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(b) If adjustment cannot be made by increasing the PML(s), ask the a/b or their representative to make a voluntary repayment to DHB and refer to county fraud/program integrity staff. Refer to MA-2900, Beneficiary Fraud and Abuse Policy and Procedures, X.D. for instructions.

c. If the local agency causes an error, delay, or fails to complete change within 30 days and it results in:

(1) An understated PML (PML should have been higher) -- Do not increase PML for past months. Document in the record the reason for the error and take no further action.

(2) An overstated PML (PML should have been lower) -- Do not decrease PML for past months:

(a) If the beneficiary was able to pay the overstated PML, deduct as an unmet medical need the difference owed back to the beneficiary from a future month(s) liability; OR

(b) If the beneficiary was unable to pay the overstated PML and the outstanding balance owed to the nursing facility cannot be cleared out by adjusting PML for two months, request prior approval from DHB DSS Support Unit to change the overstated PML(s) using DHB-5164, Change to PML Request. Refer to NC FAST Job Aid: Any adjustment amount may be charged to the county. DHB-5008 B - STEP I FINANCIAL ELIGIBILITY FOR MEDICAID A. LOWEST If gross monthly income of the b.u. is less than the lowest monthly Medicaid rate, the client is eligible for help with cost of care. B. NEED TEST AT FACILITY'S MRR 1. If gross monthly income of the b.u. is greater than or equal to the Medicaid reimbursement rate (MRR), (refer to V.B.1., above, to determine lowest MRR). a. Daily MRR (t/c to facility) b. Multiply by 31 days c. MAXIMUM MONTHLY MA RATE

2. If the gross monthly income of the b.u. is less than the facility's MRR for 31 days, the client is eligible for help with cost of care. GROSS INCOME Docusign Envelope ID: 950E9248-29CC-8930-81BC-BCEC667EB493