Nebraska Administrative Code
Topic - HEALTH AND HUMAN SERVICES SYSTEM
Title 469 - ASSISTANCE TO THE AGED, BLIND, OR DISABLED PROGRAM
Chapter 1 - GENERAL BACKGROUND
Section 469-1-005 - APPLICATION SUBMITTAL

Universal Citation: 469 NE Admin Rules and Regs ch 1 ยง 005

Current through September 17, 2024

An application for assistance may be made in person, by mail, telephone, fax, or electronic submission and may be made by the applicant, the applicant's guardian or conservator, an individual acting under a duly executed power of attorney, or another person authorized to act for the applicant.

005.01 VALID APPLICATION. An application is considered valid the date it is received by the Department and contains:

(A) Name;

(B) Address; and

(C) Proper signature of the applicant or authorized representative.

005.02 ALTERATIONS TO THE APPLICATION. Information may be added to an application up to the decision date.

005.03 ACTION TAKEN ON APPLICATIONS WITHIN ALLOWED TIMEFRAMES PER REGULATION. Eligibility determinations are made 45 days from the date of the application for the blind or aged category, and within 60 days from the date of application for the disabled category.

005.04 STATE DISABILITY PROGRAM MEDICAL APPLICATION WITH SHARE OF COST. An application for State Disability Program medical assistance for an individual with a share of cost who has a medical need may be approved with no medical payments authorized until the applicant has met the share of cost obligation.

005.06 ASSISTANCE TO AGED, BLIND, OR DISABLED AND STATE DISABILITY PROGRAM APPLICATION WITH EXCESS RESOURCES. An application for assistance for an individual who has excess resources is denied. The applicant can reapply when the resources have been spent down.

005.07 APPLICATION WITHDRAWAL. The applicant may voluntarily withdraw an application verbally or in writing. A notice of action is sent to the applicant.

005.08 AUTHORIZATION FOR RELEASE OF INFORMATION. The applicant or recipient must sign a release of information form if the Department requests.

005.09 NEW APPLICATION NEEDED. A new application is required after one calendar month of ineligibility.

005.10 NOTICE OF FINDING. A notice of action is sent to inform the applicant or recipient of any action affecting the assistance case. The types of notices are:

005.10(A) ADEQUATE NOTICE. An adequate notice includes a statement of what actions are being taken, the reasons for the intended actions, and the regulation that support the actions or the change in federal, or state, law that requires the actions.

005.10(B) TIMELY NOTICE. A timely notice is dated and mailed at least ten calendar days before the date that action would become effective, which is always the first day of the month.

005.10(C) ADEQUATE AND TIMELY NOTICE. In cases of intended adverse action, including action to discontinue, terminate, suspend, or reduce assistance, or to change the manner, or form, of payment, or service, to a more restrictive method, such as a protective payee, the applicant or recipient is given adequate and timely notice.

005.11 SITUATIONS REQUIRING ADEQUATE NOTICE. In some instances, timely notice is not needed, but adequate notice is still required. Consult the Guidance Document for a complete listing of these situations.

005.12 WAIVER OF NOTICE. An applicant or recipient may agree to waive his or her right to a timely notice in situations requiring timely notice by providing a signed statement indicating his or her choice to waive the notice.

005.13 NOTICES IN FRAUD CASES. At least five days advance written notice is given if:

(A) The agency has facts indicating that action should be taken to discontinue, suspend, terminate, or reduce assistance because of probable fraud by the applicant or recipient; and

(B) The facts have been verified where possible through collateral sources.

005.14 CONTINUATION OF BENEFITS DURING AN APPEAL. In cases of adverse action, a timely and adequate notice is sent. When the applicant or recipient requests an appeal hearing within ten days following the date a notice of action is mailed, the adverse action is not taken until a fair hearing decision is made. This regulation does not apply to those situations where only an adequate, but not timely, notice is needed.

