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

223 2) List and/or verify the resident's monthly income adjustments and/or Long-Term Care Insurance benefit payments; and compute patient payment. Provide the completed AP-5615 to the Long-Term Care institution. 3) Correct the automated system to indicate the Long-Term Care institution name and provider number and to reflect the current distribution of income. Submit the AP-5615 form to the Department. d. For change in patient payment with respect to changes in resident income: i) Verify changes in resident income, and correct if necessary. All such corrections must be initialed, ii) Compute patient payment and provide the completed AP-5615 to the Long-Term Care institution. e. For change in patient payment with respect to the post-eligibility treatment of income, the Eligibility Site shall: i) Review the AP-5615 form for Medicare part B premium deduction allowances for the first two months of admission. ii) If client is already on the Medicare Buy-In program for Medicare part B, do not adjust patient payment on AP-5615 form for the Medicare premium deduction. If client is not on the Buy-In program, adjust AP-5615 form for the Medicare premium deduction for the first two months of Long-Term Care institution eligibility. iii) If the client has a Medicare D premium, the Eligibility Site shall use the amount as an income adjustment/deduction in the patient payment calculation and complete the AP-5615 form. f. For resident leave of absence: