Page 454

Medical Services – Glossary

MS Manual 01/01/24

Coinsurance – A set percentage of covered medical costs after the deductible has been paid. Community Spouse (CS) – The legal spouse of the Institutionalized Spouse (IS) who is not institutionalized. Community Spouse Maximum Resources (CSMR) – The total amount of resources which may be considered available to the CS; this amount includes resources held solely by the CS (in which the IS has no ownership interest) and the Community Spouse Resource Allowance. Compute on the DCO-713. Community Spouse Minimum Monthly Maintenance Needs Allowance (CSMNA) – The total income that the CS needs for his/her support. This amount may not exceed the limit shown on the DCO-712. Community Spouse Monthly Income Allowance (CSMIA) – The maximum amount that an IS may contribute toward the support of the CS. Compute on the DCO-712. Community Spouse Resource Allowance (CSRA) – The maximum amount of the IS’s resources which may be transferred to the CS or to another for the sole benefits of the CS. Compute on the DCO-713. Comprehensive Plan of Care – The client has met functional/medical criteria as well as financial criteria for eligibility. The Plan of Care represents billable services. The comprehensive plan of care is good for a year and the Waiver eligibility date and the comprehensive plan of care expiration date are on the plan of care. Conditionally Eligible – An individual can be enrolled (entitled) for Part A Medicare only on the condition that he/she is eligible for QMB, and thus eligible for the state Medicaid agency to pay the Part A premium as part of the QMB benefits.

Page 3 of 14

loading…

Page 454

Official source

Medical Services – Glossary

MS Manual 01/01/24

Coinsurance – A set percentage of covered medical costs after the deductible has been paid. Community Spouse (CS) – The legal spouse of the Institutionalized Spouse (IS) who is not institutionalized. Community Spouse Maximum Resources (CSMR) – The total amount of resources which may be considered available to the CS; this amount includes resources held solely by the CS (in which the IS has no ownership interest) and the Community Spouse Resource Allowance. Compute on the DCO-713. Community Spouse Minimum Monthly Maintenance Needs Allowance (CSMNA) – The total income that the CS needs for his/her support. This amount may not exceed the limit shown on the DCO-712. Community Spouse Monthly Income Allowance (CSMIA) – The maximum amount that an IS may contribute toward the support of the CS. Compute on the DCO-712. Community Spouse Resource Allowance (CSRA) – The maximum amount of the IS’s resources which may be transferred to the CS or to another for the sole benefits of the CS. Compute on the DCO-713. Comprehensive Plan of Care – The client has met functional/medical criteria as well as financial criteria for eligibility. The Plan of Care represents billable services. The comprehensive plan of care is good for a year and the Waiver eligibility date and the comprehensive plan of care expiration date are on the plan of care. Conditionally Eligible – An individual can be enrolled (entitled) for Part A Medicare only on the condition that he/she is eligible for QMB, and thus eligible for the state Medicaid agency to pay the Part A premium as part of the QMB benefits.

Page 3 of 14