SR 17-07 Dated 05/17

STATE OF NEW HAMPSHIRE

INTER-DEPARTMENT COMMUNICATION – Division of Family Assistance (DFA)

FROM OFFICE OF THE DIRECTOR, DFA:		Terry R. Smith
DFA SIGNATURE DATE:		April 21, 2017
AT (OFFICE):		Division of Family Assistance (DFA)
TO:		District Office Supervisors
SUBJECT:	Changes to New HEIGHTS Systems align New HEIGHTS Alternate Payee Screen with DFA Form 778, Authorized Representative Declaration; Changes in NH Electronic Application SYstem (NH EASY), Which allow Applicants or Recipients to Create or Terminate Alternate Payees or Authorized Representatives via NH EASY; Changes to Authorized Representatives (AR) Responsibilities to Assist with Electronic Benefit Transfer (EBT) Accounts; Change to EBT EDGE that EDGE Will No Longer Automatically Generate EBT Cards for Alternate Payees when New HEIGHTS Sends a Request; Revised DFA Form 778, Authorized Representative Declaration, Its Associated Instructions, DFA Form 778(i), and Its Associated Spanish and Nepali Translations, DFA Form 778(Sp) and DFA Form 778(Ne)

NEW HEIGHTS CHANGES, NH EASY CHANGES, AUTHORIZED REPRESENTATIVE CHANGES, AND DFA FORM 778 REVISIONS EFFECTIVE DATE:	May 5, 2017
EBT EDGE CHANGE EFFECTIVE DATE:	May 21, 2017

SUMMARY

This SR releases:

●	Changes to New HEIGHTS systems to align New HEIGHTS Alternate Payee screen with DFA Form 778 Authorized Representative Declaration;
●	Changes in NH Electronic Application System (NH EASY), which allow applicants or recipients to create or terminate alternate payees or Authorized Representatives via NH EASY;
●	Change to EBT EDGE that EBT EDGE will no longer automatically generate EBT Cards for alternate payees when New HEIGHTS sends a request. Instead EBT EDGE will send a message to the EBT Unit and the EBT Unit will decide whether an EBT Card will be generated for the alternate payee;
●	Changes to Authorized Representatives (AR) responsibilities to assist with Electronic Benefit Transfer (EBT) Accounts; and
●	Revisions to DFA Form 778, Authorized Representative Declaration, its associated instructions, and its associated Spanish and Nepali translations.

POLICY

Agencies may now serve as Authorized Representatives.

Authorized Representatives (AR) may be designated to receive or access benefits on behalf of the recipient by:

●	Obtaining an Electronic Benefit Transfer (EBT) card that has the AR’s name on it, which will have access to the recipient’s EBT benefits; (Recipients use Form 778 to designate whether the recipient wants an AR to have access to the recipient’s Food Stamp benefits, cash benefits, or both); or
●	Assisting the recipient with ordering replacement EBT Cards, balance inquiries, PIN selections, PIN changes, and general EBT related questions.

EBT EDGE Change

EBT EDGE will no longer generate EBT Cards for alternate payees when New HEIGHTS sends a request. Instead, EBT EDGE will send a message to the EBT Unit and the EBT Unit will decide whether an EBT card will be generated according to the documentation in the client’s e-folder. For Authorized Representatives (AR), the EBT Unit will generate an EBT card if the client selected the option to have their AR receive an EBT Card. If the client did not select the option to have an AR receive an EBT Card, the EBT Unit will not generate an EBT Card but the AR will be able to contact EBT Customer Service. For other types of Alternate Payees, the EBT Unit Will rely on case comments to determine if an EBT Card should be generated for the alternate payee.

DESCRIPTION OF REVISIONS MADE TO FORMS

DFA Form 778 is a 1-page, double-sided form, used to allow an applicant or recipient for any DFA program or service to name an authorized representative (AR) who will act on their behalf. The form also allows the applicant or recipient to indicate which responsibilities they wish the AR to fulfill.

The following revisions were made to DFA Form 778 Authorized Representative:

●	The form was revised to allow agencies to be able to serve as ARs;
●	To simplify the form unnecessary language was removed and related AR duties were combined;
●	EBT Access was modified to allow an applicant or recipient to choose whether an AR’s EBT card will have access to Cash, Food Stamps, or both;
●	A new option was added to allow an applicant or recipient to allow an AR to contact EBT customer service without receiving an EBT card;
●	Must be 18 or Older replaced Optional under the field for the AR’s date of birth to ensure only adults serve as ARs;
●	The AR’s statements of understanding were updated pursuant to 42 CFR 435.923; and
●	The form was updated to clarify that an AR relationship will exist until the AR or the applicant or recipient tells DHHS of a change.

