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on the medical needs of the facility’s population. To find that rate: https://ncdhhs.servicenowservices.com/fee_schedules Rates are adjusted quarterly. 2. Facility's Private Rate (DHB-5008, SUPPLEMENT B, Step I., B.) When the a/b’s gross income is greater than the Medicaid reimbursement rate for the facility, determine if net income (after exclusions) is less than the facility's private rate. Contact the facility to establish the facility's private rate for 31 days. Compare net income to the facility's private rate to establish whether financial eligibility exists.

a. Determine Net Countable Income From gross income subtract:

(1) PLA exclusions, deductions, disregards, exemptions, and the MN PLA maintenance allowance.

(2) The net countable income is only used to determine financial eligibility in Step 1. Do not use this amount in STEP II to determine patient monthly liability (pml).

b. Compare net countable income to private rate for 31 days.

(1) If net countable income is less than or equal to the facility's private rate, the person is financially eligible. Proceed to Step II to determine the patient monthly liability

(2) If net countable income is greater than facility's private rate, continue to 3, below.

3. Needs Test Using All Other Predictable Medical Expenses (DHB-5008, SUPPLEMENT B Step I., C.) Use the same net countable income calculated in 2., above and:

a. Subtract the facility's private rate for 31 days.

b. Compare the amount left to the total amount of predictable medical expenses that will not be covered by the nursing facility.

(1) If the predictable medical expenses are equal to or greater than the income, financial eligibility exists. Proceed to STEP II.

(2) If predictable medical expenses are less than the income, the a/b is financially ineligible for cost of care. Deny the application for cost of care or propose termination if an active case.

C. Determine Patient Monthly Liability (PML)--STEP II After establishing that financial eligibility exists in STEP I, proceed to determine the patient's share of cost. STEP II determines the amount of income an a/b must pay to the facility for cost of care. This is called patient monthly liability Docusign Envelope ID: 950E9248-29CC-8930-81BC-BCEC667EB493