When authorizing payment of LTC facility services with Buy-In for individuals not yet enrolled in the Buy-In Program, the CAO will:
Enter the Medicare B premium (medical expense code 12) as a paid expense on the Medical Expenses screen to ensure the Medicare B premium is listed on the notice.
Send a system generated notice of eligibility listing the Medicare B premium to the individual, individual’s representative, and the LTC facility.
Once the CAO receives notification from the Social Security Administration that the LTC recipient has been enrolled in the Buy-In Program, the CAO must take the following action:
Update the gross Social Security Income on the Unearned Income Screen in Phase IVB.
End the Medicare B premium so that it is no longer displayed on the notice.
Select ‘Yes’ on the Expense Questions screen to modify a medical expense. This will queue the Medical Expenses screen.
Enter the end date of the Medicare B premium in the ‘end date’ field on the Medical Expenses screen.
Send a system generated notice with the updated income and payment toward cost of care to the individual, individual’s representative, and the LTC facility. The notice will no longer list the Medicare Part B premium. 55 Pa. Code § 133.4
Issued May 1, 2012