The following procedures pertain to actions a worker will follow when assigned a new application that was initiated for ADvantage/SPPC services by the applicant, representative, or other:

1. When an online application is submitted, the electronic system will assign the case to a HCMN for medical eligibility and will automatically assign a new case number if the applicant does not have an existing case number available for use.
2. The system will automatically place the medical section (if not already vending for another medical service) in application status. In addition, the appropriate authorizations for ADvantage and/or SPPC will be automatically added to the case and placed in “A” status.
3. The system will assign the case to the appropriate worker or gatekeeper depending on the county EWA set up. Worker will schedule an interview and send ADM-92 requesting any additional documents or verification required to determine financial eligibility.
   1. The interview may be conducted with the client, a family member. Power of Attorney, or an authorized representative and may be face to face in the county office or client’s home or by phone. Refer to article LTC: Interview Process.
   2. Review article LTC: Look Back Period for All Assets for LTC. Use Form 08MA011E (MA-11) Assessment of Assets to gather asset information. If there is a community spouse, review article LTC: Spousal Impoverishment.
   3. In the process of obtaining information, ask for verification of gross income for the ADvantage Waiver client to determine if there will be a need to establish a Medicaid Income Pension Trust. Refer to article LTC: Medicaid Income Pension Trust – Establish.
4. Once financial eligibility is determined, worker will either deny (using appropriate denial reason code) if not financially eligible or code authorization(s) into “F” status if financially eligible.
5. Once the medical decision is available in Harmony, the system will read the authorization lines for the financial determination. Once the financial determination is also available the system will take final action to certify or deny the lines as appropriate (if not already denied financially). An auto generated notice of the final decision will be sent to the assigned SSS/SSS Supervisor via Outlook email from the Harmony system.

The following procedures pertain to actions a worker will follow when they are the first to become aware that an application for ADvantage/SPPC is needed:

1. The worker or gatekeeper assisting the client will navigate to the online application and complete the application for in home services.

   The Harmony Online application is for ADvantage/SPPC services. The Harmony Referral Form is for NF or ADvantage/SPPC re-opens where services were closed less than 90 days.

2. Once the application is processed within the Harmony system it will assign to the worker or gatekeeper per the county EWA set up and worker will proceed with step C above to schedule the interview.

   There will be at least a 1-day delay between the entry of the online application and when the case in IMS is assigned via EWA and authorization lines are added as appropriate.