016.14.06 Ark. Code R. 007
The purpose of the SSBG program is to provide financial assistance to states in delivering social services most appropriate to their population.
Since 1962, the United States Congress has authorized funds to states for social services for low income families and individuals. Prior to 1975, social services funding was provided through two separate titles of the Social Security Act: Title IV-A (social services to families with dependent children) and Title VI (social services for the aged, blind and disabled). Eligibility was closely tied to related income maintenance programs (Aid to Families with Dependent Children provided under Title IV-A and Aid to the Aged, Blind and Disabled provided under Title VI). Under each program only certain specified services could be funded. On January 4, 1975, Public Law 93-647 was signed into law. This law removed the social services provisions for Title IV-A, abolished Title VI, and added Title XX to the Social Security Act effective October 1, 1975.
The Omnibus Budget Reconciliation Act of 1981, Public Law 97-35, amended Title XX of the Social Security Act to establish the Social Services Block Grant (SSBG) program effective October 1, 1981. This program provides federal assistance to states for social services directed at the goals of achieving economic self-support or self- sufficiency; preventing or remedying neglect, abuse, or exploitation of children or adults; preventing or reducing inappropriate institutionalization; and securing referral for institutional care, where appropriate. Under the SSBG program, states have the sole responsibility for determining what services will be provided, who will be eligible for services, and how the funds will be distributed within the state. The State of Arkansas currently operates under this SSBG program.
The following federal laws and regulations form the basis for the operation of the SSBG program.
Omnibus Budget Reconciliation Act of 1981 (Section 2352)
In addition there are laws which apply to all federally funded programs. These include:
Title VI of the Civil Rights Act of 1964, as amended -prohibits discrimination on the basis of race, color, or national origin (including persons with limited English proficiency)in all federal programs.
Section 503 of the Rehabilitation Act of 1973 - requires government agencies and contractors to take affirmative action in the employment and advancement of qualified handicapped individuals.
Section 504 of the Rehabilitation Act of 1973 - prohibits discrimination on the basis of handicap in federally funded programs.
Age Discrimination Act of 1975 - prohibits discrimination on the basis of age in federally funded programs.
Americans with Disabilities Act of 1990 - prohibits discrimination against a qualified individual with a disability with regard to employment and the provision of public services.
The following are the major federal regulations which govern the operation of the SSBG program. Regulations are initially issued into the Federal Register and subsequently codified into the Code of Federal Regulations. Copies of the Code of Federal Regulations and the Federal Register are available in most public libraries.
45 CFR (Code of Federal Regulations) Part 96 - block grant regulations issued by the Department of Health and Human Services.
45 CFR Part 80 - regulations implementing the Civil Rights Act of 1964.
45 CFR Part 84 - regulations to implement nondiscrim-ination against the handicapped (Section 504 of Rehabilitation Act of 1973, as amended).
45 CFR Part 90 - regulations to implement the Age Discrimination Act of 1975.
41 CFR 60-741 - regulations implementing Section 503 of the Rehabilitation Act of 1973 (affirmative action regulations for handicapped workers).
28 CFR Part 35 - regulations to implement subtitle A of Title II of the Americans with Disabilities Act, Public Law 101-336 (prohibiting discrimination on the basis of disability in the services, programs, or activities of all state and local governments).
The Department of Health & Human Services (DHHS) is in compliance with Titles VI and VII of the Civil Rights Act and is operated, managed, and delivers services without regard to age, religion, disability, political affiliation, veteran status, sex, race, creed, color, or national origin.
Social Services Block Grant (SSBG) legislation enables DHHS to claim federal funds to provide social services for individuals and families. Although program responsibility is vested with the specific program divisions/offices (see Section 2120), citizens are involved in the planning process and have an opportunity to respond to the planning decisions during a thirty day public review and comment period each year.
Overall management and administration of the SSBG program rests with the Office of Finance and Administration (OFA) which is responsible for centralized planning, policy development, financial management, financial standards, and overall monitoring and co-ordination of the administration of the SSBG program on behalf of the Director of DHHS. OFA also is charged with monitoring the SSBG program for federal regulatory compliance.
OFA consists of the Chief Fiscal Officer and the following I sections: Contract Support Section (CSS), Human Resources/ Support Services, General Operations Section and Managerial Accounting Section. Support Services is responsible for promulgation of policies and procedures for the SSBG program.
DHHS Chief Fiscal Officer
The Chief Fiscal Officer will make an annual allocation of SSBG funds to affected program divisions and agencies and make adjustments throughout the year based upon the fore-casting of long and short-term needs and availability of federal funds.
Contract Support Section
Contract Support Section provides a standard and uniform approach to the financial management requirements for DHHS contracts, including those with SSBG funds. Contract Support Section' areas of responsibility include:
providing centralized administration, review and quality control of all DHHS contracts and grants with an SSBG funding component;
developing contracts and grants containing SSBG funding;
providing technical assistance and training to DHHS contractors on overall compliance requirements;
providing standardization, technical assistance, and training to DHHS program divisions on compliance requirements;
SOCIAL SERVICES BLOCK GRANT PROGRAM MANUAL02-15-04
conducting provider site visits to determine overall compliance and conducting service-to-billing audits for contractors receiving over $5,000 in SSBG funds;
preparing the annual federal SSBG post-expenditure report in coordination with Managerial Accounting Section, the Division of Aging and Adult Services, the Department of Education and Spinal Cord Commission;
Any questions on contract operations, financial guidelines or policy regarding contracting in the SSBG program shall be referred to CSS.
General Operations Section
The General Operations Section is responsible for:
the preparation of the proposed and final SSBG Comprehensive Services Program Plan (with the participation of DHHS divisions and offices);
coordination of the development of policies and procedures for the SSBG program;
the analysis and dissemination of laws and regulations relating to the SSBG program;
In addition, the General Operations Section coordinates the payment of bills, invoices, etc., for the SSBG program.
Managerial Accounting Section
The OFA Managerial Accounting Section will provide to CSS I reports of expenditures by program codes, with detailed data by client units and service codes.
DHHS divisions and offices are annually allocated SSBG funds for program operational functions. Each division and office is responsible for the operation of its own SSBG program, as approved and monitored by CSS including:
' the solicitation of proposals from potential service providers;
the negotiation and approval of provider contracts;
the monitoring of contracts already in place;
the program and budget review of contracts;
the delivery of direct services;
the management of allocated funds; and
the routing of approved performance standards and divisional compliance requirements.
All of the above responsibilities must be accomplished in accordance with policies and procedures established by the Office of Finance and Administration.
Prior to each state fiscal year, the Director of DHHS or designee makes an allocation of SSBG funds to each of the DHHS
Workforce Education - Arkansas Rehabilitation Services). Each division and office is responsible for managing these funds and approving contracts and administrative expenditures for programs within its area of expertise.
Federal law authorizing the SSBG requires the state to develop (with public input) and submit to the federal government, a services program plan outlining the manner in which block grant funds will be spent and the categories of persons who will be served. The Arkansas Comprehensive Services Program Plan (CSPP) is such a plan.
The CSPP is based upon the allocations made during the allocation process. Before the beginning of each state fiscal year, the Director of the DHHS or designee allocates SSBG funds to each DHHS division and office. Each division and office is then responsible for obligating these funds for purchase of service agreements and administrative agreements within its program area(s). Each division and office prepares a plan for estimated expenditures, service activities, eligible categories, and estimated number of clients to be served within its program area, which is integrated by OFA into the overall CSPP and SSBG Program Manual.
The proposed plan is usually issued in March of each year. Then, after publication of notice in a newspaper of general daily circulation and consideration of public comments, a final plan is issued which specifies the services to be provided or purchased by DHHS during the new state fiscal year. The plan contains a list of service definitions, goals, estimated expenditures, and estimated number of clients to be served for each service offered.
The plan also explains the structure and organization of DHHS, the planning process, and related funding sources. Copies of the proposed plan are made available for public review. The final plan is placed on the DHHS internet web site. Copies of the final plan are mailed to contract providers who request copies. Other interested parties may obtain copies by requesting them from OFA, General Operations Section. Federal law requires an update to the CSPP whenever substantive changes are made during the program year. Copies of updates are mailed to individuals and organizations who have requested copies of the CSPP.
In accordance with Section 2006 of Title XX of the Social Security Act, an annual post-expenditure report is required. The report shall be in such form and contain such information as the Department finds necessary to provide an accurate description of SSBG activities, to secure a complete record of the purposes for which funds were spent, and to determine the
services provided in whole or in part with SSBG funds; the number of children and the number of adults receiving each service; the criteria applied in determining eligibility for each service, including fees, if any; and the method by which each service was provided. OFA Contract Support Section is responsible for preparing the report in coordination with OFA Managerial Accounting Section.
DHHS issues several manuals and other policy issuances to guide providers and staff of DHHS divisions and offices in the implementation of the SSBG program.
Policy issuances may be based upon federal law or state program decisions. Formal issuance makes regulations and program materials accessible to all DHHS divisions and offices and providers.
All policy is issued under the authority of DHHS. Policy and procedures specified in Departmental manuals may not be changed, modified, or waived by any individual or agency except through a superseding policy issuance or a written waiver.
The following is a listing and brief explanation of policy issuances in addition to the SSBG Program Manual and CSPP:
The Contract Manual contains policy and procedures, forms, and instructions for the administration of purchased services through DHHS.
The Financial Guidelines for Purchased Services (Guidelines) provides the rules and regulations governing the financial control of funds administered for the purchase of services within DHHS. It includes financial standards for the operation of programs and policy and procedures for fiscal accountability. The Guidelines is the official authority
(along with the applicable OMB circulars referenced in the Guidelines) on allowable costs, required fiscal reporting and record keeping, audit, and other fiscal requirements. It should be noted, however, that the Guidelines contain more regulations than just those of the SSBG program, as it deals with financial standards governing the application of all federal and state funds utilized to purchase human services through DHHS.
The Office of Finance and Administration has responsibility for the issuance, interpretation and distribution of policies and procedures for the SSBG program. Any questions on client eligibility, overall financial guidelines, or other matters of general program policy or procedures shall be referred to the Chief Fiscal Officer (CFO) for interpretation, explanation, and, if necessary, development of revised or additional policies and procedures. Except in an emergency, all such
Arkansas Department of Health & Human Services
Office of Finance and Administration
Donaghey Plaza West, Slot W401
P.O. Box 1437
Little Rock, Arkansas 72203-1437
A formal written request for a waiver of policy contained in the Social Services Block Grant Program Manual must be submitted to the CFO or designee for approval. The request must be submitted or approved by the appropriate program agency director and state the specific section of policy for which the waiver is requested, duration of the waiver request and complete justification for the waiver.
Determination of eligibility will be the responsibility of providers of services both direct and purchased.
All providers of direct or purchase services will use the policy and procedures outlined in this manual. In some situations the forms used by the Department of Health & Human Services (DHHS) County Offices may differ from the forms specified in this manual. However, any and all deviations from the forms specified in this manual shall be approved by the Chief Fiscal Officer (CFO) of DHHS prior to their usage. The procedures to be followed and the instructions for completion of these forms will be included in the DHHS Program Policy Manual.
Every person has the right to apply or re-apply for services. No application or inquiry can be ignored by either providers or DHHS representatives.
The distinction between an application and an inquiry is as follows:
An application is the action by which an individual indicates in writing to the provider his/her desire to receive services.
An inquiry is simply a request for information about available services in the community.
Families and individuals must be free to accept or reject services. Acceptance or rejection of a service shall not be a prerequisite for the receipt of any other SSBG services.
A departmental employee or contract provider shall not on the basis of age, religion, disability, political affiliation, veteran status, sex, race, color, or national origin:
individualized education plans, or other similar services that are designed to meet the particular needs of an individual.);
No person will be prevented from participation, denied benefits or subjected to discrimination on the basis of age, religion, disability, political affiliation, veteran status, sex, race, creed, color or national origin. All DHHS staff and providers must comply with the provisions of the Civil Rights Act of 1964, Sections 503 and 504 of the Rehabilitation Act of 1973, as amended, and the Americans with Disabilities Act of 1990.
The provider has the responsibility for informing applicants, recipients, and clients that services are provided on a non-discriminatory basis and that they have a right to file a complaint with the Department of Health & Human Services or Federal Government if discrimination has occurred on the basis of age, religion, disability, political affiliation, veteran status, sex, race, creed, color or national origin.
Applicants or recipients, or an individual acting on behalf of an applicant or recipient, may appeal (through a hearing process) the denial, reduction, or termination of a service, the level of a fee that has been assessed, or failure to act upon a request for service with reasonable promptness.
The first level of appeal in any of the situations outlined above shall be made to the director of the program where the alleged inequity occurs. If the client filing the appeal receives no satisfaction at the program level, the next step is to send a written request for a hearing to the Chief Fiscal Officer of DHHS or designee, P.O. Box 1437, Slot W401 Little Rock, Arkansas 72203. The written request must be sent within sixty (60) days of the program director's ruling and must state, with specificity, the basis for the appeal and the relief sought.
Prior to setting a formal hearing, an attempt will be made to resolve the appeal informally. The CFO or designee will first refer the hearing request to a contract officer. The contract officer, accompanied by a program representative selected by the program agency or division director, will make initial inquiries into the client's situation. The contract officer and program agency representative will interview both the provider representative and the client and review pertinent records of both. Based on the findings, a report will be compiled outlining the problems and proposing solutions. The report must be completed within fifteen working days of receipt of the request for a hearing. The report will be forwarded to the CFO or designee. The CFO or designee and the program agency director will review the report and make recommendations for resolving the problem to the contract officer within fifteen calendar days. The contract officer will present the proposed solution to the client and/or provider within five working days of the date the solution is received. If a solution can be reached that is satisfactory to both the client and provider, no formal hearing will be held. The contract officer will obtain the signatures of the client and/or provider representative who filed the appeal. The original signed solution will be filed in the office of the CFO or designee in a special hearing file. Copies of the solution will be provided to the client and/or provider and program agency. If the proposed solution from the informal review is not acceptable to both parties a formal appeal may be filed utilizing the Administrative Hearings/Appeals procedure.
The purpose of the Administrative Hearing/Appeals process is to provide a mechanism by which a client may appeal adverse action taken under a program funded through the Arkansas Department of Health & Human Services. Complaints which solely assert an objection to federal or state laws or regulations are not subject to appeal under this procedure.
When a client (or designated representative) wishes to request an administrative hearing, he or she may do so by submitting a request in writing to the DHHS Appeals and Hearings Office. The request must be received by the Appeals and Hearings Office no later than thirty (30) calendar days from the date of receipt of the notification of the adverse action by the client or no later than ten (10) calendar days from the date of receipt of the informal review decision from the CFO. The written request shall be submitted to:
Arkansas Department of Health & Human Services Appeals and Hearings Office I P.O. Box 1437, Slot N401
Little Rock, Arkansas 72203-1437
(NOTE: A copy of the request shall also be submitted to the CFO or designee.)
The notice of appeal request must contain:
A statement of the specific action being appealed;
The reason the client believes the action was incorrect;
The specific relief requested.
When a request for a formal hearing is received, the Appeals and Hearings Office will request a copy of the client file from the responsible program agency. The file will contain relevant records which constitute documentary evidence to support the notice of adverse action sent, verification obtained which resulted in the adverse action, any relevant correspondence and any information supplied by the client. The file must also contain a Hearing Statement prepared by the program agency which summarizes the basis for the adverse action and the position of the program agency. The Hearing Statement, however, is not original evidence, so complete documentation will be required in the file to support the Hearing Statement. The Hearing Statement will contain the issue as stated by the client. The Hearing Statement shall also list the name of the program agency's representative for the administrative hearing.
The client (or designated representative) will be advised by form notice prepared by the Appeals and Hearings Office that he or she has fifteen (15) calendar days from the date of the notice to review the Hearing File at the program agency or at a specified DHHS County Office and to notify the Appeals and Hearings Office of any individuals he or she wishes to subpoena for the administrative hearing. The program agency must advise the Appeals and Hearings Office at the time the Hearing File is sent of any witnesses the program agency wishes to have subpoenaed to document the adverse action taken. The reverse side of the Hearing Statement provides space to request subpoenas for witnesses. Appropriate program agency employees will attend administrative hearings without being subpoenaed. The program agency representative will be notified by the Appeals and Hearings Office of any witnesses the client has requested to be subpoenaed. The program agency representative will have five (5) calendar days from the receipt of this notice to request subpoenas for rebuttal witnesses.
After the time has expired for subpoenaing witnesses, the hearing officer will schedule the hearing to afford the parties, and attorneys, if any, at least ten (10) calendar days notice of the date, place, and the time of the hearing. The scheduling letter shall also contain the name of the hearing officer who will conduct the hearing. In the event any party cannot attend the hearing for good cause, the party may request that the hearing be rescheduled. The hearing may be rescheduled by the hearing officer upon a showing of good cause.
