Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 20 - Division of County Operations › Rule 016.20.99-012 - MS 99-8: Earnings of ICF/MR Residents - Changes to the Medical Services Policy manual to allow residents of ICF/MR facilities to keep all of their earnings up to an amount equal to the current SSI SPA

Current through Register Vol. 49, No. 6, June, 2024
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3000
Guidelines for the Long Term Care Program and Other
			 AABD
Categories
3100
General
			 Information
3110
Facilities Which Provide Services
Facilities which provide medically necessary care and services
				24 hours per day on a long term basis include private nursing facilities,
				Benton Services Center, Arkansas Human Development Centers, private
				intermediate care facilities for the mentally retarded (ICF/MR's), and ICF/HR
				facilities with both over and under 15 beds.
3120
Services Provided Under
			 Medicaid
In addition to facility vendor payments, all services listed in
				the pamphlet, "Your Guide to Medicaid Services in Arkansas", are available to
				individuals under the Long Term Care Program, with the following exception:
				Individuals in the State Human Development Centers are not eligible for the
				Prescription Drug Program.
3130
licensing and Classification
			 of Facilities
To receive vendor payment under the Medicaid Program, a
				facility must be licensed and certified by the Office of Long Term Care (OLTC),
				and must execute a provider agreement with the Division of Medical
				Services.
The OLTC publishes a directory listing all participating
				facilities. Changes to the directory are issued periodically. The directory and
				updates are provided to each county office.
3135.
Nursing
			 Facility
Section 1919 (a) of the Social Security Act defines a nursing
				facility as an institution which is primarily engaged in providing:
Skilled nursing care and related services for residents who
				require medical or nursing care,
Rehabilitation services for the rehabilitation of injured,
				disabled, or sick persons, or
Health-related care and services to individuals who because of
				their * mental or physical condition require care and services (above the level
				of room and board) which can be made available to them only through
				institutional facilities,
and is not primarily for the care and treatment of mental
				diseases.
»
3140
Personal Allowance for Facility Residents
Each recipient in a facility is allowed to retain $40 per
				month from their income for personal expenses. (EXCEPTION: Recipients whose
				only income is SSI will have their monthly payment reduced to $30. They are
				allowed to keep this amount as a personal allowance.) Upon written
				authorization of a resident, the facility must hold, safeguard and account for
				the personal funds of the resident deposited with the facility. If the
				resident's personal funds are in excess of $50, the facility must deposit the
				funds in excess of $50 in an interest bearing account (or accounts), separate
				from any of the facility's operating accounts, that credits all interest earned
				on the resident's account to his or her account. A resident's personal funds
				may not be commingled with facility funds or with any person's funds other than
				another resident. The resident's individual financial record must be available
				on request to the resident or his/her legal representative.
1
In addition to the $40 personal needs allowance, ICF/MR
				residents, including residents of State Human Development Centers, who have
				income from employment are allowed to keep all of their earnings up to an
				amount equal to the current SSI SPA.
A resident with earnings who is receiving intermediate
				care in a nursing facility may keep up to $100 increased personal needs
				allowance if his/her physician has stated that a period of employment activity
				is necessary as a therapeutic or rehabilitative measure. If a resident
				receiving skilled care in a nursing facility becomes employed, the Utilization
				Review Section of the OLTC should be contacted and requested to reevaluate
				medical necessity.
Certain SSI recipients whose stay in a nursing facility
				is not expected to exceed 3 months and who have a home to maintain will be
				allowed to retain full SSI benefits for personal expenses for three calendar
				months following the month of entry. The SSI payment, in these instances, will
				not be considered in eligibility or payment determination (Re. MS
				3401).
A $90 personal needs allowance will be given to a veteran
				receiving a VA pension in a facility who has no spouse or dependent children. A
				veteran's surviving spouse who has no dependents and who receives a VA pension
				will also be given a $90 allowance. The full $90 allowance will be allowed only
				when VA has reduced the pension to $90. (Re. MS 3348.1). Veterans receiving VA
				compensation do not qualify for the $90 PNA.
3150
Special Charges to
			 Recipients in Facilities
The facility must inform the patient prior to or at the
				time of admission or application, and during his/her stay, of services
				available in the facility and of related charges, including charges for
				services not covered by Medicare or the per diem rate. Recipients may be
				charged only for optional services (services * not necessary or consistent with
				the normal care of the patient). When such services are provided, documentation
				must be on file with the OLTC. -The refusal of a recipient to accept optional
				services offered by a facility must not effect a decrease or alteration in the
				services required or necessitated by his/her condition or otherwise considered
				as normal care. Inquiries from recipients or family members concerning special
				charges will be referred to the OLTC.
