Rhode Island Code of Regulations › Title 210 - Executive Office of Health and Human Services › Chapter 50 - Medicaid Long-Term Services and Supports › Subchapter 00 - Long-Term Services › Part 8 - Post-Eligibility Treatment of Income (PETI) › Section 210-RICR-50-00-8.9 - Determination and Collection of Beneficiary Liability

Current through June 14, 2024
A. PETI income is the amount of an LTSS
				  beneficiary's income that is applied to the LTSS Medicaid cost of care after
				  the deduction of all available allowances. If the beneficiary's gross income is
				  depleted by the allowances deducted - PETI income is zero dollars ($0.00) -
				  there is no beneficiary liability and no payment toward the Medicaid cost of
				  care is required.
1. Agency Responsibilities -
				  In determining and applying PETI income for beneficiary liability purposes, the
				  agency has the following responsibilities:
a.
				  Calculation of beneficiary liability. In general, the determination of
				  beneficiary liability is based on the income and resources of the applicant
				  beginning on the eligibility date, which is the first (1st) day of the month in
				  which an application is filed and date stamped as received by the agency. There
				  is no beneficiary liability for services covered during the ninety (90) day
				  retroactive period which begins in the month prior to the filing of the
				  application.
b. Collection date.
				  The obligation to pay beneficiary liability varies by type of LTSS when
				  eligibility is determined by the State in a month after the application is
				  filed irrespective of the eligibility date as follows:
(1) HCBS beneficiaries - Beneficiary
				  liability begins on the first (1st) day of the month in which a determination
				  of eligibility is made. If eligibility is determined in a month after the
				  application was filed, beneficiary liability does not accrue retroactively back
				  to the eligibility date, however. Therefore, collection of beneficiary
				  liability for HCBS beneficiaries is always prospective and begins on the first
				  (1st) day of the calendar month after eligibility is determined by the
				  State.
(2) NF and other health
				  institutions. LTSS beneficiaries residing in health institutions are obligated
				  to pay what they can afford toward the cost of care beginning on the date of
				  admission. Accordingly, for beneficiaries who were residing in such
				  institutions on the date the application was filed, liability toward the cost
				  of care begins on the eligibility date - the first (1st) day of the month in
				  which an application is filed - irrespective of the date eligibility is
				  actually determined by the State. Thus, beneficiary liability does accrue
				  retroactively for LTSS beneficiaries residing in health care
				  institutions.
c.
				  Reductions. In instances in which the LTSS applicant has no spouse or
				  dependents and has incurred LTSS costs during the period an application is
				  pending, liability for the cost of care may be reduced for the first (1st)
				  month to take these additional costs into consideration.
d. Adjustments. In general beneficiary
				  liability must be recalculated at any time there is a change in a factor that
				  was used as the basis for an allowance including, but not limited to, the death
				  of the non-LTSS spouse, sale of a home, change in living arrangement, income,
				  or scope of benefits. Beneficiary liability is also adjusted prospectively,
				  even in situations in which a beneficiary did not make a timely report of such
				  a change. The only exceptions to prospective adjustments are as follows:
(1) Partial month eligibility. Beneficiary
				  liability is adjusted when a LTSS beneficiary receives services for less than a
				  full month due to death, discharge, or change in LTSS living arrangement, such
				  as nursing facility to home.
(2)
				  Beneficiary Overpayments. Retroactive adjustments are made when an agency
				  system error resulted in an overpayment liability by a beneficiary for one (1)
				  month or more. The adjustments date back to the first (1st) of the month when
				  the error was made. Retroactive adjustments are NOT made when beneficiary
				  liability is understated.
e. Notice. Beneficiary liability may not be
				  imposed without first providing prior notice to the beneficiary indicating the
				  amount of the monthly payment and appeal rights. This requirement applies at
				  the time of the initial eligibility determination in the benefit decision
				  notice and Medicaid LTSS renewals as well as at any time there is reassessment
				  of need indicating a change in living arrangement is required, such as the
				  beneficiary no longer has the highest need for a NF level of care.
f. Provider notification. Notification is
				  provided to the health care institution or HCBS provider if there are any
				  changes to beneficiary liability.