The CAO will determine the countable income of an ICF/ID resident in the same way as for an individual in a Long-Term Care (LTC) facility except for the following modifications:
If the individual has earnings from a sheltered workshop or other therapeutic activity arranged by the facility, the CAO may determine monthly gross earned income based on the actual earnings received during the previous six months and on any significant changes which are expected to occur during the next six months.
EXAMPLE: An individual worked three days a week during the past six months, but will work only two days a week in future months.
The CAO will treat the average monthly earnings as monthly income for the next six months. The CAO will recalculate the earnings at the end of the six months to arrive at a monthly average that can be anticipated for the next six months. If the individual is receiving Medically Needy Only (MNO) Medical Assistance (MA), the CAO will recalculate the earnings at each complete and partial redetermination. If the individual is not receiving MNO MA, the CAO will create an alert to recalculate the income at the six month interval between complete redeterminations.
If a resident of a State-operated ICF/ID is the beneficiary of a trust, the facility will request a review of the trust document by its Office of Legal Counsel (OLC). The OLC will determine what portion of the fund and/or income from the fund is to be considered available to the individual when determining eligibility and the individual's payment toward the cost of care. The facility will advise the CAO of the OLC decision; and
The Facility Reimbursement Officer in a State-operated facility is responsible for reporting all income or changes in income to the CAO. This includes reporting the interest accrued or received from Vecchione or other excluded accounts.
The operator or manager of a private ICF/ID is responsible for reporting all changes to the CAO.
55 Pa. Code § 4310 42 CFR § 435.725(e) 42 CFR § 435.832(e)
Updated August 27, 2013 Issued May 1, 2012