C ALTCS Interview for an Incapacitated Customer

Program	Manual Section
ALTCS	MA1302C

Procedure

Follow these steps to complete an interview for an incapacitated customer:

Step	Action
1	Was the application submitted by someone authorized to apply on the customer’s behalf (see MA1301A.3)? If NO, contact the person who submitted the application, family members or others, including social workers or nursing facility staff, to see if they will represent the customer. When unable to find a representative, make a referral to the County Public Fiduciary office. Continue to step 2. If YES, continue to step 2.
2	Schedule the financial interview.
3	Did someone respond to the interview request? If NO, STOP. Deny the application for appointment missed. If YES, continue to step 4.
4	Complete the interview. NOTE If you encounter a situation where the customer’s identity is unknown, and the Rep is unable to answer the interview questions, complete the interview in HEAplus answering as many of the questions as you can. Enter unknown where needed. Discuss with your supervisor and if your supervisor agrees identity is not verified and needs to be verified, submit a policy clarification request (PCR) requesting help getting the proof.
5	Request the PAS.
6	Do you have all the proof needed to determine financial eligibility? If YES, determine financial eligibility. When the customer is not eligible, deny the application. When the customer is financially eligible, wait for the PAS to be completed to disposition the case. If NO, continue to Step 7.
7	Send an RFI for the proof needed. NOTE When the application was not submitted by someone authorized to apply on the customer’s behalf also send the Statement of Incapacity (DE-217). The form will not be attached by HEAplus. You will need to send it separately. The representative may sign the application when the DE-217 has been completed by the physician and is in the case file.
8	Was all the proof provided? If YES, determine financial eligibility. If the customer is not eligible, deny the case. When the customer is financially eligible, wait for the PAS results to disposition the case. If NO, Deny the case for the appropriate reason.
9	When the PAS is completed, disposition the case. Is the customer medically eligible? If NO, STOP. Deny the application for failed PAS. If YES, approve the application.