SR 05-36 Dated 11/05

STATE OF NEW HAMPSHIRE

INTER-DEPARTMENT COMMUNICATION

SUMMARY

This SR releases an increase from $50 to $56 in the monthly personal needs allowance (PNA) for residents of nursing facilities, community residences, and residential care facilities.

Form 799, Spousal Income Protection, and Form 799A, Income Computation Worksheet for Allocation of Income for Institutionalized Individuals, have been updated accordingly.

POLICY

Effective November 1, 2005, the monthly personal needs allowance (PNA) will increase from $50 to $56. The $6 increase in the PNA impacts:

§   Residents of nursing facilities, community residences, and residential care facilities: Residents in these types of living arrangements are now legally entitled to keep $6 more a month for personal needs expenses.

§   Cost of care determinations for certain medical assistance recipients: Nursing facility recipients, and recipients of Home and Community-Based Care for the Developmentally Disabled (HCBC-DD) and Home and Community-Based Care for individuals with an Acquired Brain Disorder (HCBC-ABD) residing in independent living arrangements, will now have up to $6 less a month considered available when determining patient liability.

§   Supplemental payments to OAA, APTD, and ANB nursing facility residents: Nursing facility residents receiving supplemental payments because their available income was less than the former PNA of $50, will receive up to $6 more a month if no other changes have occurred in their case.

§   Income allocated to the community spouse or dependents: Nursing facility residents will now have $6 less per month to allocate to their community spouse or dependents.

§   OAA, APTD, and ANB nursing facility residents with available income between $50 and $56: Nursing facility residents whose available income is equal to or more than the former $50 PNA but less than the new $56 PNA, are now eligible for supplemental payments.

PROCEDURES

NF Patient Liability

Manual adjustments are necessary for nursing facility recipients with liability amounts that have been overridden by the worker. New HEIGHTS report NMC810RA, MC PT Liab Override RPT, which will be available after the mass change, will identify those cases requiring an adjustment. All other nursing facility recipients will automatically receive the New HEIGHTS-generated AE0009, Patient Liability Letter, if a new patient liability is created or a change is made to a current resident’s patient liability.

HCBC-DD/ABD Cost of Care

District Offices must adjust the cost of care amount for recipients of HCBC-DD/ABD for November and subsequent months on Form 517-C, Payment Toward Cost of Care Agreement. A report identifying these cases will be provided under separate cover.

NEW HEIGHTS CHANGES

The evening of October 19, 2005, New HEIGHTS will run all open nursing facility cases through a mass change to apply the increased personal needs allowance.

/•­·   A Notice of Decision (NOD) will be generated for any OAA, APTD, or ANB nursing facility recipient experiencing a change in their supplemental payment or now newly eligible for a supplemental payment. Individuals eligible for a supplemental check will receive the regular "cash" opening NOD explaining the supplemental checks. All NODs generated will have the following special message added to the regular text:

THE NEW HAMPSHIRE STATE LEGISLATURE RECENTLY APPROVED AN INCREASE IN THE AMOUNT OF MONEY THAT MAY BE KEPT BY NURSING HOME MEDICAID RECIPIENTS FOR PERSONAL NEEDS. THIS AMOUNT IS NOW $56 PER MONTH. BECAUSE THIS AMOUNT HAS INCREASED BY $6 A MONTH, YOU MAY SEE UP TO $3 MORE IN EACH CHECK YOU GET FROM US IF NO OTHER CHANGES HAVE HAPPENED IN YOUR CASE.

·   New HEIGHTS-generated AE0009 will be generated to any nursing facility resident experiencing a change in liability. The following special message will be added to any AE0009s generated during this mass change:

THE NEW HAMPSHIRE STATE LEGISLATURE RECENTLY APPROVED AN INCREASE IN THE AMOUNT OF MONEY THAT YOU MAY KEEP FOR YOUR PERSONAL NEEDS. THIS AMOUNT IS NOW $56 PER MONTH. BECAUSE YOU CAN KEEP $6 MORE A MONTH, THE AMOUNT YOU ARE RESPONSIBLE FOR PAYING TO THE NURSING FACILITY ON BEHALF OF THE CARE YOU GET HAS DECREASED BY UP TO $6.

