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West Virginia Income Maintenance Manual Chapter 24

West Virginia Income Maintenance Manual Page 34 Chapter 24 Long Term Care

other(s) is determined in the same way. The DFA-NH-3 is used for notification of the amount due each facility. Step 1: Determine the client's monthly contribution toward his cost of care. Step 2: Multiply the number of days the client was in the first facility by the per diem rate for the facility. The result is the clients cost of care for this facility for the month. Step 3: Compare Step 1 to Step 2. If Step 1 is less than or equal to Step 2, the client's entire contribution toward his cost of care is paid to the first facility. If Step 1 is greater than Step 2, the Step 2 amount is paid to the first facility and the difference between Step 1 and Step 2 is paid to the second facility. 24.7.9 NOTIFICATION AND CALCULATION SHEETS RELATED TO COST OF CARE All notification letters regarding the client’s contribution to his cost of care must contain the following statement: “This resource must be paid for in-facility days and bed-hold days unless you are notified otherwise in writing.” 24.7.9.A Notice of Client’s Contribution toward His Cost of Care (DFA-NH-3) The DFA-NH-3 is primarily used to notify the client or his authorized representative, the nursing facility administrator and the LTC Unit of the client's contribution to his cost of care. The DFA- NH-3 is not a substitute for any client notification letter. When appropriate, the DFA-NH-3 is attached to letters notifying the client about a change in benefits or a decision on an application. The IM-NL-LTC-1 calculation form should also be attached. When there is a related change in the CSMA and/or the FMA, the IM-NL-LTC-2 calculation form should also be attached. The form is prepared when there is any change in the client’s contribution toward his cost of care. The form is completed when the eligible client first enters the nursing facility, leaves a nursing facility, is transferred to a different nursing facility, or when the ineligible individual who is in a nursing facility becomes eligible for payment. When the client resides in more than one nursing facility in the same month and his contribution must be divided, see Section 24.7.8. This form is also used to notify the Bureau for Medical Services (BMS) LTC unit that it is to pay for LTC Services for individuals who have requested a waiver of their denial of LTC services