The individual or representative must report a change in income within ten days of the change. If necessary, the CAO will re-evaluate the individual’s eligibility and determine the individual’s payment towards the cost of MA LTC facility services within ten days.
The CAO must count the total amount of income available each month to the individual. The CAO must also consider changes in the income of a CS or any dependents if the individual is receiving an income deduction for that individual. The CAO must review the income of the CS and dependents at each scheduled renewal.
The CAO must make the change effective in the month it was reported if the individual’s payment toward cost of care decreases. The CAO must send a notice to the individual, the individual’s representative (if any), and the LTC facility. 55 Pa. Code § 133.4(c)
NOTE: Because this change will benefit the individual and the LTC facility will not submit its billing for the month of the change until the month ends, the LTC facility will be able to adjust its billing.
If the individual becomes ineligible or the individual’s payment to the LTC facility increases because of a change in the individual’s income, the CAO must make the change effective for the first day of the calendar month in which the 15 day advance notice expires. If the change was not reported timely, the CAO must determine whether an overpayment exists.
See Supplemental Handbook Chapter 910, Overpayment Recovery for more information about overpayments.
55 Pa. Code § 133.4(b) 55 Pa. Code § 255.4(a)
Examples:
Mr. T reports on January 8 that his RSDI and pension increased as of January 1. The CAO adjusts the income on January 16 and sends an advance notice to change his payment toward the cost of care effective January 1.
Mr. S reports on February 12 that his RSDI and pension increased as of January 1. The CAO adjusts the income on February 13 and sends an advance notice to change his payment toward the cost of care effective February 1. The CAO then processes an overpayment for January, because the individual did not report the change timely.
Mrs. N reports on January 10 that her RSDI and pension increased as of January 1. The CAO adjusts the income on January 20 and sends an advance notice to change her payment toward the cost of care effective February 1. No overpayment is charged against Mrs. N, because she reported the change timely and the CAO acted on the change timely.
The Minimum Monthly Maintenance Needs Allowance, dependent maintenance allowance, and excess shelter standard are revised each year (effective July 1) to reflect new Federal Poverty Income Guidelines (FPIGs) released by the Federal Government.
42 USCA § 1396r-5(d)(4)(A) (B)
The Shelter Utility Allowances (SUA) are revised each year (effective October 1) by the Department of Agriculture.
7 CFR § 273.9(d)(6) (page 11)
On January 1 of each year, the special NMP income limit and the Maximum Monthly Maintenance Needs Allowance change.
If the change in the Community Spouse Maximum Monthly Maintenance Needs Allowance limit makes the spouse eligible for an allowance, the CAO must apply the deduction to the first month for which the LTC facility can make the change in its billing. The CAO must send the individual, the CS and the LTC facility a notice verifying the new amount of the spousal allowance and cost of care. The LTC facility will complete a claim adjustment to deduct the spousal allowance for the months back to the effective date of the change.
If the individual left the LTC facility, the CAO must be provided a written statement indicating the amount the individual had planned to make available during each month beginning on the effective date of the change. The CAO must provide a notice to the individual, the individual’s representative, the CS and the LTC facility.
If the CSMMNA changes for any reason, the individual or representative must sign another Certification of Payment of Income form, PA 1847. The CAO must deduct only the amount actually given to the CS. 55 Pa. Code § 181.452(d)(2)(vi)
The individual or representative must report income changes within ten days. The individual must report changes in his income as well as the income of the CS and any dependents in the community who are receiving a dependent allowance.
If the individual is late in reporting a change that decreases the individual’s payment toward the cost of LTC facility services, the CAO must make the change effective beginning the month of the change. When the LTC facility receives its copy of the notice, it must process a claim adjustment to correct past billings. See Chapter 438, Benefits and Billing. 55 Pa. Code § 133.4(c)
If the individual is late in reporting a change that makes the individual ineligible or that increases the individual’s payment toward the cost of LTC facility services, the CAO must make the change effective the first day of the calendar month in which 15 day advance notice expires. If it creates an overpayment, the CAO must complete an Overpayment Referral, OIG 189.
55 Pa. Code § 133.4(b) 55 Pa. Code § 255.4(a)
Updated March 12, 2012, Replacing December 2, 2005