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State of Maryland Medical Assistance Manual Revised April 2014

Attach to the OES 011 (LTC) Notice of Eligibility for the Post-Eligibility Medical Expense Deduction a copy of the A/R’s Non-Covered Service Report sent by DHMH. 10. Set a “745” alert in CARES as a reminder to recalculate the recipient’s available income for any anticipated change in the recipient’s income (e.g. January 1st COLA increase in Social Security income) or other deductions (e.g. annual increase in health insurance premium or the community spouse’s rent). Also, set a “745” alert for the date the deduction for non-covered services is estimated to end, i.e. when the full amount approved by DHMH will have been deducted. 11. Fully narrate in CARES. Include the requested amount of non-covered service deduction, the amount approved by DHMH, the type of service, the provider, and the anticipated ending month for the deduction. 12. If the recipient’s income or a deduction changes, follow the above procedures for manual calculation of the non-covered service deduction and the available income and for entry into CARES. Suppress the CARES notice and send the manual DHMH 4240 (LTC) Notice of Change in Available Income to recipient, any designated representative, and the LTC facility.

Time Frame for Deducting Non-covered Services from a Recipient’s Available Income for the Cost of Care in a LTC Facility or Waiver

• The deduction may not begin before the month that the expense is incurred by the recipient. • When an applicant indicates they have pre-eligibility medical expenses and acceptable documentation is provided (bills, receipts, contract), the CM submits the OES 001 Request for Non-Covered Services to DHMH if the applicant is found eligible. If a deduction is approved by DHMH, the CM allows the deduction beginning in the first month of eligibility. • When a recipient requests a deduction for non-covered services during periods of eligibility, the CM must immediately submit the request to DHMH. If DHMH approves a deduction, the CM begins the deduction the month the request and required documentation were submitted, as this is an interim change. • If there is a contract for regular payments for an item or service, the monthly obligation may be allowed for the period specified in the contract. • If the non-covered service deduction request approved by DHMH, after allowing other deductions, exceeds the recipient’s net countable income for the month, the excess portion of the deduction for non-covered services may be carried forward into additional month(s). If necessary, it may be carried into subsequent 6-month period(s) under consideration. The deductions continue until the monthly amounts deducted for the non-covered service total the amount approved by DHMH for the deduction. • Unpaid bills for medical services incurred during the 3 months prior to the month of the current application may be considered for a non-covered service deduction if the bills are for services received during the consideration period associated with an earlier application:

Rev. 10/2013

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