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NC FAST notifies the facility of the a/b’s PML using the DHB-5016. The living arrangement code is based on level of care for anyone authorized or certified by Step III procedures for other covered services only. XIII. PLA PROCEDURES WHEN THE A/B IS INELIGIBLE FOR COST OF CARE FOR REASONS NOT RELATED TO INCOME An a/b in a LTC living arrangement may be in financial need but not be eligible for Medicaid to pay cost of care because of reasons not related to income. Medicaid may be able to help with other medical costs under PLA budgeting. This procedure is different from STEP III budgeting, above, because STEP III is related only to the a/b's income. This section instructs you on when to do this and how. A. The following reasons result in PLA budgeting: 1. The case is under a transfer of resources sanction. Apply the cost of medically necessary care for which the a/b is responsible to the deductible DAILY, as incurred. (FL-2 is required)

2. The completed FL-2/MR-2 has not been received in the agency for the appropriate level of care with at least telephone approval. Do not apply the cost of care to the deductible.

The FL-2/MR-2 must be received in NC Tracks within 10 workdays of telephone prior approval. 3. Individual in a facility which is not yet licensed or certified.

a. Budget PLA for months prior to the month of certification and for the month in which certification begins.

b. Apply the facility's Medicaid per diem costs for the appropriate level of care (FL-2 required) to the PLA deductible. Verify the actual amount with the facility's business office.

(1) Use the amount the a/b is responsible for towards the PLA deductible to the extent that it is not covered by insurance or paid by any third party, including family.

(2) If the deductible is met prior to facility's certification: