DLTC Memo Series 2008-02
Date: January 23, 2008
To: Listserv
For: Area Administrators / Human Services Area Coordinators-LTC
County COP Coordinators
County Department of Community Program Directors
County Departments of Developmental Disabilities Services Directors
County Departments of Human Services Directors
County Departments of Social Services Directors
County Waiver Coordinators
DLTC Bureau Directors
DLTC Section Chiefs
Tribal Chairpersons/Human Services Facilitators
Family Care Managed Care Organizations/WPP
Aging and Disability Resource Centers
From: Sinikka Santala
Administrator
Subject: Medical/Remedial Expenses used for Long-Term Care Medicaid
Eligibility and Cost-Sharing
Document Summary
Effective immediately, certain types of medical/remedial expenses will
not be allowed when determining cost-shares or spenddowns for people
participating in Family Care, Partnership and Home and Community Based
Waiver programs
Background
Federal law permits states to impose reasonable limits on allowable
amounts of medical/remedial expenses, so long as these limits are
described in the Medicaid State Plan and are approved by the Center for
Medicaid and Medicare Services (CMS). The Bureau of Eligibility Management
(BEM) has amended the State Plan to reflect changes in this regard. OPS
Memo #08-02, dated 01/04/2008 was issued to inform Income Maintenance
Agencies of the new policy at http://www.dhs.wisconsin.gov/em/ops-memos/2008/default.htm.
This DLTC Memo and the attached technical assistance document informs
applicable agency staff in County Waivers Agencies, Managed Care
Organizations (MCOs) and Aging and Disability Resource Centers (ADRCs) of
how these changes affect the processing of Family Care and Home and
Community Based Waiver applications or recertifications.
Policy
Effective immediately, the following types of bills may not be used as
medical/remedial expenses to offset the cost-share or to meet the
spenddown obligation in the eligibility determination process in Family
Care (both at the nursing home and non-nursing home level of care),
Partnership, and in the Home and Community Based Waivers:
- Medical bills which remain unpaid, but were previously used to meet
a Medicaid deductible;
- Bills which were for the cost of institutional care provided during
a previous Medicaid divestment penalty period;
- Bills that represent a patient liability amount/cost share incurred
during some previous period of institutionalization and Medicaid
eligibility or an unpaid Medicaid Home and Community Based
Waiver/Family Care or Partnership cost-share obligation.
- Medical bills which will be paid by a legally liable third party,
e.g. private health insurance, Medicare, Medicaid, etc.
- Medical bills which were previously allowed as a medical/remedial
expense and counted to reduce a waiver cost share or used to reduce a
nursing home patient liability obligation.
A technical assistance document illustrating example for each situation
stated above is attached.
Action Required: Effective immediately, the disallowed medical/remedial
expenses described in this memo cannot be used when processing eligibility
for Family Care, Partnership and Home and Community Based Waivers, or
Institutional Medicaid. The policy applies to new applications and to
current participants/enrollees at review/certification time.
REGIONAL OFFICE CONTACT: Human Services Area Coordinators
CENTRAL OFFICE CONTACT: Rita Cairns
Bureau of Long-Term Support
P. O. Box 7851
Madison, WI 53707-7851
608-266-6891
cairnri@wisconsin.gov
MEMO WEB SITE: http://www.dhs.wisconsin.gov/dsl_info/
Attachment: Technical Assistance Document
(PDF 25 KB)
Return
to Numbered Memos Index
|