The hearing will normally be held at the DHHS Appeals and Hearings Office in Little Rock. It may be held at a DHHS County Office upon request made to the hearing officer by a party.
It is the responsibility of the program agency's representative to be familiar with the case, and to be able to answer pertinent questions relating to the issue at hand asked by the client or the hearing officer. The program agency representative should be prepared to cross-examine adverse witnesses. The program agency representative may request legal assistance when preparing for the hearing, and may also request representation at the hearing by written request directed to the DHHS Chief Counsel.
The hearing will be conducted by a hearing officer from the DHHS Appeals and Hearings Office. No person who had any part in the decision being appealed may serve as the hearing officer. The client may secure representation by a friend, attorney, or other designated representative. The hearing will be conducted in an informal but orderly manner by the hearing officer who will control the conduct of the proceedings. The party initiating the appeal has the burden of proving whatever facts it must establish to sustain its position by a preponderance of the evidence. The hearing officer will explain the hearing procedure to the parties. The Hearing Statement will be read by the program agency representative. An opening statement may also be presented by the client or his or her representative. The program agency will present its case first, which includes presenting evidence and questioning witnesses. The client will then present his or her case. He or she may do so with the aid of others. The client will be given the opportunity to present
witnesses, advance arguments, offer additional evidence and to question or refute any testimony or evidence. The client will be allowed to question the program agency representative, and to confront and cross-examine any adverse witnesses. Questioning of parties and witnesses will be confined to the issues involved. All relevant evidence may be presented as directed by the hearing officer. The hearing officer may question any party or witness.
If the client fails to appear for the hearing and does not contact the Appeals and Hearings Office prior to the date of the hearing of his or her inability to attend, the appeal will be considered abandoned.
The hearing officer will prepare a Final Order based on a comprehensive report of the proceedings. The format will consist of an Introduction, Findings of Fact, Conclusions of Law and a Decision. The Final Order will be issued by the Appeals and Hearings Office. Final administrative action must be completed within ninety (90) calendar days from the receipt of the appeal. This time may be shortened by the hearing officer when appropriate upon good cause demonstrated by a party to the proceeding.
If the client is not satisfied with the decision of the Appeals and Hearings Office, he or she has the right to judicial review under the Arkansas Administrative Procedures Act, Ark. Code Ann. § 25-15-212 as amended. A petition must be filed in an appropriate Circuit Court within thirty (30) calendar days from the date the client received the Final Order of the Appeals and Hearings Office. Copies of the petition are served on the program agency, the DHHS Appeals and Hearings Office and any other parties of record in a manner authorized under the Arkansas Rules of Civil Procedure.
Case records shall be kept confidential and kept in a secure file. Information in case records shall not be disclosed for any purpose other than:
Case records must be maintained for a period of five years from the date of expiration or termination of the SSBG contract. If an audit is in process at the end of the five year period, the records must be maintained until the resolution of the audit.
ARKANSAS DEPARTMENT OF HEALTH AND HUMAN SERVICES Sections 3600-3700
Client records shall be open to inspection upon request by the Department of Health & Human Services and representatives of the federal government involved in the administration of the SSBG program.
Under Title XIX (Medicaid) Regulations, which are applicable to the state Medicaid program, a long term care facility may accept only those persons "whose needs can be met by the facility directly or in cooperation with community resources or other providers of care with which it is affiliated or has contact." Residents of long term care facilities are accepted as residents by such facilities for the purpose of meeting the health and rehabilitation needs of the resident which cannot be met except by residence in such facilities or institutions. Once accepted, the facility must provide services to meet the specific needs of the resident based on his individual plan of care. Once a patient has been admitted to a Title XIX long term care facility, the Title XIX vendor payment (with required resident cost sharing payments) is considered to be payment in full for services required to be provided by the Nursing Facility (NF) or Intermediate Care Facility for the Mentally Retarded (ICF/MR) not otherwise covered as ancillary services by Medicaid.
The term "nursing facility" means an institution (or distinct part of an institution) which is engaged in providing to residents:
Medicaid regulations also spell out the responsibilities of these facilities for providing certain services as a condition of certification. These include providing specialized and supportive rehabilitative services, providing or arranging for social services as needed by the resident, and providing an activities program designed to encourage restoration to self-care and maintenance.
Such services are, therefore, responsibilities of the Title XIX facility and must be provided by the facility under its
ARKANSAS DEPARTMENT OF HEALTH AND HUMAN SERVICES Section 3700-3800
Title XIX program, not from SSBG funds. Any costs of such services which are not reimbursable through other provisions of the Medicaid program must be paid from the Title XIX vendor payment. For this reason, no authorization or payment may be made under SSBG for services to individuals receiving a Title XIX vendor payment.
SSBG funds may not be used to purchase services for inmates of a jail or prison if:
The service is the inherent responsibility of the facility, such as food, shelter, clothing, general maintenance and administration (including the determination function), general supervision and personal care; or
The activities are intrinsic to the purpose of the facility as determined by facility charter, state law or standards, relevant licensing or certification requirements, or federal or state court decisions.
If a service does not involve the prohibitions stated above, it could be purchased under SSBG for individuals living in a jail or prison.
Examples of services which might be provided under SSBG to inmates of a jail or prison include mental health services, special services to a blind or disabled inmate, and other similar services which would provide services to the inmate beyond the inherent responsibilities of the institution.
Applications for direct services delivered by DHHS divisions must be made at the appropriate division or office. Applications for purchased services must be made at the office of the SSBG provider from whom the individual wishes to receive services. The applicant is responsible for the completion of all application documents; however, the provider representative or applicable DHHS representative shall provide assistance in the completion of such application forms upon request. Applications must be made on the Application for Social Services Block Grant Services (Form DHHS-100) (Appendix D) and signed by the applicant except in the following cases:
Form DHHS-100 advises the applicant of his/her rights and his/her responsibility to give the Department accurate information for determination of eligibility. These rights and responsibilities will also be explained to the applicant by the person assisting with the application. Financial information will be accepted according to the client's statements.
An authorized representative is someone designated by the client to act on his/her behalf. In order to establish a client's eligibility for SSBG services, the person acting as authorized representative must be knowledgeable of the client's living arrangements and income. A provider representative or employee may not act as an authorized representative unless the provider has legal custody of the client.
An individual under age 18 shall be considered emancipated and allowed to sign the application if the individual is:
The reason for considering a minor emancipated must be documented in the case record.
The tasks to be completed during the interview include:
The provider shall secure essential social and financial information to determine eligibility.
The applicant shall be relied upon as the primary source of information. However, when the applicant is unable to provide essential information, the provider shall assist in obtaining any necessary verifications.
During the initial application interview the Application Form DHHS-100 is completed by the applicant. However, assistance shall be provided by the provider representative upon the request of the applicant. (Please see Section 4110 for additional information.) It should be noted that in certain circumstances, the provider representative may actually complete the application documents rather than the applicant (such as in cases involving protective services, foster care, etc.).
When the information presented by the applicant or his/her representative during the first interview establishes that the applicant is ineligible, the application shall be denied immediately. Form DHHS-160 shall be sent or given to the client, with a copy maintained in the client's record.
The provider representative may make a home visit if necessary to establish eligibility. The fact that a home visit has been made and additional information acquired to support eligibility shall be recorded in the case narrative.
Collateral information is evidence provided by written documents or by persons other than the applicant.
The provider representative shall use a consent for release of information signed by the client to secure information from a collateral source. The release must specify the information needed and the names of the collateral sources. If a client refuses to sign a consent form and collateral information must be obtained, refer to Section 4140.B. regarding notification of case denial.
The provider representative shall check records or conduct inquiries by correspondence only when information can best be obtained in these ways. Routine record checking or correspondence which will not likely bring forth additional information needed to establish eligibility shall be avoided.
The provider representative has a maximum of thirty (30) days from the date of application to dispose of the application by one of the following actions - approval, denial or withdrawal.
When action on an application has been delayed because of the provider, the applicant shall be notified by the 20th day following the date of application of the reason for the delay and of his/her right to an appeal using Form DHHS-l60.
If the applicant has been instructed to provide information to clear eligibility but fails to do so, the provider representative shall notify the applicant by the 20th day of the exact reason for the delay using Form DHHS-l60 and explain that he/she has ten (10) days from the date of the notification to provide information to clear the remaining eligibility factor(s) or the application shall be denied. A second DHHS-l60 announcing final action is unnecessary. If the applicant notifies the provider representative that he/she is unable to provide essential information, the provider representative shall assist in obtaining the information, but the application must be disposed of within thirty (30) days.
Deficit income (i.e., when total operating expenses are greater than gross receipts) will be treated the same as income. The amount of the deficit is subtracted from the gross income from other sources to obtain the total gross income.
Gross receipts include the value of all products sold, government crop loans, money received from the rental of farm equipment to others, and incidental receipts from the sale of wood, sand, gravel, and similar items. Operating expenses include cost of feed, fertilizer, seed, other farming supplies, cash wages paid to farmhands, depreciation charges, cash rent, interest on farm mortgages, farm building repairs, farm taxes (not state and federal income taxes), and similar expenses. The value of fuel, food, or other farm products used for family living is not included as part of net income.
Deficit income (i.e., when total operating expenses are greater than gross receipts) will be treated the same as income. The amount of the deficit is subtracted from the gross income from other sources to obtain the total gross income.
The case record must document that each eligibility requirement has been met before services may be granted. These points of eligibility include:
The following are categories under which applicants may receive SSBG services.
Services to Division of Children and Family Services clients needed as a result of a case plan for family support/reunification, prevention or remedy abuse, neglect or exploitation of children, crisis intervention with children and families, and designed to help adoptive and extended families at risk or in crisis may be provided without regard to income.
The required documentation for the youth's case record to establish status eligibility is a written referral of the youth to the provider for services by the courts, a law enforcement agency or DYS. The written referral must include the following information: date, name or ID number of youth, referring justice system agency, statement of problem/reason for referral, signature and title.
SSBG eligibility and, if applicable, fee assessments are determined on the basis of income and family size of the eligibility unit of the primary client, using the following income scale (see Section 4210, subsections B, C, and D to determine family size):
Family Size | Annual Income | Monthly Income | Family Size | Annual Income | Monthly Income |
1 | $12,018 | $ 1,002 | 6 | $30,508 | $2,542 |
2 | 15,716 | 1,310 | 7 | 31,201 | 2,600 |
3 | 19,414 | 1,618 | 8 | 31,895 | 2,658 |
4 | 23,112 | 1,926 | 9 | 32,588 | 2,716 |
5 | 26,810 | 2,234 | 10 | 33,281 | 2,773 |
For over ten family members, add $693 to the annual income for a family size of ten for each additional member.
The amount of any currently available income not specifically excluded under one of the provisions in Section 4210.G. must be determined and considered. The client's statement will normally be sufficient verification of income. However, the provider representative is expected to act as a prudent person and to make additional investigation when the client's statements are unclear, incomplete, or contradictory, or when he/she has reasonable grounds for believing that the statements are incorrect. This is not intended to mean that the provider representative should require routine verification of income
for all clients or any group of clients, but only that the provider representative shall make an additional investigation when the circumstances of the particular case give reasonable grounds for believing that the client's statements are not indicative of his/her true situation. In such cases, the provider representative shall first seek clarification from the applicant. If the applicant cannot resolve the matter, contact with collaterals may be necessary with the applicant's permission. If the applicant does not wish collaterals to be contacted, he/she has the option of terminating his/her application or providing sufficient information himself to resolve the problem within the thirty (30) day time limit for disposing of the application.
The following are three examples of situations in which a provider representative would be expected to investigate further in order to be considered prudent:
If a client claims to be employed full-time in order to receive day care for his/her children, but claims to have income significantly below the minimum wage, then the provider would be expected to investigate further.
If the income or family size of a client changes drastically without explanation between reevaluations, shortly after services were denied, or after a fee is assessed for services, the provider would be expected to investigate further.
If a client claims to be unemployed or under employed and yet maintains a standard of living beyond his/her means (e.g., maintaining an apartment on no income) without a reasonable explanation, the provider would be expected to investigate further.
The monthly gross amount of any earnings from employment will be determined. Monthly gross income is computed by multiplying weekly earnings by 4 1/3, bi-weekly earnings by 2 1/6, semi-monthly earnings by 2. If the earnings fluctuate, the provider representative shall determine, by averaging or other means, an amount which fairly reflects the income actually currently available to the applicant on a monthly basis. The computation of earnings should be maintained in the client file to support the earnings reflected on the application or the re-evaluation.
The monthly amount of any unearned income not disregarded must be determined. Verification shall be by the client's statements.
Social Security benefits are paid upon retirement, disability, or death of a covered wage earner. Retirement benefits are payable at age 62.
Social Security disability benefits are payable at any age. A wife or widow is eligible at any age if there are minor children of the wage earner living in the home. An individual may receive a child benefit at any age if incapacitated prior to age 21. All unmarried minor children of a wage earner are covered, even though the wage earner and the mother of the children were later separated or divorced. Illegitimate children may be covered if the wage earner can be established as the parent.
Railroad Retirement Benefits are paid to individuals and spouses covered under the Railroad Retirement Act. An individual may receive both Railroad Retirement and Social
Security, if covered under both programs, and the wife of a Railroad Retirement beneficiary may receive a wife's benefit while drawing Social Security.
In addition to determining financial eligibility, the provider representative must establish the need for service to be rendered under SSBG. Service need is a state agency requirement with certain federally mandated elements. Its purpose is to insure that funds are expended only for services to eligible clients which are needed by the client to alleviate some problem or condition. At the same time, it is recognized that in the wide range of services provided under SSBG, there will be many types of service need, some of which are less obvious than others. For example, the fact that an elderly individual has neighbors, friends, or family with whom he/she could socialize does not mean that he/she cannot benefit from an organized program of activities in a senior citizen center among persons of his/her own age group. In almost all cases, the determination of service need will involve some judgment on the part of the provider representative.
For definitions of primary client, family, single adult, emancipated minor, income, monthly gross income, exclusions from monthly gross income, and services, please see Section 4210: Definitions Regarding Eligibility.
Service need consists of three separate but interrelated requirements which are outlined individually below.
Except in protective services or DCFS custody situations, services shall be provided only to clients who voluntarily request the service. For protective services cases, a dated agency record documenting the circumstance of actual or potential abuse, neglect, or exploitation of a child or adult shall be used in place of a voluntary request for services.
Specific requirements may be imposed for the receipt of individual services by the applicable SSBG Program Manual Service Chapter.
For example, to receive the service "Special Services for the Disabled - Work Activity" an individual must have a developmental disability as defined in the Glossary and be twenty-one years old or older or have completed public school activities.
A narrative entry or problem statement on Form DHHS-100 stating that a particular service is being provided to meet a specific need of the person shall be taken as certification that the person meets all service need requirements for that service. Providers shall maintain sufficient records to show that they have provided services under SSBG only to the persons specified in their contract and eligible for the service under the SSBG Program Manual.
Services must be directed toward one of the five national SSBG goals. Goals for individual clients are specified in Form DHHS-100.
Provider staff are expected to provide under SSBG only those services which are needed to meet one of these goals. A narrative entry or a statement by the provider on the DHHS-100 stating the national goal and the services needed shall be regarded as sufficient verification of individual service need.
Beyond this requirement, the judgment of service need shall be left to the judgment of the individual provider. It is preferable from a program standpoint to provide services in borderline cases rather than risk denying services to clients who could benefit from them.
Clients who have voluntarily requested SSBG services and meet financial eligibility requirements should not be denied services on the basis of service need unless it is obvious that the individual could receive no possible benefit from the services requested.
Service need must be established in accordance with the following federally mandated goals:
Please refer to Appendix B - List of Service and Unit Codes and Appendix C - Service Chapters for a complete listing of unit codes, service definitions, methods of delivery, eligible categories, descriptions of service activities, goal(s) for which services are rendered, objective(s), and the geographic area in which each service is available.
The following are the "Service Codes."
The individual with or for whom a plan is developed and a goal is set is considered to be the primary client; however, the service plan must take into account the relation of his/her needs to the functioning of his/her family as a whole. Services to families and individuals must be in accord with plans developed in cooperation with the client, be responsive to the needs of each individual within the family, while taking account of the relation of individual needs to the functioning of the family as a whole, and be related to the goals and objectives as previously described.
Frequently, the service provided to the primary client will have an effect on other members of the family; however, no other family member becomes a primary client unless he/she requires service(s) and a specific goal is set with him/her.
Individual service plans should set objectives which are realistic and attainable within a specified period of time, usually one year. Only one goal may be established for a primary client at any given point in time, although goals may change to reflect changes in the client's situation.
It should be noted that while only one goal is established at a given time for a primary client, one or more barriers may prevent him or her from attaining that goal; thus, one or more services may be required.
