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State of Tennessee DHS Project Breast reduction

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State of Tennessee DHS Project Breast reduction

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									RFP ATTACHMENT 6.1, PRO FORMA CONTRACT ATTACHMENT C

State of Tennessee
DHS V.I.P. Process Description
Prepared by: DHS Policy / Systems
Date: January 31, 2005
Process: 1.3.44 Effective Date of Action
Program Affected: All Programs             Users: Caseworkers and above

    Process:

       When an individual reports a change in their circumstances a date must be calculated upon which the effects
       of that change become effective. The system shall maintain a table of monthly “cut-off” dates. A monthly
       “Positive Action Cut-Off Date” is determined by Production Control and is defined as the last day that
       “positive” changes may be submitted that result in the change being made effective the next month. A
       “negative” change may require a ten-day adverse action period and, therefore, the system is to maintain a
       table of “Negative Adverse Action Cut-Off” dates. A “Negative Adverse Action Cut-Off Date” is defined as the
       last day in the month an adverse action can be taken to effect the next month and provide the advanced
       notice as required by program rules. Some negative actions do not require advance notice. These actions are
       negative action cut-off dates and are determined by Production Control, and are defined as the last day the
       change may be submitted and the system make the change effective the following month. The system shall
       distinguish between an intake application, a change and/or re-certification application by individual and / or
       case and apply appropriate dates for benefit eligibility and issuance based on program rules.

    Sub-Processes:

   1. Calculate Adverse Action/Maintain Cutoff Dates

       The system shall calculate an adverse action date based upon program rules and the date a change is
       processed. The system shall establish and maintain a table of cut-off dates.

       ADVERSE ACTION (Output)
       Adverse Action Begin Date
       Adverse Action End Date
RFP ATTACHMENT 6.1, PRO FORMA CONTRACT ATTACHMENT C

State of Tennessee
DHS V.I.P. Process Description
Prepared by: DHS Policy / Systems
Date: January 31, 2005
Process: 1.3.44 Effective Date of Action
Program Affected: All Programs             Users: Caseworkers and above
       DATE TABLE (Output)
       Positive Action Cut-Off Dates
       Negative Action Cut-Off Dates

   2. Determine Date Change Is Effective

       The system shall determine a “Budget Effective Date” and a “Case Change Effective Date” based upon the
       type of change, the date it was reported and the associated program rules. For those changes that do not
       affect the budget, only a “Case Change Effective Date” needs to be calculated and output. For those changes
       that affect the budget, both a “Budget Effective Date” and a “Case Effective Date” shall be calculated and
       output. The system must record and compare the date a change actually occurred, the date the change was
       reported, and the date the action was taken to see if the change was reported timely and processed timely.
       The system shall use this information when determining the need for and the amount of any supplements or if
       a claim referral may be required.

       ADVERSE ACTION (Input)
       Adverse Action Begin Date
       Adverse Action End Date

       CASE (Input)
       Case ID
       Program Type
       Sub-Program Type
       Case Status
       Case Change Reported Date
RFP ATTACHMENT 6.1, PRO FORMA CONTRACT ATTACHMENT C

State of Tennessee
DHS V.I.P. Process Description
Prepared by: DHS Policy / Systems
Date: January 31, 2005
Process: 1.3.44 Effective Date of Action
Program Affected: All Programs           Users: Caseworkers and above
       BENEFIT (Output)
       Negative Change to Benefit Indicator

      BUDGET (Output)
      Budget Effective Date
      Change Affecting Budget Type

      CASE (Output)
      Case Change Effective Date

   3. Determine if Change Requires Adverse Action Period

      The system is to determine if a change requires an adverse action period based upon the Program/Sub-
      Program type, the type of change reported and program rules.

      CASE (Input)
      Case ID
      Program Type
      Sub-Program Type
      Case Change Type

      BENEFIT (Output)
      Negative Change to Benefit Indicator
      Benefit Type

   4. Issue Adverse Action Notice
RFP ATTACHMENT 6.1, PRO FORMA CONTRACT ATTACHMENT C

State of Tennessee
DHS V.I.P. Process Description
Prepared by: DHS Policy / Systems
Date: January 31, 2005
Process: 1.3.44 Effective Date of Action
Program Affected: All Programs              Users: Caseworkers and above
       If an adverse action period is required, the system is to issue an adverse action notice using ADVERSE
       ACTION, BENEFIT, BUDGET, CASE, CHILD CARE, INDIVIDUAL, SUPPORT SERVICE and NOTICE data.

