THE CLIENT OR HIS OR HER REPRESENTATIVE, THAT THE CLIENT WANTS AN OPPORTUNITY TO HAVE A SPECIFIC ACTION OF A COUNTY DEPARTMENT OR LOCAL SERVICE DELIVERY AGENCY REVIEWED BY THE STATE DEPARTMENT IS CONSIDERED AN APPEAL AND A REQUEST FOR A STATE LEVEL FAIR HEARING. THE COUNTY DEPARTMENT OR LOCAL SERVICE DELIVERY AGENCY SHALL, WHEN ASKED, AID THE PERSON IN PREPARING A REQUEST FOR A HEARING. IF THE REQUEST FOR A HEARING IS MADE VERBALLY, THE COUNTY DEPARTMENT SHALL PREPARE A WRITTEN REQUEST WITHIN TEN (10) CALENDAR DAYS FOR THE CLIENT OR HIS OR HER REPRESENTATIVE'S SIGNATURE OR HAVE THE CLIENT PREPARE SUCH REQUEST, SPECIFYING THE ACTION HE OR SHE WOULD LIKE TO APPEAL AND THE REASON FOR APPEALING THAT ACTION.
1. THE CLIENT IS ENTITLED TO:
A. REPRESENTATION BY ANY PERSON HE OR SHE CHOOSES PURSUANT TO SECTION 26-2-127(1)(A)(IV), C.R.S., LEGAL COUNSEL RETAINED AT THE CLIENT’S OWN EXPENSE, OR HE OR SHE MAY REPRESENT HIM OR HERSELF;
B. EXAMINE THE COMPLETE CASE FILE AND ANY OTHER DOCUMENTS, RECORDS, OR PERTINENT MATERIAL TO BE USED BY THE COUNTY AT THE STATE LEVEL FAIR HEARING, AT A REASONABLE TIME BEFORE THE DATE OF HEARING AS WELL AS DURING THE HEARING. HOWEVER, THE FILE SHALL NOT INCLUDE THE NAMES OF CONFIDENTIAL INFORMANTS, PRIVILEGED COMMUNICATIONS BETWEEN THE COUNTY DEPARTMENTS AND ITS ATTORNEY, THE NATURE AND STATUS OF PENDING CRIMINAL PROSECUTIONS, AND ANY OTHER INFORMATION THAT IS CONFIDENTIAL OR PRIVILEGED.
2. THE CLIENT AND STAFF OF THE COUNTY DEPARTMENT ARE ENTITLED TO:
A. PRESENT WITNESSES;
B. ESTABLISH ALL FACTS AND CIRCUMSTANCES PERTINENT TO THE DECISION BEING APPEALED;
C. ADVANCE ANY ARGUMENTS WITHOUT UNDUE INTERFERENCE;
D. QUESTION OR REFUTE ANY TESTIMONY OR EVIDENCE, INCLUDING OPPORTUNITY TO CONFRONT AND CROSS-EXAMINE ADVERSE WITNESSES.
3.587.1 STATE LEVEL FAIR HEARING PROCEDURES
ONE OR MORE PERSONS FROM THE COLORADO DEPARTMENT PERSONNEL & ADMINISTRATION, OAC, ARE APPOINTED TO SERVE AS ALJ FOR THE STATE DEPARTMENT.
A. THE STATE ALJ SHALL, IN PREPARATION FOR THE HEARING, REVIEW THE REASONS FOR THE DECISION UNDER APPEAL AND BE PREPARED TO INTERPRET APPLICABLE DEPARTMENTAL RULES GOVERNING THE ADULT FINANCIAL PROGRAM AND THE ISSUE(S) UNDER APPEAL.
B. WHEN LEGAL COUNSEL DOES NOT REPRESENT THE CLIENT AND/OR THE DEPARTMENT OR LOCAL SERVICE DELIVERY AGENCY, THE ALJ SHALL ASSIST IN BRINGING FORTH ALL RELEVANT EVIDENCE AND ISSUES RELATING TO THE APPEAL.
C. UPON RECEIPT BY THE OAC OF AN APPEAL REQUEST, OAC ASSIGNS A CASE NUMBER. THE OAC SETS A HEARING DATE AT LEAST TEN (10) DAYS FROM THE DATE THE APPEAL WAS REQUESTED, AND SENDS A LETTER BY FIRST CLASS OR CERTIFIED MAIL TO THE APPELLANT AND THE COUNTY DEPARTMENT OR LOCAL SERVICE DELIVERY AGENCY NOTIFYING THEM OF THE DATE, TIME, AND PLACE OF THE HEARING.
1. THE LETTER ADVISES THE APPELLANT THAT IF THESE ARRANGEMENTS ARE NOT SATISFACTORY, HE OR SHE MUST NOTIFY THE OAC. AN ALJ WILL DECIDE IF GOOD CAUSE EXISTS, AND WHETHER THE DATE, TIME, AND/OR PLACE OF THE HEARING WILL BE CHANGED.