The instructions were revised accordingly

The Spanish and Nepali translated versions of the form will be updated accordingly.

The current version of this form will be used until the supply is exhausted, at which point the new version will be printed.

The English version of this form is available in the DHHS Warehouse and can be ordered using current forms reordering procedures, via the Quarterly Forms Order (QFO). The forms are also available electronically, for Department staff only, in the Family Services Folder on the N Drive. The forms may be downloaded from the DHHS website at http://www.dhhs.nh.gov/dfa/forms.htm. Translated forms may be printed from the Family Services Folder on the N Drive when needed, or if a larger supply is needed, contact the Supervisor of the Policy Development Unit.

NEW HEIGHTS SYSTEMS PROCEDURES AND IMPLEMENTATION

To align New HEIGHTS processes with the reality of client/alternate payee relationships and existing DFA Form 778 Authorized Representative Declaration, the following changes have been made to New HEIGHTS Alternate Payee processes.

●	Alternate Payees will now have certain permissions, such as receipt of an EBT Card, tied to a program (Cash, Food Stamps, and/or Medicaid);
●	The Alternate Payee screen now aligns with the duties section of the revised DFA Form 778; and
●	Alternate Payees can be added or removed from pending or closed cases.

Authorized Representative Duties on Alternate Payee Screen

The Alternate Payee Screen now aligns with DFA Form 778 Authorized Representative Declaration by adding checkboxes to designate AR duties from Form 778.

●	The following Case Related Permissions, which are AR duties that apply to an entire Assistance Group and not a particular program, now appear on the Alternate Payee screen:

–	Get, fill out, and sign applications, forms and other DHHS paperwork for me;
–	Get my notices from DHHS;
–	Go to my eligibility interviews for me; and
–	Request and represent me at an appeal.

●	The following Benefit Related Permissions, which are AR duties that apply to a specific type of benefit such as Food Stamps, Cash or Medicaid, now appear on the Alternate Payee screen:

–	Get an EBT Card and talk to customer service for

■	Food Stamps; and/or
■	Cash

–

Talk to EBT customer service. Note: Workers cannot select both “Talk to EBT Customer Service” and “Get an EBT Card and talk to customer service.” If an applicant or recipient selects both “Talk to Customer Service” and “Get an EBT Card” workers should ask the applicant or recipient whether the applicant or recipient wants the AR to have a separate EBT card and check the box that corresponds to the applicant or recipient’s answer, if the applicant or recipient cannot be reached, the default will be to allow the AR to have an EBT Card;

–

Can talk to an MCO or QHP.

Alternate Payee Type on Alternate Payee Screen

Alternate Payees can be one of four types: guardian, conservator, power of attorney, or Authorized Representative. Any of the four types of alternate payees must be marked as verified before any designated case or benefit permissions will take effect. Guardians and conservators must be verified by receipt of legal documentation of the guardianship or conservatorship. Powers of attorney may be verified by a power of attorney document or a signed and completed DFA Form 778. Authorized representatives must be verified by a signed and completed DFA Form 778. If an alternate payee is a guardian or conservator, all case and benefits permissions will automatically be selected except for “Talk to EBT Customer Service” once the alternate payee type is selected. For powers of attorney and authorized representatives, workers will need to designate the case and benefit permissions indicated on the completed DFA Form 778 or the power of attorney document. If guardian or conservator is selected as an alternate payee type, an end date field will appear on the Alternate Payee details tab. Workers must enter an end date if an alternate payee’s guardianship or conservatorship documentation contains an expiration date. After the end date, the alternate payee’s case and benefit permissions will no longer be valid.

Other Alternate Payee Screen Changes

A Ver. Letter button now appears on the right side of the Alternate Payee Details tab. Workers use this button to generate a request for verification of the authorized representative. A prefilled copy of DFA Form 778 will generate if the type of Alternate Payee is Authorized Representative or Power of Attorney. See the attached BI0011 letter for reference;

NH EASY SYSTEM PROCEDURES

NH EASY users will now be able to add, update, and view their alternate payee, which will be referred to as Authorized Representative in NH EASY, via NH EASY. NH EASY users will be able to select any type of Authorized Representative: Authorized Representative, Power of Attorney, guardian, or conservator. Users can make changes to their alternate payee through a standalone screen on their NH EASY account or add an alternate payee through a MAGI only NH EASY application.