The individual(s) must presently reside in Arkansas and intend to make it his/her home. No specific duration of residence is required. If the applicant has the present intention to make the state his/her home, his/her eligibility will not be affected by the fact that he/she intends to leave the state at some future time. Residence is not affected by temporary absence from the state.
When all eligibility requirements have been established, the provider representative shall:
When denying an application, the provider representative shall:
However, verification already obtained should be recorded for future reference; and
When an applicant requests his/her application be withdrawn, the provider representative shall:
If a service is denied because of unavailability or lack of resources and the client is eligible for the service, the provider representative should refer the client if the service is available from another provider. If the client is eligible, the application will be denied on Form DHHS-160 with the reason "Service Not Available."
When applications are approved within thirty (30) days of the date the application was signed, the applicant is eligible as of the date of signature, provided that it is established that the client was eligible as of that date. The effective date may not be prior to the date of application (date of signature). The effective date will be the date of approval for applications not processed within thirty (30) days of the date of application.
Notwithstanding any other provision of this manual, the Chief Fiscal Officer or designee, may authorize retroactive eligibility for any time period for any client or group of clients whom he/she finds were improperly deprived of services or payment for services under the SSBG program.
DHHS has a continuing responsibility to provide services for eligible recipients as adequately as funds will permit and to insure that no ineligible recipient continues to receive services.
The provider agency and the recipient have the responsibility to insure that information upon which a recipient's eligibility and fee assessment(s), if applicable, are based is current and complete. See Section 4800 for a discussion of fees for services.
A new application shall be completed at intervals no greater than 12 months.
The SSBG provider has the responsibility to:
recipient fails to provide the necessary information within ten (10) days, begin action to terminate, reduce services or close the case.
The recipient has the responsibility to provide complete and correct information concerning his/her situation at any time it is requested by the provider agency.
The recipient also has the responsibility to report to the provider any change that affects his/her eligibility or, if applicable, his/her fee assessment within five (5) days of the date the change occurs.
A re-evaluation involves the re-determination of all eligibility requirements. Each requirement must be met and recorded in the case narrative or on the prescribed form.
Cases may be scheduled for re-evaluation as necessary at any time within the twelve (12) month time limit. However, cases will be scheduled for financial re-evaluation no later than the eleventh (11th) month so that any action necessary to complete the re-evaluation may be accomplished before the expiration of the twelve (12) month time limit or before the end of the eleventh (11th) month if the client is to continue eligibility. A client found financially ineligible to receive services may continue to receive services until the end of the month in which the determination is made. If the advance notice period extends into the following month, the client may continue to receive services until the end of the month in which the case is closed.
A personal interview with the recipient is required by the provider. Home visits to establish continued eligibility shall be made only when necessary.
During the re-evaluation interview, the provider shall:
After the re-evaluation interview, the re-evaluation shall be completed in the following manner:
If the recipient does not provide the necessary information within ten (10) days from the date of the letter, the case will be closed.
The recipient has the primary responsibility for reporting any change affecting eligibility within five (5) days of the date the change occurs so that the provider representative can initiate the appropriate case action(s).
At any time the provider has information regarding a change affecting eligibility, an investigation shall be made and any appropriate case action(s) shall be taken within thirty (30) days. Such action(s) shall be taken based upon factual information.
When the provider proposes to terminate or reduce services, increase a fee assessment, begin charging a fee, or close a case, a DHHS-160 giving full details of the pending action shall be given or mailed to the
client at least ten (10) days prior to the anticipated date of action. A notice must be sent if any service is discontinued, even though other services may be continued. If the termination, reduction, or fee increase meets one of the conditions set out in Section 4630.B., advance notice is not required; the case may be closed the same day the DHHS-160 is completed. If the termination, reduction or fee increase meets one of the conditions set forth in Section 4630.C., no Notice of Action, DHHS-160, is required.
When the provider has obtained factual information that indicates that services should be terminated or reduced, or the case closed because of the probable fraud of the client, and such factual information has been verified (when possible through collateral sources), only five (5) days advance notice is required.
If advance notice is sent to a client due to failure to re-evaluate and a DHHS-100 is received showing the client to be ineligible for services, then a second DHHS-160 must be sent and another advance notice must be given, unless the situation meets one of the conditions set out in Sections 4630.B. or 4630.C.
Providers with computer capability may substitute a computer generated notice of action for the Form DHHS-160 with prior approval of the text by the Chief Fiscal Officer or designee.
A DHHS-160 must be sent but advance notice is not required when:
No Notice of Action, DHHS-160, is required when:
When no notice is sent to a client in accordance with one of the conditions set out above, the provider representative must document the situation in the client's case record.
The recipient has the responsibility to notify the provider within five (5) days of any change of address. The provider representative should also be alert for other changes which may be indicated by a change of address.
A client statement of changes in income shall be sufficient verification of a client's income. A statement shall also be sufficient to verify non-receipt or discontinuance of income.
The provider is responsible for continuous assessment of the service plan including the appropriateness of services being rendered, barriers, and the goal to be achieved. At a minimum, the provider representative must review the service plan once every twelve (12) months or when information is made known that requires a change in the service plan. Cases should remain open only when planned activity is taking place with respect to goal achievement or to maintaining a client in a goal status where barriers are being controlled.
Termination of a Purchased Service
When a purchased service is terminated by the provider, the provider has the following responsibilities:
When a case is closed, the client is eligible to receive services until the last day of the month in which the action is taken except when a client fails to pay a Department approved fee. (In this situation, the case is closed and services terminated immediately.) If the advance notice is given in one month but the advance notice period extends into the following month, the client is eligible until the last day of the month in which the case is actually closed.
A case may also be closed when a client's behavior is disruptive to the delivery of services to other clients in the program. Prior to closing the case, the provider must give the client or his/her parent or guardian, when appropriate, a written warning stating that his/her behavior is disruptive to the program and that services will be terminated if the disruptive behavior is not corrected. This warning should include specific examples of disruptive behavior and changes the client can make in order to remain in the program and must be sent at least ten (10) days prior to initiating closure of the case. If the disruptive behavior has not been changed within ten (10) days, the provider must send Form DHHS-160, Notice of Action, giving the client ten (10) days advance notice that his/her case will be closed. Whenever possible, the provider should assist the client in finding an appropriate source for needed services.
If a client exhibits behavior that threatens the life, health or property of other clients or provider staff, his/her case may be closed immediately by documenting the client's violent behavior in the case narrative and notifying the client of termination of services on Form DHHS-160, Notice of Action. No advance notice is required.
A provider may find it necessary to change the funding source under which a client is receiving services. If the funding source is changed and services continue un-interrupted at no additional cost to the client, it is not necessary to send a Notice of Action, Form DHHS-160, to the client; however, a narrative entry should be made in the client's case record noting the change.
A change in funding source may be made temporarily (e.g., at the end of the contract year when SSBG funds are exhausted). If a re-determination of eligibility becomes overdue during the period that services are provided through another funding source, the case will be considered closed and the client must reapply for services using the Application for Services, Form
DHHS-100, if SSBG services are to be reinstated. If the period for which eligibility has been certified has not ended, services may be reinstated under SSBG with only a narrative entry in the client's case record. The re-evaluation due date will remain unchanged. During the period that services are provided under another funding source, the client's responsibility to report changes of status that may affect eligibility continues (see Section 4630).
If a case is closed, services are reduced, or a fee is imposed or increased while services are being provided under another funding source, the policies and procedures governing that funding source will apply and it will not be necessary to send the Notice of Action, Form DHHS-160.
Providers shall maintain an accurate and current individual case record at the facility in a readily accessible location for each client determined eligible. The record must contain the following completed forms:
In addition, narrative entries should be included to explain any circumstances not clarified on the forms listed above (e.g., if a home visit is made to establish eligibility it should be recorded in the case narrative).
To ensure compliance, a random sample of provider cases will be pulled by DHHS staff for a detailed review of all eligibility factors on at least an annual basis. The review will consist of a review of the client's case record, an interview with the client or authorized representative (if appropriate), and verification of eligibility factors. Client interviews will not be conducted in the following situations:
Protective Service Cases
Substitute care of children
Status eligible clients (Division of Youth Services)
Client deceased or moved from the area
Special waiver.
Arkansas has adopted a fee system with fee assessment based on client income adjusted by family size. The three types of fees that are allowable are flat fees, flat fees varying with income, and fees based on percentages of unit rates varying with client income. When fees are charged for a service, specific fee information will be detailed in the service chapters (Appendix C).
A fee may be assessed and collected from recipients of a specified SSBG service only when authorized in the purchase of service contract documents and this manual. If fees are charged for a particular service based on client income, a provider may not accept or reject a client based on the fee requirement. However, if a recipient fails to pay an allowable fee (one assessed in accordance with state guidelines and authorized in the contract document), then that recipient's case may be terminated.
The three types of allowable fees are listed and described below.
The division(s)/office(s) requiring fees will furnish fee scales to providers for services requiring income related fees. These scales are used with form DHHS-100 to determine client fees.
Fee tables or flat fee authorization forms are distributed by the division(s)/office(s) prior to the charging of fees for SSBG services by a provider.
Income scales of fee tables are updated to conform to any adjustment in income guidelines. Other updates are made as needs arise. For Unit Rate Percentage Fees, adjustments are made at the time of any change in unit rates in a particular contract. Changes in fee rates for Flat Fees and Flat Fees Varying With Income are made by revising the one set of tables for a service offered by a division or office. Changes in fee tables for these services should take place only on a regular schedule (e.g., annually).
The determination of fees and fee amounts are based on the criteria used to determine eligibility. Income for fee purposes is determined and computed for all service recipients in accordance with the procedures outlined in Section 4200 and the definitions listed in Sections 4210.E. - Income, 4210.F. -Monthly Gross Income, and 4210.G. - Exclusions from Monthly Gross Income.
When an income related fee is charged for a service, it is necessary to determine and compute income levels for both categorically and non-categorically eligible recipients, since fees are charged to both groups.
When a client applies for and is determined eligible to receive a service for which a fee is charged, the provider must inform the client of the assessed fee, using forms DHHS-100 and DHHS-160. If income related fees are charged, fee tables provided by the division/office will be used. Fees begin at the time of service delivery.
If at the time of re-evaluation a recipient who is not paying fee is found to be in an income range for which a fee is charged, or if a recipient paying a fee is found to be in an income range for which a higher fee will be charged, an advance notice, Form DHHS-160, must be given or sent to the recipient informing him/her that a fee will be charged, or that it will change. If the advance notice is given in one month but the advance notice period extends into the following month, the recipient's status with regard to fee assessment will not change until after the last day of the month in which the change is actually effective. No advance notice is necessary if a fee is dropped or decreased; however, the client must be notified with a DHHS-160 of the change. The client's fee status will not change until after the last day of the month in which the change is effective.
If retroactive eligibility is authorized for any recipient under the provisions of Section 4500 of this manual, fees will be assessed for any units of service which are billed with the fee assessment period extending back to the time authorized for retroactive eligibility.
For services for which a fee has been set in this manual, a client shall be denied the service or terminated immediately upon failure to pay the established fee (unless the provider or a third party desires to pay the fee for the client). If a client is terminated for nonpayment of a fee, the client is not eligible for other services requiring a fee until the client pays the required fee and any fees previously due from the client and unpaid. The client can, if otherwise eligible, receive any services not requiring a fee.
Fees are collected and retained by the provider. Each provider's monthly billing is reduced in an amount equal to the total of all fees assessed in that month. Uniform collection procedures for all SSBG recipients are established by the provider who may choose to schedule collections to take place up to one week in advance of service delivery, at the time of service delivery, or shortly after service delivery.
When a fee is charged, the fee is collected for each unit of service delivered.
When providers follow absentee billing procedures to obtain reimbursement for clients temporarily absent from the program, the provider must collect fees from the client for the absentee days and a fee must be collected for each unit billed to the state.
If a recipient fails to make fee payments, the provider shall arrange for collection of the fee, or, if necessary, for the termination of the service.
Client fee revenue and fee receivables accounts should be established in the provider's accounting system to reflect the assessment and collection of fees. All income from client fees should be properly receipted and documented in the provider's records.
The following financial guidelines are in addition to those published in the Financial Guidelines for Purchased Services and, taken together, provide the rules and regulations governing the methodology of financial control of SSBG funds administered by the Department of Health & Human Services (DHHS), Office of Finance and Administration.
Agreements for SSBG purchase of services in the State of Arkansas are normally required to be matched from state and/or local funds at a rate of 25 percent of the total contracted amount, unless otherwise specified in the official allocation.
The standard matching requirement may be increased or decreased for particular services if requested by the DHHS division/office responsible for the service and approved by the Chief Fiscal Officer of DHHS.
See Section 3700 of the Financial Guidelines for Purchased Services for regulations regarding matching funds.
In addition to the items listed in Section 3700 of the Financial Guidelines for Purchased Services, the following cannot be used to satisfy the matching requirement for SSBG funds:
It should also be noted that SSBG funds are not allowed to be used as matching funds for other state or federal funds except as allowed by specific state or federal statute.
An agency may donate property or the use of property to a provider to be considered as match. If title to the property is donated, the fair market value of the property may be considered as match. If the use of property or equipment is donated, the fair rental value may be considered as match. Please see the Financial Guidelines for Purchased Services for the acceptable methods of establishing fair rental or fair market value.
The Department may not receive more than 25 percent of the total federal fiscal year SSBG funds per quarter on a cumulative basis. In order to be able to maintain payment capabilities to all providers, the Department requires that payments to individual providers be limited by quarter.
Scheduled payments and advance payments reimbursement methodologies are not allowable under SSBG funding. Please refer to Section 3300 of the Financial Guidelines for Purchased Services for additional information.
In addition to the unallowable costs listed in Section 7400 of the Financial Guidelines for Purchased Services, the following are unallowable under SSBG funding:
The provider may only post suggested contribution schedules or distribute schedules to service recipients if authorized in writing by the Chief Fiscal Officer of the Department of Health & Human Services. Approval for provider posting and distributing of such schedules will comply with Department requirements, including but not limited to the following:
The contributions must be used only to fund allowable costs incurred in providing service to additional eligible clients and/or improved or expanded services to eligible clients. Any required audit must specify both the total amount of contributions received and the expenditure of the contributions.
Billing for absentee client provisions apply only to fixed enrollment service programs for which an enrollment limitation is specified. Clients may be temporarily absent from the program because of illness or some reason connected with the plan of service. The intent of the absentee billing policy is to avoid penalizing either the client (by filling the client's slot in the program due to temporary absence) or the provider (by not allowing reimbursement for the client's slot while it is held open pending the client's return). The facility must be open and the services available before absentee billing is allowable. Programs affected by this policy include day service centers, adult day care programs, residential facilities providing substitute care for children or youth, and supervised living services for adults.
For programs normally operating five days a week, billing for clients who are temporarily absent continue until the client has been absent for ten (10) consecutive program days regardless of the calendar month(s) involved. Note, however, that certain programs may have more restrictive policies that supersede this subsection.
For residential programs operating seven (7) days a week, billings for clients who are temporarily absent may continue until the client has been absent for fourteen (14) consecutive program days regardless of the calendar month(s) involved. Note, however, that certain programs may have more restrictive policies that supersede this subsection.
Absences from a residential program which are a part of the client's service plan (such as a home visit) are not counted as absences for billing purposes.
Billing for absentee clients is not permitted for those providers whose service programs are planned to serve different clients on different days. Absentee billing is also not permitted when a facility has negotiated a unit rate based on average daily attendance, or when a utilization factor has been added with the intent of offsetting absences.
Billing for absent clients is allowable only when there is a reasonable expectation the client will return to the program following the specified period of necessary absence. If the client is either discharged or leaves a facility and is not expected to return, billing must cease on the date the client leaves the facility.
If a subcontractor performs some or all of the contracted services for a provider, absentee billing will be permitted only to the extent that the provider is required to and actually does make payment to the subcontractor.
The provider must document the reason for each instance of billing for an absent client. The client's name, and days absent are minimum requirements. Furthermore, certain programs may require additional documentation.
Since providers delivering services on a daily basis may suffer financial losses when centers do not open because of inclement weather, a policy has been developed allowing the provider to submit billing for these situations. The policy may be applied when particular circumstances exist (as outlined below) and specified conditions are met. The policy differs from absentee billing policy in that it is applied when the center must close, while absentee billing takes place when the center is open and one or more clients fail to attend.
The policy may be applied by providers delivering a service to clients who must travel to and from a center on a daily basis. For providers serving clients on a fixed enrollment basis, billing will be for the total number of contracted program slots; for those with average daily attendance programs, billing will be for the average number of slots normally billed.
Billing for inclement weather is not allowable for Division of Developmental Disabilities Services.
When fees are charged, the policy provides for full unit rate reimbursement for those units billed on inclement weather days. This will avoid charging fees to a client for days when the center is closed.