A copy of the AE0009 is attached to the SR for reference.

POST-MASS CHANGE REPORTS

The reports described below will be produced as a result of the Mass Change and will be available on October 20, 2005.

NMC540RA: AG’s Affected by MC

This report lists all cases that the Mass Change ran successfully through confirmation. It contains the following information: DO, Worker Name, Client Name, and Case Number.

NMC550RA: MC Exception

This report lists cases that were selected for computation during the Mass Change, but were not confirmed. These cases require further District Office action. The report contains the following information: DO, Worker Name, Client Name, Case Number, Reason for Exception, and Mass Change Type.

NMC810RA: MC PT Liab Override RPT

The Nursing Facility with Patient Liability Override report lists cases that contain a Patient Liability override and therefore the amount did not change. All cases must have the overridden liability reviewed and adjusted by November 15 to allow AIM enough time to produce a new "Letter 100" to the nursing facility for 11/05 liability. The report contains the following information: DO, Worker ID, Client Name, and Case Number.

HCBC DD/ABD Excel Report

This ad hoc report will be sent to District Offices under separate cover within the week. Using the report, District Offices must manually adjust the November cost of care amount for recipients of HCBC-DD/ABD. All adjustments must be effective November 1, and Form 517-C must be completed and sent to the area agency by November 4, 2005.

FORMS REVISIONS

Form 799, Spousal Income Protection, and Form 799A, Income Computation Worksheet for Allocation of Income for Institutionalized Individuals, have been revised to include the increase in the PNA from $50 to $56 per month. With new spousal applications November 1, 2005 or later, use the updated forms which replace Forms 799 and 799A, released by SR 05-16/July 1, 2005.

The new versions of Forms 799 and 799A will be electronically transmitted to each District Office with the electronic distribution of this SR. Contact Linda White, DFA/State Office, at 271-4580 with any questions related to detaching the forms to your PC.

UNRELATED TECHNICAL CORRECTION

Adult Assistance Manual Section 621.05, Cost of Care: HCBC-ECI Financial or Medical Assistance, was revised to remove the procedural steps for determining the cost of care liability for non-MEAD individuals determined eligible for Home and Community-Based Care for the Elderly and Chronically Ill (HCBC-ECI). Because the Bureau of Elderly and Adult Services determines the amount of income the HCBC-ECI recipient must apply towards the cost of care, this text is unnecessary.

POLICY MANUAL REVISIONS

Revised Family Assistance Manual Topics

Section 614.01   Cost of Care: HCBC-DD/ABD

Revised Adult Assistance Manual Topics

Section 215.01   Residential Care Facility Payment

Section 217.01   Community Residence Payment

Section 619.01   Cost of Care: Nursing Facility

Section 619.03   Supplemental Payments: Nursing Facility

Section 621.05   Cost of Care: HCBC-ECI Financial or Medical Assistance

Section 623.05   Cost of Care: HCBC-DD Medical Assistance

Section 624.05   Cost of Care: HCBC-ABD Medical Assistance

IMPLEMENTATION

The revised policy is effective November 1, 2005, and applies to any cases processed on or after that date.

CLIENT NOTIFICATION

In addition to the special text messages added to the client notices generated by New HEIGHTS and described in the Notices section above, nursing facility residents and their community spouses will be receiving an additional letter in January, at which time information about the increase in the PNA’s affect on income allocated to the spouse will be further explained.

The Bureau of Elderly and Adult Services notified the nursing facility administrators of the increase in the PNA on September 2, 2005. Administrators of community residences were notified as the Division of Developmental Services deemed appropriate.

TRAINING

No training is planned or needed.

FORMS POSTING INSTRUCTIONS

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 31, 2005.

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

DFA/JBV:s