Offset of Client Share (Recipient Liability) 510-05-85-60
(Revised 4/1/12 ML #3321)
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(N.D.A.C. 75-02-02.1-41.1)
Up to fifteen dollars per month of expenses for necessary medical or remedial care , incurred by a member of the Medicaid unit , or a spouse or child they were legally responsible for, in a month prior to the month for which eligibility is being determined, may be subtracted from client share ( recipient liability ), other than client share created as a result of medical care payments, to determine remaining client share, provided that:
The expense was incurred in a month during which the individual who received the medical or remedial care was not a Medicaid recipient or the expense was incurred in a month the individual was a Medicaid recipient, but was for a service not covered by Medicaid;
The expense was not previously applied in determining eligibility for, or the amount of, Medicaid benefits for any Medicaid recipient;
The medical or remedial care was provided by a medical practitioner licensed to furnish the care;
The expense is not subject to payment by any third party, including Medicaid and Medicare;
The expense was not incurred for swing bed services provided in a hospital, nursing facility services, or HCBS during a period of ineligibility because of a disqualifying transfer ;
Each expense claimed for subtraction is documented by the applicant or recipient in a manner which describes the service, the date of the service, the amount of the cost incurred, the amount of the cost remaining unpaid, the amount of the cost previously applied in determining Medicaid benefits for any Medicaid recipient, and the name of the service provider; and
The Medicaid unit is still obligated to pay the expense.
The Medicaid unit must apply the remaining client share to expenses of necessary medical care incurred by a member of the Medicaid unit in the month for which eligibility is being determined. The Medicaid unit is eligible for Medicaid benefits to the extent the expenses of necessary medical care incurred in the month for which eligibility is being determined exceed remaining client share in that month.