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MEDICAL SERVICES POLICY MANUAL,SECTION M M-100 Overpayments M 130 Overpayment Evaluation Excess Income

For LTC cases, the amount claimed for repayment will be limited to the LTC vendor payments made during the period of ineligibility when the amount of the LTCF’s private payment rate for the month(s) of ineligibility exceeds the excess income. If the private pay rate is less than the excess income, then the amount claimed for recovery will be the LTC vendor payment plus the Medicaid payment for all medical services received during the period. The procedure for determining the amount of overpayment to be recovered is as follows: 1. The County Office will compute net countable income for the entire period of ineligibility. Net countable income for each month in the period will be determined by applying all exclusions and deductionswhich would be applicable if computing Medically Needy eligibility for the individual(s) (add together the net countable income received in each month in the period). 2. The County Office will compute the total MNIL for the entire period of ineligibility (add together the monthly MNILs for each month in the period). 3. The County Office will compute excess income by deducting the MNIL for the period (Re. 2, above) from the net countable income for the period (Re. 1 above). 4. The Overpayments Unit will compare themedical expenses incurred during the period of ineligibility to the excess income for the period. a. For LTC cases, if the total private pay rate for the period of ineligibility (add together the private pay rate for the patient’s level of care for each month in the period) is more than the amount of excess income, the amount claimed for repayment will be limited to the total vendor payments. b. If the total private pay rate for the period of ineligibility is less than the amount of extra income, then the amount claimed for repayment will be the total vendor payment plus any medical expenses incurred. c. For non-LTC cases, the amount claimed for repayment will be the lessor of the excess income or the amount of payment for medical services received during the period.