2. AN INFORMATION SHEET SHALL BE ENCLOSED WITH THE LETTER THAT EXPLAINS THE HEARING PROCEDURES TO THE APPELLANT. THE INFORMATION SHEET INFORMS THE APPELLANT THAT:
A. HE OR SHE HAS THE RIGHT TO REPRESENTATION BY AN AUTHORIZED REPRESENTATIVE RETAINED AT HIS OR HER OWN EXPENSE, SUCH AS LEGAL COUNSEL, A RELATIVE, A FRIEND, OR ANOTHER SPOKESPERSON, OR HE OR SHE MAY REPRESENT HIMSELF OR HERSELF;
B. THE APPELLANT OR HIS OR HER REPRESENTATIVE HAS THE RIGHT TO EXAMINE ALL MATERIALS TO BE USED AT THE HEARING, BEFORE AND DURING THE HEARING; AND
C. FAILURE TO APPEAR AT THE HEARING AS SCHEDULED, WITHOUT HAVING SECURED A PROPER EXTENSION IN ADVANCE, OR WITHOUT HAVING SHOWN GOOD CAUSE FOR FAILURE TO APPEAR, SHALL CONSTITUTE ABANDONMENT OF THE APPEAL AND CAUSE A DISMISSAL THEREOF.
3. IF OAC SETS THE HEARING FORTY-FIVE (45) DAYS OR MORE FROM THE DATE OF THE NOTICE OF HEARING, THE COUNTY DEPARTMENT/AGENCY SHALL, WITHIN FIFTEEN (15) DAYS BUT NO LATER THAN THIRTY (30) DAYS PRIOR TO THE HEARING, PREPARE AND MAIL A HEARING PACKET TO THE APPELLANT WITH A COPY TO OAC. IF THE HEARING IS SET LESS THAN 45 DAYS FROM THE DATE OF THE NOTICE OF HEARING, THE COUNTY DEPARTMENT/AGENCY SHALL, WITHIN FIVE (5) DAYS BUT NO LATER THAN TEN (10) DAYS PRIOR TO THE HEARING, PREPARE AND MAIL THE HEARING PACKET. THE HEARING PACKET SHALL CONTAIN THE FOLLOWING INFORMATION:
A. THE REASONS FOR THE DECISION OF THE COUNTY DEPARTMENT OR LOCAL SERVICE DELIVERY AGENCY AND A SPECIFIC EXPLANATION OF EACH FACTOR INVOLVED, SUCH AS THE AMOUNT OF EXCESS PROPERTY OR INCOME, ASSIGNMENT OR TRANSFER OF PROPERTY, OR RESIDENCE FACTORS;
B. THE SPECIFIC STATE RULES GOVERNING THE ADULT FINANCIAL PROGRAM ON WHICH THE DECISION IS BASED WITH A NUMERIC REFERENCE TO EACH SUCH RULE, INCLUDING THE APPROPRIATE CODE OF COLORADO REGULATIONS (C.C.R.) CITES;
C. NOTICE THAT THE COUNTY DEPARTMENT OR LOCAL SERVICE DELIVERY AGENCY WILL ASSIST HIM OR HER BY PROVIDING RELEVANT DOCUMENTS FROM THE CASE FILE FOR HIS OR HER CLAIM, IF HE OR SHE SO DESIRES, AND THAT HE OR SHE HAS THE OPPORTUNITY TO EXAMINE RULES AND OTHER MATERIALS TO BE USED AT THE HEARING CONCERNING THE BASIS OF THE COUNTY DECISION.
4. INFORMATION THAT THE APPELLANT OR HIS OR HER REPRESENTATIVE DOES NOT HAVE AN OPPORTUNITY TO SEE SHALL NOT BE MADE AVAILABLE AS A PART OF THE HEARING RECORD OR USED IN A DECISION ON AN APPEAL. NO MATERIAL MADE AVAILABLE FOR REVIEW BY THE ALJ MAY BE WITHHELD FROM REVIEW BY THE APPELLANT OR HIS OR HER REPRESENTATIVE.
5. IN ADULT FINANCIAL PROGRAM APPEALS, THE ALJ HAS TWENTY (20) CALENDAR DAYS FROM THE HEARING DATE TO ARRIVE AT AN INITIAL DECISION. ONCE AN INITIAL DECISION IS RENDERED, THE OAC IMMEDIATELY SENDS THE CASE AND THE INITIAL DECISION TO THE STATE DEPARTMENT, OFFICE OF APPEALS. THE OFFICE OF APPEALS SERVES THE INITIAL DECISION ON THE PARTIES VIA FIRST CLASS MAIL AND PROVIDES FOR AN OPPORTUNITY FOR THE PARTIES TO FILE EXCEPTIONS TO THE INITIAL DECISION PRIOR TO THE OFFICE OF APPEALS ISSUING A FINAL AGENCY DECISION.
