| TO: | ALL COUNTY OFFICES |
| FROM: | JANEL R. LUCK, DIRECTOR |
| SUBJECT: | SOCIAL SERVICE COORDINATORS INCORPORATED |
DISCUSSION:
Social Service Coordinators Incorporated (SSC) is an organization which is contracted with five Medicare Advantage plans to assist Medicare recipients in obtaining benefits through the Department of Social Services Medicare Cost Savings Programs which include the Qualified Medicare Beneficiary (QMB) and Specified Low Income Medicare Beneficiary (SLMB and SLMB-2 or QI-1) Programs. The Medicare Advantage plans that they are currently contracted with are Coventry, Group Health Plan, Humana, PacifiCare, and United Healthcare. In addition to assisting Medicare Advantage plan members with receiving benefits through Medicare Cost Savings Programs, they also facilitate enrollment into “Extra Help” or low income subsidy program for members who are eligible for both Medicaid and Medicare benefits.
A claimant may designate SSC to serve as his or her authorized representative to assist in applying for either QMB or SLMB benefits. A copy of the SSC authorized representative form is attached. County Family Support Division (FSD) offices may provide information to SSC in regards to claimants for which they are acting on behalf of the claimant as an authorized representative through the application process and up to and including any administrative hearing process. This includes sending a copy of any request for information notices as well as case action notices to SSC regarding a claimant's application for QMB or SLMB benefits. The county office must verify that there is a signed authorized representative form in the claimant's record designating SSC as the authorized representative prior to providing any information to SSC regarding a claimant's application for benefits. If a signed authorized representative form is not in the record and cannot be located, do not provide any information to SSC regarding the claimant.
County FSD offices may accept documentation provided from SSC such as bank statements, letters or policy packets from life insurance companies, pay stubs, and other types of documentation to determine eligibility on behalf of the claimant. County FSD offices cannot accept the SSC representative's statement as verification when determining the claimant's eligibility.
EXAMPLE OF ACCEPTABLE VERIFICATION: The eligibility specialist receives an application for QMB benefits on behalf of Ms. Lee. An IM-6AR appointing SSC as Ms. Lee's authorized representative for her QMB application is also provided. SSC provides the eligibility specialist a copy of Ms. Lee's current bank statement. This is considered acceptable verification of Ms. Lee's resource eligibility in regards to how much is in her bank account.
EXAMPLE OF UNACCEPTABLE VERIFICATION: The eligibility specialist receives a QMB application for Mr. Montgomery with a signed authorized representative form appointing SSC as his authorized representative. Mr. Montgomery has a pension from GE Electric. SSC faxes the eligibility specialist a statement that they contacted GE Electric and verified that Mr. Montgomery's pension is $456.00 per month. This information is not acceptable verification of the pension Mr. Montgomery is receiving from GE Electric. A statement from the company who issues the pension or other documentary evidence must be obtained.
NECESSARY ACTION:
- Review this memorandum with appropriate staff.
ATTACHMENTS:
Social Service Coordinators Auth Rep Form 2007 
ER