3160
Nondiscrimination
The Division of County Operations complies with all
				provisions of the Civil Rights Act of 1964, Section 504 of the Rehabilitation
				Act of 1973, and the
Americans With Disabilities Act of 1990. All facilities
				authorized to participate in the LTC program must also comply with these
				provisions. No person will be prevented from participation, denied benefits, or
				otherwise subjected to discrimination based upon race, color, sex, national
				origin, disability, age, religion, political affiliation, or veteran
				status.
The Division of County Operations has the'responsibility
				of informing applicants and recipients that assistance is provided on a
				nondiscriminatory basis and of their right to file a complaint with the
				Division, the Department of Health and Human Services, the Department of
				Justice, and/or the United States Civil Rights Commission if they feel they
				have been discriminated against on the basis of one of the above.
The OLTC is responsible for securing a statement of
				compliance from all hospitals and facilities authorized to participate in the
				Medicaid program, and for assuring that the Statement of Compliance is
				officially adopted and posted on the premises. The OLTC will also assure that
				copies of the policy are provided to all employers and staff, and to all
				referral agencies. The OLTC will conduct annual reviews of facilities to insure
				compliance with these provisions.
3170
Freedom of
			 Choice
Residents of nursing and ICF/MR facilities, and AABD
				recipients whose primary insurance is Medicare, are not required to participate
				in the Medicaid Primary Care Physician Managed Care Program.
These recipients will have freedom of choice in the
				selection of facilities, physicians, pharmacies, and other medical providers.
				The recipient should be informed that payment under the Medicaid program can be
				made only to medical providers authorized to participate in the Medicaid
				program. If the recipient wishes to utilize the services of a personal
				physician or other medical practitioner who does not participate in the
				Medicaid program, the recipient will be advised that payment cannot be made by
				the Agency for these services, and that the cost will be his/her
				responsibility.
3180
Placement
Relatives or friends of a facility applicant should help
				in making the selection of a Medicaid certified and licensed facility. Names
				and addresses of facilities that can provide the appropriate care and services
				will be given to the patient or his/her family.
If the applicant is unable to make this choice and if
				there are no relatives or friends to assist in the decision, the county office
				will assist with the placement. If placement cannot be made, a request for
				assistance should be made to the OLTC.
3200
Application
			 Process
3210
Initial Application for Facility Payment
An application for facility services may be made by the
				applicant, designated representative, next of kin, or person(s) acting
				responsibly for the individual. Applications should be made in the county where
				the facility chosen by the individual is located. If an application is made in
				the applicant's home county
-
before facility entry, but
				the applicant enters a facility in another county, the
-
application will be denied by input to
				WIMA, using denial Reason 53. A DCO-700 will then be completed, advising the
				client or the representative that the application has been sent to the
				appropriate county. All records will then be
transferred to the county where the facility is located.
				A new application will not be needed by the receiving county, and the original
				date of application will be entered in ACES when the application is
				reregistered.
NOTE* If a period of eligibility has been, or will be,
				established in a facility in the county of initial application, that county
				will certify the case for the eligible period before transferring the case to
				the second county.
Annlications may be processed for deceased persons.
				Application may be made by any person with responsibility for the medical debts
				of the deceased person.
Amplication for facility services will be made on Form
				DCO-777. This form will be completed for all applications for facility vendor
				payment unless the individual is currently receiving assistance as an AFDC,
				U-18, or Foster Care (Cat. 91 or 92) recipient. No new application is needed
				for these categories.
3220
Reapolication for
			 Facility Payment
Rpannlication for facility services is made in the same
				manner as initial
annlications Previous records will be reviewed. If the
				applicant comes from
another county where his case was closed, the record will
				be secured from that
county.
3230
Distinction Between
			 Application and Inquiry
Every person has the right to apply for Medicaid. No
				application or inquiry may be ignored.
The distinction between an application and an inquiry is
				as follows:
1.
An
			 application is the action by which an individual indicates in writing to the
			 Agency his desire to receive services.
2.
An inauiry is simply a request for
			 information about eligibility requirements for services. An inquiry may be
			 followed by an application.