6. THE INITIAL DECISION SHALL NOT BE IMPLEMENTED PENDING REVIEW BY THE OFFICE OF APPEALS AND ENTRY OF A FINAL AGENCY DECISION. ALL FINAL AGENCY DECISIONS ON THESE APPEALS SHALL BE MADE WITHIN NINETY (90) CALENDAR DAYS FROM THE DATE THE REQUEST FOR HEARING IS RECEIVED.
D. WHEN THE CLIENT HAS HAD A COUNTY CONFERENCE AND WISHES TO APPEAL THE COUNTY DEPARTMENT OR LOCAL SERVICE DELIVERY AGENCY 'S ACTION TO THE OAC, THE FOLLOWING PROCEDURES SHALL BE FOLLOWED:
1. AS PART OF THE COUNTY CONFERENCE THE CLIENT IS INFORMED THAT IF HE OR SHE WISHES TO APPEAL TO THE OAC FOR A HEARING, THE COUNTY DEPARTMENT OR LOCAL SERVICE DELIVERY AGENCY SHALL PROVIDE RELEVANT DOCUMENTS FROM THE CASE FILE FOR THE CLIENT’S CLAIM, IF HE OR SHE SO DESIRES, AND THAT HE OR SHE MAY HAVE THE OPPORTUNITY TO EXAMINE MATERIALS AS DESCRIBED IN THE SECTION 3.587.1.C.2.;
2. THE COUNTY DEPARTMENT OR LOCAL SERVICE DELIVERY AGENCY SHALL FORWARD A COPY OF THE COUNTY DECISION BEING APPEALED AND A COPY OF THE WRITTEN NOTIFICATION OF THE DECISION GIVEN TO THE CLIENT TO THE OAC.
3. A COPY OF THE OAC’S NOTICE TO THE CLIENT SETTING A DATE FOR THE HEARING IS FORWARDED TO THE COUNTY DEPARTMENT OR LOCAL SERVICE DELIVERY AGENCY. THE COUNTY DEPARTMENT OR LOCAL SERVICE DELIVERY AGENCY SHALL PROVIDE THE CLIENT WITH A HEARING PACKET IN ACCORDANCE TO SECTION 3.587.1.C.3.
4. IF THE CLIENT INDICATES TO THE COUNTY DEPARTMENT THAT HE OR SHE DESIRES TO WITHDRAW THE APPEAL, THE COUNTY DEPARTMENT SHALL OBTAIN A STATEMENT TO THAT EFFECT IN WRITING AND FORWARD IT TO THE OAC.
5. IF A CLIENT HAS LEGAL COUNSEL OR ANOTHER AUTHORIZED REPRESENTATIVE FOR THE APPEAL, THE COUNTY DEPARTMENT OR LOCAL SERVICE DELIVERY AGENCY WILL NOT DISCUSS THE MERITS OF THE APPEAL OR THE QUESTION OF WHETHER OR NOT TO PROCEED WITH IT WITH THE CLIENT UNLESS THE DISCUSSION IS IN THE PRESENCE OF, OR WITH THE PERMISSION OF, SUCH COUNSEL OR SUCH OTHER AUTHORIZED REPRESENTATIVE.
6. IF THE COUNTY DEPARTMENT OR LOCAL SERVICE DELIVERY AGENCY LEARNS THAT LEGAL COUNSEL WILL REPRESENT THE CLIENT, THE COUNTY DEPARTMENT OR LOCAL SERVICE DELIVERY AGENCY SHALL MAKE EVERY EFFORT TO ENSURE THAT IT, TOO, IS REPRESENTED BY AN ATTORNEY AT THE HEARING. THE COUNTY DEPARTMENT/AGENCY MAY BE REPRESENTED BY AN ATTORNEY IN ANY APPEAL THAT IT CONSIDERS SUCH REPRESENTATION DESIRABLE.
7. IF THE APPELLANT NEEDS INTERPRETATION SERVICES, THE COUNTY DEPARTMENT SHALL ARRANGE TO HAVE PRESENT AT THE HEARING A CERTIFIED INTERPRETER WHO WILL BE SWORN TO TRANSLATE CORRECTLY.
8. THE FACT THAT AN APPELLANT AND THE COUNTY DEPARTMENT OR LOCAL SERVICE DELIVERY AGENCY HAVE BEEN NOTIFIED THAT A HEARING WILL BE HELD DOES NOT PREVENT THE COUNTY DEPARTMENT/AGENCY FROM REVIEWING THE CASE AND CONSIDERING ANY NEW FACTORS WHICH MIGHT CHANGE THE STATUS OF THE CASE, OR TAKING SUCH ACTION AS MAY BE INDICATED TO REVERSE ITS DECISION OR OTHERWISE SETTLE THE ISSUE. ANY CHANGE THAT RESULTS IN VOIDING THE CAUSE OF APPEAL SHALL BE IMMEDIATELY REPORTED BY THE COUNTY DEPARTMENT TO THE OAC.
