Resident Payment System 400-29-40-05

(Revised 2/02 ML #2785)

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The county shall determine the recipient's responsibility for payment toward the room and board expense in a licensed basic care facility. This is accomplished by completing the appropriate screens in the Resident Payment System.

 

The county must use the Resident Payment System screen(s) each time there is a change in the amount the recipient is required to pay toward the room and board costs in a licensed basic care facility. Notification of any change in recipient responsibility is sent to the basic care facility and to the recipient.

 

BUDGETING EXAMPLE -- MONTH OF ENTRY INTO A

BASIC CARE FACILITY

Scenario – Mr. Jones entered the basic care facility on August 13th. For the month of August, he had rent expense of $325.00. The deductions in the month of entry will be clothing allowance of $60.00, the Medicaid level for one of $492.00, and the rent expense of $325.00 and the Medicaid Recipient Liability disregard in this case of $128.00. Total expenses for Mr. Jones in the month of entry into the basic care facility equals $1005.00. Mr. Jones has income of $700.00. Following is the example as it would appear in the resident payment system:

 

Computation: $700.00 income minus $1005.00 deductions = $0 recipient responsibility towards room and board expense.

 

In the month of entry, allow the deduction of Medicaid level for one and reasonable living expenses.

 

BUDGETING EXAMPLE OF AN INDIVIDUAL IN A

BASIC CARE FACILITY

 

Scenario -- Ongoing case for George Dakota who entered the basic care facility August 29, 20__, and the benefit month is December. George receives SSI of $565.00 monthly. The deduction allowed is $60.00 clothing allowance (zero Medicaid recipient liability). Following is an example of how the system would budget this situation.

 

TECS CLIENT ID: 00000    RESIDENT NAME: Dakota, George

SSN: 585-05-0250   BIRTHDATE: 02-111993   AGE: 77

FACILITY: Basic Care Facility  CITY: Bismarck STATE: ND

 

Room and Board Rate: $16.60

 

BCAP ELIGIBILITY START DATE: 0829_ _ MEDICAID REDETERMINATION DUE DATE:

 

CLOSING EFFECTIVE DATE: FUNCTIONAL ASSESSMENT DATE: 0129_ _

 

WORKER NAME: Susie E. Worker WORKER COUNTY:  08

 

PAYMENT MONTH: 12_ _ RESIDENT PAYMENT AMT: $505.00 PHYSICAL COUNTY:

 

 

Computation: Income is $565.00 and with the allowable deduction of $60.00 the basic care recipient responsibility is $505.00 and the resident is responsible for paying this amount to the basic care facility for room and board expenses.

 

 

BUDGETING EXAMPLE – TEMPORARY STAY OF

LESS THAN SIX MONTHS

 

Scenario -- Tom Jones is in a licensed basic care facility recovering from surgery. He will return home within six months. Mr. Jones’ stay is temporary; therefore, he is allowed additional deductions such as health insurance premium and the Medicaid level for one. The additional deductions are allowed in these cases so the individual can maintain their residence while residing temporarily in a basic care facility.

 

TECS CLIENT ID: 123456    RESIDENT NAME: JONES, Tom

SSN: 501-00-0000    BIRTHDATE: 02211907 Age: 92

FACILITY: Basic Care Facility    CITY: Bismarck State: ND

Room and Board Rate: $16.60

 

BCAP Eligibility State Date: 0801_ _  Medicaid Redetermination date due: 0801_ _

Closing Effective Date:   Functional Assessment date: 08-01-_ _

Worker Name:     Worker County:

Payment Month: 12_ _ Resident Payment Amt: $00.00  Physical County:

 

 

Computation: Monthly Income is $565.00 and the deductions are $871.00 leaving a recipient responsibility of $0 for room and board costs.