Billing may be submitted for a maximum of five (5) days in a calendar month, for up to fifteen (15) days in a calendar year. The policy may only be applied when public schools in the provider's area of service have been forced to close because of inclement weather. (This should not be taken to mean that a provider must close when local schools close.)
If the provider's service area covers more than one public school district and not all of those districts close because of inclement weather, the provider will still have the option of closing the center; however, if clients are able to travel to and from the center, the provider is expected to open the center.
Before closing, every effort should be made to discuss the situation with the contract officer to determine alternatives to closing.
In certain cases, it may be necessary for a provider to close because of inclement weather even when local public schools remain open, or the provider may be forced to exceed the limitation on days stated in the above inclement weather policy. In these situations, the provider must request and receive special authorization to bill for additional inclement weather days from the Chief Fiscal Officer or designee.
Form DHHS-0145, Client and Service Data Sheet, is completed at the end of each billing period by the provider. The first page of this form summarizes:
By multiplying units times rate for each and all types of services, the provider can arrive at the gross amount due for services provided during the month. The fees assessed SSBG clients for the billed services should then be subtracted, showing the net amount due from SSBG.
The second and subsequent pages of the DHHS-0145 detail the services by client and include client data.
Billing forms are included in "Appendix D."
The DHHS-0145 is sent to the division/office with which the contractor/grantee has a legal agreement unless the contractor/grantee is given other instructions. (See Chapter thirteen of the Contract Manual for invoicing procedures.)
Division of Developmental Disabilities Services, Arkansas Rehabilitation Services, Division of Behavioral Health Services - Alcohol and Drug Abuse Prevention, Division of Aging and Adult Services and Arkansas Spinal Cord Commission all have their own method other than the DHHS-0145 to invoice and report client units served.
Inclement weather billing may be submitted for a maximum of five (5) days in a calendar month or fifteen (15) days in a calendar year. If possible, the provider should make every effort to discuss the situation with the contract officer before closing.
The provider will complete monthly billing for each client on a DHHS-0145 as usual, with units billed for normal operation entered as usual. Units billed under the inclement weather policy will be shown separately and as follows:
* enter the service code and description of service again immediately below the line showing normal billing;
* complete the Number of Units section showing total units billed under this policy; and
* enter the letter "W" in the Fee column to identify units billed in this manner and to show that no fee will be charged to the client by the provider.
When local schools are closed and the number of days (5 days per calendar month not to exceed 15 days per calendar year) have not been exceeded, the following applies:
When local schools are open and the provider determines that due to the weather conditions, closure of the facility is required or the number of days (5 days per calendar month not to exceed 15 days per calendar year) have been exceeded, the following procedure is followed:
In addition to the DHHS-0145 described above, a provider billing under actual cost reimbursement must submit a letter bill indicating what allowable expenditures were made during the month and the number of service units provided for each service. The total allowable expenditure for each service is divided by the number of units of that service to determine the unit rate. The unit rate is then multiplied by the number of units to compute the amount of reimbursement due the provider for that month. The provider will sign and date the letter and submit it to the division/office with which the contractor/grantee has a legal agreement unless the contractor/grantee is given other instructions. The billing and payment process is the same as described in Section 5610. For example, if a contractor provided 482 units of service in month X and the contract provides for a unit rate reimbursement of $22.50 per unit, then the total amount for the letter invoice should be $10,845.00 (482 X $22.50). Or, if the actual operational costs for the provider for month X was $22,792.45 and they serviced 823 units, the unit rate is calculated to be $27.69 ($22,792.45/823). Please see the Financial Guidelines for Purchased Services, Appendix C, for more examples of the Unit Rate Calculation.
If Medicare, Medicaid, private insurance, or any other source of third party payment for a SSBG client is available, those sources must first be exhausted. Every effort must be made by service providers to utilize Medicaid whenever possible. Documentation of the exhaustion of such benefits must be included in the client's case record. (Protective Service cases are exempt.)
If the source of third party recovery reimburses only a portion of the cost of a SSBG service, then only that portion not covered by the third party source may be billed to SSBG.
If an SSBG service provider receives an overpayment or duplicate payment for service to a SSBG client, the error must be promptly reported to CSS. An adjustment may be made on the next month's billing. Recoupment and/or appropriate audit activity will then be initiated.
The following appendices are adopted by reference in their entirety and are intended to be a part of the Social Services Block Grant Program Manual as if set forth fully herein.
APPENDIX A-1
GLOSSARY OF TERMS
GLOSSARY OF TERMS
Adult: By legal definition, either an individual who is 18 years of age or over or an emancipated minor.
Adult Single: See Single Adult.
Alcohol Abuse: Excessive use of or dependency on alcoholic beverages; or the use of alcoholic beverages to the extent that health is substantially impaired or endangered, or social or economic functioning is substantially disrupted.
Blind: Legal blindness is the condition in which visual acuity does not exceed 20/200 in the better eye with best correction or in which the field of vision is restricted to 20 degrees or less. Casework services may be extended to individuals with conditions involving progressive visual loss or a progressive eye disorder that will result in blindness.
Child: An individual between birth and 18 years of age unless the individual has been emancipated. (See definition of Emancipated Minor.) Individuals between 18 and 21 may be considered children in order that they may receive certain specified services. These services are: Substitute Care for Children for foster children under 21 when in school or training, in specialized foster care, in a residential treatment facility, or in a therapeutic foster care situation; Substitute Care for Youth for individuals ages 8 through 18.
Children, Foster: See Foster Children.
Client, Primary: The individual for whom or on behalf of, a service is given, i.e., the person for whom a goal is set. The terms "individual", "customer", "consumer" and "service recipient" are interchangeable with the term "client". *
Deaf and Hearing Impaired: Those individuals with physical impairment causing severe irreversible damage to the sensorineural and/or cortical structures of the ear necessary for normal hearing and whose condition has been present since birth or from the formative years and is not amenable to current medical or surgical treatment. The loss of functional hearing is of such magnitude as to severely impede or preclude the ability to hear conversational speech, as well as most information messages conveyed through sound, both vocal and non-vocal.
Delinquent Youth: Youth adjudicated as delinquent or youth referred by an official of the justice system because of an alleged delinquent act or a pattern of delinquent acts.
Developmental Disabilities: Any one or a combination of conditions which has continued or can be expected to continue indefinitely related to autism, cerebral palsy, epilepsy, and mental retardation (or a person who functions like a person with mental retardation) existing from birth or as a result of illness, accidents, or unknown causes prior to the age of twenty-two (22).
Disabled/Handicapped: Any individual who has a physical or mental condition which substantially limits one or more of such person's major life activities, who has a record of such an impairment, or who is regarded as having such impairment (includes alcohol and drug dependence). Drug Abuse: A physical or psychological condition characterized by excessive abuse of or dependency on drugs with increasing detachment from the normal assumption of responsibility for personal needs and those of dependents.
Emancipated Minor: An individual who has been given the right by a court to manage his own affairs or one who has acquired emancipation by common law. A common law emancipated minor is one upon whom has been conferred the right to his own earnings and whose parents' legal duty to support him has been terminated. This emancipation may be expressed by a voluntary agreement of parent and child (unless the child is mentally incompetent) or by the marriage of the minor. An emancipated minor or a child living in a residential facility or foster home or with an individual not legally responsible for his support is considered a one-person eligibility unit. A child living in a residential facility may make regular weekend visits home when authorized by the facility as a part of the treatment plan and still be considered a resident of the facility and therefore a one-person eligibility and fee assessment unit.
Estimate of Expenditures: All proposed costs for services including outlay for staff, purchase of service supplies, and other administrative costs.
Exclusions from Monthly Gross Income: See Income, Monthly Gross, Exclusions from.
Family: One or more adults and children, if any, related by blood or law and residing together in the same household. Spouses are legally responsible for each other and shall be considered as a part of the same family unit unless they reside in separate households (e.g., one spouse in a supervised living facility). If either spouse has legal responsibility for a child, then both spouses and the child are considered as a family unit. Where adults other than spouses reside together, each is considered a separate family by the state. Emancipated minors and children living under the care of individuals not legally responsible for their care are considered one-person families by the state.
FINS (Family in Need of Services): Any family whose juvenile shows evidence of behavior which includes, but is not limited to, the following:
o Being habitually and without justification absent from school while subject to compulsory school attendance;
o Being habitually disobedient to the reasonable and lawful commands of his parent, guardian, or custodian; or o Having absented himself from his home without sufficient cause, permission, or justification.
Foster Children: Children for whom a Division has legal custody or guardianship.
Foster Family Home: A home approved by the Division of Children and Family Services to provide room, board, and care including parenting for children.
Functional Dependency: A physical condition which limits an individual's ability to perform necessary self-care activities.
Income: Income is any monetary remuneration received on a regular basis, including a TEA payment. Only income currently available on a regular basis shall be considered. Lump sum and other one time payments shall be annualized, except for stock dividends. Unpredictable income of indeterminate amounts will not be considered, e.g., insurance settlement.
Income Monthly Gross: The following sources are considered in computing the family's monthly gross income:
Income, Monthly Gross, Exclusions from: The following are excluded from the computation of monthly gross income:
Medical Maintenance: Care directed toward the correction, amelioration, or stabilization of a medical condition which has been diagnosed as such by a licensed medical practitioner operating within the scope of medical practice as defined by state laws, and which care is provided by or under the direct supervision of such a medical practitioner or other health professional licensed by the state or accredited by the appropriate professional organization. Some medical services are allowable when:
Mental Retardation: A condition manifested in childhood, characterized by significantly sub-average general intellectual functioning existing concurrently with deficiencies in adaptive behavior, and diagnosed by a licensed or accredited medical or psychological practitioner.
Minor, Emancipated: See Emancipated Minor.
Monthly Gross Income: See Income, Monthly Gross.
Monthly Gross Income, Exclusions from: See Income, Monthly Gross, Exclusions from.
Primary Client: See Client, Primary.
Provider: See Social Services Block Grant (SSBG) Provider.
Services: Those activities provided the client to enable him to over-come barriers (problems) to goal achievement.
Single Adult: Where adults other than spouses reside together, each shall be considered a separate eligibility/fee assessment unit. An adult is an individual 18 years of age or older. Individuals 18-21 years of age may be considered a family member (approved on a case-by-case basis) for the purpose of determining income eligibility on behalf of the family. This applies only to individuals if they continue to receive the majority of their support from the family due to training, education (completion of high school activities) or unemployment.
Specific Learning Disabilities: Children with Specific Learning Disabilities are those who (despite average intellectual capacity) have significant discrepancies among developmental levels in language, perception, sensory motor integration, cognition, attention, activity level, and memory which interfere with achievement in the basic educational skills of reading, spelling, writing, and mathematics, and whose problems are not secondary to other handicapping conditions.
Spinal Cord Injured: Those individuals suffering from an injury to the spinal cord (through trauma, disease, or congenital dysfunctions such as spina bifida) who are substantially disabled. (See Disabled/Handicapped in GLOSSARY OF TERMS.)
Social Services Block Grant Services (SSBG) Provider: An organization, public or private, or individual that delivers services, directly or through contract, which are paid for in whole or in part by SSBG funds.
Status Offenders: Youth found by the court to be in need of service based on truancy, running away, or incorrigibility; or youth referred by an official of the justice system because of an alleged status offense or pattern of truancy, running away, or incorrigibility. (See FINS.)
Visually Impaired: Those individuals who have visual acuity in the better eye with best correction between 20/70 and 20/200; or an angle of vision subtending between 20 and 30 degrees; or a severe functional visual problem; or a progressive condition which will lead ultimately to a severe visual handicap or to blindness.
Youth at Risk: Youth who are clearly at risk of being processed as a delinquent or a status offender.
APPENDIX A-2
COMPONENT DEFINITIONS
COMPONENT DEFINITIONS
Advocacy: See SUPPORTIVE ACTIVITIES.
Aftercare: Services provided to youth committed to a youth service facility under the authority of the Division of Youth Services. Services to specific individuals may include: providing a field evaluation including recommendations for release plans; services to families of committed youth; visiting youth at the Youth Services facilities; developing an individualized case plan; advocacy on behalf of the youth; supervision; transportation and follow-up.
Arrangement: See SUPPORTIVE ACTIVITIES.
Assessment: An investigative process which may include administration and interpretation of appropriate evaluative tools in order to determine a client's adaptive behavior and functioning level, so that appropriate programming activities may be planned.
Attendant Activities: See PERSONAL CARE.
Camping: An experience which provides a creative recreational, social and educational opportunity to encourage each camper's mental, physical, and social growth through personal and social adjustment, recreational activities (such as swimming, classes, field trips, archery, and cookouts), and room and board.
Case Plan Development: Setting of client goals and objectives and determination with client of strategy to meet goals and objectives; selection of appropriate services, service providers, and treatment modes; scheduling of service delivery dates and times; estimating length of time or units of service required to meet client need; re-planning if necessary.
Casework Management: Significant communication, either directly or by correspondence, with or on behalf of a client. These communications must be in relation to the development of individualized case plans or the delivery of services based on a case plan. Services to specific individuals may include: gathering and processing social and medical information; developing an individualized case plan, including establishment of time-framed and measurable objectives; problem solving; consultation with youth and family; arrangement with other appropriate services; advocacy on behalf of the youth; supportive services; transportation and follow-up.
Child Day Care: Services to provide appropriate care for eligible children during any part of the calendar day (including after-school care) which met not only the normal supervisory, physical, health, and safety needs, but also provide for the intellectual, social, emotional, and physical growth and development of the child. These
ARKANSAS DEPARTMENT OF HEALTH AND HUMAN SERVICES
SOCIAL SERVICES BLOCK GRANT PROGRAM MANUAL
services are provided to enable employment of the parent or legal caretaker or relatives with physical custody (where the parent or parents are not residing in the household) to participate in training or education programs; or to prevent or remedy a family crisis.
Commodity Distribution: Activities involved in provision of food to eligible recipients, including transporting the commodities to distribution sites and storing and distributing the commodities.
Communication Equipment: Device or apparatus which enables or aids an individual to receive and transmit information orally, in writing, or in any other form which will assist that person to function more effectively in daily living or employment.
Community Integration Companion: Activities to instruct the individual in daily living and community living skills in integrated settings. Included are such activities as shopping, sports, participation in clubs, etc. Such services are focused on training/mentoring and are not meant to be recreational.
Comprehensive Training Center Activities: Activities provided to assist individuals in attaining needed skills. These are provided in a residential setting. Activities are: vocational assessment; aptitude testing; instruction in personal grooming and self-care; training; tutoring; attendant services; placement services; purchase of special clothing necessary to engage in training (such as cosmetology uniforms, protective aprons, mechanics' uniforms); and occupational therapy.
Consultation: See SUPPORTIVE ACTIVITIES.
Counseling, Group: Same as INDIVIDUAL AND FAMILY COUNSELING, but offered in a group setting where individuals can benefit from inter-action among group members and counselor(s).
Counseling, Individual and Family: Exploration of interests and skills; problem identification and resolution; identification of feasible goal; provision of emotional support and guidance; advice about community resources; provision of basic skills for functioning in the community; exploration with client of possible alternative behavior patterns; development and strengthening of capacity for personal and social functions. In family counseling, service is provided to one or more family members to help them fulfill their roles. Counseling is provided by a qualified professional (as defined by the DHHS Division or Office administering the program).
Court Study: Same as INVESTIGATION.
Court Testimony: In response to a subpoena, the person who developed a home study appears in court to give information and respond to questions under oath regarding the development of the report and to provide
ARKANSAS DEPARTMENT OF HEALTH AND HUMAN SERVICES
SOCIAL SERVICES BLOCK GRANT PROGRAM MANUAL
recommendations regarding the suitability of the home on which the report was developed for placement of children.
Counseling, Nutrition: See INSTRUCTION.
Day Treatment: A set of services rendered to patients who require more intensive care than that found in an outpatient program, but who do not require twenty-four hour inpatient or residential care. Day Treatment involves an integrated and programmed segment of care which includes a variety of services (such as group therapy and a variety of other techniques) in a group setting. Meals may be included in services.
(Such meals should meet the nutritional requirements outlined in MEAL, GROUP.)
Devices, Aids, and Appliances: Purchase or repair of devices and appliances such as hearing aids, artificial limbs, eyeglasses, mobility assistance appliances (e.g., wheelchairs, canes), aids for daily living, and necessary personal hygiene items. They may be purchased when necessary for a client to receive the specific social service and must not be currently available to the client through Titles XVIII or XIX.
Detoxification (Medical): Initial withdrawal from alcohol and other drug addiction in a medical environment as a portion of the overall addiction treatment process.
Diagnosis: Determination or re-determination of the detailed nature and extent of the client's problem, need, or condition; thorough investigation and analysis of the cause of the client's situation; usually includes a written description of the diagnosis prepared by a professional worker. (Distinguished from ASSESSMENT which is a brief evaluation and from DIAGNOSIS AND EVALUATION (MEDICAL) which usually focuses more on medical condition.) Also includes Psychosocial Evaluation and Vocational Evaluation. Diagnosis is performed by a qualified professional (as defined by the DHHS Division or Office administering the program).
Diagnosis and Evaluation (Medical): Determination of:
Drug Testing: Includes screening for any type of drug.
Emergency Shelter: Temporary care and protection, until a satis- factory plan can be made, for adults and children who have left or been removed from their homes and are in need of such immediate shelter and supervision services. Emergency shelter is provided for a maximum ninety days per placement depending on the needs of the client.
ARKANSAS DEPARTMENT OF HEALTH AND HUMAN SERVICESAppendix A-2
SOCIAL SERVICES BLOCK GRANT PROGRAM MANUAL07-01-05
(Individual contracts may limit the number of days per placement or the number of placements per year.)
Escort Services: Personal accompaniment of individual to and from service providers and other community resources. Assisting passenger in entering and leaving a vehicle; helping clients obtain needed services upon arrival at their destination; assistance with climbing stairs, entering doorways, crossing streets. Also includes personal accompaniment on common carriers for both intrastate and interstate transportation.
Follow-Along: Same as FOLLOW-UP.
Follow-Up: Maintenance of contact with client; determination of whether client has progressed toward objectives or goal, of service effectiveness and need for additional services, and of necessity for rescheduling service appointments.
Guidance and Job Placement: A process to aid individuals in developing work skills, habits, and attitudes to assist in job placement, education, and training. (Distinguished from COUNSELING which is not specifically focused on job placement.) Includes Vocational and Occupational Guidance. Placement activities include screening, selecting and referring job seekers to job openings; matching needs and ability of job seekers to jobs.
Habilitation Training: This activity includes planned experiencesthat are aimed at assisting the person to acquire, retain or improve their skills in a wide variety of areas that directly affect their ability to function as independently as possible in the community. This training will occur entirely, or in part, in clinical settings licensed by the Division of Developmental Disabilities Services
Health Education: Included in INSTRUCTION.
Health Screening: Brief determination of (1) general nature of physical or mental condition; (2) type and extent of need or problem; (3) urgency of need; and (4) appropriate service provider. Also includes administration of simple tests. These services are administered at service program sites only.
Hearing Evaluation (Non-Medical): Administration and interpretation of tests and evaluation of hearing by a qualified professional (as defined by the DHHS Division or Office administering the program).
Home Study: Determination of the type(s) of family (or families) appropriate for placement of a child, assessment of parenting potential of a family for the child(ren), and preparation of the family for permanent placement. Sometimes done in response to an out-of-town inquiry.
ARKANSAS DEPARTMENT OF HEALTH AND HUMAN SERVICESAppendix A-2
SOCIAL SERVICES BLOCK GRANT PROGRAM MANUAL07-01-05
Household Tasks: Household tasks include home cleaning, laundry, yard maintenance, shopping, and meal preparation. Information and Referral: See SUPPORTIVE ACTIVITIES.
Institutional Placement Services: Included in PLACEMENT.
Instruction: Direction and assistance in acquiring skills for adequate personal functioning, including household management, home maintenance, personal care, consumer affairs, nutrition, parenting, child care, infant stimulation, social skills, home health care, retirement planning, and safety. (Distinguished from training which consists of more formal activity. Instruction is usually provided on an individual basis, while training is provided in a group setting.)
Intake: Investigative process which may include initial interview; needs assessment; assistance with or completion of forms; eligibility determination; assessment of fees, if any; supervisory conferences; travel; preparation of written narratives/reports; and development of a preliminary case plan.
Integrated Support Services: Integrated Support Services provide the necessary support for an individual with a developmental disability to live in an independent situation (e.g., apartment, duplex, home) and/or a family environment. These services enable persons with a develop-mental disability to live, work, and enjoy recreational opportunities in the community.
Intensive Family Services: Services intended for families whose children are at imminent risk of out-of-home placement. Service goals are to prevent unnecessary out-of-home placements and to promote reunification of families with children in placement. Services are a combination of counseling services and support services based on a service model that emphasizes immediate, intense, short-term, in-home, and behaviorally oriented services to families.
Interpreter Services: Communication assistance for deaf, deaf/blind, blind, or non-English speaking individuals; assistance in understanding instructions or directions.
Intervention: Action to relieve a stressful situation or series of problems which are immediately threatening to a person's health and/or welfare.
Intervention, Crisis: Crisis intervention involves an immediate response to an unanticipated family disruption. Timely actions are taken to support and intervene to prevent further deterioration and, when possible, to utilize the momentum of the crisis to catalyze constructive changes. Crisis intervention is limited to thirty days.
ARKANSAS DEPARTMENT OF HEALTH AND HUMAN SERVICESAppendix A-2
SOCIAL SERVICES BLOCK GRANT PROGRAM MANUAL07-01-05
Investigation: Gathering of information needed to provide service, to establish the need for service or to prepare court documents; verification and substantiation of information. May include: COURT STUDY, OUT OF TOWN INQUIRY.
Legal Activities: Provision of legal advice, counseling and representation by attorneys and/or trained legal paraprofessionals in legal matters and the payment of associated legal costs.
Legal Guardianship Activities: See LEGAL ACTIVITIES.
Light Duties: See HOUSEHOLD TASKS and PERSONAL CARE TASKS.
Lodging: Purchase of temporary overnight accommodations associated with the intrastate or interstate transportation of clients. (Distinguished from ROOM AND BOARD and EMERGENCY SHELTER.)
Meal, Delivered: Meal delivery and service to a client's home. The meal must be a minimum of one-third of the daily recommended dietary allowance as established by the National Research Council. In certain instances such as emergencies or inclement weather, a meal which does not meet dietary allowance standards may be provided.
Meal, Group: Meal served to a client in a group setting (such as a senior citizen center), including food purchase and preparation. The meal must be a minimum of one-third of the daily recommended dietary allowance as established by the National Research Council. (In certain instances such as emergencies and inclement weather, a meal which does not meet dietary allowance requirements may be provided. For the same reasons, it may also be necessary to provide the meal in other than the usual group setting.) For day care for children, the cost of a snack may also be included as an allowable cost.
Medical Care: Care directed toward the correction, amelioration, or stabilization of a medical condition which has been diagnosed as such by a licensed medical practitioner operating within the scope of medical practice as defined by state laws. Care is provided by or under the direct supervision of such a medical practitioner or other health professional licensed by the state or accredited by the appropriate professional organization. Some medical services are allowable when:
Medical History: See DIAGNOSIS AND EVALUATION (MEDICAL).
Medical Support Services: Services provided in cases where additional medical diagnostic needs are identified at the time of the evaluation.
ARKANSAS DEPARTMENT OF HEALTH AND HUMAN SERVICESAppendix A-2
SOCIAL SERVICES BLOCK GRANT PROGRAM MANUAL07-01-05
This may occur after it is determined that the same service is not being provided through another source.
Out of Town Inquiry: See HOME STUDY and INVESTIGATION.
Outreach: Contact initiated by provider to identify clients (only those certified eligible) in need of services, to provide information about services, to inform about benefits, and to encourage the use of appropriate services; activities to assist individuals in gaining access to service; in some cases, associated with physically working outside in the community.
Peer Support: Provision of guidance, support, advice and information to a disabled person by a person with a disability who has successfully developed ways of coping with disability related issues. Supervision of peer supporters is provided by professional service agency staff.
Personal Care: Personal care is assistance with daily living tasks such as bathing, body hygiene and dressing, feeding, grooming, and assistance with special devices such as braces and artificial limbs.
Personal Care Instruction: See INSTRUCTION.
Personal Supplies: Obtaining and providing supplies to clients which are necessary for personal care. Also includes school supplies.
Placement: Locating, determining the suitability of placement, and situating client in an alternate living arrangement, including visit to facility with client. Includes INSTITUTIONAL PLACEMENT.
Prescription, Purchase and Administration of Drugs: Prescription, purchase, and administration of drugs to a client by legally authorized personnel. Prescription, purchase, or administration of drugs is allowable when:
Recreation: An activity in a group setting for individuals as participants, performers, or spectators. Activities (such as sports, performing arts, crafts, and games) are made available in order to increase social interaction, reduce isolation, and promote mental and physical health of the participants.
Recreational Supplies: Supplies provided to the client which are used in therapeutic recreational activities (for instance, sports equipment).
Report Development: The act of compiling a written report on the suitability of a home and/or persons being studied for the placement of children.
Residential Treatment: Care for individuals whose physical, emotional, or behavioral problems, as diagnosed by a qualified professional, cannot be remedied in their own home. Activities include: treatment planning; psychiatric and/or group therapy; psychosocial casework and/or counseling services to individuals and their families; educational consultation; tutoring; independent living training skill such as self care; non-medical speech therapy; health education; socialization experiences; recreational activities; non-medical transportation; personal supplies (such as notebooks or note paper); room and board; prescription, purchase, and administration of drugs.
Room and Board: Provision of shelter and three meals a day or any other full nutritional regimen. Room and board is allowed for selected social services of which it is a necessary but minor component, and is provided for a maximum of six (6) months per placement per year.
School Supplies: Included in PERSONAL SUPPLIES.
Social Interaction: Interaction of client with other clients or individuals through in-person contact in community facility or other facility outside the client's home, facilitated by a service provider process by which client learns to interact with society, including development of roles and expectations. Activities include: talking, listening, reading, writing, and other types of communication. (Distinguished from TELEPHONING and VISITING.)
Speech Evaluation (Non-Medical): Administration and interpretation tests and the evaluation of speech, the voice, and spoken and written language by a qualified professional to determine if defects in these areas exist.
The evaluation is performed by a qualified professional (as defined by the DHHS Division or Office administering the program).
Staffing: Interaction among agency staff to ensure continuity of services for clients. (Distinguished from CONSULTATION which is usually among inter-agency providers.)
Subsistence Services: Payment made to or on behalf of a client to cover basic subsistence expenses such as food, shelter, clothing, and other essential living costs incurred by the client during rehabilitation. The payment is provided only when the client requires the assistance to achieve his or her rehabilitation goals and objectives. (These payments are authorized in Section 2005 (a) (2) of the Social Services Block Grant Act.)
Supervision: Supervision of client, including leadership, direction, guidance, and watchful attention; overseeing of actions and behavior to
ARKANSAS DEPARTMENT OF HEALTH AND HUMAN SERVICESAppendix A-2
SOCIAL SERVICES BLOCK GRANT PROGRAM MANUAL07-01-05
safeguard rights and interest; protection against self-harm and harm to others.
Supportive Activities: Interaction of service recipient and professional staff member and other associated activities. Activities include: talking, listening, reading, and writing to assist the client to attain appropriate goal. (Distinguished from SOCIAL INTERACTION and VISITING.)
This unit is a part of case management activities and therefore, is different from counseling and therapy. Other activities not involving interaction between recipient and service staff are also allowable. They are:
Advocacy: Interaction between service providers and other individuals or agencies acting on behalf of the client to obtain rights and services and to represent client interests.
Consultation: Interaction between providers and specialists to share knowledge about client problems; outlining of case management responsibilities and decision on mix of services and appropriate service providers. (Distinguished from STAFFING which is usually intra-agency consultation.)
Information and Referral: Provision of answers to questions and of factual data about public or private services and service providers. Linkage with service provider; guidance and direction to appropriate community resources. (Distinguished from ARRANGEMENT because no appointment is made.)
Arrangement: Making appointments with service providers on behalf of the client. Also called SCHEDULING or ASSISTANCE. (Distinguished from REFERRAL where no appointment is made.)
Telephoning: Interacting with client by telephone for purposes of reducing social isolation and insuring health and safety; determining if special assistance is required; providing psychological reassurance; notifying contact person in case of no answer. (Distinguished from SOCIAL INTERACTION which takes place at a community facility and VISITING which involves going to the client's home.) Also called TELEPHONE REASSURANCE.
Testing, Psychological: Administration and interpretation of one or more of a variety of psychological tests by a licensed psychological examiner.
Therapy, Group: Contact between a group of clients and one or more clinical staff for the purpose of remediation of the client's problem and determination of client's progress.
Therapy, Individual (Medical): Individual therapy delivered by a psychiatrist.
ARKANSAS DEPARTMENT OF HEALTH AND HUMAN SERVICESAppendix A-2
SOCIAL SERVICES BLOCK GRANT PROGRAM MANUAL07-01-05
Therapy, Individual (Non-Medical): Individual, psychosocial, non-medical therapy delivered by a MSW/MA, by a Ph.D. psychologist, or by other clinical staff.
Therapy, Lay: Contact with the parents or guardian of a child on behalf of the child, in a protective service case, by a trained and supervised volunteer lay-therapist, directed toward improving parental functioning and, therefore, the child's environment to aid in eliminating or preventing child abuse and neglect.
Therapy, Occupational: The art or science of directing a client's response to selected activities to promote and increase independence in the home, maintain health and prevent disability, and train individual to function most effectively in his/her environment.
Therapy, Physical: Physical and mechanical treatment by a qualified professional using techniques such as massage and regulated exercise.
Physical therapy is provided by a qualified professional (as defined by the DHHS Division or Office administering the program).
Therapy, Speech (Non-Medical): The treatment of defects and diseases of the voice, of speech, and of spoken and written language. Non-medical speech therapy is that therapy which is not medical care.
Training Supplies: Supplies which are made available to an individual to assist her or him in training or in performing a job. In general, the devices are provided to a service recipient to help that person achieve the goals of a service plan. Items must be specifically related to training or employment. For example, special goggles needed for training could be purchased, but ordinary clothing could not. Other examples of these devices would be tools, shop aprons, and special adaptive items such as magnification aids for the visually impaired.
Transportation: Conveyance of client from one location to another.
Tutoring: Instruction supporting the continuance of education, usually on a one-to-one basis.
Visiting: Interaction of a socially and/or geographically isolated individual and a professional, paraprofessional, or volunteer by in-person contact in the client's home. Activities include: talking, listening, reading, and writing.
Vocational Training: Activities to aid individual in obtaining needed skills, including specific skills training, individual instruction, and purchase of special clothing required for training, such as uniforms and aprons.
APPENDIX A-3
SERVICE DELIVERY AREAS
SERVICE DELIVERY AREAS
For purposes of Social Services Block Grant planning and service delivery, Arkansas is divided into five Service Delivery Areas. Each Service Delivery Area (SDA) is comprised of a number of counties
The Service Delivery Areas, counties included in each area and the locations of the Department of Health & Human Services county offices are listed on the following page. The map following the list shows the Service Delivery Areas and counties
SSBG SERVICE DELIVERY AREAS AND LOCATIONS OF DEPARTMENT OF HEALTH AND HUMAN SERVICES COUNTY OFFICES
Service Area I
Baxter ................................. | .Mountain Home |
Benton ................................ | ........ Bentonville |
Boone ................................. | ............ Harrison |
Carroll ................................. | ........... Berryville |
Crawford ............................. | ......... Van Buren |
Franklin ............................... | ................ Ozark |
Logan .................................. | Booneville/Paris |
Madison .............................. | .......... Huntsville |
Marion ................................. | .............. Yellville |
Newton ................................ | ............... Jasper |
Polk ..................................... | ................. Mena |
Scott .................................... | ............ Waldron |
Searcy ................................. | ............ Marshall |
Sebastian ............................ | ......... Fort Smith |
Washington ......................... | ........ Fayetteville |
Service Area II
Clay ................................. | ................... Piggott |
Craighead ....................... | ............. Jonesboro |
Fulton .............................. | .................... Salem |
Greene ............................ | ............. Paragould |
Independence ................. | .............. Batesville |
Izard ................................ | ............. Melbourne |
Jackson ........................... | ................ Newport |
Lawrence ........................ | ........ Walnut Ridge |
Mississippi ..................... | Blytheville/Osceola |
Poinsett ........................... | ............. Harrisburg |
Randolph ........................ | ........... Pocahontas |
Sharp .............................. | ................. Ash Flat |
Service Area III
Cleburne ........... | ..................... Heber Springs |
Conway ............. | .............................. Morrilton |
Faulkner ............ | ............................... Conway |
Johnson ............ | ........................... Clarksville |
Lonoke .............. | ................................ Lonoke |
Perry ................. | ............................. Perryville |
Pope ................. | .......................... Russellville |
Prairie ............... | ....................... DeValls Bluff |
Pulaski ............. | Little Rock/North Little Rock |
Stone ................ | .................... Mountain View |
Van Buren ......... | ................................. Clinton |
White ................. | ................................. Searcy |
Woodruff ........... | ............................... Augusta |
Yell .................... | ............................... Danville |
Service Area IV
Calhoun ................................... | ...... Hampton |
Clark ........................................ | ..Arkadelphia |
Columbia .................................. | ...... Magnolia |
Dallas ....................................... | ........ Fordyce |
Garland .................................... | .. Hot Springs |
Hempstead .............................. | ............ Hope |
Hot Spring ................................ | ........ Malvern |
Howard .................................... | ...... Nashville |
Lafayette .................................. | ..... Lewisville |
Little River ................................ | ...... Ashdown |
Miller ........................................ | ....Texarkana |
Montgomery ............................. | ..... Mount Ida |
Nevada .................................... | ........ Prescott |
Ouachita .................................. | ....... Camden |
Pike ......................................... | Murfreesboro |
Saline ....................................... | ......... Benton |
Sevier ....................................... | ..... DeQueen |
Union ....................................... | ..... El Dorado |
Service Area V
Arkansas ............................. | DeWitt/Stuttgart |
Ashley ................................... | ......... Hamburg |
Bradley .................................. | ............ Warren |
Chicot .................................... | .... Lake Village |
Cleveland .............................. | ............... Rison |
Crittenden ............................. | West Memphis |
Cross .................................... | ............. Wynne |
Desha ................................... | ........ McGehee |
Drew ..................................... | ........ Monticello |
Grant ..................................... | ......... Sheridan |
Jefferson ............................... | ........ Pine Bluff |
Lee ........................................ | ......... Marianna |
Lincoln .................................. | .......... Star City |
Monroe .................................. | ....... Clarendon |
Phillips .................................. | ............ Helena |
St. Francis ............................. | ..... Forrest City |
DEPARTMENT OF HUtVlAM SERVfCES
Map of Service Defivery Areas
APPENDIX B
LIST OF SERVICE AND UNIT CODES
Refer to the service chapters (Appendix C) for service definitions, methods of delivery, eligible categories, descriptions of service activities, goal(s) for which services are rendered, objective(s), and the geographic area in which each service is available.