9. UPON RECEIPT OF NOTICE OF A STATE HEARING ON AN APPEAL, THE COUNTY DEPARTMENT OR LOCAL SERVICE DELIVERY AGENCY SHALL ARRANGE FOR A SUITABLE HEARING ROOM APPROPRIATE TO ACCOMMODATE THE NUMBER OF PERSONS, INCLUDING WITNESSES, WHO ARE EXPECTED TO BE IN ATTENDANCE, TAKING INTO CONSIDERATION SUCH FACTORS AS PRIVACY; ABSENCE OF DISTRACTING NOISE; AND THE NEED FOR TABLE, CHAIRS, ELECTRICAL OUTLETS, ADEQUATE LIGHTING AND VENTILATION, AND CONFERENCE TELEPHONE FACILITIES.
E. TELEPHONIC CONFERENCE HEARINGS MAY BE CONDUCTED AS AN ALTERNATIVE TO IN-PERSON HEARINGS UNLESS OTHERWISE REQUESTED BY ANY OF THE PARTIES. ALL APPLICABLE PROVISIONS OF THE IN-PERSON HEARING PROCEDURES WILL APPLY, SUCH AS THE RIGHT TO BE REPRESENTED BY COUNSEL, THE RIGHT TO EXAMINE AND CROSS-EXAMINE WITNESSES, THE RIGHT TO EXAMINE THE CONTENTS OF THE CASE FILE, AND THE RIGHT TO HAVE THE HEARING CONDUCTED AT A REASONABLE TIME AND DATE.
1. THE ALJ SHALL CONDUCT THE HEARINGS IN ACCORDANCE WITH THE STATE ADMINISTRATIVE PROCEDURE ACT, ARTICLE 4 OF TITLE 24, C.R.S, SPECIFICALLY, SECTION 24-4-105.
2. THE COUNTY DEPARTMENT OR LOCAL SERVICE DELIVERY AGENCY SHALL HAVE THE BURDEN OF PROOF, BY A PREPONDERANCE OF THE EVIDENCE, TO ESTABLISH THE BASIS OF THE DECISION BEING APPEALED. EVERY PARTY TO THE PROCEEDING SHALL HAVE THE RIGHT TO PRESENT HIS OR HER CASE OR DEFENSE BY VERBAL AND DOCUMENTARY EVIDENCE, TO SUBMIT REBUTTAL EVIDENCE, AND TO CONDUCT SUCH CROSS-EXAMINATION AS MAY BE REQUIRED FOR A FULL AND TRUE DISCLOSURE OF THE FACTS. SUBJECT TO THESE RIGHTS AND REQUIREMENTS, WHERE A HEARING IS EXPEDITED AND THE INTERESTS OF THE PARTIES WILL NOT BE SUBSEQUENTLY PREJUDICED THEREBY, THE ALJ MAY RECEIVE ALL OR PART OF THE EVIDENCE IN WRITTEN FORM OR BY VERBAL STIPULATIONS.
F. THE FOLLOWING PROVISIONS GOVERN THE PROCEDURE AT STATE HEARINGS BEFORE THE ALJ:
1. THE HEARING IS CLOSED TO THE PUBLIC. HOWEVER, ANY PERSON OR PERSONS WHOM THE APPELLANT WISHES TO APPEAR FOR OR WITH HIM OR HER MAY BE PRESENT, AND, IF REQUESTED BY THE APPELLANT ON THE RECORD, SUCH HEARING MAY BE PUBLIC;
2. THE PURPOSE OF THE HEARING IS TO DETERMINE THE PERTINENT FACTS IN ORDER TO ARRIVE AT A FAIR AND EQUITABLE DECISION IN ACCORDANCE WITH THE RULES OF THE STATE DEPARTMENT. IN ARRIVING AT A DECISION, ONLY THE EVIDENCE AND TESTIMONY INTRODUCED AT THE HEARING IS CONSIDERED BY THE ALJ. HOWEVER, IN CIRCUMSTANCES WHEN IT IS SHOWN AT THE HEARING THAT MEDICAL OR OTHER EVIDENCE COULD NOT, FOR GOOD CAUSE, BE OBTAINED IN TIME FOR THE HEARING, THE ALJ MAY PERMIT THE INTRODUCTION OF SUCH EVIDENCE AFTER THE HEARING. THE OPPOSING PARTY MUST ALSO BE FURNISHED WITH A COPY OF THIS NEW EVIDENCE AND MUST HAVE THE OPPORTUNITY TO CONTROVERT OR OTHERWISE RESPOND TO IT. DELAYS IN RENDERING THE INITIAL DECISION WILL BE ATTRIBUTED TO THE PARTY REQUESTING THAT THE ALJ HEAR ADDITIONAL EVIDENCE AFTER THE HEARING;
3. ALTHOUGH THE HEARING IS CONDUCTED ON AN INFORMAL BASIS AND AN EFFORT IS MADE TO PLACE ALL THE PARTIES AT EASE, IT IS ESSENTIAL THAT THE EVIDENCE BE PRESENTED IN AN ORDERLY MANNER SO AS TO RESULT IN AN ADEQUATE RECORD;
4. WHEN AN ALJ MAKES A DECISION REGARDING THE MERITS OF THE CASE, OR THE DISMISSAL OF THE APPEAL, THAT DECISION IS CALLED AN INITIAL DECISION, SEE SECTION 3.587.2 ADDRESSING INITIAL DECISIONS;
5. A COMPLETE AND EXACT RECORD OF THE HEARING SHALL BE MADE BY ELECTRONIC OR OTHER MEANS. WHEN REQUESTED BY THE PARTY, THE OAC SHALL CAUSE THE PROCEEDINGS TO BE TRANSCRIBED AT THE EXPENSE OF THE REQUESTING PARTY;
6. THE ALJ SHALL NOT ENTER A DEFAULT AGAINST ANY PARTY FOR FAILURE TO FILE A WRITTEN ANSWER IN RESPONSE TO THE NOTICE OF HEARING, BUT SHALL BASE THE INITIAL DECISION UPON THE EVIDENCE INTRODUCED AT THE HEARING. HOWEVER, AN APPELLANT MAY BE GRANTED A POSTPONEMENT OF THE HEARING IF THE COUNTY DEPARTMENT OR LOCAL SERVICE DELIVERY AGENCY HAS FAILED TO PROVIDE THE HEARING PACKET REQUIRED BY SECTION 3.587.1.D.3, AND THE APPELLANT HAS THEREFORE BEEN UNABLE TO PREPARE FOR THE HEARING.
