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(1) The beneficiary died and has unmet medical needs which have not previously been deducted. Revise the PML for the month of death only. [This is the only reason you can revise for unmet medical needs in month of death.]
(2) The a/b goes home unexpectedly within six months and must be rebudgeted for prior months as well as month of discharge.
(3) The a/b returns home anytime, and must be rebudgeted the month of discharge only to allow a deduction for maintenance of the home.
NC FAST sends an automated DHB-5016 when the DHB DSS Support Unit enters the change.
b. If the local agency wants to change a PML amount already posted in NC FAST for a previous month, the DHB DSS Support Unit must give prior approval. (See V.C.10., above.) NC FAST sends an automated DHB-5016 when DHB DSS Support Unit keys the revision.
D. Patient Liability When A/B is in More Than One Facility in a Month - Split Liabilities
If the a/b receives care in more than one medical facility in a calendar month, it may be necessary to determine how much of the liability the patient owes to each facility. Remember that different levels of care within a hospital such as acute care and swing bed are considered separate facilities for claims processing purposes. The caseworker enters the total PML for the month and then completes a manual DHB-5016, Notification of Eligibility for Medicaid/Amount and Effective Date of Patient's Liability to split the pml between the facilities.
1. A/b does not have Medicare
On the first day of month, the beneficiary is in the:
a. Hospital-- Assign the full PML to the hospital.
b. Nursing Facility
Report the lesser of these amounts to the facility:
(1) The full PML owed each month; or
(2) The facility's Medicaid per diem multiplied by the number of days (do not count date of discharge) that the patient was in the facility.
c. The amount of the "split" PML which is reported to the second facility following a non-Medicare hospital or facility admission is:
Docusign Envelope ID: 950E9248-29CC-8930-81BC-BCEC667EB493