Form H0005, Policy Clarification Request

Documents

Effective Date: 7/2021

H0005.pdf

Instructions

Updated: 7/2021

Purpose

To obtain a case-specific policy clarification or interpretation for Texas Works (TW), Medicaid for the Elderly and People with Disabilities (MEPD), and Community Care Services Eligibility (CCSE).

Procedure

Eligibility field staff use this form to request a case-specific policy clearance or interpretation. Prior to submitting a request for a policy clearance, eligibility field staff and their supervisor must review all applicable policy sources (e.g., handbooks, bulletins, and previous policy clarifications). If unable to determine the appropriate action, the requestor submits this form electronically to the Field Policy Unit or Case Analyst to request a case-specific policy clarification. Service Improvement Program (SIP) Coordinators and Specialists, Centralized Representation Unit (CRU) staff and others may also use this form to request a case-specific policy clarification. SIP, CRU, and CCSE should follow their established procedures for requesting case-specific policy clarifications from the Field Policy Unit or Case Analyst.

This form may also be used by other HHSC State Office staff, including Quality Control, Ombudsman, and legal or training, to request a case-specific policy clarification.

The requestor should ensure the form is properly completed and contains all relevant and essential information. The requestor will be contacted if additional information is needed.

If Field Policy staff or the Case Analysts determine that additional research or direction is needed, the request for clarification will be escalated to Program Policy for review.

Number of Copies

If the clarification is pertinent to the eligibility determination, image the request and subsequent response for the case record.

Transmittal

Electronically mail the form as an attachment to the designated mailbox per program area.

Program Area	Mailbox
CCSE	HHSC Community Care Services Eligibility Field Policy Services Asst
MEPD	HHSC MEPD Policy Support
TW	HHSC Texas Works Policy Support
Program Policy (For use by Field Policy or other HHSC state Office staff only)	HHSC AES PSAD

Include a descriptive email title with the appropriate handbook section. (Ex: F-1231 Funds for a nonprofit organization or SNAP: A-1822 e-signature on 1808 valid). Use “Urgent” if an answer is needed within a day. (Ex: Urgent SNAP: A-231 SNAP HH Comp Joint).

Note: If the policy clarification is from an external requestor, the clarification is escalated directly to Program Policy.

Detailed Instructions

Program Type — Select the program relevant to the policy clarification. If multiple programs should be selected, complete a separate request for each program.

Part I

Policy Clarification Requester — Staff complete Part I to request a policy clarification request.

Requestor’s Name — Enter the name of the person requesting the policy clarification.

Area Code and Phone Number — Enter the requestor’s phone number.

Email Address — Enter the requestor’s email address.

Requesting Area — Select the area requesting the policy clarification.

Policy Topic — Type a brief description of the policy subject. Ex. Income Verification, Alien Status, Dependent Deduction Allowance, etc.

Region Number — Enter the region requesting the policy clarification.

Date — Enter the date the policy clarification.

Part II

Policy Clarification Reviewer — Supervisory staff complete Part II after reviewing the policy clarification request.

Supervisor’s Name — Enter the name of the person reviewing the policy clarification.

Area Code and Phone Number — Enter the supervisor’s phone number.

Email Address — Enter the supervisor’s email address.

Part III

Complete Case Details — The requestor completes Part III to provide case-specific details.

Case Name — If the request relates to the household, enter the Head of Household’s (HOH) name. If the request relates to a specific eligibility determination group (EDG) number, enter the name associated with the EDG.

Client No. — Enter the number associated with the client.

Application or Case No. — Enter the number associated with the case.

EDG No. — Enter the number associated with the specific program received by the client.

File Date — Enter the day the application was received.

Type of Assistance — Select the type of assistance (TOA) most relevant to the case and clarification request. Select “Other” and indicate all programs or a specific, unlisted TOA.

Urgent — Only select “Yes” when an expedited response is needed (e.g., cases with expedited processing timeframes or cases that are past due). Select “No” for all other requests.

Request Due Date if Urgent — If selecting “Yes” above, enter the date the response is needed.

Reason for Urgency — If selecting “Yes” above, briefly explain the reason for the urgent request.

External Attorney or Estate Planner (MEPD Only) — If an external attorney has contacted the eligibility field staff, or if the person has an attorney involved, provide the attorney’s information along with any legal paperwork pertaining to the case that the attorney has prepared. All Legal documents should be reviewed by the regional attorney before the policy clarification request is submitted to the MEPD Policy Support mailbox.

Part IV

Questions and Substantiating Documentation — The requestor completes Part IV to provide case-specific research.

Case Situation — Provide specific information on all relevant and essential information such as what, when, why, how, etc. Include the program type, applicable household or budgeting situation (e.g., individual, couple, spousal), and any relevant bulletins or previous policy clarifications. Note: If the request is the result of an IT or Help Desk ticket, include the relevant email and reference number.

Examples:

SPRA month is November 2018. Total resources as of Nov. 1, 2018, were $96,516.43; SPRA was $48,258.21. Worker was unable to expand the SPRA because the community spouse was receiving monthly earnings of $5,879.79. Total resources as of Dec. 1, 2018, were $86,294.16. The person was ineligible due to excess resources. Community spouse lost their job in January 2019. Case was certified in error on Feb. 9, 2019, with a medical effective date of Dec. 1, 2018, and is still active.
Household consists of mom and her three children. Mom is applying for SNAP but has an open SNAP E&T sanction. Mom is now considered an ineligible student and TIERS is attempting to close her SNAP E&T sanction before the penalty period is over.
Application for CAS on Feb. 3, 2019. Form 3052 received from the physician is dated Oct. 19, 2017. Policy requires the Form 3052 include a statement that the person has a current medical need but does not address the date of the practitioner’s signature.

Specific Policy Question — Provide the specific policy question needed to address the case situation.

Examples:

What is the correct way to handle this case?
Should the case be denied and the person asked to reapply, in which case only the resources in the person’s name are countable?
Could the SPRA be expanded in January or February after the spouse lost his job?
Should the SNAP E&T sanction be closed?
What timeframe is a practitioner’s signature valid on a Form 3052 for CAS?

Reviewed Policy Material Related to this Case-Specific Clarification — Identify all applicable handbook sections that the requestor, supervisor and PCC reviewed. Do not quote or cut and paste the entire sections of the handbook on the form. Include a proposed response on how the reviewed policy applies to the policy question.

Example: According to TWH A-340, Chart B, under Medical Programs, for I-551, there is not mention of code DV, nor is it mentioned in any of the following policy. It is unclear whether the code DV grants individual’s approval for medical benefits.

Part V

MEPD Only — If the requestor selected “MEPD” as the program type at the top of the form, the requestor completes Part V with any relevant attorney information.

Was the agency attorney consulted to review documents? — Select “Yes” or “No.”

Name of HHS Regional Attorney — Enter the HHS regional attorney’s name.

Area Code and Phone Number — Enter the HHS regional attorney’s phone number.

Regional Attorney’s Response (Include any electronic correspondence or documents with the request.) — Enter a summary of the HHS regional attorney’s response. Information can be summarized by either the program specialist or regional attorney as appropriate.

Part VI

Field Policy Response — Select the appropriate Field Policy area completing Part VII to provide a response.

Name of Program Specialist — Enter the name of the Program Specialist providing the response.

Date of Response — Enter the date the response is completed.

Handbook Section(s) — Enter handbook sections used to provide the response.

Other Policy Sources — Enter any bulletins, broadcasts, job aids or other policy sources used to provide the response.

Case-Specific Response — Explain the case-specific relevance of the citations of any listed handbook sections or other policy sources.

Part VII

Program Policy Response — Program Policy staff complete Part VIII to provide a response. If the question was escalated to Program Policy, this section contains the final response. If the question was not escalated to Program Policy, the answer provided in Part VII should be considered final.