      ADVERSE ACTION (Input)
      Adverse Action End Date

      BENEFIT (Input)
      Benefit Type
      Benefit Amount
      BUDGET (Input)
      Budget Effective Date

      CASE (Input)
      Case ID
      Program Type
      Sub-Program Type
      Case Name - First Name
      Case Name - Last Name
      Case Name - Middle Initial
      Case Change Effective Date
      Case Action Reason Code(s)
      Language Type
      Requested Transmission Type
      Case Change Reported Date
      Case Change Type
      Case Change Effective Date
RFP ATTACHMENT 6.1, PRO FORMA CONTRACT ATTACHMENT C

State of Tennessee
DHS V.I.P. Process Description
Prepared by: DHS Policy / Systems
Date: January 31, 2005
Process: 1.3.44 Effective Date of Action
Program Affected: All Programs               Users: Caseworkers and above
       INDIVIDUAL (Input) (Multiple)
       Individual Recipient - First Name
       Individual Recipient - Last Name
       Individual Recipient - Middle Initial

      SUPPORT SERVICE (Input)

      CHILD CARE (Input)

      NOTICE (Input)
      Notice Type
      Notice Sub-Type
      Notice Transmission Type
      Notice Reason Type
      Notice Requested Date
      Notice Comment Indicator
      Notice Free-form Text - Comments
      Notice Language Type

      NOTICE (Output)
      Case ID
      Program Type
      Sub-Program Type
      Adverse Action End Date
      Case Name - First Name
      Case Name - Last Name
      Case Name - Middle Initial
RFP ATTACHMENT 6.1, PRO FORMA CONTRACT ATTACHMENT C

State of Tennessee
DHS V.I.P. Process Description
Prepared by: DHS Policy / Systems
Date: January 31, 2005
Process: 1.3.44 Effective Date of Action
Program Affected: All Programs               Users: Caseworkers and above
       Case Change Effective Date
       Case Action Reason Code(s)
       Case Language Type
       Case Change Type
       Case Change Reported Date
       Case Change Effective Date
       Requested Transmission Type
       Benefit Type
       Benefit Amount
       Budget Effective Date
       Individual Recipient - First Name
       Individual Recipient - Last Name
       Individual Recipient - Middle Initial
       Notice Type
       Notice Sub-Type
       Notice Transmission Type
       Notice Reason Type
       Notice Requested Date
       Notice Comment Indicator
       Notice Free-form Text - Comments
       Notice Language Type

   5. Allow Adverse Action Period Prior to Actual Benefit Decrease or Termination

      If an adverse action was required and an adverse action notice was issued, then the system is to allow the
      specified period to expire prior to applying the benefit decrease or termination. The system shall recognize
      when a Families First closure authorized by CSR has been re-opened during the adverse action period and
RFP ATTACHMENT 6.1, PRO FORMA CONTRACT ATTACHMENT C

State of Tennessee
DHS V.I.P. Process Description
Prepared by: DHS Policy / Systems
Date: January 31, 2005
Process: 1.3.44 Effective Date of Action
Program Affected: All Programs              Users: Caseworkers and above
       alert the CSR that final closure is necessary if failure to comply for the same reason is indicated by the user.
       Refer to the process “FF Final Closure Notice” for additional detail.

       ADVERSE ACTION (Input)
       Adverse Action Begin Date
       Adverse Action End Date

       CASE (Input)
       Case Change Effective Date

       BENEFIT (Output)
       Benefit Type
       Benefit Amount
       Benefit Date
       Families First Benefit Countable Indicator
       Families First Benefit Date
       Food Stamp Benefit Reduction Amount
       Food Stamp Benefit Reduction - Percentage of Deduction

       BUDGET (Output)
       Budget Effective Date

   6. Apply Change Effective the First Day of the Next Month

       If the reported change did not require adverse action, then the system is to apply the change effective the first
       day of the next budget month. The system shall allow overlapping eligibility dates based upon program rules.
       The system shall determine if additional benefits are due to a client when a change is made and the amount
RFP ATTACHMENT 6.1, PRO FORMA CONTRACT ATTACHMENT C

State of Tennessee
DHS V.I.P. Process Description
Prepared by: DHS Policy / Systems
Date: January 31, 2005
Process: 1.3.44 Effective Date of Action
Program Affected: All Programs            Users: Caseworkers and above
       cannot be added to the current or the next month’s benefits and issue benefits appropriately, as a supplement
       or a restoration, based upon business rules.

