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CODE OF COLORADO REGULATIONS 10 CCR 2505-10 8.100 Medical Services Board

222 c. The eligibility site conclusions with respect to the spouses' ownership and availability of income and resources, and the spouses' right to a fair hearing concerning these conclusions. 2. If either spouse establishes that the community spouse needs income above the level provided by the minimum monthly maintenance needs allowance due to exceptional circumstances, which result in significant financial duress, such as loss of home and possessions due to fire, flood, or tornado, an additional amount may be substituted for the MMMNA if established through a fair hearing. 3. Appeals from decisions made by the eligibility site shall be governed by the provisions under Recipient Appeals Protocols/Process at 8.058. 8.100.7.V. Long-Term Care Institution Recipient Income 1. Determination of Income and Communication between the Long-Term Care institution and the Eligibility Site Using the AP-5615 Form for Patient Payment a. Sections I, II and IV of the AP-5615 form are to be completed by the Long- Term Care institution for all admissions, readmissions, transfers to and from another payer source, including private pay and Medicare, discharges, deaths, changes in income and/or patient payment, medical leaves of absence and non-medical/programmatic leave in excess of 42 days combined per calendar year. b. The initial determination of resident income for patient payment shall be made by the Eligibility Site. The Eligibility Site shall notify the Long-Term Care institution of current resident income. c. On receipt of AP-5615 form, the Eligibility Site will, within five working days: i) For an admission, a readmission or a transfer from/to private pay, Medicare, or another payer source: 1) Verify and correct, if necessary, data entered by the Long- Term Care institution.