005.14(A) ON-GOING CASE MANAGEMENT. Normal case activities, and implementing changes to the assistance case, that are not directly related to the appeal issue is still completed.

005.14(B) ADVERSE ACTION Adverse action pending an appeal is not carried out if:
(i) The case action being appealed required adequate and timely notice;

(ii) The applicant or recipient requests an appeal hearing within ten days following the date the notice of finding is mailed; and

(iii) The applicant or recipient does not refuse continued assistance.

005.14(C) RECOUPMENT CIRUCMSTANCES. If the appealed action is sustained by the hearing decision, the benefits received by the applicant or recipient while the hearing was pending will be subject to recoupment.

005.15 REFUSAL OF CONTINUED BENEFITS DURING AN APPEAL. An applicant or recipient has the right to refuse the continuation of benefits pending an appeal hearing by checking the statement to that effect on the Request for Fair Hearing form, or by handwriting a refusal request.

005.16 REDETERMINATION OF ELIGIBILITY FOR THE AGED, BLIND, OR DISABLED PAYMENT OR STATE DISABILITY PROGRAM. Whenever there is a reported, or suspected, ineligibility of benefits for an applicant or recipient, immediate action to determine current eligibility is taken. A review and eligibility determination is completed according to the following:

005.16(A) REDETERMINATION FOR THE ASSISTANCE TO THE AGED, BLIND OR DISABLED PROGRAM. Every twelve months for the Assistance to the Aged, Blind, or Disabled Payment program, although the eligibility may be redetermined in less than twelve months to coordinate review dates for more than one program.

005.16(B) REDETERMINATION FOR THE STATE DISABILITY PROGRAM. At the end of twelve months or the disability ruling by a medical consultant for the State Disability Program medical assistance only, or State Disability Program medical assistance with a share of cost and no further medical needs are apparent or indicated. The disability time frame from the medical consultant may dictate less than twelve months of eligibility and the individual is ineligible when the disability ruling ends. The case is then closed and a notice sent.

005.16(C) REDETERMINATION FOR SUPPLEMENTAL SECURITY INCOME RECIPIENTS. Every twelve months, or less, for a recipient who are current pay Supplemental Security Income status. An application is not required at the time of the review.

005.16(D) REDETERMINATION FOR SUPPLEMENTAL SECURITY INCOME 1619(b) PROVISION RECIPIENTS. Every twelve months, or less, for individuals who are determined eligible by Supplemental Security Income for the 1619(b) provision are not required to complete an application at the time of review.

005.16(E) TEMPORARY NONPAY STATUS FOR SUPPLEMENTAL SECURITY INCOME RECIPIENTS. A determination of eligibility review is not required for periodic Supplemental Security Income non-pay status for income due to an extra pay period.

005.17 INCOME REVIEW. An income review is completed every twelve months for the Assistance to the Aged, Blind, or Disabled Payment program.

005.17(A) INCOME REVIEW NOT REQUIRED. An income review is not required for recipients of Supplemental Security Income.

005.18 DISABILITY REVIEW. When the initial disability determination was made by the Department, all procedures necessary for a redetermination of disability are required for recipients of the Assistance to the Aged, Blind or Disabled payment program or the State Disability Program. A redetermination of disability must be made no later than twelve months after the initial determination of disability.

005.19 PRUDENT PERSON PRINCIPLE. When the statements of the client are incomplete, unclear, or inconsistent, or when other circumstances in the particular case indicate to a prudent person that further inquiry must be made, additional verification is obtained before eligibility is determined.

005.19(A) PRIMARY RESPONSIBILITY. The client has the primary responsibility for providing verification of information relating to eligibility.

005.19(B) VERIFICATION METHODS. Verification may be supplied in person, through electronic submission, the mail, or another source.

005.19(C) AVAILABLE ASSISTANCE. When it would be extremely difficult, or impossible, for the individual to provide verification in a timely manner, the individual may ask the Department for assistance.

Disclaimer: These regulations may not be the most recent version. Nebraska may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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