      CASE (Input)
      Case ID
      Program Type
      Sub-Program Type
      Case Change Effective Date

      BUDGET (Input)
      Budget Effective Date

      BENEFIT (Output)
      Benefit Type
      Benefit Amount
      Benefit Date
      Families First Benefit Countable Indicator
      Food Stamp Benefit Reduction Amount
      Food Stamp Benefit Reduction - Percentage of Deduction
RFP ATTACHMENT 6.1, PRO FORMA CONTRACT ATTACHMENT C
 Program     Rule
   Type    Number                                                          Rule
FS         1        The agency shall take prompt action on all changes to determine if the change affects the household's
                    eligibility of allotment.
FS         2        For changes that result in an increase in a household's benefits, the agency must notify the household
                    immediately of the required verification it must provide.
FS         3        For changes which result in an increase in a household's benefits, the agency must allow the
                    household 10 days from the date the change was reported to provide the verification.
FS         4        If the verification is provided within the 10-day period, the agency must make the change effective with
                    the first allotment for which it is administratively feasible for issuance to occur.
FS         5        If the verification is not provided within the 10-day period, but the household provides it at a later date,
                    the change must be made no later than the first allotment issued after the date the verification was
                    provided. This household is not entitled to a supplementary benefit.
FS         6        If a change is reported too late in the month to affect the next month's benefits a supplementary benefit
                    must be issued so that the household receives it by the 10th day of the following month, or the
                    household's normal issuance cycle for the month, whichever is later.
FS         7        For changes which result in an increase in a household's benefits due to the addition of a new
                    household member who is not a member of another certified household when the household has
                    provided the required verification and it is too late in the month to affect the next month's allotment, the
                    agency must increase the allotment for that month by issuing a supplementary benefit.
FS         8        For changes which result in an increase in a household's benefits due to a decrease in the household's
                    gross monthly income by $50 or more, when the household has provided the required verification and it
                    is too late in the month to affect the next month's allotment, the agency must increase the allotment for
                    that month by issuing a supplementary benefit.
FS         9        Prior to any action to reduce or terminate a household's benefits within a certification period the
                    household must be provided with timely and adequate advance notice before the adverse action is
                    taken, with certain exceptions.
FS         10       An adverse action is a reduction in the food stamp allotment.
FS         11       An adverse action is termination of the household's food stamp benefits within the certification period.
FS         12       An adverse action is the reduction in the length of a certification period.
FS         13       An adverse action is the removal of a household member from the assistance group.
FS         14       When a food stamp certification period expires, eligibility ends and provisions concerning adverse
                    action do not apply, since this is not a termination.
FS         15       To be considered timely, the notice of adverse action must be mailed at least 10 days prior to the
                    effective date of the adverse action.
FS         16       If the adverse action notice period ends on a weekend or a holiday and a request for a fair hearing or
RFP ATTACHMENT 6.1, PRO FORMA CONTRACT ATTACHMENT C
Program    Rule
  Type    Number                                                        Rule
                   continuation of benefits is received the day after the weekend or holiday, the request shall be
                   considered to have been timely.
FS        17       A notice of adverse action is not required when implementing a mass change.
FS        18       A notice of adverse action is not required when the agency determines, based on reliable information,
                   that all members of the household have died.
FS        19       A notice of adverse action is not required when the agency determines, based on reliable information,
                   that the household has moved from the state.
FS        20       A notice of adverse action is not required when the household has been receiving an increased
                   allotment to restore lost benefits, the restoration is complete, and the household was previously notified
                   in writing of when the increased allotment would end.
FS        21       A notice of adverse action is not required when the household's allotment varies from month to month
                   within the certification period to take into account changes which were anticipated at the time of
                   certification, and the household was notified of this at the time of certification.
FS        22       A notice of adverse action is not required when a household filed a joint application for food stamps
                   and Families First and has been receiving food stamps pending approval of Families First and was
                   notified at the time of certification that food stamp benefits would be reduced upon approval of the
                   Families First grant.
FS        23       A notice of adverse action is not required when a household member is disqualified for intentional
                   program violation, or the benefits of the remaining household members are reduced or terminated to
                   reflect the disqualification of that household member.
FS        24       A notice of adverse action is not required when a household is certified on an expedited basis
