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Medical Services Policy Manual, Section H

H 400 Post Eligibility

The medical expenses must be verified as currently due and unpaid. Future anticipated expensesmay be used when it is verified that these expenses have occurred with regularity in the past and will continue to occur with regularity in the future. Only the non-covered medical expenses for the facility recipient may be deducted. When there is a contract between an applicant and a medical provider and regular payments on a medical bill are being made, the monthly payment will be deducted as a noncoverable medical expense. When there is no contract, the monthly amount of the medical expense being paid may be deducted, with verification that regular payments are being made. Deduction of medical expenses is not allowed for nursing facility and ICF/IID residents for items and services included in the state’s Reimbursement Cost Manual as allowable cost items (items the facility will provide). Examples of these include wheelchairs, canes, crutches, walkers, ambulance services or enrollment fees for ambulance services (unless there is not a Health Care enrolled ambulance provider in the area), other transportation services, over-the-counter pain killers, antacids, laxatives, cough syrups, suppositories, anti- diarrhea medication, diapers, band-aids, bandages, peroxide, antiseptics. Facilities are required to provide these items and services at no additional charge to the recipient. An income offset for the purchase of eyeglasses, contact lenses, hearing aids, prostheses, and dentures can be made only if the following procedure is followed: • The items must be prescribed by a physician or other licensed medical practitioner. • The items must be a part of the recipient’s plan of care. It must be determined by the facility interdisciplinary team that the recipient’s quality of life will be enhanced and that they are able to utilize the item(s). • The request must be approved by the facility’s Quality Assessment and Assurance Committee. • The cost of the item(s) must be determined. • The recipient or authorized representative must provide the eligibility worker with verification of the above. The recipientor authorized representative must notmake the purchase or pay the medical bill until the eligibility worker has made an adjustment to the patient liability.