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

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

Issuance

RCH benefits must not be issued until the GA 18 form is received from the facility. The bill must be paid within 10 working days of receipt of the GA 18 provided all other eligibility factors are met.

Note: If a client enters the RCH facility after the GA grant was already issued or the EW is not notified , an overpayment must be established for the amount of the original grant the client was not eligible for (less the personal needs amount for clients in an RCH). [Refer to CB 25-118].

Issuing Board and Care Manually

CalSAWS Money Management must be updated with the RCH payment amount and the CATS team must be emailed. [Refer to "Issue Board and Care Manually" workaround from CATS].

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

Examples

On August 1st, Mr. Jack received his GA benefits of $150. On August 29th, the EW is notified that Mr. Jack has been residing at Momentum since August 1st and is expected to stay the whole month of August. On September 1st, the RCH facility submits the GA 18, billing the amount for the period of August 1st through August 31st. The EW makes the payment within 10 working days as follows:

Reviews the GA 18 for completeness.
Enters August 1 as the begin date and admission date in CalSAWS.
Determines the client received an overpayment of $122 in personal needs ($150 regular personal needs - $28 RCH personal needs = $122 overpayment).
Determines the RCH facility will receive $901.
Updates Money Management in CalSAWS with the RCH payment amount and emails CATS. [Refer to "Issue Board and Care Manually" workaround from CATS].
Establishes an overpayment for the $122 personal needs amount that the client was not eligible for. [Refer to CB 25-118].
Completes the “County Use Only” section of the GA 18 and sends it to the facility as form of receipt.

Mr. Mo 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.
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. Mo moved from the facility (taken from the GA 18 “Final Bill”).
2. 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 and the payment is appropriately prorated.
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.”
Updates Money Management in CalSAWS with the RCH payment amount and emails CATS. [Refer to "Issue Board and Care Manually" workaround from CATS].

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.
Updates Money Management in CalSAWS with the RCH payment amount and emails CATS. [Refer to "Issue Board and Care Manually" workaround from CATS].
Completes the “County Use Only” section of the GA 18 and sends it to the RCH facility.

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. Document actions taken in a CalSAWS Journal Entry.
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. 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) Update Money Management in CalSAWS with the RCH payment amount. Document actions taken in a CalSAWS Journal Entry.
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. Process an application for any other programs as appropriate. Document actions taken in a CalSAWS Journal Entry.
Moves from independent living to an RCH and does not notify the EW timely or moves after the regular GA grant has been issued,	Record information from the GA 18 in CalSAWS. Make payment within 10 working days from receipt of the GA 18 the following month (never paid in current month) Update Money Management in CalSAWS with the RCH payment amount. Establish an overpayment for the original issued amount the recipient was not eligible for. [Refer to CB 25-118 for instructions on creating a recovery account for board and care payment in CalSAWS]. Document actions taken in a CalSAWS Journal Entry.

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.