SERVICES
DISABLED
(Medical)
APPENDIX C
SERVICE CHAPTERS
Service chapters provide complete information of each service offered through the purchased services program. Each chapter is devoted to a separate service and includes the following:
The Arkansas Comprehensive Services Program Plan (CSPP), published annually by DHHS, lists the services authorized under the SSBG program. To be provided, a service must be listed or referenced in the CSPP or be a pilot project. (Certain aspects of Purchased Services may be initiated as pilot projects and may continue until sufficient data has been gathered and verified to determine the feasibility of incorporating the project into general use.) Service definitions in the service chapters are based on the CSPP. Unit definitions appear in service chapters. Updates to service chapters will be issued to reflect any changes or amendments to the CSPP.
The numbering system for the service chapters is based on the two-digit service code used by the Arkansas Department of Health & Human Services for service identification and billing. Each service is treated separately in a single service chapter, with here (3) major sections in each service chapter. The three sections in each chapter are:
Section A - SERVICE DEFINITION: This section shows the name of the service, the two-digit service code assigned to that service (as shown in Appendix B), and a brief definition of the service. (For easy reference, the name of the service and the service code will be repeated at the top of each page in Section B and Section C.)
Section B - SERVICE PAGES: These pages show how a division or office has tailored the service to meet the needs of that agency's client population. If more than one division or office is offering that service, the divisions/offices are presented in alphabetical order.
Section C -UNITS OF SERVICE: In addition to a review of the unit codes and unit titles (which were covered in Appendix B), unit definitions that exist for the service are provided in this section.
Here is a simple example of how the Service Chapters are organized. The two-digit service code for CHORE SERVICES is 03. Thus, the first two digits on all pages in that service chapter are 03. Section 03.A. lists the definition of "chore services." Section 03.B shows how the Division of Aging and Adult Services provides that service to its clients. Section 03.C shows the unit codes and titles, along with the unit definitions.
Services provided by a certified case manager chosen by the consumer whose role is to locate, coordinate and monitor a group of services. Services may include:
Eligibility Categories TEA Recipients | Goals |
1. Self-Support | |
SSI Recipients | 2. Self-Sufficiency |
Income Eligibles | 4. Prevention of Unnecessary |
Institutionalization |
Geographic Availability
This service is available statewide. Allowable Components (Purchase)
Case Plan Development | Follow Up |
Counseling, Group | Intake |
Counseling, Individual | Supportive Activities |
and Family |
One (1) unit = 5 minutes through 15 minutes Two (2) units = 16 minutes through 30 minutes Three (3) units = 31 minutes through 45 minutes Four (4) units = 46 minutes through 60 minutes
The performance of household chores such as running errands, preparing food, simple household tasks, heavy cleaning, and yard and walk maintenance which client is unable to do alone and which do not require the services of a trained homemaker or other specialist. Chore does not include medically-oriented personal care tasks or any household management tasks such as menu planning, bill paying, checking account management, etc.
Eligibility Categories | Goals |
TEA Recipients | 2. Self-Sufficiency |
SSI Recipients Income Eligibles | 3. Prevention of Neglect, Abuse, or Exploitation |
4. Prevention of Unnecessary Institutionalization |
Geographic Availability
Services available statewide. Services currently being provided in Service Delivery Areas III, IV, and V. (Aging and Adult Services Regions V and VII)
Allowable Components (Purchase)
Case Plan Development | Supportive Activities |
Household Tasks | Transportation |
Special Notes
This service is available to individuals sixty years or older or to the spouse of an individual who is sixty years or older and receiving services through SSBG or Title III of the Older Americans Act. The service is also available to a handicapped/disabled individual who is a dependent of and residing with an individual who is sixty years or older and receiving services through SSBG or Title III. In protective services cases (as certified by the Protective Services Unit of the Division of Aging and Adult Services), any adult will be eligible for the service.
Adult day care is a group program designed to provide care and supervision to meet the needs of four or more functionally impaired adults for periods of less than twenty-four hours, but more than two hours per day in a place other than the adult's home.
Eligibility Categories TEA Recipients | Goals |
2. Self-Sufficiency | |
SSI Recipients Income Eligibles | 3. Prevention of Neglect, Abuse, or Exploitation |
4. Prevention of Unnecessary Institutionalization |
Geographic Availability
Available statewide. Service is delivered in Service Delivery Areas III, IV, and V (Aging and Adult Services Regions V and VII) and may be provided in additional service delivery areas if funding becomes available.
Allowable Components (Purchase)
Case Plan Development | Meal, Group |
Escort Services | Social Interaction |
Health Screening | Supportive Activities |
Instruction | Transportation |
Interpreter Services |
Special Notes
This service is available to individuals sixty years or older. The service is also available to a handicapped/ disabled individual who is a dependent of and residing with an individual who is sixty years or older and receiving services through SSBG or Title III. In protective services cases (as certified by the Protective Services Unit of the Division of Aging and Adult Services), any adult will be eligible for the service.
Service to provide a hot meal (or other as appropriate) that contains at least one-third (1/3) of the nutritional value of the Recommended Daily Allowance (R.D.A.). Meal is delivered to the client's home.
Eligibility Categories | Goals |
TEA Recipients | 2. Self-Sufficiency |
SSI Recipients Income Eligibles | 3. Prevention of Neglect, Abuse, or Exploitation |
4. Prevention of Unnecessary Institutionalization |
Geographic Availability Available statewide.
Allowable Components (Purchase)
Case Plan Development | Meal, Delivered |
Instruction | Outreach |
Special Notes
This service is available to individuals sixty years or older or to the spouse of an individual who is sixty years or older and receiving services through SSBG or Title III of the Older Americans Act. The service is also available to a handicapped/disabled individual who is a dependent of and residing with an individual who is sixty years or older and receiving services through SSBG or Title III. In protective services cases (as certified by the Protective Services Unit of the Division of Aging and Adult Services), any adult will be eligible for the service.
The Instruction component of this service will be limited to the provision of nutritional information to clients.
In the event of weather-related emergencies (for instance, snow and ice, extreme heat and cold, tornados, or other disasters), participants may be provided either the regular home-delivered meals or an alternative meal arrangement which ensures that participants receive meals.
Services to or on behalf of adults (age eighteen and over) who are threatened by harm through the action or inaction of another individual or through other hazardous circumstances.
PROTECTIVE SERVICES FOR ADULTS SERVICE CODE 17
Eligibility Categories TEA Recipients | Goals 3. Prevention of Neglect, |
SSI Recipients | Abuse, or Exploitation |
Income Eligibles | |
Without Regard to Income |
Geographic Availability Available statewide.
Allowable Components (Purchase)
Case Plan Development | Instruction |
Child Day Care | Intervention |
Counseling, Group | Investigation |
Counseling, Individual/ | Legal Activities |
Family | Outreach |
Diagnosis | Social Interaction |
Emergency Shelter | Supportive Activities |
Follow-up | Transportation |
Special Note
Service limited to individuals who are victims of domestic violence and living in a domestic violence shelter.
Services on behalf of neglected, abused, or exploited children (including runaways), which are designed to prevent or remedy that situation and include strengthening parental child care capacity, preserving family life, and providing a safe environment for the child.
Eligibility Categories | Goals |
TEA Recipients | 3. Prevention of Neglect, |
SSI Recipients | Abuse or Exploitation |
Income Eligibles | |
Without Regard to Income |
Geographic Availability Available statewide.
Counseling, Group | Instruction |
Counseling, Individual | Intervention, Crisis |
and Family | Supervision |
Home Study |
Services are non-residential support services directed toward amelioration of behavioral and/or emotional problems in order to allow the juvenile to transition back into his or her home or community, and to prevent or reduce the need for re-institutionalization.
Eligibility Categories Goals |
TEA Recipients 1. Self-Support |
SSI Recipients 2. Self-Sufficiency |
Income Eligibles 4. Prevention of Unnecessary |
Status Eligible Institutionalization |
Geographic Availability
Available statewide. The service is delivered through programs located in Service Delivery Areas II and III.
Allowable Components (Purchase)
Casework Management: Significant communication, either directly or by correspondence, with or on behalf of a client. These communications must be in relation to the development of individualized case plans or the delivery of services based on a case plan. Services to specific individuals may include: gathering and processing social and medical information; developing an individualized case plan, including establishment of time-framed and measurable objectives; problem solving; consultation with youth and family; arrangement with other appropriate services; advocacy on behalf of the youth; supportive services; transportation; and follow-up.
Assessment | Follow-up |
Case Plan Development | Intervention |
Counseling, Group | Investigation |
Counseling, Individual | Supportive Activities |
and Family | Transportation |
Therapy: Therapeutic relationship between a client and a qualified therapist (as defined by the individual's professional license in the State of Arkansas) for the purpose of accomplishing changes that are identified as goals in the treatment plan. May include individual therapy or group therapy, and consultation with the referral source as needed.
Case Plan Development | Supportive Activities |
Counseling, Group | Testing, Psychological |
Counseling, Individual | Therapy, Group |
and Family | Therapy, Individual |
Diagnosis | (Medical) |
Intervention | Therapy, Individual |
(Non-Medical) |
(Continued)
Diagnosis and Evaluation: Assessment of the nature and ex- tent of a youth's emotional and/or behavioral problems and recommendations for treatment strategies to remedy the identified problems. The specific diagnostic services provided and/or the level of sophistication of reports produced for the referring agency in any individual case would be based on an assessment of the youth and information needs of the referring agency. Services to specific individuals may include: educational evaluation, social assessment, psychological evaluation, psychiatric evaluation, and consultation with the referring/treatment agency. Assessment and planning may also include medical evaluation, if one of the above assessments indicates a physical association with the emotional and/or behavioral problem(s).
Diagnosis | Supportive Activities |
Diagnosis and Evaluation | Testing, Psychological |
(Medical) |
Special Note
For purposes of income eligibility determination, youth over the age of eighteen can be considered for this service through a special waiver request.
* Services to facilitate client's involvement (as spectator or participant) in activities, sports, arts, crafts, games and for social interaction to promote personal enrichment, satisfying use of leisure time, or development of new skills or knowledge, and/or to reduce social isolation.
TEA Recipients | 2. Self-Sufficiency |
SSI Recipients Income Eligibles | 3. Prevention of Neglect, Abuse, or Exploitation |
4. Prevention of Unnecessary Institutionalization |
Geographic Availability
Available statewide. (Aging and Adult Services Regions I, II, III, IV, VI, VII and VIII)
Allowable Components (Purchase)
Case Plan Development | Recreation |
Health Screening | Social Interaction |
Instruction | Supportive Activities |
Interpreter Services | Telephoning |
Outreach | Visiting |
Special Notes
This service is available to individuals sixty years or older or to the spouse of an individual who is sixty years or older and receiving services through SSBG or Title III of the Older Americans Act. This service is also available to handicapped/ disabled individuals who are a dependent of and residing with an individual who is sixty years or older and receiving services through SSBG or Title III. In protective services cases (as certified by the Protective Services Unit of the Division of Aging and Adult Services), any adult will be eligible for the service.
Supportive services uniquely required by blind and visually impaired persons. These services are designed to provide the client with personal training to overcome barriers to effective participation in community life skills activities.
Eligibility Categories | Goals |
TEA Recipients | 2. Self-Sufficiency |
SSI Recipients | |
Income Eligibles |
Geographic Availability
Available statewide. The service is delivered through a program located in Service Delivery III.
Allowable Components (Direct) Communication Equipment
Services are designed to assist persons to function at their highest level of independence despite any limiting physical or mental conditions which may include drug and alcohol dependency.
Eligibility Categories | Goals |
TEA Recipients | 1. Self-Support |
SSI Recipients | 2. Self-Sufficiency |
Income Eligibles | 4. Prevention of Unneces Institutionalizatio |
Geographic Availability Available Statewide.
Allowable Components (Purchase) Guidance and Job Placement Meal, Group
Special Notes
Work activity center services are provided by the Division only to individuals with developmental disabilities as defined in the Glossary.
Services are available to individuals twenty-one years old or older. Individuals under twenty-one may also receive the service, but only if they have completed public school activities. This service does not take the place of public school education or services.
Eligibility Categories | Goals |
TEA Recipients | 1. Self-Support |
SSI Recipients | 2. Self-Sufficiency |
Income Eligibles | 3. Prevention of Neglect, Abuse, or Exploitation |
4. Prevention of Unnecessary | |
Institutionalization |
Geographic Availability Available statewide.
Allowable Components (Purchase)
Assessment Counseling, Group | Counseling, Individual and Family |
Supportive Activities |
Eligibility Categories TEA Recipients | Goals 1. Self-Support |
SSI Recipients | 2. Self-Sufficiency |
Income Eligibles | 3. Prevention of Neglect, |
Abuse, or Exploitat | |
4. Prevention of Unnecess | |
Institutionalizatio | |
5. Appropriate Institu- | |
tionalization |
Geographic Availability Available statewide.
Allowable Components (Direct) | Allowable Components (Purchase) |
Case Plan Development | Case Plan Development |
Counseling, Group | Communication Equipment |
Counseling, Individual | Counseling, Group |
and Family | Counseling, Individual |
Devices, Aids and Appliances Diagnosis Diagnosis and Evaluation | and Family Devices, Aids and Appliances |
(Medical) | Follow-Up |
Follow-Up Guidance and Job Placement Inst | Guidance and Job Placement ruction |
Instruction Interpreter Services | Interpreter Services Meal, Group |
Intervention | Peer Support |
Subsistence Services | Personal Care |
Supportive Activities | Recreation |
Therapy, Occupational | Subsistence Services |
Therapy, Physical | Supportive Activities |
Therapy, Speech | Therapy, Physical |
(Non-Medical) | Therapy, Speech |
Training Supplies | (Non-Medical) |
Transportation | Transportation |
Tutoring | |
Vocational Training |
Special Notes
Arkansas Rehabilitation Services (ARS) requires that there be an open ARS case for any client to whom this service is provided. This requirement is made to ensure that services are offered as part of a complete ARS case plan. The designated ARS representative may authorize services for clients under the age of 18 if all other eligibility requirements are met. For direct and purchased service components, a client 16 years of age or older is considered an adult.
Eligibility Categories | Goals |
TEA Recipients | 1. Self-Support |
SSI Recipients | 2. Self-Sufficiency |
Income Eligibles | 3. Prevention of neglect Abuse, or Exploitat |
4. Prevention of Unneces Institutionalizatio | |
5. Appropriate Instituti alization |
Geographic Availability Available statewide.
Allowable Components (Direct)
Camping | Outreach |
Case Plan Development | Personal Care |
Communication Equipment | Personal Supplies |
Counseling, Individual | Placement |
and Family Devices, Aids and Appliances | Prescription, Purchase and Administration of Drugs |
Diagnosis | Supervision |
Diagnosis and Evaluation | Supportive Activities |
(Medical) | Telephoning |
Escort Services | Therapy, Individual |
Follow-Up | (Medical) |
Household Tasks | Therapy, Individual |
Instruction | (Non-Medical) |
Intervention | Therapy, Physical |
Investigation | Transportation |
Special Notes
To meet individual client needs, the Commission's case managers may arrange for the purchase of services, supplies, or devices to supplement the services they provide.