7. WHEN THE ALJ DISMISSES AN APPEAL FOR REASONS OTHER THAN FAILURE TO APPEAR, THE DECISION OF THE ALJ SHALL BE AN INITIAL DECISION WHICH SHALL NOT BE IMPLEMENTED UNTIL AFTER THE OFFICE OF APPEALS COMPLETES ITS REVIEW AND ENTERS A FINAL AGENCY DECISION.
8. WHEN OAC HAS NOTIFIED THE APPELLANT OF THE TIME, DATE, AND PLACE OF THE OAC HEARING AND THE APPELLANT FAILS TO APPEAR AT THE HEARING, WITHOUT GIVING NOTICE TO THE ALJ OF ACCEPTABLE GOOD CAUSE FOR HIS OR HER INABILITY TO APPEAR AT THE HEARING, THEN THE APPEAL SHALL BE CONSIDERED ABANDONED. THE ALJ SHALL ENTER AN ORDER OF DISMISSAL AND THE OAC SHALL SERVE IT UPON THE PARTIES. THE DISMISSAL ORDER SHALL NOT BE IMPLEMENTED PENDING REVIEW BY THE OFFICE OF APPEALS AND ENTRY OF A FINAL AGENCY DECISION.
HOWEVER, THE APPELLANT, SHALL HAVE TEN (10) CALENDAR DAYS FROM THE DATE THE ORDER OF DISMISSAL WAS MAILED TO DRAFT AND SEND A LETTER TO THE ALJ EXPLAINING THE REASON FOR HIS OR HER FAILURE TO APPEAR. IF THE ALJ THEN FINDS THAT THERE WAS GOOD CAUSE FOR THE APPELLANT NOT APPEARING, THE ALJ SHALL VACATE THE ORDER DISMISSING THE APPEAL AND RESCHEDULE THE HEARING DATE.
IF THE APPELLANT SUBMITS A LETTER SEEKING TO SHOW GOOD CAUSE AND THE ALJ FINDS THAT THE STATED FACTS DO NOT CONSTITUTE GOOD CAUSE, THE ALJ SHALL ENTER AN INITIAL DECISION CONFIRMING THE DISMISSAL.
IF THE APPELLANT DOES NOT SUBMIT A LETTER SEEKING TO SHOW GOOD CAUSE WITHIN THE TEN (10) DAY PERIOD, THE ORDER OF DISMISSAL SHALL BE FILED WITH THE OFFICE OF APPEALS OF THE STATE DEPARTMENT. THE OFFICE OF APPEALS SHALL CONFIRM THE DISMISSAL OF THE APPEAL BY A FINAL AGENCY DECISION, WHICH SHALL BE SERVED UPON THE PARTIES.
AFTER THE FINAL AGENCY DECISION IS SERVED ON THE PARTIES, THE COUNTY DEPARTMENT OR LOCAL SERVICE DELIVERY AGENCY SHALL CARRY OUT THE NECESSARY ACTIONS WITHIN TEN (10) CALENDAR DAYS OF THE FINAL AGENCY DECISION BECOMING EFFECTIVE. THE ACTIONS MAY BE: TO PROVIDE ASSISTANCE IN THE CORRECT AMOUNT; TO TERMINATE ASSISTANCE; TO RECOVER ASSISTANCE INCORRECTLY PAID; AND/OR OTHER APPROPRIATE ACTIONS IN ACCORDANCE WITH THE RULES AND FINAL AGENCY DECISION.
