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(1) Shorten the deductible period. The last PLA budgeting month is the month in which certification begins on any day.

Eligibility for help with cost of care begins with the day of nursing home certification. Issue a DHB-5016 using the deductible balance, (may be $0), as the PML amount for the month of certification, beginning with the date of certification through the last day of the month. If the deductible was met in a prior month or there is not a deductible, NC FAST sends the DHB-5016.

(2) The first month of LTC budgeting and full patient liability is the month after the facility is certified.

(3) Deduct the facility's Medicaid per diem costs for the appropriate level of care (FL-2 required) as a one-time unmet medical need from the first LTC month's PML if:

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Official source

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(1) Shorten the deductible period. The last PLA budgeting month is the month in which certification begins on any day.

Eligibility for help with cost of care begins with the day of nursing home certification. Issue a DHB-5016 using the deductible balance, (may be $0), as the PML amount for the month of certification, beginning with the date of certification through the last day of the month. If the deductible was met in a prior month or there is not a deductible, NC FAST sends the DHB-5016.

(2) The first month of LTC budgeting and full patient liability is the month after the facility is certified.

(3) Deduct the facility's Medicaid per diem costs for the appropriate level of care (FL-2 required) as a one-time unmet medical need from the first LTC month's PML if:

(a)Date of service was during the month, and prior to the…#

(a) Date of service was during the month, and prior to the day, certification of the nursing home begins,

(b)The PLA deductible is met prior to the date of nursing…#

(b) The PLA deductible is met prior to the date of nursing home certification, and

(c)The charges were paid from the a/b’s income. Refer to…#

(c) The charges were paid from the a/b’s income. Refer to VIII.E.3., above, for procedures and an example.

4. The individual is under a VA contract for VA payment of cost of care. There is no cost of care charged to the veteran.

a. LTC budgeting begins the same month that the contract ends.

b. The patient's liability (PML) to the facility for a first or transition month is the lesser of these amounts: (1) A full month's liability as computed in Step II, or (2) The number of days after the contract ends, multiplied by the facility's Medicaid daily rate (per diem).

B. If PLA budgeting results in:

1. No Deductible

a. Authorize the individual for help with other Medicaid covered services.

b. Notify the applicant using the DSS-8108 (approving the application) or beneficiary (continuing eligibility), the representative, and the facility: (1) That the cost of care in the facility will not be paid by Medicaid; (2) The reason or specific condition of eligibility which has not Docusign Envelope ID: 950E9248-29CC-8930-81BC-BCEC667EB493