NH MAGI Only Application

A screen has been added to the MAGI Only Application process to allow NH EASY applicants to add ARs. The screen contains the same case and benefit permissions as the New HEIGHTS Alternate Payee screen. If an applicant adds an alternate payee as part of a MAGI only application, the AR information will be included as part of the NH EASY Application Summary below the Additional Food Stamp Information section, additionally a document called the eAuthorized Representative Declaration will be created and appear in the Document Inbox with the AR information..

NH EASY Standalone AR Screen

A new NH EASY standalone screen has been added to NH EASY to allow NH EASY users to view, edit, and add AR. The standalone screen contains case and benefit permissions identical to the New HEIGHTS alternate payee screen. If NH EASY users make changes to their AR(s) with the NH EASY standalone screen, a document called the eAuthorized Representative Declaration will be created in the inbox and the information will be automatically updated in New HEIGHTS tables. The standalone NH EASY AR screen will allow NH EASY users to add ARs and choose the case and benefit permissions they want the AR to have. Standalone screen users will be prompted to complete DFA Form 778 when adding an AR. The standalone AR screen will allow NH EASY users to update AR information by removing existing case or benefit permissions, or editing AR information (other than name) if the AR is an individual. Screen help will tell NH EASY users that to add case or benefit permissions for an existing AR the user must enter and save a comment. Upon saving the comment the eAuthorized Representative Declaration will be saved as unprocessed. Workers will be notified of the update to the eAuthorized Representative Declaration and will need to view the comments and enter the changes manually into New HEIGHTS.

POLICY MANUAL REVISIONS

Revised Adult Assistance Manual Topics

Section 111.01 AR Acting in Place of the Individual

PART 705 ISSUING BENEFITS

Revised Family Assistance Manual Topics

PART 111 AUTHORIZED REPRESENTATIVES (AR)

Section 111.01 AR Acting in Place of the Individual

PART 707 ISSUING FINANCIAL ASSISTANCE BENEFITS

Revised Food Stamp Manual Topics

PART 111 AUTHORIZED REPRESENTATIVES (AR)

PART 707 ISSUING BENEFITS

Revised Medical Assistance Manual Topics

PART 111 AUTHORIZED REPRESENTATIVES (AR)

Section 111.01 Authorized Representative (AR) Acting in Place of the Individual

IMPLEMENTATION

The changes to New HEIGHTS, NH EASY, AR policy, and DFA Form 778 revisions released in this SR are effective May 5, 2017. The change to the EBT EDGE system in this SR is effective May 21, 2017.

CLIENT NOTIFICATION

No special client notification is planned or needed.

TRAINING

No special training is planned or needed.

FORMS MANUAL POSTING INSTRUCTIONS

Remove and Destroy	Insert
Forms Manual
DFA Form 778, Authorized Representative Declaration, DFA SR 16-03/January 2016 1 back-to-back sheet	DFA Form 778, Authorized Representative Declaration, DFA SR 17-07/May 2017 1 back-to-back sheet
DFA Form 778(i), Instructions for DFA Form 778 DFA SR 16-03/January 2016 1 back-to-back sheet	DFA Form 778(i), Instructions for DFA Form 778 DFA SR 17-07/May 2017 1 back-to-back sheet
DFA Form 778(Ne), Nepali Version of DFA Form 778 DFA SR 16-03/January 2016 1 back-to-back sheet	DFA Form 778(Ne), Nepali Version of DFA Form 778 DFA SR 17-07/May 2017 1 back-to-back sheet
DFA Form 778(Sp), Spanish Version of DFA Form 778 DFA SR 16-03/January 2016 1 back-to-back sheet	DFA Form 778(Sp), Spanish Version of DFA Form 778 DFA SR 17-07/May 2017 1 back-to-back sheet

DISPOSITION

This SR may be destroyed or deleted after its contents have been noted and the revised manual topics released by this SR have been posted to the On-line manuals.

DISTRIBUTION

This SR will be distributed according to the electronic distribution list for DFA policy releases. This SR, and revised On-Line Manuals, will be available for agency staff in the On-Line Manual Library, and for public access on the Internet at www.dhhs.nh.gov/DFA/publications.htm, effective May 29, 2017. Additionally, this SR, and printed pages with posting instructions, will be distributed under separate cover to all internal hard copy holders of the Adult Assistance, Family Assistance, Food Stamp, Medical Assistance and Forms Manuals.

DFA/BDC:s