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3. Budgeting principles:
a. Patient liability is always $0 for the month of entry into nursing care even if the move takes place on the first day of the month. NC FAST generates a DHB-5016.
b. Budgeting by LTC rules and assignment of PML begins the month after entry into an approved level of care. (Refer to V., above).
4. Use the DSS-8110A (automated) to notify the beneficiary and the representative of the patient liability amount. 5. Complete the program transfer. .
a. Failure to change category from SA to MA prior to first LTC month does not prevent payment of cost of care.
b. The full PML for the next month. 6. NC FAST sends an automated DHB-5016.
C. VA Contract For Payment Of Cost Of Nursing Care Ends LTC budgeting begins the same month the contract ends. (Refer to XIII.A. 4. below)
D. Moves from LTC Facility To Different LTC Facility or Hospital 1. When LTC beneficiary moves from LTC facility to hospital:
a. Continue with LTC budgeting procedures. Refer to IX.D., above, for instructions on ”split” liabilities.
b. The LTC facility is not required to hold a bed for the a/b while they are in the hospital. The LTC facility is required to readmit the a/b if it has an available bed when they are ready to be discharged from the hospital. If a bed is not available, the a/b will be either discharged to a new LTC facility or to PLA. Medicaid does not pay to hold a LTC bed while the a/b is in the hospital because that would be duplication of services.
(1) The a/b’s family can pay the cost of holding a bed directly to the facility. This would not be considered income to the a/b.
(2) The cost of holding a bed is not considered an unmet medical cost to the a/b. 2. When LTC beneficiary is discharged From LTC Facility To New LTC Facility:
Continue LTC budgeting procedures. Refer to IX.D. above for procedures to split liabilities. Docusign Envelope ID: 950E9248-29CC-8930-81BC-BCEC667EB493