Page 24
24
(1) If adjustment can be made by increasing future PML(s), make the change and notify the a/b or their representative using a timely notice.
(2) If adjustment cannot be made by increasing the PML(s), ask the a/b or their representative to make a voluntary repayment to DHB and refer to the local agency fraud/program integrity staff.
6. If the LTC beneficiary is discharged to PLA (including a move to an adult care home):
a. Inform the a/b, their representative, or the facility that any previously unreported UMN charges must be reported within ten days of the change in living arrangement.
b. Deduct verified UMN charges from their PML for the month of discharge. The UMN deduction cannot be greater than the PML. Charges which exceed the amount of their PML and were reported within ten days may be used towards the PLA deductible. Refer to MA-2360, Medicaid Deductible.
c. If the beneficiary moved to an adult care home and they will be authorized for Medicaid under the Special Assistance program, deduct charges up to the amount of their PML in the month of discharge.
7. If the beneficiary dies:
a. Verify any reported patient responsible medical charges which have not been allowed previously.
b. Deduct allowable charges up to the amount of the PML for month of death only.
IX. REPORTING PATIENT MONTHLY LIABILITY ON DHB-5016, Notification of Eligibility for Medicaid/Amount and Effective Date of Patient's Liability A. Purpose of DHB-5016 1. The DHB-5016 notifies the nursing facility of the patient's monthly liability for their share of the cost of care. There are two ways to transmit the DHB-5016 to the facility. One is an automated DHB-5016issued by NC FAST. The other way is a manual DHB-5016 issued by the county caseworker.
2. For Hospice patients in a nursing facility, enter the Hospice code in NC FAST to ensure the automated DHB-5016 is sent to the Hospice agency.
B. Issuing a DHB-5016 1. NC FAST issues an automated DHB-5016 when the caseworker: Docusign Envelope ID: 950E9248-29CC-8930-81BC-BCEC667EB493