Frequently Asked Questions: Income Calculation for
Payment of Room and Board in Substitute Care
Family Care Member Income Calculation for Payment of Room and
Board in Substitute Care
for Standardizing Member Income Considered Available for Room and Board
March 10, 2010; Presenters: Charles Jones and Deb
Rathermel, Division of Long Term Care; 52 minutes (PowerPoint
Handouts, PDF, 109 KB)
Question: Should a member's VA aid and attendance allowance be
counted as income on the room and board worksheets completed for members
in substitute care facilities?
Answer: For purposes of considering funds available to pay for
room and board, all VA allowances should be considered unearned income on
line 11 of the automated PPS version or on line 4 of the Excel version of
the tool for determining a member's income available to pay for room and
board in substitute care.
Question: Can MRE/OTC (specialized medical
supplies) be allowed to offset cost shares for people at the non-Nursing
Home Level of Care?
Answer: Specialized medical equipment and supplies
is a benefit that is not available at the non-Nursing Home Level of Care
and therefore costs of OTC (over the counter) paid out-of-pocket by the
member are considered deductions for purposes of determining both cost
share and room and board.
Question: MCOs report medical/remedial expense information to
Income Maintenance, but since this information is usually not relevant for
Group A eligibles who have no cost share, it might not be entered by Income
Maintenance in CARES. Is that alright?
Question: A member has earned income that
fluctuates from month to month. Thus, the member's unearned income
fluctuates as well. The result is that the income information in CARES is
unreliable. How should this situation be handled for purposes of
determining the member's income available for room and board?
Answer: The MCO should examine available
information about the member's earned and unearned income for the past 12
months and use it to calculate prospective average monthly earned and
unearned income for the member. The MCO should enter that average monthly
earned and unearned income information it has calculated into the
appropriate fields in lines 10 and 11 of the automated room and board
The examination of available information about the member's earned and
unearned income for the past 12 months should be reviewed at least every
six months and the prospective averages recalculated.
Question: What if the member is not found in PPS?
Answer: Only members who were enrolled using the central
enrollment process or any new enrollments from a waitlist will be in PPS.
Members can be moved in to PPS two ways:
- In PPS select 'Basic Registration' from the left side navigation and
enter basic information for the system to pull the member's
information from CARES. (see instructions
for detailed directions).
- In the Adult functional screen eligibility page select the link at
the bottom of the page to create someone in PPS.
Question: What are the expectations of DHS for implementation of
changes in the recently released DLTC numbered memo 2010-05 for
standardizing room and board in substitute care?
The goal is to standardize the following
three procedures. The expected implementation timelines for each are
- A methodology for determining the room and board rate:
As noted in the recently released DLTC
numbered memo 2010-05 (PDF, 54 KB), a separate memo
methodology will be circulated soon with implementation of the
standardized methodology by all Managed Care Organizations (MCOs) expected by January 1, 2011.
In the meantime, MCOs can set room and board rates using either a cost-based methodology or a flat-rate methodology based on some reasonable
- Determination of member income available for room and board:
As noted in the numbered memo, after April 1, 2010, MCOs are expected
to use the new automated on-line tool to re-determine each memberís
income available for room and board at either:
- The memberís next Medicaid recertification date, or
- At a sooner date (e.g., next member-care plan review, all members on April 1); if
a sooner date is used, MCOs are asked NOT to report any change in
medical/remedial expenses to income maintenance until the memberís
next Medicaid recertification date.
- Documentation of member contribution to room and board and any MCO
As noted in the numbered memo, after April 1, 2010, all MCOs are
expected to use the new automated on-line tool for determining each
memberís income available for room and board Ė use of that tool is
the only documentation needed by DHS, however MCOs are free to print a
copy for membersí case records.
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April 23, 2014