                   contingent on verification, and the household is provided a written notice that no further benefits will be
                   issued until the postponed verification is provided and the household fails to provide the verification or
                   provides verification which changes its benefits.
FS        25       A notice of adverse action is not required when a household is converted from cash repayment of a
                   claim for over-issuance of benefits to allotment reduction because the household failed to comply with
                   its repayment agreement.
FS        26       A notice of adverse action is not required when a resident of a drug or alcohol treatment center or a
                   group living arrangement loses eligibility because the facility loses its certification from the appropriate
                   agency(ies), or has lost its status as an authorized representative because FNS has suspended it as a
                   retailer.
FS        27       A notice of adverse action is not required when a household voluntarily requests that the case be
                   terminated.
FS        28       A notice of adverse action is not required when sufficient evidence exists to determine that the
RFP ATTACHMENT 6.1, PRO FORMA CONTRACT ATTACHMENT C
Program    Rule
  Type    Number                                                        Rule
                   household will not be living in the state. In this instance, adequate notice must be issued before the
                   household's next issuance date.
TCM/TCS   29       Changes are effective the first day of a month, rather than during a month, for active TennCare
                   Medicaid or TennCare Standard cases, unless adding a member(s).
TCM       30       A 10-calendar day notice of adverse action must be given for verbal requests for closure of TennCare
                   Medicaid benefits.
TCM       31       The effective date of TennCare Medicaid closure for an individual that met a spend-down in one of the
                   following sub-programs will be at the end of the 12 month’s worth of coverage (i.e. from 1-13-07
                   through 1-12-08.) The sub-programs are 1} Aged Non-Institutionalized, 2} Blind Non-Institutionalized,
                   3} Disabled Non-Institutionalized, 4} Medically Needy. The effective date of closure will be at the end
                   of their 12 month’s coverage.
TCM       32       An application is needed to add additional household members to TennCare Medicaid and TennCare
                   Standard cases, unless the individual is a newborn.
TCS       33       The effective date of a TennCare Standard closure is the last day of the month.
TCM/TCS   34       Advance notice shall not be required to terminate TennCare Medicaid or TennCare Standard for an
                   individual if there is documentation confirming that the individual has died.
TCM/TCS   35       Advance notice shall not be required to terminate TennCare Medicaid or TennCare Standard for an
                   individual if there is documentation confirming that the individual is no longer a resident of the state.
TCS       36       Advance notice shall not be required to terminate TennCare Standard for an individual who has
                   requested voluntary closure, either verbally or by a written request.
TCM       37       A 10-calendar day notice of adverse action shall be provided if a change in resources results in an
                   individual’s case being closed.
TCM/TCS   38       A 10-calendar day adverse action notice shall be sent if an action that was taken in a case has a
                   negative effect on the individual’s continued benefits with certain exceptions.
TCM/TCS   39       A negative action is termination of benefits for TennCare Medicaid and TennCare Standard.
TCM/TCS   40       A negative action is reduction of benefits for TennCare Medicaid and TennCare Standard.
TCM       41       A negative action may be an increase of patient liability for individuals in long term care. The sub-
                   programs which may be affected are blind-, aged- and disabled-institutionalized.
TCM/TCS   42       A negative action is a reduction or discontinuation of TennCare Medicaid or TennCare Standard
                   services.
TCM/TCS   43       A newborn is eligible to be added for TennCare Medicaid or TennCare Standard coverage from the
                   date of birth if born to a TennCare Medicaid or TennCare Standard eligible mother and the child’s
                   coverage is extended for a full 12 months from the date of birth.
TCM/TCS   44       The newborn baby must remain under the care and control of the mother to get the full 12 month’s
RFP ATTACHMENT 6.1, PRO FORMA CONTRACT ATTACHMENT C
Program    Rule
  Type    Number                                                         Rule
                   coverage.
TCM/TCS   45       For changes that result in a positive effect to an individual’s benefits, if verified according to rules, this
                   will result in a change effective the first day of the next recurring month, with some exceptions. This
                   applies to Medically Needy cases, in the action of reducing the amount of a spend-down, or
                   inTennCare Standard, in the reduction of a premium.
TCM/TCS   46       All other additional members to an open TennCare Medicaid or TennCare Standard case, except for
                   newborns, will be added to the case from the date of their application or the date that they become
                   eligible.
TCM/TCS   47       A positive action is approving an individual for benefits for TennCare Medicaid or TennCare Standard.
TCS       48       A positive action is a decrease in a TennCare Standard premium.
TCS       49       A negative action is an increase in a TennCare Standard premium.
TCM       50       For the following sub-programs, a decrease in a patient’s liability would be a positive change: Aged-
                   Institutionalized, Blind-Institutionalized and Disabled-Institutionalized.
TCM/TCS   51       A positive action is an approval of TennCare Medicaid or TennCare Standard services.
