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3. Charges reported to the local agency after processing the application, completion of a recertification, or during an authorized c.p. are treated as a change in situation. The local agency should respond and complete the change within 30 days.

H. Budgeting Procedures for UMN Calculate the total allowable cost of UMNs.

1. Convert the following types of UMNs to a monthly amount and deduct from the a/b’s income.

a. Private health insurance premiums; and

b. Scheduled payments for medical bills.

2. Deduct the amount of UMNs that occur incidentally from the a/b’s income by reducing a future month(s)’ PML.

a. After UMNs are reported and verified, deduct entire amount owed.

b. Revise PML effective the next month after notice requirements in MA- 2420, Notice and Hearings Process, are met.

3. Never decrease a PML for a month that has already been billed unless it is the month of discharge or death. Refer to IX.C.

4. If a change is reported during a CP:

a. Revise PML effective the next month after notice requirements is met.

b. Notify the beneficiary of the following:

(1) Amount and effective date of the PML(s) which are reduced because of incidental UMN charges; and

(2) Amount and effective date of the ongoing PML for the month(s) after the deduction for non-monthly UMN charges is satisfied.

c. When the PML is changed, NC FAST sends the automated DHB- 5016, Notification of Eligibility for Medicaid/Amount and Effective Date of Patient's Liability giving the beginning month of the new PML.

5. If the a/b or their representative reports a change in unmet medical needs (including charges that are prorated and deducted monthly) and they result in:

a. An overstated PML (a/b paid too much in a prior month): Make the necessary adjustment by deducting additional UMN charges from the next month's liability after the notice requirements are met.

b. An understated PML (a/b paid too little and received UMN allowance to which they were not entitled in a prior month): Docusign Envelope ID: 950E9248-29CC-8930-81BC-BCEC667EB493

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H. Budgeting Procedures for UMN Calculate the total allowable cost of UMNs.

1. Convert the following types of UMNs to a monthly amount and deduct from the a/b’s income.

a. Private health insurance premiums; and

b. Scheduled payments for medical bills.

2. Deduct the amount of UMNs that occur incidentally from the a/b’s income by reducing a future month(s)’ PML.

a. After UMNs are reported and verified, deduct entire amount owed.

b. Revise PML effective the next month after notice requirements in MA- 2420, Notice and Hearings Process, are met.

3. Never decrease a PML for a month that has already been billed unless it is the month of discharge or death. Refer to IX.C.

4. If a change is reported during a CP:

a. Revise PML effective the next month after notice requirements is met.

b. Notify the beneficiary of the following:

(1) Amount and effective date of the PML(s) which are reduced because of incidental UMN charges; and

(2) Amount and effective date of the ongoing PML for the month(s) after the deduction for non-monthly UMN charges is satisfied.

c. When the PML is changed, NC FAST sends the automated DHB- 5016, Notification of Eligibility for Medicaid/Amount and Effective Date of Patient's Liability giving the beginning month of the new PML.

5. If the a/b or their representative reports a change in unmet medical needs (including charges that are prorated and deducted monthly) and they result in:

a. An overstated PML (a/b paid too much in a prior month): Make the necessary adjustment by deducting additional UMN charges from the next month's liability after the notice requirements are met.

b. An understated PML (a/b paid too little and received UMN allowance to which they were not entitled in a prior month): Docusign Envelope ID: 950E9248-29CC-8930-81BC-BCEC667EB493