Congregate Care Providers – please see the letter and form in the links the following links:
Congregate Care Provider Letter 3 2 15
Congregate Care Change Form -5023 (2-15)
The letter appears below in its totality.
I make special note of the final sentence: “all non-person specific SSP forms can be found on our website at: http://otda.ny.gov/programs/applications/#ssp. We have been experiencing difficulties when person-specific forms that accompany client letters are being copied and used by Congregate Care providers for another recipient. These forms have a unique barcode to help us identify the recipient, and problems result when used for someone other than that recipient.”
March 2, 2015
Dear Congregate Care Provider:
The purpose of this letter is to share with you the revised Congregate Care Change Report Form (LDSS-5023 revised 2/15) and to request that you begin using this version of the form to make us aware of changes, especially admissions and discharges, for the SSP recipients in your care. Many of the revisions are the result of suggestions made by the Congregate Care provider community. Certain sections have been modified or repositioned to help make sure the necessary information is captured. When completed correctly, we expect this form will require fewer follow-ups with you and allow us to process changes more quickly and accurately.
Summarized below are some of the important changes to the revised LDSS-5023:
- Section I – is the new location for the forwarding instructions. We are no longer requiring that you submit this form to your local Social Security office. If you currently share with your local department of social services please continue to do so.
- Section II – asks that the SSP recipient’s residence and mailing address be included. We understand that these addresses may differ from the Provider address, which often times reflects the administrative office where payments and correspondence is sent.
- Section III – includes a column for the Effective Date of the move, and specifies if the move is into or out of the facility. This date is especially important to us when calculating the benefit amount for the month of admission.
- Sections V & VI – have been created for income and resources, and the income section collects any type of earned and unearned income changes.
- Section VII – special attention needs to be paid to the “payee” area on this section.
- If you are the Representative Payee (RP) for federal Supplemental Security Income (SSI) benefits, check this box as you automatically serve as the payee for SSP benefits. No additional forms are required.
- If the resident receives federal SSI benefits but has not designated an RP or needs to change the RP, this change can only be made by the Social Security Administration (SSA). Once this takes place, SSA will pass this information to us for SSP benefit purposes.
- If the resident receives only SSP benefits and requires a payee, or change in payee, the LDSS 5023 cannot be used in this situation. The Designated Representative form (LDSS-5024) needs to be completed and forwarded to us.
Consistent with the rules stated above, if the resident receives federal SSI benefits, any banking changes need to made with the Social Security Administration. A resident who receives only SSP benefits can use the LDSS-5023 to designate where the SSP benefits are to be deposited. A separate Direct Deposit form (LDSS-5025) is not required.
On a final note, all non-person specific SSP forms can be found on our website at: http://otda.ny.gov/programs/applications/#ssp. We have been experiencing difficulties when person-specific forms that accompany client letters are being copied and used by Congregate Care providers for another recipient. These forms have a unique barcode to help us identify the recipient, and problems result when used for someone other than that recipient.
I appreciate your cooperation. If you have any questions please contact us at [email protected].
Sincerely,
/s/ JH 3/2/15
John Haley
Director, SSP Bureau
Enclosure