TCM       52       The effective date of a TennCare Medicaid closure or negative action is the last day of the month,
                   except for individuals who receive the 45 day presumptive eligibility (for pregnancy, Breast and
                   Cervical Cancer, and for Foster Care presumptive coverage) and the individuals who receive a year’s
                   coverage when they meet a spend-down in the following sub-programs, Aged Non-institutionalized,
                   Blind Non-institutionalized, Disabled Non-institutionalized, and Medically Needy.
TCM       53       The effective date of a Medicaid closure for a Foster Care Presumptive, Breast and Cervical Cancer
                   Presumptive and Presumptive coverage on pregnant women will be the end of their 45 days of
                   coverage.
CC        54       Currently, the child care certificate program has no cutoff dates in TCCMS.
CC        55       All changes reported to the certificate program shall be entered into the system as soon as they are
                   known to the certificate program and verification received (if required).
CC        56       Any adverse action (decrease in hours of child care provided, termination or suspension of child care
                   enrollment, and/or termination of eligibility) requires a 10-calendar day prior notice to be mailed to the
                   parent/caretaker. When child care enrollment is affected, a copy of the notice is also sent to the day
                   care provider.
CC        57       Any changes reported to the certificate program prior to being reported to Family Assistance shall be
                   reported to the appropriate Family Assistance worker by a representative of the certificate program.
                   Changes in income or household composition will only be accepted by the certificate program when
                   reported as verified by the FF worker.
CC        58       FF participants who are receiving child care will have up to 30 calendar days of continued child care
RFP ATTACHMENT 6.1, PRO FORMA CONTRACT ATTACHMENT C
Program    Rule
  Type    Number                                                        Rule
                   service to “bridge” gap periods of non-compliance with FF work requirements due to illness,
                   unemployment, breaks in classes, waiting for activity components to start, unless otherwise notified by
                   the FF case manager. Extensions which exceed 30 days require state office approval.
CC        59       Following the birth of a child, a parent/caretaker may continue to receive child care for up to six weeks
                   after the birth, and six weeks at any time during the pregnancy if there is a verified medical reason for
                   bed rest.
CC        60       Six weeks child care may also be provided following major surgery if verified by a written doctor’s
                   statement.
CC        61       The certificate program may have up to 7 working days after receiving a referral to arrange child care
                   for a parent/caretaker requesting child care.
CC        62       The certificate program will immediately report to the FF case worker any problems in arranging child
                   care so that FF compliance procedures may be addressed by FF.
CC        63       For most FF customers the effective date of subsidized child care will not begin prior to the approval
                   date for FF. One exception exists if the parent/caretaker needs child care in order to participate in a
                   two-week compliance period prior to FF approval.
CC        64       TCC participants and second parent/caretakers or alleged parents residing in the home and who are
                   working will be given an initial 30- calendar day grace period in order to meet the minimum work
                   requirements.
CC        65       Changes reported during re-certification interview for funding sources other than FF will be effective the
                   next day following the end of the re-certification date if completed before that date. If a late re-
                   certification interview within the last 10-calendar days prior to the re-certification date finds the
                   parent/caretaker to be ineligible, the parent/caretaker shall be given a 10 day advance termination
                   notice.
CC        66       Any parent/caretaker who files an appeal will be given the choice of continuing child care during the
                   appeals process or of having subsidized child care ended. If the appeal upholds the department’s
                   action, the parent/caretaker will be responsible to repay the child care if it was continued by the
                   certificate program at the parent/caretaker’s request.
CC        67       If an individual provides requested information within 10 days following the issuance of the termination
                   notice and can prove good cause for not reporting, they may be returned to active status. Good cause
                   reasons are: late in providing additional verification following an interview or mail-in prior to the re-
                   determination date; hospitalization of the participant or child; death of an immediate family member.
CC        68       There are situations in which a parent/caretaker may have a retroactive parent co-fee. If the late
                   assessment of co-pay was due to an action over which the parent had control or responsibility, the
                   parent may be responsible for a retroactive co-fee. If the lateness in assessment was due to an action
RFP ATTACHMENT 6.1, PRO FORMA CONTRACT ATTACHMENT C
 Program    Rule
   Type    Number                                                       Rule
                    over which the state or certificate program had control or responsibility, the co-pay fee will be waived.
CC         69       If a TCC parent was paying a co-pay fee but is later found to have been a FF case during that period of
                    time, the parent is due a refund for those fees paid during FF eligibility provided the payment can be
                    verified.
CC         70       Sometimes a child care enrollment is made for a period of time for which the provider has already
