1. When client’s benefits are changed from a J to an A case (or any other change from one case to another):

1. Worker completes PS1B to obtain “A” case number and then closes the “J”case with reason code 23A “Needs transferred to SSP-Aged Category”. Once all edits are cleared on the J case closure, the worker processes the “A” case to certify benefits using reason 26D “Transferred from a J case’ (no change from normal procedures). Both actions must be done at the same time with the correct reason code to ensure accurate case actions.
2. Worker submits a ticket to the HelpDesk explaining that the case number has changed from a “J” case to an “A” case.
3. Worker will completely certify the new LTC authorization on the “A” case (if the open service is for ADvantage, the worker will also code the F199 & F200 blocks appropriately.
4. A new application is not needed in this situation since there is already an open/approved service in Harmony for the client. The HelpDesk will update the case number in Harmony.

Note: Transfers from B or D cases to A cases when a client turns 65 is no longer required. If a client on a C, H, or J case is applying for SSP, they need to be placed on a D or A case depending on the client’s age.

2. Program Transition

1. If the client is receiving ADvantage or SPPC services and requests to be evaluated for transition to the other program (SPPC to ADvantage or ADvantage to SPPC); the worker should navigate to the online application located on the InfoNet and complete the application for in home services. Once the application is submitted the system will notify the HCMN in Harmony of the request and add the appropriate authorization line in “A” status in IMS.
   • There may be a 1-day delay between the entry of the online application and when the authorization line is added to the case in IMS.
2. Worker determines financial eligibility for service.
3. If eligible, update the auth to “F” status.
4. If not financial eligible the worker will deny the authorization.

3. Transitioning from SPPC or ADvantage Waiver to Nursing Home services:

1. Worker receives an ABCDM-83-A or received a telephone call from a family member notifying him/her that the client needs to enter or has entered a nursing facility. This serves as an application for services. Complete the Harmony Referral form for the NF application.
2. Worker will code an LT auth for NF services and place it into application status.
3. Worker determines financial eligibility for nursing services and the LT auth is updated to “F” status if eligible. Refer to the following articles:
   • Nursing Facility Services (ABD Related) – Determining Income Eligibility
   • Medicaid Income Pension Trust – Establish
   • Nursing Facility Services (ABD Related) – Determining Resource Eligibility
   • Home Property Overview
   • Home Property Forms
   • Spousal Impoverishment
   • Transfer of Assets / Penalty Period Overview
4. If the client is not financially eligible for nursing services the worker will deny the authorization.HCMN III will make the medical determination in Harmony. Once the medical decision is available, and auto generated notice of the decision will be sent to the assigned SSS/SSS Supervisor via Outlook email from the Harmony system.
5. Harmony will close the LT or SW authorization for the existing service. The worker is responsible for updating the medical section and the NF authorization line applying any copayment amounts and date, as appropriate.
6. Refer to article Vendor Payments: ZERO vs FULL Vendor Payments.
7. If applicable, process any needed updates on the medical section.

4. Transitioning from Nursing Facility to SPPC or ADvantage

1. If the NF client requests to transition home with ADvantage or SPPC services, the worker should navigate to the online application located on the InfoNet and complete the application for in home services. Once the application is submitted, the system will notify the HCMN in Harmony of the request and add the appropriate authorization lines(s) in “A” status in IMS.
   • There may a 1-day delay between the entry of the online application and when the authorization line is added to the case in IMS.
2. If client is found to be medically and financially eligible to transition home with ADvantage or SPPC; the worker will close the NF auth with the verified NF discharge date, update the ADvantage/SPPC authorization lines as appropriate, and notify the HCMN III of the NF closure date. The medical section will remain open on the case.
3. The HCMN III will update the medical decision in Harmony for the appropriate date (verified NF discharge date) to allow the system to update the ADvantage and/or SPPC authorizations as appropriate.