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State of Maryland Medical Assistance Manual Revised April 2014

• If the amount approved by DHMH for the non-covered service deduction is less than the A/R’s monthly available income without the non-covered service deduction, use the amount approved by DHMH as the deduction. • If the non-covered service deduction approved by DHMH exceeds the A/R’s monthly available income, use the A/R’s monthly available income without the non-covered service deduction as the monthly deduction for the non-covered services. Then, the available income is reduced to $0. All of the A/R’s net countable income, after any other deductions are subtracted (e.g. spousal maintenance allowance, personal needs allowance), is allowed as the deduction for non-covered services, so that the recipient may pay the provider’s bill in full as quickly as possible. • Complete more than one column on the DHMH 1159D worksheet if you expect a change in income, cost of care, or deductions- e.g., the recipient’s income will change due to a cost of living increase, or the deduction for Medicare premiums will end in the 3rd month of Medicaid eligibility when Medicare Buy-In begins. • Estimate how many months the deduction for non-covered services will continue until the monthly deductions total the deduction approval by DHMH. Establish a way (e.g. CARES “745” alerts, tracking system) to assure that the monthly deductions continue until the total is reached, and that the monthly amount is adjusted as necessary when the recipient’s net countable income and/or other deductions change over time. 6. Enter the required information onto the INST screen of CARES. The monthly deduction for non- covered services is entered in the field for “UNCVRD MED AMT”. Complete the INST screen for the current month, any ongoing month with a change, and any historic month with a change. 7. Check the MAFI screen of CARES for each impacted month to assure that it has the correct information and calculations. Make any necessary corrections to assure that the available income is correct on CARES for each month, and will transmit correctly to MMIS recipient screen 4 as the “patient resource amount”. The line for “Non-covered Med Exp” on the MAFI screen represents the sum of three fields from the INST screen: “UNCVRD MED AMT” for the non-covered services, “MEDB PREM AMT” for non-covered Medicare premiums, and “UNCOVERED INS PREMIUM AMT” for other non-covered insurance premiums. 8. If a change or correction is necessary to MMIS Recipient Screen 4 that cannot be processed through the CARES-MMIS interface, submit the 206C form to the DHMH LTC Reconciliation Unit (e.g. to change the available income/resource amount for one or more historic months). 9. Suppress the CARES notice. Issue the manual DHMH 4240 (LTC) Notice of Change in Available Income and OES 011 (LTC) Notice of Eligibility for the Post-Eligibility Medical Expense Deduction to the recipient, any designated representative and the LTC facility (if the consent to release of information is signed). Complete the DHMH 4240 (use additional notices as necessary) to inform the recipient of the allowed deductions and the available income for the current month and for any subsequent months with a change. Under “other” specify the allowable deduction.

Rev. 10/2013

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