                    received payment. In these instances a backdated EAV is requested by the child care worker making
                    the enrollment. The provider will then be paid separately for that child enrollment. There are other
                    instances in which adjustments either for overpayment or underpayment must be made to providers.
                    These should be addressed in provider payment processes.
CC         71       A day care provider who attains a new star bonus rating assessed by day care licensing will have a
                    payment change effective on the next billing cycle following the effective date the star bonus was
                    entered by day care licensing.
IV-E FC    72       A reported change or adverse action that has a negative effect on a foster child’s continued benefits
                    requires adequate and advance notice to the foster child or the foster child’s DCS representative prior
                    to any action to reduce, suspend, or terminate a foster child’s benefits.
IV-E FC    73       A foster child or the foster child’s DCS representative shall be provided 10 days advance notice prior to
                    any action to reduce or terminate a foster child’s benefits.
IV-E FC    74       The effective date of the change in benefits resulting from an adverse action is the first month after the
                    10-calendar day notice of adverse action expires.
IV-E FC    75       Advance notice shall not be required to terminate a foster child’s benefits if there is documentation
                    confirming the foster child has died.
IV-E FC    76       Advance notice shall not be required to terminate a foster child’s benefits if the foster child’s DCS
                    representative confirms the foster child’s whereabouts are unknown.
IV-E FC    77       Advance notice shall not be required to terminate a foster child’s benefits if the foster child waives
                    his/her right to advance notification.
IV-E FC    78       Advance notice shall not be required to terminate or suspend a foster child’s benefits if the child has
                    been placed at facility where he/she is not eligible to receive assistance.
IV-E FC    79       Advance notice shall not be required to terminate a foster child’s benefits if the foster child has moved
                    out of state and the foster child has been approved for assistance in another state.
IV-E FC    80       Advance notice shall not be required to close the foster child’s Title IV-E foster care case if the foster
                    child has been approved for SSI and DCS elects to close the child’s Title IV-E foster care rather than
                    continue to maintain an eligible Title IV-E foster care case.
IV-E FC    81       A 10-calendar day notice of adverse action shall be provided if a change in income results in a foster
                    child’s case being closed.
RFP ATTACHMENT 6.1, PRO FORMA CONTRACT ATTACHMENT C
 Program     Rule
   Type    Number                                                        Rule
IV-E FC    82       A 10-calendar day notice of adverse action shall be provided if a change in resources results in a foster
                    child’s case being closed.
IV-E FC    83       A notice shall be given by the effective date of a change in benefits if the change results in a positive
                    effect on the foster child’s continued benefits.
IV-E FC    84       A 10-calendar day notice of adverse action shall be provided if the foster child is released from DCS
                    custody and is no longer eligible for benefits as a foster child.
IV-E FC    85       If a change in a foster child’s circumstances results in a change in benefits, the new benefits shall be
                    effective the first month following the date of the change if the change occurs before the cut-off date.
IV-E FC    86       If a change in a foster child’s circumstances results in a change in benefits, the new benefits shall be
                    effective the second month following the date of the change if the change occurs after the cut-off date.
AA         87       An adoption assistance payment may be increased or decreased based on a child’s age and the
                    standard rate structure.
AA         88       If a child’s level of care changes, the adoptive parent may request an increase in the payment. The
                    effective date is the first day of the month following the determination.
AA         89       The adoption assistance agreement may be revised at the first of the month to reflect a change in the
                    amount of the payment due to across the board increases, changes in the standard payments due to
                    age changes, or parent(s)’s contributions of support.
FFP        90       A 10-calendar day notice of adverse action prior to benefit decrease or termination may be required.
FFP        91       A 10-calendar day notice of adverse action is not required when the Agency has factual information
                    confirming the death of a recipient or of a Families First payee and no person can be named as an
                    alternate payee.
FFP        92       A 10-calendar day notice of adverse action is not required when the Agency receives a clear written
                    statement, signed and dated by the recipient, that he/she no longer wants Families First benefits.
FFP        93       A 10-calendar day notice of adverse action is not required when has been admitted or committed to an
                    institution where he/she is not eligible to receive Families First benefits.
FFP        94       A 10-calendar day notice of adverse action is not required when the recipient has entered a skilled
                    nursing home or intermediate care facility and vendor payments will be authorized through Medicaid.
FFP        95       A 10-calendar day notice of adverse action is not required when the recipient’s whereabouts are
                    unknown and Agency mail directed to him/her has been returned by the Post Office indicating no
                    forwarding address.
