SR 05-26 Dated 09/05

STATE OF NEW HAMPSHIRE

INTER-DEPARTMENT COMMUNICATION

SUMMARY

This SR releases the following changes regarding the "currently obligated, unpaid prior medical debt" allowed as a deduction during the post-eligibility cost of care computation for nursing facility assistance:

§   the Medicaid provider payment rate must be used for nursing facility expenses that are considered to be "currently obligated, unpaid prior medical debt," not the actual rate billed by the facility; and

§   nursing facility expenses incurred during any period of ineligibility due to excess resources or receipt of lump sum are not considered an allowable "currently obligated, unpaid prior medical debt," and therefore cannot be used as a deduction during the cost of care computation.

POLICY

For individuals determined eligible for nursing facility assistance on or after September 1, 2005, the following changes apply to "currently obligated, unpaid prior medical debts" that are allowed as a deduction during the individual’s post-eligibility cost of care computation:

§   the Medicaid provider payment rate for the nursing facility must be used for nursing facility charges that are considered to be "currently obligated, unpaid prior medical debt." The actual rate billed by the facility is no longer allowed. Note: Non-nursing facility-related medical expenses that are considered to be "currently obligated, unpaid prior medical debts" may still be allowed as a cost of care deduction in the actual amount charged; and

§   nursing facility expenses incurred during a period of ineligibility due to excess resources or receipt of lump sum are not considered an allowable "currently obligated, unpaid prior medical debt" and cannot be used as a deduction when determining the individual’s liability for cost of care. Current policy disallowing a cost of care deduction for nursing facility expenses incurred during a penalty period remains unchanged.

Example: An individual applies for nursing facility assistance on September 1, 2005. The individual has $5,000 in counted resources and had more resources in previous months. The individual has currently obligated, unpaid nursing facility debts for June, July, and August. Because the individual’s resources exceeded the resource limit in June, July, and August, the nursing facility bills that are owed for those months cannot be used as "currently obligated, unpaid prior medical debts" to offset the individual’s current cost of care liability.

POLICY MANUAL REVISIONS

Revised Adult Assistance Manual Topics

Section 619.01   Cost of Care: Nursing Facility

IMPLEMENTATION

The changes described in this SR apply to all new applications for nursing facility assistance made on or after September 1, 2005. Current recipients of nursing facility assistance who have been allowed to deduct outstanding nursing facility expenses at the actual rate billed by the facility are "grandfathered," and may continue to use actual costs.

CLIENT NOTIFICATION

No special client notification is planned or needed.

TRAINING

No special training is planned or needed.

DISPOSITION

This SR may be destroyed or deleted after its contents have been noted and the revised manual topics released by this SR have been posted to the On-line manuals.

DISTRIBUTION

This SR will be distributed according to the electronic distribution list for Division of Family Assistance policy releases. This SR, and revised On-Line Manuals, will be available for agency staff in the On-Line Manual Library, and for public access on the Internet at http://www.dhhs.nh.gov/DHHS/DFA/LIBRARY, effective October 1, 2006.

This SR, and printed pages with posting instructions, will be distributed under separate cover to all hard copy holders of the Adult Assistance Manual.

DFA/JBV:s