Source: http://regulations.delaware.gov/register/march2011/final/14%20DE%20Reg%20900%2003-01-11.htm
Timestamp: 2018-08-16 04:52:04
Document Index: 580484353

Matched Legal Cases: ['§273', '§1', '§1', '§271', '§1', '§271', '§1', '§1902', '§2318', '§273']

14 DE Reg 900 03-01-11 FINALORDER
Delaware Health and Social Services (“Department”) / Division of Social Services initiated proceedings to amend the Division of Social Services Manual (DSSM) regarding the Food Supplement Program, specifically, Mandatory Verifications. The Department’s proceedings to amend its regulations were initiated pursuant to 29 Delaware Code Section 10114 and its authority as prescribed by 31 Delaware Code Section 512.
The Department published its notice of proposed regulation changes pursuant to 29 Delaware Code Section 10115 in the January 2011 Delaware Register of Regulations, requiring written materials and suggestions from the public concerning the proposed regulations to be produced by January 31, 2011 at which time the Department would receive information, factual evidence and public comment to the said proposed changes to the regulations.
7 CFR §273.2(f)(1), Mandatory verification
First, the Councils appreciate that there are multiple consumer-oriented provisions. For example, §1.B.1 recites as follows: “If an alien does not wish DSS to contact INS to verify his or her immigration status, give the household the option of withdrawing its application or participating without that member.”
Agency Response: Thank you; DSS acknowledges your appreciation.
Second, §1.H. 1 could be cause for concern. It recites as follows: “The disability must be one considered permanent under the Social Security Act.” The Social Security Administration general standard for SSI and SSDI benefits is that the disability must either be expected to last for at least 1 year or result in death. See attached Q&A document. The second SSA attachment recites as follows:
Most of the listed impairments are permanent or expected to result in death, or the listing includes a specific statement of duration is made. For all other listings, the evidence must show that the impairment has lasted or is expected to last for a continuous period of at least 12 months.
In many cases, an individual will not know the precise “listing” upon which his/her SSI/SSDI benefits are based. Moreover, individuals may be found eligible if their condition(s) do not meet a listing but are functionally equivalent to a listing. Unless USDA regulations require DSS to limit disability eligibility to SSI/SSDI beneficiaries with a “permanent” disability as juxtaposed to beneficiaries awaiting death or with 12-month+ conditions, we recommend amending this section. Consider the following alternative: “The disability must be one considered permanent or expected to last more than 12 months or result in death under the Social Security Act.”
Agency Response: No change is being made to this section. Title 7 CFR §271.2 establishes the standard which is contained in this section of the manual. It requires a food benefit applicant to meet disability requirements as defined under Section 221 (i) of the Social Security Act.
Third, in §1.H.2.ii, consider substituting “chronic” for “permanent”. Alternatively, consider the following substitute: “...s/he suffers from some other severe physical or mental disease or non-disease related disability considered permanent or expected to last more than 12 months or result in death.”
Agency Response: No change is being made to this section. We are again required to use the standard which is contained at Title 7 CFR §271.2. The standard uses the word “permanent”.
Fourth, in §1.H.2.ii, consider the following amendment: “...statement from a physician, advanced practice nurse, or licensed or certified psychologist...”. As a practical matter, many individuals are now primarily treated by an advanced practice nurse rather than a traditional physician. Advanced practice nurses are authorized to perform independent acts of diagnosis and prescribe drugs. See Title 24 Del.C. §1902(b)(1). State law bars health insurers from denying benefits for eligible services when provided by an advanced practice nurse instead of a physician. See Title 18 Del.C. §2318. The attached December 28, 2010 News Journal article underscores that many individuals are primarily treated by advanced practice nurses.
Agency Response: DSS is also required to use the FNS Title 7 CFR§273.2 (f) (1) (viii) (4) standard which is reflected in the language of the proposed regulation. No change to the regulation was made as a result of this comment.