FFP        96       A 10-calendar day notice of adverse action is not required when the recipient moves out of state and
                    the Agency has established that he/she has been accepted for assistance in another state.
FFP        97       A 10-calendar day notice of adverse action is not required when a Families First child is removed from
                    the home as a result of a judicial determination or is voluntarily placed in a foster home by his/her
RFP ATTACHMENT 6.1, PRO FORMA CONTRACT ATTACHMENT C
Program    Rule
  Type    Number                                                       Rule
                   parents or legal guardian.
FFP       98       A 10-calendar day notice of adverse action is not required when the Agency has received notification
                   that a member of the assistance group has been approved for SSI.
FFP       99       A 10-calendar day notice of adverse action is not required when assistance is to be discontinued or
                   reduced as a result of an appeal decision that upholds the county office.
FFP       100      When a 10-calendar day notice of Adverse Action is required, action shall not be taken on a reported
                   change that will reduce or terminate Families First benefits until the 10-day adverse notice has expired.
FFP       101      The 10-calendar day adverse action period begins the day after the day that the Notice of adverse
                   action is mailed to the assistance group.
FFP       102      If the 10th day of the adverse action period falls on a weekend or holiday, the 10-day adverse action
                   period will end at the close of business on the next working day.
FFP       103      When a 10-calendar day notice of Adverse Action is required, a termination or decrease in benefits will
                   be made effective with the month following the expiration of the 10-day adverse action period unless
                   the expiration falls during recurring processing.
FFP       104      When a 10-calendar day notice of Adverse Action is required, termination or decrease in benefits will
                   be made effective with the second subsequent month following the expiration of the 10-day adverse
                   action period when the change is reported during recurring processing.
FFP       105      An increase in benefits will be made effective with the month following the reported change.
FFP       106      A change reported during recurring processing that results in an increase in benefits will be effective
                   the second subsequent month following the reported change, except when the change is to add an
                   individual.
FFP       107      When adding an individual who is required to be included in the Families First assistance group, other
                   than a newborn, the benefits will be increased effective with the date the individual entered the home.
FFP       108      When adding a newborn to a Families First assistance group, the effective date of the change will be
                   the newborn’s birth date.
FFP       109      When adding an individual who is an optional Families First assistance group member, the effective
                   date of the change will be the date that the request to add the individual was made.
RFP ATTACHMENT 6.1, PRO FORMA CONTRACT ATTACHMENT C
           1.3.44
  Effective Date of Action

                                 Adverse Action



                                                                 Case
      Adverse Action    Case
                                                                                                                  Case



                                                                                                                               Benefit
                                                            Determine if                                    Apply change
    Calculate Adverse
                              Determine Date               Change requires       Adverse Action            effective the 1st
    Action / Maintain                                                                                 No
                             change is effective           Adverse Action          Required?               day of the next
      Cutoff Dates                                                                                                             Budget
                                                               Period                                       budget month




        Date Table
                                                                                       Yes

                                                                Benefit
                                                  Budget
                                     Benefit
                          Case




                                                                                                                  Case


                                                                                  Issue Adverse
                                                            Adverse Action                                       Notice
                                                                                   Action Notice



                                                                Budget                                         Individual



                                                                                                               Child Care
                                                            Support Service




                                                                   Case
                                                                                  Allow Adverse                  Benefit
                                                                                Action Period prior
                                                                                 to actual benefit
                                                                                   decrease or                   Budget
                                                               Adverse Action       termination

								
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