Eligibility Categories TEA Recipients | Goals |
1. Self-Support | |
SSI Recipients Income Eligibles | 2. Self-Sufficiency |
Geographic Availability
Available statewide. Developed through a program located in Service Delivery Area III.
Allowable Components (Purchase)
Case Plan Development | Instruction |
Counseling, Group | Outreach |
Counseling, Individual | Supportive Activities |
and Family | Transportation |
Follow-Up | |
Guidance and Job Placement |
(SSBG recipients of Extended Services must have an open Division of Rehabilitation Services case and the service must have been authorized by one of the Division's counselors.)
Service provides selective placement in an alternate living situation, such as a foster home, group home, or residential treatment facility for a planned period of time for a child who has to be separated from his natural or legal parents. This service includes casework and intervention services with the child, his parents/guardians, caregivers, and community resources.
Eligibility Categories | Goals |
TEA Recipients | 1. Self-Support |
SSI Recipients | 2. Self-Sufficiency |
Income Eligibles | 3. Prevention of Neglect, |
Abuse, or Exploitation | |
4. Prevention of Unnecessary | |
Institutionalization | |
5. Appropriate Institution- | |
alization |
Geographic Availability
Services are available statewide. Purchased services are delivered in Service Areas III and V.
Allowable Components (Purchase)
Emergency Shelter for Children: Emergency shelter available on a twenty-four hour basis for up to forty-five days in a six-month period for children who have left or have been removed from their homes and are in need of such immediate shelter and supervision services.
Case Plan Development | Placement |
Counseling, Group | Prescription, Purchase, and |
Counseling, Individual | Administration of Drugs |
and Family | Recreational Supplies |
Follow-up | Room and Board |
Instruction | Social Interaction |
Intervention | Supportive Activities |
Intervention, Crisis | Therapy Group |
Legal Activities | Therapy, Individual |
Medical Care | (Non-Medical) |
Outreach | Transportation |
Personal Supplies |
Residential Treatment Care: Treatment provided in a residential facility. Service is provided for individuals whose physical, emotional, or behavioral problems cannot be remedied in their own home, as diagnosed by a qualified professional. (Services may include therapeutic camping experiences for clients served in a residential treatment program.) The following activities (described in terms of standard components) are offered as needed to individual clients:
Case Plan Development | Prescription, Purchase, and |
Counseling, Group | Administration of Drugs |
Counseling, Individual | Recreation |
and Family | Recreational Supplies |
Diagnosis | Room and Board |
Diagnosis and Evaluation | Social Interaction |
(Medical) | Supportive Activities |
Follow-Up | Testing, Psychological |
Home Study | Therapy, Group |
Instruction | Therapy, Individual |
Intervention, Crisis | (Non-Medical) |
Medical Care | Therapy, Speech |
Personal Supplies | Transportation |
Placement | Tutoring |
Special Notes
This service is provided to children (defined under "Child" in the Glossary) and to individuals between eighteen and twenty-one years of age if already a client of DCFS.
The service is provision of care in a group living facility for all or part of a calendar day for individuals with socially diagnosed problems of functional dependency, alcoholism, drug abuse, medically and/or psychologically diagnosed problems of emotional illness, or mental retardation/ developmental disabilities, and youth in need.
Eligibility Categories | Goals |
TEA Recipients | 1. Self-Support |
SSI Recipients | 2. Self-Sufficiency |
Income Eligibles | 3. Prevention of Neglect, Abuse, or Exploitation |
4. Prevention of Unnecessary Institutionalization |
Geographic Availability Available statewide.
Allowable Components (Purchase)
Assessment | Residential Treatment |
Special Notes
Any facility which serves clients under the age of eighteen must comply with the Child Care Facility Licensing Act.
While the Supervised Living Facility provides basic treatment in a residential setting, other CSPP services may be purchased separately for individuals, as needed, if not already included in the Supervised Living Services.
Eligibility Categories | Goals |
TEA Recipients | 1. Self-Support |
SSI Recipients Income Eligibles | 2. Self-Sufficiency |
Geographic Availability
Services are available statewide; delivered in residential program located in Service Delivery Area III.
Allowable Components (Purchase)
Case Plan Development | Follow-Up |
Counseling, Group | Personal Care |
Counseling, Individual | Room and Board |
and Family | Supervision |
Diagnosis | Supportive Act |
Special Notes
Any facility which serves clients under the age of eighteen must comply with the Child Care Facility Licensing Act.
While the Supervised Living Facility provides basic treatment in a residential setting, other CSPP services may be purchased separately for individuals, as needed, if not already included in the Supervised Living Services.
Services provided for all or part of a calendar day in a supervised living program, which includes payment for room and board under SSBG, constitute one unit of service.
* Residential detoxification includes twenty-four hour per day nursing care and daily physician services to clients while undergoing detoxification in a residential/live-in setting. Daily physician services must include physician-patient contact and the physician's review of the patient's progress. One day (all or any part of a calendar day) constitutes a unit of service.
Those activities which, when not otherwise available, are planned with individuals in order that they may fulfill their intellectual potential for employment through education or training denied to them without positive intervention.
Eligibility Categories | Goals |
TEA Recipients | 1. Self-Support |
SSI Recipients Income Eligibles | 2. Self-Sufficiency |
Geographic Availability
Available statewide. Service is delivered in a residential program located in Service Delivery Area IV.
Allowable Components (Direct)
Assessment | Room and Board |
Case Plan Development | Supervision |
Comprehensive Training | Supportive Activities |
Center Activities | Testing, Psychological |
Counseling, Group | Therapy, Group |
Counseling, Individual | Therapy, Individual |
and Family | (Non-Medical) |
Guidance and Job Placement Training Supplies | |
Interpreter Services | Tutoring |
Medical Care | Vocational Training |
Special Notes
Arkansas Rehabilitation Services (ARS) requires that there be an open ARS case for any client to whom this service is provided. This requirement is made to ensure that services are offered as part of a complete ARS case plan. The designated ARS representative may authorize services for clients under the age of eighteen if all other eligibility requirements are met. For direct and purchased service components, a client sixteen years of age or older is considered an adult.
Transporting client from one location to another by public or private vehicle so that client has access to needed service, care or assistance. SSBG funding may be used for this service only when the service is not available through Title XVIII or XIX of the Social Security Act.
Eligibility Categories TEA Recipients | Goals |
2. Self-Sufficiency | |
SSI Recipients Income Eligibles | 3. Prevention of Neglect, Abuse, or Exploitation |
4. Prevention of Unnecessary Institutionalization |
Geographic Availability Available statewide.
Allowable Components (Purchase)
Case Plan Development Escort Services | Transportation |
Special Notes
This service is available to individuals sixty years or older or to the spouse of an individual who is sixty years or older and receiving services through SSBG or Title III of the Older Americans Act. The service is also available to a handicapped/disabled individual who is a dependent of and residing with an individual who is sixty years or older and receiving services through SSBG or Title III. In protective services cases (as certified by the Protective Services Unit of the Division of Aging and Adult Services), any adult will be eligible for the service.
Eligibility Categories TEA Recipients | Goals |
1. Self Support | |
SSI Recipients | 2. Self-Sufficiency |
Income Eligibles | 4. Prevention of Unnecessary Institutionalization |
Geographic Availability Available statewide.
Allowable Components (Purchase) Transportation
Organized efforts performed by trained personnel in certified mental health facilities to help individuals to overcome mental, emotional, social, and psychological dysfunctioning.
Eligibility Categories | Goals |
TEA Recipients | 1. Self-Support |
SSI Recipients | 2. Self-Sufficiency |
Income Eligibles | 3. Prevention of Neglect, Abuse, or Exploitation |
4. Prevention of Unnecessary Institutionalization | |
5. Appropriate Institution-alization |
Geographic Availability Available statewide.
Allowable Components (Purchase)
Case Plan Development | Speech Evaluation |
Counseling, Group | Supportive Activities |
Counseling, Individual | Testing, Psychological |
and Family | Therapy, Group |
Day Treatment | Therapy, Individual |
Diagnosis | (Medical) |
Diagnosis and Evaluation (Medical) | Therapy, Individual (Non-Medical) |
Follow-Up Meal, Group | Therapy, Speech (Non-Medical) |
Prescription, Purchase, and Administration of Drugs Residential Treatment | Transportation |
Services to children and families of children based on individual family services plan. These services allow children and families to receive training to strengthen the child/family functioning in their home and community.
Eligibility Categories | Goals |
TEA Recipients | 2. Self-Sufficiency |
SSI Recipients | 4. Prevention of Unnecessary |
Income Eligibles | Institutionalization |
Geographic Availability Available statewide.
Allowable Components (Purchase)
Habilitation Training | Meal, Group |
Services delivered at the request of a court or child welfare agency which may include gathering information about a family or families and presentation of the information to the court in a written report. Testimony in court about the report may be required. Supervision of visitation and development of a written report resulting from the visitation may also be included.
Eligibility Categories | Goals |
TEA Recipients SSI Recipients | 3. Prevention of Neglect, Abuse or Exploitation |
Income Eligibles |
Geographic Availability Available statewide.
Allowable Components (Purchase)
Court Testimony | Report Development |
Home Study | Supervision |
Service to provide hot meals (or other as appropriate) that contain at least one third (1/3) of the nutritional value of the Recommended Daily Allowance (R.D.A.). Meals are served in a group setting such as a senior center or elderly housing facility.
Eligibility Categories | Goals |
TEA Recipients | 2. Self-Sufficiency |
SSI Recipients Income Eligibles | 3. Prevention of Neglect, Abuse, or Exploitation |
4. Prevention of Unnecessary Institutionalization |
Geographic Availability Available statewide.
Allowable Components (Purchase)
Case Plan Development | Meal, Group |
Instruction | Outreach |
Special Notes
This service is available to individuals sixty years or older or to the spouse of an individual who is sixty years or older and receiving services through SSBG or Title III of the Older Americans Act. This service is also available to a handicapped/disabled individual who is a dependent of and residing with an individual who is sixty years or older and receiving services through SSBG or Title III. In protective services cases (as certified by the Protective Services Unit of the Division of Aging and Adult Services), any adult will be eligible for the service.
The Instruction Component of this service will be limited to the provision of nutritional information to clients.
* Supportive Services for Children and Families is a coordinated set of services designed to address a wide range of problems. This service is intended to help parents in their child-rearing role, promote healthy development and social functioning of children, prevent unnecessary removal of children from their homes, strengthen family functioning, and meet the needs of families in crisis.
SUPPORTIVE SERVICES FOR CHILDREN AND FAMILIES SERVICE CODE 38
Eligibility Categories | Goals |
TEA Recipients | 1. Self-Support |
SSI Recipients | 2. Self-Sufficiency |
Income Eligibles | 3. Prevention of Neglect Abuse or Exploitati |
Geographic Availability This service is available statewide.
Allowable Components (Purchase)
Counseling, Group | Instruction |
Counseling, Individual | Intensive Family Services |
and Family | Intervention, Crisis |
Home Study | Supervision |
Special Notes
This service interfaces with Title IV-B and, as a child welfare service, is provided without regard to income. This service is a clustered service which comprises emergency services, supportive services to children in their own home, employment services, services to youth in need and transportation services. To meet individual client needs, the Division's staff may arrange for the purchase of services or supplies to supplement the services they provide.
Eligibility Categories | Goals |
TEA Recipients | 1. Self-Support |
SSI Recipients | 2. Self-Sufficiency |
Income Eligibles | 3. Prevention of Neglect, Abuse, or Exploitation |
4. Prevention of Unnecessary Institutionalization | |
5. Appropriate Institu-tionalization |
Geographic Availability
Available statewide. Developed through programs located in Service Delivery Areas III and V.
Allowable Components (Purchase)
Case Plan Development | Outreach |
Commodity Distribution Instruction | Supportive Activities |
Eligibility Categories | Goals |
TEA Recipients | 2. Self-Sufficiency |
SSI Recipients Income Eligibles | 3. Prevention of Neglect, Abuse or Exploitation |
4. Prevention of Unnecessary Institutionalization | |
5. Appropriate Institution-alization |
Geographic Availability This service is available statewide.
Allowable Components (Purchase) Diagnosis and Evaluation (Medical)
Services provide selective placement in a foster home, group home, or residential treatment facility for a planned period of time for delinquent youth committed to the Division of Youth Services by a Juvenile/Chancery Court. This service includes casework and intervention service with the youth, parents/guardians, caregivers, and community resources.
SERVICE CODE 42
Eligibility Categories Goals |
TEA Recipients 1. Self-Support |
SSI Recipients 2. Self-Sufficiency |
Income Eligibles 4. Prevention of Unnecessary Status Eligible Institutionalization |
Geographic Availability Available statewide.
Allowable Components (Purchase)
Assessment | Personal Supplies |
Case Plan Development | Placement |
Casework Management | Prescription, Purchase and |
Counseling, Group | Administration of Drugs |
Counseling, Individual and Re | creational Supplies |
Family | Room and Board |
Diagnosis | Social Interaction |
Diagnosis and Evaluation | Supportive Activities |
(Medical) | Testing, Psychological |
Follow-up | Therapy, Group |
Instruction | Therapy, Individual |
Intervention, Crisis | (Non-Medical) |
Medical Care | Transportation |
Outreach |
Special Notes
For purposes of income eligibility determination, youth over the age of eighteen can be considered for this service through a special waiver request.
Organized efforts performed by trained personnel in certified mental health facilities to help individuals overcome mental, emotional, social, and psychological dysfunctioning.
Eligibility Categories | Goals |
TEA Recipients | 1. Self-Support |
SSI Recipients | 2. Self-Sufficiency |
Income Eligibles | 3. Prevention of Neglect, Abuse, or Exploitation |
4. Prevention of Unnecessary Institutionalization 5. Appropriate Institution- alization |
Geographic Availability Available statewide.
Allowable Components (Purchase)
Case Plan Development | Residential Treatment |
Counseling, Group | Speech Evaluation |
Counseling, Individual | Supportive Activities |
and Family | Testing, Psychological |
Day Treatment | Therapy, Group |
Diagnosis | Therapy, Individual |
Diagnosis and Evaluation | (Medical) |
(Medical) | Therapy, Individual |
Follow-Up | (Non-Medical) |
Meal, Group | Therapy, Speech (Non- |
Prescription, Purchase, and | Medical) |
Administration of Drugs | Transportation |
May include prescribing and administering drugs by a physician or registered nurse. Each quarter hour of service constitutes one unit.
Services necessary to maintain a person with a developmental disability in their community. Services are based on an individual service plan and include such services as adult development, vocational maintenance and personal care.
Eligibility Categories | Goals |
TEA Recipients | 1. Self-Support |
SSI Recipients | 2. Self-Sufficiency |
Income Eligibles | 4. Prevention of Unnecessary Institutionalization |
Geographic Availability Services are available statewide.
Allowable Components (Purchase)
Child Day Care | Meal, Group |
Emergency Shelter | Personal Care |
Guidance and Job Placement Supp | ortive Activities |
Habilitation Training | Therapy, Occupational |
Integrated Support Services | Therapy, Physical |
Intervention | Therapy, Speech (Non-Medical) |
A community residential service to provide supervision when necessary and coordinate support services to allow the individual to maintain an independent life style.
Eligibility Categories | Goals |
TEA Recipients | 1. Self-Support |
SSI Recipients | 2. Self-Sufficiency |
Income Eligibles | 3. Prevention of Neglect, Abuse, or Exploitation |
4. Prevention of Unnecessary Institutionalization |
Geographic Availability Available statewide.
Allowable Components (Purchase) Integrated Support Services
Special Notes
While the Supported Living Facility provides basic treatment in a residential setting, other CSPP services may be purchased separately for individuals, as needed, if the services are not already a part of Supported Living Services.
Individuals who are not adults may also receive this service when a service provider determines on an individual basis that a child will benefit from and can be accommodated by the provider's program. In making this determination, the provider must adhere to all eligibility and service need criteria established by the Department of Health & Human Services.
Social Services Block grant funds are not used for the purchase of room and board; persons receiving the service may be charged for room and board.
This service is provided by the Division only to individuals with developmental disabilities as defined in the Glossary.
Services provide selective placement in a foster home, group home, or residential treatment facility for a planned period of time for delinquent youth committed to the Division of Youth Services by a Juvenile/Chancery Court. This service includes casework and intervention service with the youth, parents/guardians, caregivers, and community resources.
Eligibility Categories | Goals |
TEA Recipients SSI Recipients Income Eligibles Status Eligible | 1. Self-Support 2. Self-Sufficiency 4. Prevention of Unnecessary Institutionalization |
Geographic Availability
Available statewide. The service is delivered through programs located in Service Delivery Areas I, II and III.
