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BAM 430 4 of 9 SDA SPECIAL LIVING ARRANGEMENT AUTHORIZATION AND PAYMENT BPB 2019-014 10-1-2019

BRIDGES ADMINISTRATIVE MANUAL STATE OF MICHIGAN DEPARTMENT OF HEALTH & HUMAN SERVICES

• Wrong provider authorized. Paid The only change that can be made to a paid authorization is to decrease the client pay amount or increase the type of care. DHS-768 Invoice/ Adjustment Request) To receive payment a provider must complete and submit a DHS- 768. Each DHS-768 covers a calendar month, a new DHS-768 must be submitted for each additional month or portion of a month. Example: If the client is in care from 6/24-7/29 they must provide 2 separate invoices, one for 6/24 to 6/30 and a separate one for 7/1 to 7/29, as care was provided in 2 different calendar months. The completed DHS-768 should be mailed to: Michigan Department of Human Services Economic Stability Administration, Suite 1402 P.O. Box 30037 Lansing, MI 48909 Authorization Terminations End an authorization when the client: • Is no longer eligible for SDA. • Is no longer eligible for provider payment due to income (also see Repayment Agreements in this item). • Leaves the facility. End the authorization by entering an end date The end date is: • The date the client is no longer eligible for SDA. • The date the client is no longer eligible for facility payment. • The day before the client leaves the facility. If the client enters another facility, complete another authoriza- tion. If the client dies, the end date is the date of death.

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Official source

BAM 430 4 of 9 SDA SPECIAL LIVING ARRANGEMENT AUTHORIZATION AND PAYMENT BPB 2019-014 10-1-2019

BRIDGES ADMINISTRATIVE MANUAL STATE OF MICHIGAN DEPARTMENT OF HEALTH & HUMAN SERVICES

• Wrong provider authorized. Paid The only change that can be made to a paid authorization is to decrease the client pay amount or increase the type of care. DHS-768 Invoice/ Adjustment Request) To receive payment a provider must complete and submit a DHS- 768. Each DHS-768 covers a calendar month, a new DHS-768 must be submitted for each additional month or portion of a month. Example: If the client is in care from 6/24-7/29 they must provide 2 separate invoices, one for 6/24 to 6/30 and a separate one for 7/1 to 7/29, as care was provided in 2 different calendar months. The completed DHS-768 should be mailed to: Michigan Department of Human Services Economic Stability Administration, Suite 1402 P.O. Box 30037 Lansing, MI 48909 Authorization Terminations End an authorization when the client: • Is no longer eligible for SDA. • Is no longer eligible for provider payment due to income (also see Repayment Agreements in this item). • Leaves the facility. End the authorization by entering an end date The end date is: • The date the client is no longer eligible for SDA. • The date the client is no longer eligible for facility payment. • The day before the client leaves the facility. If the client enters another facility, complete another authoriza- tion. If the client dies, the end date is the date of death.