RCH Payments

The following table provides some guidelines for the EW to utilize when processing aid payments for clients residing in an RCH facility:

If a recipient...	Then...
Is admitted, transferred or discharged,	The RCH facility staff will inform the EW via telephone call or by reporting the information on the SAR 7.
Is hospitalized,	The EW will pay the facility for the period of his/her hospitalization provided: The recipient returns to the facility during the same month he/she was hospitalized, AND The facility has reserved a bed for the recipient during his/her absence.
Leaves the facility (either overnight or for the weekend),	SSA will pay the facility for the period of his/her absence provided: The recipient returns to the facility, and The facility has reserved a bed for the recipient during his/her absence, and The absence was for therapeutic reasons.

Budgeting Income

If the recipient has income, the income will first be subtracted from the personal needs amount and then from the care and supervision amount. The GA grant will be prorated from the date the application is received/date stamped by SSA.

Payment Procedures

The following may be used by the EW as a guide for processing payments to the RCH facilities:

EW
1. Enters all required information in CalSAWS.
2. Performs the "Split Payment" process to pay the RCH facility and to pay the client’s Personal Needs.
RCH Facility
1. Provides the following information on the GA 18:
  1. Case number.
  2. Birth date and Social Security Number.
  3. Eligibility Worker’s Number.
  4. Name of the facility.
  5. Completes the GA 18 and bills Social Services Agency by the 10th day of the month or the date the recipient is discharged from the facility.
  6. Indicates on the GA 18 if this is a "final" billing.
EW
1. Pays the bill within 10 working days of its receipt, provided ALL eligibility factors have been cleared.
2. Returns all bills to the RCH if Social Services Agency has not received a date stamped application packet.
3. NOTE: If a billing is for an incorrect amount, Social Services Agency will pay the correct amount, and notify the RCH facility of their error in computation.

Examples

On August 3rd, Mr. Jack received his GA benefits of $253. Mr. Jack moves to First Street RCH facility on August 29th. On September 1st, the RCH facility submits the GA 18, billing the prorated amount for the period of August 29th through August 31st. The EW receives the GA 18 on September 1st and makes the payment within 10 working days as follows:

Reviews the GA 18 for completeness.
1. Enters August 29 as the begin date and admission date in CalSAWS.
2. The original GA amount of $253 paid for August plus the billed amount of $87.19 for the 3 nights spent at First Street RCH facility equals $340.19.
3. Since $340.19 does not exceed the maximum RCH rate of $901, the facility is paid the full amount billed of $87.19).
4. REMINDER: The facility payment is prorated and paid based on the GA 18 indicating the number of nights the client actually spent in the RCH facility
Completes the “Split Payment” process in order to make the appropriate payments to the RCH facility.
Put the RCH future benefits on hold.
Completes the “County Use Only” section of the GA 18 and sends it to the facility as form of receipt.

Mr. Mc applies for GA and moves into RCH "A" on September 1st. He calls to report he has moved into RCH "B" on September 22nd. The EW receives the GA 18 on
September 24th from RCH "A" indicating “Final Bill” and billing the prorated amount for the period of September 1st through September 21st.

Below are the steps to be followed by the EW at Intake and Continuing in setting-up and in issuing the RCH payment:

RCH “A” Facility:

During Intake:
1. Completes the case record appropriately in CalSAWS.
2. Completes Board and Care entries in CalSAWS to add the RCH “A” facility.
Completes the “Split Payment” process in order to make the appropriate payments to the RCH facility.
Requests Supervisor to put the RCH benefit on hold
When the GA 18 is received on September 24th from RCH “A” facility: (This may be at Intake or Continuing):
1. Completes Board and Care information in CalSAWS including the date Mr. Mc moved from the facility (taken from the GA 18 “Final Bill”).
2. Note: The facility payment must be prorated end date entered. The GA 18 indicates the number of nights the client actually spent in the RCH facility, be sure this coincides with the end dates entered.
3. Completes the “County Use Only” section of the GA 18 and sends it to RCH “A”.
4. Completes Board and Care info in CalSAWS to add the new RCH “B.”
Completes the “Split Payment” process in order to make the appropriate payments to the RCH facility.
Puts the future benefit for RCH “B” on hold.

RCH “B” facility:

The Continuing EW must follow the process below when the bill is received:

Receives the GA 18 by October 5th from RCH “B” facility billing for period beginning September 22nd through September 30th.
Makes payment within 10 working days from the date the GA 18 is received.
Completes the “Split Payment” process in order to make the appropriate payments to the RCH facility.
Puts the RCH future benefits on hold.
Completes the “County Use Only” section of the GA 18 and sends it to the RCH facility.

Budgeting

If the applicant/recipient has income, this must FIRST be subtracted from the personal needs amount and the remainder is to be subtracted from the care and supervision (RCH payment).

Issuance

If a client enters the RCH facility after the GA grant was already issued, the original grant issued in the month must be manually added to the billed or the entitled benefit amount.

Future Benefits

RCH benefits must not be issued until the GA 18 form is received from the facility. Payment must be put on hold.

Split Payment for RCH Facilities

In order to make the appropriate payments to the RCH facility via warrant, and the personal needs payment to the client via EBT, the split payment process must be completed in CalSAWS.

REMINDER: Initial benefits (personal needs and facility payment) must be prorated.

Change in Residence

If a Recipient...	Then the EW MUST...
Leaves the RCH and does not contact the EW,	Record information appropriately in CalSAWS. Discontinue GA at the end of the month.
Notifies the EW within 10 working days that she/he has moved to another RCH,	End Date the RCH facility the recipient moved from in CalSAWS. Note: The GA 18 indicates the number of nights the client actually spent in the RCH facility be sure this coincides with the End Dates entered. Make payment within 10 working days from the date the new RCH facility sends in the GA 18 the following month (never paid in current month) Complete the “Split Payment” process in order to make the appropriate payments to the RCH facility. Put RCH future benefit on hold. Document actions taken in a CalSAWS Journal Entry. Reminder: A new SCD 1400 is not required if the existing one is still valid.
Moves to independent living,	Request all required forms for standard housing verification. Ensure that a valid SCD 1400 is on file for all Unemployable recipients, and Refer all Employable recipients to VS, as appropriate. NOTE: Process a CalFresh application, if appropriate.

Billing and Payment After GA Discontinues

When the facility sends a bill and the GA case is already in discontinued status, the facility may be paid for the month billed (prior month) IF the client met GA eligibility
during the month being billed.

Example Example Client is approved for SSI on January 17th and GA discontinues on January 31st. The facility submits a bill on February 5th for 31 days in January. Since the client was eligible and active on GA until the end of January, the facility may be paid for the entire 31 days.