Allowable Components (Purchase)
Assessment | Personal Supplies |
Case Plan Development | Placement |
Casework Management | Prescription, Purchase and |
Counseling, Group | Administration of Drugs |
Counseling, Individual and Re | creational Supplies |
Family | Room and Board |
Diagnosis | Social Interaction |
Diagnosis and Evaluation | Supportive Activities |
(Medical) | Testing, Psychological |
Follow-Up | Therapy, Group |
Instruction | Therapy, Individual |
Intervention, Crisis | (Non-Medical) |
Medical Care | Transportation |
Outreach |
Special Note
For purposes of income eligibility determination, youth over the age of eighteen can be considered for this service through a special waiver request.
Services necessary to maintain a person with a developmental disability in their community. Services are based on an individual service plan and include such services as adult development, vocational maintenance and personal care.
Eligibility Categories | Goals |
TEA Recipients | 1. Self-Support |
SSI Recipients | 2. Self-Sufficiency |
Income Eligibles | 3. Prevention of Neglect, Abuse or Exploitation |
4. Prevention of Unnecessary Institutionalization |
Geographic Availability Services are available statewide.
Allowable Components (Purchase) Therapy, Speech (Non-Medical)
Services to children and their families and adults based upon a Multi Agency Plan of Services (MAPS). The services are designed to allow persons the supports needed for them to function in a community setting.
Eligibility Categories | Goals |
TEA Recipients | 1. Self-Support |
SSI Recipients | 2. Self-Sufficiency |
Income Eligibles | 3. Prevention of Neglect, Abuse or Exploitation |
4. Prevention of Unnecessary | |
Institutionalization | |
5. Appropriate Institution- | |
alization |
Geographic Availability Services are available statewide.
Allowable Components (Purchase)
Supportive Activities: Ancillary supportive activities necessary to maintain individuals in their home/community.
Child Day Care | Supportive Activities |
Counseling, Group | Testing, Psychological |
Counseling, Individual | Therapy, Group |
and Family Diagnosis and Evaluation | Therapy, Individual (Medical) Therapy, Individual |
(Medical) | (Non-Medical) |
Emergency Shelter | Therapy, Occupational |
Instruction | Therapy, Physical |
Medical Care | Therapy, Speech (Non-Medical) |
Personal Care | Tutoring |
Subsistence Services |
Transportation: The conveyance of an eligible individual from one location to another.
Transportation
Integrated Support Services: Wrap around supportive services to individuals to fully integrate the individual into his/her home/community.
Community Integration | Intervention, Crisis |
Companion | Social Interaction |
Follow-up | Supervision |
Integrated Support Services |
A unit of service is defined in the individual's Multi Agency Plan of Services.
* Supportive Services for Children and Families is a coordinated set of services designed to address a wide range of problems. This service is intended to help parents in their child-rearing role, promote healthy development and social functioning of children, prevent unnecessary removal of children from their homes, strengthen family functioning, and meet the needs of families in crisis.
Eligibility Categories TEA Recipients SSI Recipients Income Eligibles | Goals |
1. Self-Support 2. Self-Sufficiency 3. Prevention of Neglect, Abuse or Exploitation |
Geographic Availability This service is available statewide.
Allowable Components (Purchase)
Counseling, Group | Instruction |
Counseling, Individual | Intensive Family Services |
and Family | Intervention, Crisis |
Home Study | Supervision |
Special Notes
This service interfaces with Title IV-B and, as a child welfare service, is provided without regard to income. This service is a clustered service which comprises emergency services, supportive services to children in their own home, employment services, services to youth in need and transportation services. To meet individual client needs, the Division's staff may arrange for the purchase of services or supplies to supplement the services they provide.
APPENDIX D
SSBG FORMS AND INSTRUCTIONS
Instructions for the
DHHS-0145
CLIENT AND SERVICE DATA SHEET FOR SOCIAL SERVICES BLOCK GRANT FUNDING
Purpose: Form DHHS-0145 is the billing form for purchased services provided to clients determined eligible for Social Services Block Grant (SSBG) services. It is completed and submitted by the provider as follows
Completion of "Page 1 of _____":
Name of Provider: Enter the legal name of the provider as it appears on the contract or grant to which services are being billed.
DFA or Grant #: Enter the seven-digit DFA contract number as it appears on the contract to which services are being billed.
Billing Period: Enter the beginning and ending date of the period of time for which billing is being submitted (month, date, and year).
TIN: Enter the provider's tax identification number.
Service Code: Enter the four digit service code(s) for which billing is being submitted. These codes must be authorized by the contract being billed for the time period being billed. Each four digit code will be entered on a separate line, and may be entered only once.
Number of Clients: Enter the total number of clients receiving services for each service code indicated.
Number of Units: Enter the total number of units of service provided for each service code indicated.
Unit Rate: Enter the unit rate specified in the contract or grant for each service code indicated.
Total for Services: Enter the total amount billed for each service code indicated. This is the total number of units multiplied by the unit rate.
TOTAL for all services: Enter the total amount billed for all services provided.
Adjustment: Enter any adjustment necessary and explain in the blank space to the left of the word "Adjustment".
Total Fees: If client fees are charged for the services being billed, enter the total amount of fees.
NET Total for all services, with adjustment, minus fees: Enter the total calculated from "Total for all services", plus or minus "Adjustment", minus "Total Fees".
Signature of Provider and Date Submitted: To be signed and dated by the individual authorized to sign for the provider.
Page 1 of (blank): In the blank space provided, enter the total number of pages of the DHHS-0145 being submitted for this billing.
Completion of "Page ____ of _____ " As many pages will be completed as necessary to include all client data for this billing. Re-enter Name of Provider, DFA or Grant #, Billing Period, and TIN on each page.
Client Name: Enter the last name, first name, and middle initial of the individual(s) for whom services are being billed.
CLIENT AND SERVICE DATA SHEET FOR SOCIAL SERVICES BLOCK GRANT FUNDING
Client SSN: Enter the client's Social Security Number.
Client DOB: Enter the client's date of birth (month, date, year).
Nat'l Goal: Enter the national SSBG goal to which services are addressed. See SSBG Program Manual.
Service Code: Enter the four-digit service code(s) for services provided to this client during this billing period for which billing is being submitted. Each four digit code will be entered on a separate line, and may be entered only once per client. Note: if more there is more than one service code for a client, the "Client Name", "Client SSN", "Client DOB", and "Nat'l Goal" need only be entered on the first line for that client.
# of Units: Enter the number of units of service provided to each client for each service code indicated.
Fees: Enter the amount of fees charged the client, if applicable.
Unit Rate: Enter the unit rate for each service code indicated for each client.
Total: Enter the total amount billed for each client for each service. This is the total number of units, for each client for each service, multiplied by the unit rate for that service.
Page (blank) of (blank): Enter the page numbers in the spaces provided.
Routing
The DHHS-0145 will be completed by the provider and a copy made for the retention by the provider. Unless otherwise indicated in the terms of the contract or grant, the original DHHS-0145 should be forwarded to:
Office of Finance and Administration
Contract Support Section
P.O. Box 1437, Slot W205
Little Rock, AR 72203-1437
ARKANSAS DEPARTMENT OF HEALTH AND HUMAN SERVICES NOTICE OF ACTION TO APPLICANTS FOR AND RECIPIENTS OF SSBG SERVICES
TO (Applicant): FROM:
Name: Name:
Address Address:
Telephone: (Home) Telephone:
(Work)
ACTION TAKEN:
ONLY THOSE ITEMS INDICATED PERTAIN TO YOU
This is to notify you that effective:
(month/day/year)
Service Fee Service Fee
Reason(s) for above: ____________________________________________________________________________
____________________________________________________________________________
______________________________________________________ ____________________
Provider Date
If you are not satisfied with the action we plan to take or you feel that you have been discriminated against, you have the right to discuss your case with a member of the provider staff. You may also request a hearing by DEPARTMENT OF HEALTH AND HUMAN SERVICES staff by filing a written request with the Chief Fiscal Officer of DHHS, P.O. Box 1437, Slot W401, Little Rock, Arkansas 72203-1437. Services are provided in compliance with Title VI and Title VII of the Civil Rights Act and Section 504 of the Rehabilitation Act.
INSTRUCTIONS TO THE DHHS-160
NOTICE OF ACTION
TO APPLICANTS FOR AND RECIPIENTS OF
SOCIAL SERVICES BLOCK GRANT SERVICES
Purpose
Form DHHS-160 notifies applicants for and recipients of SSBG services of approval (if a fee is charged), denial and closure of their case.
Completion
TO: Enter the applicant's/recipient's name and mailing address.
FROM: Enter the name and mailing address of the provider making the case action. A rubber stamp may be used if desired.
EFFECTIVE: Enter the month, day and year that the action is effective.
If a 10 day advance notice is being given, this date should be the last day of the month in which the advance notice period ends. (See Section 4630.A. of the SSBG Program Manual.)
Check the appropriate item to indicate the action being taken.
Reason(s) for the above: Enter explanation(s) for the action taken which will assist the applicant or recipient in understanding the action. The provided must sign and date the form in the spaces provided.
Routing
The original must be mailed or hand delivered to the applicant or recipient. One copy must be retained in the case record.
DHHS-160 Instructions Alternate formats (large print, audio tape, etc.) will be provided upon request.
APPENDIX E
SSBG PROGRAM DESCRIPTION FROM THE CATALOG OF FEDERAL DOMESTIC ASSISTANCE
CATALOG OF FEDERAL DOMESTIC ASSISTANCE
The following is the description of the Social Services Block Grant as found in the Catalog of Federal Domestic Assistance. The catalog (CFDA) is published by the Office of Management and Budget (OMB) and the General Services Administration (GSA) and is made available through the Government Printing Office (GPO).
93.667 SOCIAL SERVICES BLOCK GRANT
FEDERAL AGENCY: ADMINISTRATION FOR CHILDREN AND FAMILIES, DEPARTMENT OF HEALTH AND HUMAN SERVICES
AUTHORIZATION: Social Security Act, Title XX, as amended; Omnibus Budget Reconciliation Act of 1981, as amended, Public Law 97-35; Jobs Training Bill, Public Law 98-8; Public Law 98-473; Medicaid and Medicare Patient and Program Act of 1987; Omnibus Budget Reconciliation Act of 1987, Public Law 100-203; Family Support Act of 1988, Public Law 100-485; Omnibus Reconciliation Act of 1993 Public Law 103-66; 42 U.S.C. 1397 et seq.
OBJECTIVES: To enable each State to furnish social services best suited to the needs of the individuals residing in the State. Federal block grant funds may be used to provide services directed toward one of the following five goals specified in the law:
TYPES OF ASSISTANCE: Formula Grants.
USES AND USE RESTRICTIONS: Federal funds may be used by States for the proper and efficient operation of social service programs. Except for items (1) and (4) below, for which a waiver from the Secretary may be requested, Federal funds cannot be used for the following:
ELIGIBILITY REQUIREMENTS:
Applicant Eligibility: The 50 States, the District of Columbia, Puerto Rico, Guam, the Virgin Islands, the Commonwealth of the Northern Mariana Islands, and American Samoa.
Beneficiary Eligibility: Under Title XX, each eligible jurisdiction determines the services that will be provided and the individuals that will be eligible to receive services.
Credentials/Documentation: Prior to expenditure of funds, the State must report on the intended use of the payments the State is to receive, including information on the types of activities to be supported and the categories or characteristics of individuals to be served.
APPLICATION AND AWARD PROCESS:
Pre-application Coordination: None. This program is excluded from coverage under E.O. 12372.
Application Procedure: Submission of a pre-expenditure report application is required.
Award Procedure: States are awarded funds quarterly.
Deadlines: None
Range of Approval/Disapproval Time: Not applicable.
Appeals: See 45 CFR, Part 16, Procedures of the Departmental Appeals Board.
Renewals: Not applicable.
ASSISTANCE CONSIDERATIONS:
Formula and Matching Requirements: Section 2003 of Title XX of the Social Security Act specifies how the allotments for each State and jurisdiction will be determined. Each State is entitled to payments in an amount equal to its allotment for that fiscal year. There is no matching requirement. Allotments for Title XX are subject to a limitation of $2,800,000,000 (estimate). The allotment for the jurisdictions of Puerto Rico, Guam, the Virgin Islands, and the Northern Mariana Islands shall be an amount which bears the same ratio to the amount authorized for Title XX as the fiscal year 1981 allocation bore to $2,900,000,000. The allotment for American Samoa shall be an amount which bears the same ratio to the amount allotted to the Northern Mariana Islands for that fiscal year as the population of American Samoa bears to the population of the Northern Mariana Islands. Each State's and the District of Columbia's allotment are proportional to its portion of the national population of the amount authorized for Title XX minus the amount authorized to the other jurisdictions. The statistical factors used for fund allocation are the State population and total U.S. population (ratio of population of all States and the District of Columbia to total population); source, "Current Population Reports," P-25, Bureau of the Census.
Length and Time Phasing of Assistance: Grants are awarded quarterly on a fiscal year basis. The Electronic Transfer System will be used based on quarterly grant awards for monthly cash draws from Federal Reserve Banks. The funds will remain available for projects and programs in the designated localities until December 21, 2004.)
POST ASSISTANCE REQUIREMENTS:
Reports: An annual report is required. The report shall be in such form and contain such information as the State finds necessary to provide an accurate description of such activities, to secure a complete record of the purposes for which funds were spent, and to determine the extent to which funds were spent in a manner consistent with the pre-expenditure reports required under Section 2004 of the Act. The report must include the services provided in whole or in part with block grant funds; the number of children and the number of adults receiving each service; expenditure data for both children and adults for each service; the criteria applied in determining eligibility for each service, including fees; and the method(s) by which each service was provided. States must provide DHHS with an annual report (Standard Form 269). For EZ/EC SSBG, States are also required to provide a final report at the end of the grant period. The grant period ends for EZ/EC SSBG on December 21,2004.
Audits: In accordance with the provisions of OMB Circular No. A-133 (Revised June 27, 2003), Audits of States, Local Governments and NonProfit Organizations," Non-Federal entities that expend $300,000 ($500,000 for fiscal years ending after December 31, 2003) or more in a year in Federal awards shall have a single or program-specific audit conducted for that year in accordance with the provisions of this part. Non-Federal entities that expend less than $300,000 ($500,000 for fiscal years ending after December 31, 2003) a year in Federal awards are exempt from Federal audit requirements for that year, except as noted in section.215(a), but records must be available for review or audit by appropriate officials of the Federal agency, pass-through entity, and General Accounting Office (GAO).
Records: States are required to maintain records documenting the purposes for which expenditures were made.
FINANCIAL INFORMATION:
Account Identification: 75-1534-0 -1-506.
Obligations: (Grants) FY 04 $1,700,000,000; FY 05 est. $1,700,000,000; and FY 06 est. $1,700,000,000.
Range and Average of Financial Assistance: The range is from $56,000 to $207,311,000; $30,263,000.
PROGRAM ACCOMPLISHMENTS: Fifty-seven grants were awarded in fiscal year 2004. It is estimated that 57 grants will be awarded in fiscal year 2005.
REGULATIONS, GUIDELINES, AND LITERATURE: 45 CFR 96.
INFORMATION CONTACTS:
Regional or Local Office: Local Office: Not Applicable. Regional Office: Office of Community Services Regional Liaisons in the Office of the Regional Administrator.) See Appendix IV of the Catalog for Regional Offices.)
Headquarters Office: Director, Office of Community Services, Division of State Assistance, 370 L'Enfant Promenade, SW., Washington, DC 20447. Telephone: (202) 401-2333. Contact Margaret Washnitzer or e-mail address mwashnitzer@acf.dhhs.gov.
Web Site Address: http://www.acf.dhhs.gov/programs/ocs/ssbg.
RELATED PROGRAMS: 93.600, Head Start; 93.630, Developmental Disabilities Basic Support and Advocacy Grants; 93.044, Special Programs for the Aging-Title III, Part B-Grants for Supportive Services and Senior Centers; 93.045, Special Programs for the Aging - Title III, Part C-Nutrition Services; 93.645, Child Welfare Services-State Grants;
93-647, Social Services Research and Demonstration; 93.658, Foster Care-Title IV-E; 93.669, Child Abuse and Neglect State Grants; 93.671, Family Violence Prevention and Services/Grants for Battered Women's Shelters - Grants to States and Indian Tribes.
EXAMPLE OF FUNDED PROJECTS: States and other eligible jurisdictions determine their own social services programs. Examples of funded services include child day care, protective and emergency services for children and adults, homemaker and chore services, information and referral, adoption, foster care, counseling, and transportation.
CRITERIA FOR SELECTING PROPOSALS: All States, the District of Columbia, and the five(5) other jurisdictions will receive their share of funds if they submit a pre-expenditure report that meets the requirements.
016.14.06 Ark. Code R. 007