9. THE APPELLANT MAY FILE EXCEPTIONS TO ANY ALJ INITIAL DECISION PURSUANT TO SECTION 3.587.2.C.
3.587.2 DECISION AND NOTIFICATION
A. FOLLOWING THE CONCLUSION OF THE STATE LEVEL FAIR HEARING, THE ALJ SHALL PROMPTLY PREPARE AND ISSUE AN INITIAL DECISION AND FILE IT WITH THE STATE DEPARTMENT, OFFICE OF APPEALS.
THE OFFICE OF APPEALS OF THE STATE DEPARTMENT IS THE DESIGNEE OF THE STATE DEPARTMENT’S EXECUTIVE DIRECTOR FOR REVIEWING THE INITIAL DECISION OF THE ALJ. THE OFFICE OF APPEALS ENTERS A FINAL AGENCY DECISION ON BEHALF OF THE EXECUTIVE DIRECTOR AFFIRMING, MODIFYING, OR REVERSING THE INITIAL DECISION.
1. THE INITIAL DECISION SHALL MAKE AN INITIAL DETERMINATION WHETHER THE COUNTY, LOCAL SERVICE DELIVERY AGENCY, OR STATE DEPARTMENT OR ITS AGENT ACTED IN ACCORDANCE WITH, AND/OR PROPERLY INTERPRETED, THE RULES OF THE STATE DEPARTMENT GOVERNING THE ADULT FINANCIAL PROGRAM.
2. THE ALJ HAS NO JURISDICTION OR AUTHORITY TO DETERMINE ISSUES OF CONSTITUTIONALITY OR LEGALITY OF DEPARTMENTAL RULES.
3. THE INITIAL DECISION SHALL ADVISE THE CLIENT WHO BROUGHT THE APPEAL THAT FAILURE TO FILE EXCEPTIONS TO FINDINGS OF THE INITIAL DECISION WILL WAIVE THE RIGHT TO SEEK JUDICIAL REVIEW OF A FINAL AGENCY DECISION THAT AFFIRMS THOSE FINDINGS.
4. THE OFFICE OF APPEALS SHALL PROMPTLY SERVE THE INITIAL DECISION UPON EACH PARTY BY FIRST CLASS MAIL, AND SHALL TRANSMIT A COPY OF THE DECISION EITHER ELECTRONICALLY OR IN WRITING TO THE DIVISION OF THE STATE DEPARTMENT THAT ADMINISTERS THE PROGRAM(S) PERTINENT TO THE APPEAL.
5. THE INITIAL DECISION SHALL NOT BE IMPLEMENTED PENDING REVIEW BY THE OFFICE OF APPEALS AND ENTRY OF A FINAL AGENCY DECISION.
B. UPON RECEIVING THE INITIAL DECISION, THE OFFICE OF APPEALS MAY ISSUE AN ORDER OF REMAND BASED ON AN ISSUE THAT WARRANTS AN IMMEDIATE REMAND BEFORE THE INITIAL DECISION IS EVEN MAILED TO THE PARTIES.
ADDITIONALLY, THE OFFICE OF APPEALS MAY ISSUE AN ORDER OF REMAND AFTER ITS SUBSTANTIVE REVIEW OF AN INITIAL DECISION, AND PRIOR TO ISSUING A FINAL AGENCY DECISION, BASED ON THE NEED FOR FURTHER CLARIFICATION, FINDINGS, CONCLUSIONS OF LAW, AND/OR FURTHER PROCEEDINGS. AN ORDER OF REMAND IS NOT A FINAL AGENCY DECISION THAT IS SUBJECT TO JUDICIAL REVIEW.
C. ANY PARTY SEEKING A FINAL AGENCY DECISION WHICH REVERSES, MODIFIES, OR REMANDS THE INITIAL DECISION OF THE ADMINISTRATIVE LAW JUDGE SHALL FILE EXCEPTIONS TO THE DECISION WITH THE OFFICE OF APPEALS, WITHIN FIFTEEN (15) DAYS (PLUS THREE DAYS FOR MAILING) FROM THE DATE THE INITIAL DECISION IS MAILED TO THE PARTIES. IF THAT DATE FALLS ON A WEEKEND OR STATE HOLIDAY, THE DUE DATE SHALL BE MOVED TO THE NEXT BUSINESS DAY. EXCEPTIONS MUST STATE SPECIFIC GROUNDS FOR REVERSAL, MODIFICATION OR REMAND OF THE INITIAL DECISION.
1. IF THE PARTY ASSERTS THAT THE ALJ’S FINDINGS OF FACT ARE NOT SUPPORTED BY THE WEIGHT OF THE EVIDENCE, THE PARTY SHALL, SIMULTANEOUSLY WITH, OR PRIOR TO, THE FILING OF EXCEPTIONS, REQUEST THAT THE OAC CREATE A TRANSCRIPT OF ALL OR A PORTION OF THE HEARING AND FILE IT WITH THE OFFICE OF APPEALS. NO TRANSCRIPT IS REQUIRED IF THE REVIEW IS LIMITED TO A PURE QUESTION OF LAW. SIMILARLY, IF THE EXCEPTIONS ASSERT ONLY THAT THE ALJ IMPROPERLY INTERPRETED OR APPLIED STATE RULES OR STATUTES, THE PARTY FILING EXCEPTIONS IS NOT REQUIRED TO PROVIDE A TRANSCRIPT OR RECORDING TO THE OFFICE OF APPEALS.
