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TITLE 16 HEALTH AND SAFETY DELAWARE ADMINISTRATIVE CODE 61 PLEASE NOTE: spouses with income less than the SSI standard should be referred to the Social Security Administration for benefits. 20630 Cost Of Care In The Facility After taking all of the above appropriate income disregards, any remaining income will be applied toward the cost of care in the facility. The cost of care computation is totally distinct from the eligibility computation. For instance, the $20.00 that is disregarded from income when determining if an applicant is eligible is not disregarded when budgeting for patient pay amount. Another example is that any "infrequent and inconsequential income" (gifts, contributions and interest amounting to less than $20.00 per month and received less than quarterly) that is disregarded for the eligibility determination would be counted as available income when computing the budget for the nursing facility recipient. 20630.1 Accumulation of Personal Needs Monies In some cases, the amount protected for the recipient's direct personal needs may accumulate in a savings account. Even when the individual has no immediate use for such income, personal needs monies are not to be applied towards medical care costs. However, should the amount accumulated exceed the resource limit, the recipient becomes temporarily ineligible for Medicaid. At that time, any amount above the resource limit may be applied to medical cost. 20640 Patient Pay Calculation The patient pay amount equals total gross income minus all protected amounts and disregards. The fiscal agent will compute the payment to the Nursing Facility for each recipient by multiplying the established per diem rate by the number of days of nursing facility care received in a month and deducting the patient pay amount. The per diem rate is established by DSS through an evaluation of nursing facilities' cost reports. 20640.1 Partial Months If vendor payment is made to the nursing facility for part of the month, a Patient Pay Calculation must be done to prorate the patient pay amount for that month. For example: If a patient normally would be expected to pay $120.00 toward his care in a nursing facility for a full month, but enters the home on the 21st day of June, (10 days remaining in the month), his patient pay amount for that month would be $40.00 (see calculation below). Patient pay divided by # of days in month = per diem $120.00 divided by 30 = $4.00 Per Diem x # of days in facility = prorated patient pay $4.00 x 10 = $40.00 20650 Temporary Absence from a Long-Term Care Facility 42 CFR §447.40 Payment will be made for reserving beds in long-term care (LTC) facilities for Medicaid recipients during their temporary absence for the following purposes: 20650.1 Temporary Absence from a Long-Term Care Facility for Acute Hospitalization 20650.2 Temporary Absence from a Long-Term Care Facility for Reasons Other Than Hospitalization 7 DE Reg. 781 (12/1/03) 19 DE Reg. 1092 (06/01/16) 20650.1 Temporary Absence from a Long-Term Care Facility for Acute Hospitalization 20650.1.1 Intermediate Care Facility for Individuals with Intellectual Disabilities (ICF/IID) If a recipient is hospitalized for a short period of time and is expected to return to the facility, payment to the facility may continue for a period of not more than fourteen (14) days provided the ICF/IID agrees to hold the bed for the resident. Medicaid reimbursement is available for no more than fourteen (14) days within any thirty-day period. The thirty-day count begins with the first day of hospitalization. If payments are suspended because recipient remains hospitalized more than fourteen (14) days and the thirty-day count expires, a new thirty-day count starts with readmission to the ICF/IID. In other words DMMA will not pay fourteen (14) days out of every thirty (30) days for people who remain in the hospital for weeks at a time. 20650.1.2 Other Long-Term Care Facilities If a recipient is hospitalized for a short period of time and is expected to return to the facility, payment to the facility may continue for a period of not more than seven (7) days provided the LTC facility agrees to hold the bed for the resident. Medicaid reimbursement is available for no more than seven (7) days within any thirty-day period. The