THEREFORE, IT IS ORDERED, that the proposed regulation to amend the Division of Social Services Manual (DSSM) regarding the Food Supplement Program (FSP), specifically, Requiring Verification is adopted and shall be final effective March 10, 2011.
DSS FINAL ORDER REGULATION #11-05
9032.1 Income
9032.2 Alien Eligibility
9032.3 Utility Expenses
9032.4 Medical Expenses
9032.5 Social Security Numbers
9032.7 Identity
9032.8 Reserved
9032.9 Continuing Shelter Charges
9032.10 Dependent Care Costs
9032.11 Reserved
9032.12 Disability
9032.13 Quality Control
9032.14 Students
9032.15 Legal Obligation and Actual Child Support Payments
9032.16 Additional Verification for Able-bodied Adults without Dependents (ABAWDs)
1. DSS Requires Mandatory Verification of Eligibility Factors Before Certifying Applicants
A. Gross income (unless excluded)
B. Alien Eligibility Status
1. If an alien does not wish DSS to contact INS to verify his or her immigration status, give the household the option of withdrawing its application or participating without that member.
2. DSS must verify the following factors if applicable to the alien's eligibility:
i. date of admission
ii. date status was granted
iii. military connection
iv. battered status
v. if the alien was lawfully residing in the United States on August 22, 1996
vi. membership in certain Indian tribes
vii. if the person was age 65 or older on August 22, 1996
viii. 40 qualifying quarters of covered work (if the alien is a lawful permanent resident)
ix. if any Federal means-tested public benefits were received in any quarter after December 31, 1996
x. if the alien was a member of certain Hmong or Highland Laotian tribes during a certain period of time (or is the spouse or unmarried dependent of such a person)
1. If DSS has submitted a copy of a document provided by the household to INS for verification, DSS cannot delay, deny, reduce, or terminate the individual's eligibility for benefits on the basis of the individual's immigration status while pending.
2. If SSA has responded that the individual has fewer than 40 quarters, and the individual provides documentation from SSA that SSA is conducting an investigation to determine if more quarters can be credited, DSS will certify the individual pending the results of the investigation for up to 6 months from the date of the original determination of insufficient quarters.
3. If the applicant or DSS has submitted a request to a Federal agency for verification of information which bears on the individual's eligible status, DSS will certify the individual pending the results of the investigation for up to 6 months from the date of the original request for verification.
3. DSS must provide alien applicants at least 10 days from the date of the request to submit acceptable documentation of their eligible alien status as of the 30th day following the date of application.
4. DSS must provide the household with benefits no later than 30 days following the date of application, provided the household is otherwise eligible, if DSS fails to give applicants at least 10 days to submit acceptable documentation.
5. DSS must verify a household member's citizenship or status as a non-citizen national.
i. DSS will accept participation in another program as acceptable verification if verification of citizenship or non-citizen national was obtained for that program.
ii. If the household cannot obtain acceptable verification, DSS must accept a signed third-party statement, under penalty of perjury, which indicates a reasonable basis for personal knowledge that the member in question is a U. S. citizen or a non-citizen national.
C. Utility Expenses for Unoccupied Homes
1. Verify the actual expenses for the unoccupied home.
2. If the household has utility expenses at both homes, give the appropriate SUA.
3. If the household has utility expenses only at the unoccupied home, the SUA is not permitted. Combine the actual utility expenses with the shelter costs.
1. Contact the household to determine if the information the household provided is correct if the SSN returns from SSA as unverified. Obtain the correct information so that the SSN can be resubmitted to SSA.
2. Pursue all unmatched SSNs with the client. If the household refuses to provide the correct information, take action against the household for refusal to cooperate per DSSM 9029.
3. When a household claims it cannot cooperate for reasons beyond its control, verify and document the household's inability to cooperate.
4. If an individual must appear at the SSA Office to provide correct information and refuses to, the refusal is grounds for termination per DSSM 9029.
5. When an individual household member refuses or fails without good cause to provide or apply for an SSN, that individual shall be ineligible to participate.
6. Disqualifications apply only to individual members, not the entire household. Treat the income and resources for the disqualified individual according to DSSM 9076.2.
7. Do not delay the certification for or issuance of benefits to an otherwise eligible household solely to verify the SSN of a household member.
8. Once an SSN has been verified, enter the number as verified to prevent the unnecessary re-verification of the SSN in the future.
9. Accept as verified a SSN which has been verified by another program participating in the Income and Eligibility Verification System (IEVS).
10. If an individual is unable to provide an SSN or does not have an SSN, require the individual to apply for one with SSA and provide proof of the application.
F. Residency (Including Homelessness Definition)
1. Verify residency with the verification of other information such as, but not limited to, rent and mortgage payments, utility expenses, and identity.
2. If verification cannot be accomplished with the verification of other information, use a collateral contact or other readily available documentary evidence.
3. Documents used to verify other factors of eligibility can sometimes verify residency.
4. Any documents or collateral contacts which reasonably establish the applicant's residency must be accepted.
5. Do not impose requirements for a specific type of verification.
6. Do not impose a durational residency requirement.
7. Household do not have to reside in a permanent dwelling or have a fixed mailing address as a condition of eligibility.
1. Where an authorized representative applies on behalf of a household, verify the identity of both the authorized representative and the head of household.
2. Identity may be verified through readily available documentary evidence, or if this is unavailable, through a collateral contact.
3. Accept any documents which reasonably establish the applicant's identity. (Examples include a driver's license, a work or school ID, an ID for health benefits, or for other assistance or social services program, a voter registration card, wage stubs, or a birth certificate.)
4. Do not impose requirements for a specific type of document.
1. The disability must be one considered permanent under the Social Security Act.
2. Only those individuals who suffer from one of the disabilities mentioned in the SSA list who are unable to purchase and prepare meals because of such disability will be considered disabled for the purpose of this provision.
i. If it is obvious that the individual is unable to purchase and prepare meals because s/he suffers from a severe physical or mental disability, consider the individual disabled for the purpose of the provision even if the disability is not specifically mentioned on the SSA list.
ii. If the disability is not obvious, verify the disability by requiring a statement from a physician or licensed or certified psychologist certifying that the individual (in the physician's/psychologist's opinion) is unable to purchase and prepare meals because s/he suffers from one of the non-obvious disabilities mentioned in the SSA list or is unable to purchase meals because s/he suffers from some other severe, permanent physical or mental disease or non-disease related disability.
3. The elderly and disabled individual (or his/her authorized representative) is responsible for obtaining the cooperation of the individuals with whom s/he resides in providing the necessary income information about the others to DSS.
I. Quality Control (QC)
1. Verify all factors of eligibility for households who have been terminated for refusal to cooperate with a State QC reviewer and reapply after 95 days from the end of the annual review period.
2. Verify all factors of eligibility for households who have been terminated for refusal to cooperate with a Federal QC reviewer and reapply after seven months from the end of the annual review period.
3. The annual review period is the Federal Fiscal Year, October to September.
1. Appropriate verifications include receipt of temporary or permanent disability benefits issued by governmental or private sources, or of a statement from a physician or licensed or certified psychologist.
K. Legal Obligation and Actual Child Support Payments
L. Additional Verification For Able-bodied Adults Without Dependents (ABAWD)
1. Hours worked – verify the hours worked for individuals who are satisfying the ABAWD work requirements by working, by combining work and participation in a work program, or by participating in a work or workfare program that is not operated or supervised by the State.
2. Countable months in another state – verify the number of countable months for individuals subject to the ABAWD provisions if an individual has lived in another state and there is an indication that the individual participated in that state.
2. DSS Gives Households at Least 10 Days to Provide Requested Verifications.
14 DE Reg. 900 (03/01/11) (Final)