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27.7.4 Transfers Between Institutions Effective December 1, 2008, when an institutionalized person transfers between institutions (nursing homes, hospitals, hospices) in the same month, do not prorate the patient liability between the various institutions that he or she resided in during that month. The member will pay his or her patient liability to the institution that he or she were residing in on the first day of the month. ForwardHealth will automatically deduct the appropriate patient liability amount from the first nursing home, hospice, or long term inpatient hospital claim received for the member. If the amount of the patient liability exceeds the reimbursement amount of the first claim, the remaining liability amount will be deducted from the next claim(s) received for services provided in the month that patient liability is owed. Patient liability amounts deducted from claims will appear in the provider’s remittance information. Nursing home, hospice, and inpatient hospital providers may have to occasionally transfer a patient liability amount that they collected from a member on the first day of a month to the appropriate provider who ultimately had the claim adjusted to reflect the required patient liability amount. 27.7.5 Retroactive Cost of Care Occasionally a nursing home or community waivers applicant becomes retroactively eligible. This might happen, for example, when a person, having been denied eligibility, goes to a fair hearing. If the fair hearing determines the person was eligible at the time of application, the agency must retroactively certify him or her and compute retroactive cost of care. The directions are the same as for current cost of care (see SECTION 27.7.1 INTRODUCTION). 27.7.6 Personal Needs Allowance Deduct the personal needs allowance (see SECTION 39.4.3 LTC POST-ELIGIBILITY ALLOWANCES) for all institutionalized members in both the eligibility test and the patient liability calculation. An institutionalized person's personal needs allowance may accumulate to where he or she may lose eligibility due to excess assets. To prevent this, he or she can spend money on personal needs or make a refund to Medicaid (see SECTION 22.1.9 VOLUNTARY RECOVERY [NOT ESTATE RECOVERY PROGRAM]). 27.7.7 Medical or Remedial Expenses Medical or remedial expenses an institutionalized applicant or member has incurred, and is legally obligated to pay are used as a monthly need expense when determining eligibility for Medicaid. See SECTION 27.6 MONTHLY NEED. Medical or remedial expenses an institutionalized applicant or member has incurred and is legally obligated to pay are allowed as an income deduction to reduce the patient liability amount. This is sometimes referred to as a “deviation” request when the expense is owed to a nursing home. See SECTION 15.7.3 MEDICAL/REMEDIAL EXPENSES for additional details on countable expenses. Example 1 In February, Al had a root canal performed by a dentist who is not a Medicaid provider. Al is responsible for paying $600 for the procedure. Al began making payments of $100 per month on this medical bill in March. On April 1, Al became institutionalized and eligible for Medicaid. The $100 payment that Al is making on a previously incurred medical expense is a need item when determining Al’s institutional Medicaid eligibility, and an income deduction when calculating Al’s patient liability through August. For September, there is no balance remaining on his bill and the expense is removed.