1. (a) The following types of community engagement activities shall be reported by completing and submitting BFA Form 321 “Reporting Education Participation for Community Engagement – Granite Advantage Health Care Program” (06/19):

   1. (1) For job skills training related to employment under He-W 837.05(e), the beneficiary shall provide documentation of enrollment that includes the duration and the number of hours per month the beneficiary is participating in the activity;
   2. (2) For enrollment at an accredited community college under He-W 837.05(f), the beneficiary shall provide documentation of enrollment that includes a copy of the beneficiary’s class schedule, the number of credit hours assigned for the enrolled class(es), and the semester begin and end date. The number of community engagement hours to be credited shall be determined by multiplying the number of credit hours assigned for the enrolled class(es) by 4.33;
   3. (3) For vocational educational training under He-W 837.05(h), the beneficiary shall provide documentation of enrollment that includes the duration of the activity and a copy of the beneficiary’s enrollment in the program. Community engagement hours shall be credited at 100 hours per month for the duration of the beneficiary’s verified participation in the activity not to exceed 12 months;
   4. (4) For education directly related to employment under He-W 837.05(i), the beneficiary shall provide documentation of enrollment that includes the duration of the activity. Community engagement hours shall be credited at 100 hours per month for the duration of the beneficiary’s verified participation in the activity; and
   5. (5) For study leading to a certificate of general equivalence under He-W 837.05(j), the beneficiary shall provide documentation of enrollment that includes the duration of the activity. Community engagement hours shall be credited at 100 hours per month for the duration of the beneficiary’s verified participation in the activity;
2. (b) The types of community engagement activities listed in (c) below shall be reported on a completed and submitted BFA Form 320 “Reporting Monthly Participation in Community Engagement Activities - Granite Advantage Health Care Program” (06/19).

3. (c) Beneficiaries shall provide the requested information on the form in (b) above, and the hours reported on the form in (b) above shall be credited toward the community engagement requirement as follows:

   1. (1) For time spent participating in job search and job readiness efforts under He-W 837.05(g), the beneficiary shall report the type, duration of the activity, and total number of hours per month;
   2. (2) For community, volunteer, or public service under He-W 837.05(k), the beneficiary shall report where and when the community, volunteer, or public service was performed, the number of hours performed, and the contact information for the organization or individual the service was performed for;
   3. (3) For caregiving services under He-W 837.05(l), the beneficiary shall report the name and contact information for the non-dependent relative or other person cared for, a description of the services provided, and the number of hours of caregiving services provided;
   4. (4) For participation in ASAM Level 1, as set forth in ASAM Criteria (2013), outpatient SUD services under He-W 837.05(m), the beneficiary shall report the name of the agency or organization the services were received from, and the number of hours that the beneficiary participated in the services up to 40 hours per month. For participation in any other ASAM level treatment, see exemption He-W 837.03(a)(1);
   5. (5) For beneficiaries experiencing a temporary increase in monthly employment hours for seasonal work or for other such work greater than the beneficiary’s average monthly employment hours as credited pursuant to (d)(4) below, the beneficiary shall report the increased hours which shall be limited to 2 consecutive months; and
   6. (6) For beneficiaries who are self-employed and work more hours than calculated by the department’s eligibility system(s), the beneficiary shall report the additional hours worked, and a description of the hours work and tasks performed.

4. (d) The indicated community engagement activities below shall be credited as follows if the activity is verified by the department’s eligibility system(s):

   1. (1) For system-verified participation in and compliance with SNAP employment requirements, community engagement hours shall be credited at 100 hours per month for the duration of the beneficiary’s verified participation in the program;
   2. (2) For system-verified participation in and compliance with TANF employment requirements, community engagement hours shall be credited at 100 hours per month for the duration of the beneficiary’s verified participation in the program;
   3. (3) For participation in and compliance with the employment requirements of the refugee resettlement program pursuant to 45 CFR 400.75, systemic verification of legal status and enrollment in the program. and community engagement hours shall be credited at 100 hours per month for 12 months from the date of the beneficiary’s entry into the United States; and
   4. (4) Employment information gathered during the application or redetermination process or in the department’s eligibility system(s) shall be used to determine a beneficiary’s average monthly employment hours and shall be credited towards the community engagement requirement for employment activities listed in He-W 837.05(a)-(d).

Source. #12733, INTERIM, eff 2-23-19, EXPIRES: 8-22-19; ss by #12796, eff 6-5-19 (formerly He-W 837.07); BFA form 321 in (a) and BFA form 320 in (b) amd by #12828