Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 20 - Division of County Operations › Rule 016.20.97-011 - Medical Services Policy Manual - Increase in the personal needs allowance (PNA) for most nursing facility recipients

Current through Register Vol. 49, No. 6, June, 2024
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/MR
				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 (0LTC),
				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 $40.00
				per month from their income for personal expenses. (EXCEPTION: Recipients whose
				only income is SSI will have their monthly payment reduced to $30.00. 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 $50.00, the facility must deposit
				the funds in excess of $50.00 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. Resident
				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 legal
				representative.
In addition to the $40 personal needs allowance, ICF/MR
				customers who have income from employment are allowed to keep up to $100 of
				their earnings each month for personal needs.
A customer with earnings and receiving intermediate care
				in a nursing facility may also keep up to $100 increased personal needs
				allowance if the customer's physician has stated that a period of employment
				activity is necessary as a therapeutic or rehabilitative measure. If a customer
				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 single
				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 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 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
5. Review
			 by the Office of Chief Counsel
Prior to certification of eligibility, the county worker must
				submit the trust document to the Office of Program Planning and Development,
				Slot 1220, for review by the Office of Chief Counsel (OCC), to obtain an
				opinion that the trust document meets the requirements of a valid income trust
				in Arkansas.
6. Fees and
			 Other Disbursements
CASES CERTIFIED PRIOR TO 11/1/95
A monthly fee may be paid out of the trust for the services of
				the trustee. A fee greater than the prevailing institutional charge may not be
				paid to an individual who is serving as trustee.
Other allowable disbursements from the trust may include
				monthly bank service charges, preparation of income tax returns for the trust,
				income taxes owed by the trust, and attorney's fees for preparation of the
				trust.
Trusts certified prior to 11/1/95 may continue to allow these
				distributions, as initially established. HOWEVER, NO INCREASES OVER THE INITIAL
				AMOUNTS ESTABLISHED WILL BE ALLOWED.
CASES CERTIFIED 11/1/95 AND LATER
Effective for cases certified for services 11/1/95 and later,
				fees for trustees (including trustee fees for banks), preparation of income tax
				returns and attorneys WILL NOT BE ALLOWED AS DISTRIBUTIONS FROM INCOME TRUSTS.
				THE ONLY FEES ALLOWED WILL BE THE BANK SERVICE CHARGES FOR MAINTAINING THE BANK
				ACCOUNT.
7. Trustee
			 Responsibilities
A trustee may serve without bond or supervision of any
				court.
Prior to any distribution from the trust, the trustee must
				notify the county worker responsible for the case of any fees, income taxes or
				other payments which must be made from the trust before these disbursements can
				be made, and the advance notice must be made no later than the month which
				precedes the month in which the disbursements will be made.
No disbursements of any kind can be made by the trustee until
				the trustee has been provided a current Post Eligibility Income Worksheet,
				DCO-712, completed by the county worker in charge of the case.
Any disbursements made that are not for the benefit of the
				recipient, the community spouse or other dependents, as specified on the
				DCO-712, will be considered a transfer of resources and a period of
				ineligibility will be applied.
Payments must be made from the trust each month, during the
				first week of the month, and only in the amounts specified on the DCO-712. The
				payments must be made directly to the designated recipient, i.e., to the
				recipient or responsi ble person for the personal needs al 1 owance (PNA); to
				the community spouse and/or dependent(s) for their allowances; to the recipient
				or responsible party for the recipient's noncovered medical expenses; and to
				the facility for the patient's share of cost.
While an individual is receiving Medicaid benefits in a
				facility, no disbursements other than those specified on the DCO-712 may be
				made.
The trust records shall be open to inspection and for copying
				by DHS, and periodic reporting may be required at the discretion of DHS.
If the trustee becomes aware of any change in circumstances
				which will affect the recipient's eligibility or the amounts being distributed
				monthly from the trust, the trustee shall be responsible for notifying the
				county worker of such changes. Changes to be reported include income changes,
				increase or decrease of cost of noncovered medical expenses, recipient dies or
				leaves the facility, community spouse enters a facility, etc.
The trustee must notify the county worker if in any month the
				funds are not disbursed according to the DCO-712 or if the balance in the trust
				account exceeds the maximum allowed as specified in Number 11 below so that the
				worker can adjust the facility payment(s) for the month(s) in which the vendor
				payment is affected.
8. Post
			 Eligibility Consideration of Income
The total net countable income of an individual will be
				included in the post eligibility consideration. Net income will be calculated
				as for all other Medicaid eligible individuals in the post eligibility
				process.
For example, an individual has $1500 net countable monthly
				income. For post eligibility purposes, the calculations will begin with $1500.
				The PNA, the spousal/dependent allowances (if applicable, but not in amounts
				greater than the maximum allowed on the DCO-712), and noncovered medical
				expenses of .the recipient will be deducted. The balance remaining must then be
				applied to the individual's cost of care in the facility.
The county worker will be responsible for providing the trustee
				and the recipient or his representative with a copy of the DCO-712 at initial
				certification and each time it is necessary to make a revision in the post
				eligibility budget due to income changes or other changes such as those made on
				the DCO-712 mandated by the spousal laws.
9. Begin Date of Eligibility
Eligibility for facility care shall not be retroactive to the
				month which precedes the month of establishment of the trust. Eligibility may
				begin on the first day of the month in which the trust is established, provided
				that the individual's income has been placed in the trust that month, that no
				funds have been disbursed from the trust prior to certification during that
				month and that the individual is otherwise eligible. If funds have been
				disbursed from the trust during the month of establishment of the trust and
				prior to authorization of disbursements by the DCO-712, eligibility cannot
				begin until the first of the month following the month of establishment of the
				trust.
It must be verified prior to beginning eligibility that the
				individual's income has been placed in the trust.
If the individual submits all required evidence within the
				allotted time, the individual's ownership interest will be determined and the
				findings documented in the case record. The income from the actual ownership
				interest (i.e., the interest determined by the rebuttal) will be used in the
				eligibility determination.
When the individual has successfully rebutted ownership of all
				or a portion of the income, income payments will be considered available to the
				IS in proportion to his/her interest (if any).
NOTE: This section does not apply to federal, state or other
				entitlements, pensions or retirement benefits. For example, ownership of a $600
				Social Security income entitlement for an IS cannot be rebutted.