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5. The LME/MCO coordinator has been instructed to inform the original

Special Assistance/Medicaid County DSS of eligibility immediately

(within five (5) calendar days) of the individual moving into a private

living arrangement. The IMC in the original Special

Assistance/Medicaid County of eligibility verifies and documents the

change in the case record. Appendix E Supplement 1 can be provided

to the DSS IMC for communication of information.

6. Once all eligibility information has been received and the individual is

confirmed to be in PLA, complete a DSS-8110, Your Benefits Are

Changing (Timely), and send to the beneficiary, authorized

representative, and LME/MCO transition coordinator. Inform on the

notice that the individual’s payment will change from Special

Assistance in a residential facility to Special Assistance In-Home. The

amount must be included even if the payment amount does not

change. The 5/10-day Rule does not apply, as payment will not be

terminated.

7. Determine the correct county of SAIH and Medicaid eligibility for PLA.

The county of SAIH and Medicaid eligibility is the county where the

individual is physically residing in a PLA.

8. Following written notification of the program change and SAIH

payment amount, terminate the SA/ACH case in the NC FAST system,

KEY a new application, or KEY an administrative application into the

NC FAST system for the SAIH program and process the SAIH

application through completion noting in the case narratives of the NC

FAST case that the case is the active SAIH case of an individual

approved for TCL.

9. New SA payment information: once the DSS has been notified by the

LME/MCO transition coordinator that an individual has been approved

by DHHS for TCL and has moved to a PLA arrangement, end-date

the banking evidence if the banking information is for a facility

collective account. Discuss the direct deposit and EBT Cash Card

options with the LME/MCO transition coordinator, the applicant, and/or

authorized representative.

10. If direct deposit is requested, provide/send a DHB-5097 to the

transition coordinator, the individual or authorized representative must

provide the completed Direct Deposit Authorization Form, DSS-5023,

Direct Deposit Enrollment Authorization Form. If no completed Direct

Deposit Authorization Form, DSS-5023 is provided, do not hold up SA-5250 VIII.