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State of Maryland Medical Assistance Manual Revised April 2014

the available income is $0. Beginning with the 3rd month of current eligibility, there is no deduction for Medicare premiums. Therefore, the deduction for non-covered services increases to $926.00 and the available income remains at $0. The CM determines that it will take 10 months of non-covered services deductions to total the recipient’s incurred expenses for nursing facility services.

The CM enters the information in CARES and suppresses all CARES approval notices and issues the DHMH 4240 (LTC), the OES 011 (LTC) and a copy of the DHMH Non-Covered Service Report to the recipient, representative (if applicable) and the LTC facility. These documents inform them of the eligibility decision, the number of months the non-covered services deduction will be in effect, the available income of $0, and each approved deduction including the monthly deduction for the unpaid nursing facility bill. Two columns are completed on the notice--one for the first two months of eligibility and the second column for the 3rd and ongoing months. The CM fully narrates in CARES.

The CM sets a “745” alert in CARES to recalculate the recipient’s available income for the 10th month of eligibility (the last month of deductions for the recipient’s nursing facility bills). Also, “745” alerts are established to adjust the deduction amounts and/or available income for any other month that a change to other deductions or income is anticipated. Beginning with the 11th month of eligibility, there will be no deduction for non-covered services. In the 9th month, the CM records the manual calculations on the DHMH 1159D (LTC) worksheet, enters the necessary information on CARES, and issues the manual DHMH 4240 (LTC) change notice with two columns completed for the 10th month and for the 11th and ongoing months. Again the CM sends copies of these forms to the recipient, representative (if applicable) and the LTC facility. The CM narrates in CARES.

Example 4: A recipient is in the 2nd year of the 20 months necessary to pay off a bill of $12,000 for nursing facility services received during ineligible months in the retroactive period. The recipient’s monthly Social Security income is $664. Since the recipient has no deductions besides the personal needs allowance of $74 and the non-covered services, the monthly amount deducted for non-covered services is $590 and the available income is $0.

The CM sets a “745” alert to recalculate the available income when the recipient’s Social Security check increases on January 1st. When the CM finds out what the COLA will be (in this example the COLA will be 4.1%, so the recipient’s income will increase to $692), they recalculate the deduction for non-covered services as $618 to keep the available income as $0. CARES will automatically issue the COLA letter in early December informing the customer that the available income for the cost of care will be $28. The CM issues the manual DHMH 4240 (LTC) change notice to the recipient, informing them that the deduction for non-covered services is actually $618 and that the available income for the cost of care is still $0.

Note: Remember to use current rates for the Medicare premiums and the personal needs allowance.

Questions regarding this issuance should be directed to the DHMH Division of Eligibility Policy at 410-767-1463 or 1-800-492-5231, option 2, extension 1463.