IF APPLICABLE, THE EXCEPTIONS SHALL STATE THAT A TRANSCRIPT HAS BEEN REQUESTED. WITHIN FIVE (5) DAYS OF THE REQUEST FOR A TRANSCRIPT, THE PARTY REQUESTING IT SHALL ADVANCE THE COST THEREFORE TO THE TRANSCRIBER DESIGNATED BY THE OAC, UNLESS THE TRANSCRIBER WAIVES PRIOR PAYMENT.
2. A PARTY WHO IS INDIGENT AND UNABLE TO PAY THE COST OF A TRANSCRIPT MAY FILE A WRITTEN REQUEST, WHICH NEED NOT BE SWORN, WITH THE OFFICE OF APPEALS FOR PERMISSION TO SUBMIT A COPY OF THE HEARING AUDIO RECORDING INSTEAD OF THE TRANSCRIPT. IF SUBMISSION OF A RECORDING IS PERMITTED, THE PARTY FILING EXCEPTIONS MUST PROMPTLY REQUEST A COPY OF THE RECORDING FROM THE OAC AND DELIVER IT TO THE OFFICE OF APPEALS. PAYMENT IN ADVANCE SHALL BE REQUIRED FOR THE PREPARATION OF A COPY OF THE RECORDING.
3. THE OFFICE OF APPEALS SHALL SERVE A COPY OF THE EXCEPTIONS ON EACH PARTY BY FIRST CLASS MAIL. EACH PARTY SHALL BE LIMITED TO TEN (10) CALENDAR DAYS FROM THE DATE EXCEPTIONS ARE MAILED TO THE PARTIES IN WHICH TO FILE A WRITTEN RESPONSE TO SUCH EXCEPTIONS. THE OFFICE OF APPEALS SHALL NOT PERMIT VERBAL ARGUMENT.
4. THE OFFICE OF APPEALS SHALL NOT CONSIDER EVIDENCE THAT WAS NOT PART OF THE RECORD BEFORE THE ALJ. HOWEVER, THE CASE MAY BE REMANDED TO THE ALJ FOR REHEARING IF A PARTY ESTABLISHES IN ITS EXCEPTIONS THAT MATERIAL EVIDENCE HAS BEEN DISCOVERED THAT THE PARTY COULD NOT WITH REASONABLE DILIGENCE HAVE PRODUCED AT THE HEARING.
5. WHILE REVIEW OF THE INITIAL DECISION IS PENDING BEFORE THE OFFICE OF APPEALS, THE RECORD ON REVIEW, INCLUDING ANY TRANSCRIPT OR RECORDING OF TESTIMONY FILED WITH THE OFFICE OF APPEALS, SHALL BE AVAILABLE FOR EXAMINATION BY ANY PARTY AT THE OFFICE OF APPEALS DURING REGULAR BUSINESS HOURS.
6. THE STATE DEPARTMENT’S DIVISION RESPONSIBLE FOR ADMINISTERING THE PROGRAM RELEVANT TO THE APPEAL MAY FILE EXCEPTIONS TO THE INITIAL DECISION, OR RESPOND TO EXCEPTIONS FILED BY A PARTY, EVEN THOUGH THE DIVISION HAS NOT PREVIOUSLY APPEARED AS A PARTY TO THE APPEAL. THE DIVISION'S EXCEPTIONS OR RESPONSES MUST BE FILED IN COMPLIANCE WITH THE REQUIREMENTS OF THIS SECTION. EXCEPTIONS FILED BY A DIVISION THAT DID NOT APPEAR AS A PARTY AT THE HEARING SHALL BE TREATED AS REQUESTING REVIEW OF THE INITIAL DECISION UPON THE STATE DEPARTMENT'S OWN MOTION.
7. IN THE ABSENCE OF EXCEPTIONS FILED BY ANY PARTY OR BY A DIVISION OF THE STATE DEPARTMENT, THE OFFICE OF APPEALS SHALL REVIEW THE INITIAL DECISION, AND MAY REVIEW THE HEARING FILE OF THE ALJ AND/OR THE RECORDED TESTIMONY OF WITNESSES, BEFORE ENTERING A FINAL AGENCY DECISION. REVIEW BY THE OFFICE OF APPEALS SHALL DETERMINE WHETHER THE DECISION PROPERLY INTERPRETS AND APPLIES THE RULES OF THE STATE DEPARTMENT AND/OR RELEVANT STATUTES, AND WHETHER THE FINDINGS OF FACT AND CONCLUSIONS OF LAW SUPPORT THE DECISION. IF A PARTY OR DIVISION OF THE STATE DEPARTMENT OBJECTS TO THE FINAL AGENCY DECISION ENTERED UPON REVIEW BY THE OFFICE OF APPEALS, THE PARTY OR DIVISION MAY SEEK RECONSIDERATION OF THE FINAL AGENCY DECISION PURSUANT TO SUBSECTION D. BELOW.
8. THE OFFICE OF APPEALS SHALL MAIL COPIES OF THE FINAL AGENCY DECISION TO ALL PARTIES BY FIRST CLASS MAIL.
9. FOR PURPOSES OF REQUESTING JUDICIAL REVIEW, THE EFFECTIVE DATE OF THE FINAL AGENCY DECISION SHALL BE THE THIRD DAY AFTER THE DATE THE DECISION IS MAILED TO THE PARTIES, EVEN IF THE THIRD DAY FALLS ON SATURDAY, SUNDAY, OR A LEGAL HOLIDAY. THE PARTIES SHALL BE ADVISED OF THIS IN THE FINAL AGENCY DECISION.
10. THE STATE OR COUNTY DEPARTMENT OR LOCAL SERVICE DELIVERY AGENCY SHALL INITIATE ACTION TO COMPLY WITH THE FINAL AGENCY DECISION WITHIN THREE (3) WORKING DAYS AFTER THE EFFECTIVE DATE. THE DEPARTMENT SHALL COMPLY WITH THE DECISION EVEN IF RECONSIDERATION IS REQUESTED; UNLESS THE EFFECTIVE DATE OF THE FINAL AGENCY DECISION IS POSTPONED BY ORDER OF THE OFFICE OF APPEALS OR A REVIEWING COURT.
D. NO MOTION FOR RECONSIDERATION SHALL BE GRANTED UNLESS IT IS FILED IN WRITING WITH THE OFFICE OF APPEALS WITHIN FIFTEEN (15) DAYS OF THE DATE THAT THE FINAL AGENCY DECISION IS MAILED TO THE PARTIES. THE MOTION MUST STATE SPECIFIC GROUNDS FOR RECONSIDERATION OF THE FINAL AGENCY DECISION.
THE OFFICE OF APPEALS SHALL MAIL A COPY OF THE MOTION FOR RECONSIDERATION TO EACH PARTY OF RECORD AND TRANSMIT ELECTRONICALLY OR IN WRITING TO THE APPROPRIATE DIVISION OF THE STATE DEPARTMENT.
A MOTION FOR RECONSIDERATION OF A FINAL AGENCY DECISION MAY BE GRANTED BY THE OFFICE OF APPEALS FOR THE FOLLOWING REASONS:
1. A SHOWING OF GOOD CAUSE FOR FAILURE TO FILE EXCEPTIONS TO THE INITIAL DECISION WITHIN THE FIFTEEN (15) DAY PERIOD ALLOWED BY SECTION 3.587.2.B; OR,
2. A SHOWING THAT THE FINAL AGENCY DECISION IS BASED UPON A CLEAR OR PLAIN ERROR OF FACT OR LAW. AN ERROR OF LAW MEANS FAILURE BY THE OFFICE OF APPEALS TO FOLLOW A RULE, STATUTE, OR COURT DECISION, WHICH CONTROLS THE OUTCOME OF THE APPEAL.
E. WHEN A FINAL AGENCY DECISION CONCLUDES THAT AN ACTION OF THE COUNTY, LOCAL SERVICE DELIVERY AGENCY, OR STATE DEPARTMENT WAS NOT IN ACCORDANCE WITH THE RULES OF THE STATE DEPARTMENT, OR WHEN THE COUNTY/AGENCY OR STATE DEPARTMENT DETERMINES THAT ITS ACTION WAS NOT SUPPORTED BY THE STATE DEPARTMENT’S RULES AFTER THE CLIENT MAKES A REQUEST FOR A HEARING, THE ADJUSTMENT OR CORRECTIVE PAYMENT IS MADE RETROACTIVELY TO THE DATE OF THE INCORRECT ACTION.
F. THE CLIENT IS TO BE FULLY INFORMED BY THE FINAL AGENCY DECISION OF HIS OR HER FURTHER RIGHT TO APPLY FOR JUDICIAL REVIEW OF THE FINAL AGENCY DECISION. JUDICIAL REVIEW CAN BE STARTED BY FILING AN ACTION FOR REVIEW IN THE APPROPRIATE STATE DISTRICT COURT. ANY SUCH ACTION MUST BE FILED IN ACCORDANCE WITH SECTION 24-4-106, C.R.S. AND WITH THE COLORADO RULES OF CIVIL PROCEDURE WITHIN THIRTY-FIVE (35) DAYS AFTER THE FINAL AGENCY DECISION BECOMES EFFECTIVE.
G. THE STATE DEPARTMENT WILL ESTABLISH AND MAINTAIN A METHOD FOR INFORMING, IN SUMMARY AND DEPERSONALIZED FORM, ALL COUNTY DEPARTMENTS AND OTHER INTERESTED PERSONS CONCERNING THE ISSUES RAISED AND DECISIONS MADE ON APPEALS.
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