SR 08-31 Dated 12/08

STATE OF NEW HAMPSHIRE

INTER-DEPARTMENT COMMUNICATION

SUMMARY

This SR releases the following revisions to the cost of care determination process for Home and Community-Based Care (HCBC) and Choices for Independence (CFI) services:

§   only individuals who are eligible for HCBC or CFI services by way of the "Nursing Facility CAP" income limit will be potentially liable for their cost of care. Individuals requesting HCBC or CFI services who meet the categorically-needy or medically-needy financial eligibility requirements for any category of financial or medical assistance do not have to contribute towards their HCBC or CFI cost of care;

§   determination of the cost of care for individuals receiving CFI services has been transferred from the Bureau of Elderly and Adult Services (BEAS) to the Division of Family Assistance (DFA), so that the cost of care determination process for CFI and all categories of HCBC are coordinated by DFA. This transfer of the cost of care determination process was the result of a Centers for Medicare & Medicaid Services (CMS) audit recommendation;

§   the cost of care determination process for CFI and all categories of HCBC has been automated in NEW HEIGHTS; and

§   the figure used as a "Maintenance Allowance" when reducing net income by allowable deductions during the CFI cost of care determination process is different depending upon the living arrangement:

-   If the living arrangement is "Residential Care," "Enhanced Family Care," or "Community Residence," then the $56 "Personal Needs Allowance" figure is used.

-   For Independent Living arrangements, use the "Nursing Facility CAP," currently $1,911, but $2,022 as of January 1, 2009, as the "Maintenance Allowance."

Additionally, because the CFI and HCBC cost of care determination process has now been automated in New HEIGHTS, a New HEIGHTS-generated letter AE0105, HCBC/CFI Patient Liability Letter, was created to notify HCBC or CFI recipients of their cost of care obligation. Form 517C, HCBC/CFI Patient Liability Letter, has been transferred to DFA from the Bureau of Developmental Services (BDS), and the form and its associated instructions have been updated accordingly to correspond with the information provided on the AE0105. Form 517B, Area Agency Information Release to DFA District Office, Home and Community-Based Care Waiver, is no longer needed and has been obsoleted with the release of this SR.

POLICY

Individuals who receive Home and Community-Based Care (HCBC) or Choices For Independence (CFI) services and are also categorically-needy or medically-needy recipients of any category of financial or medical assistance, do not have to contribute towards their HCBC or CFI cost of care. Only individuals who are eligible for HCBC or CFI services via the "Nursing Facility CAP" will be potentially liable for their cost of care.

The cost of care determination process for CFI services will now be processed by DFA. This transfer from BEAS to DFA of the CFI cost of care determination process centralizes calculation of the cost of care for all categories of HCBC and CFI with DFA, per CMS recommendations. Additionally, the figure used as a "Maintenance Allowance" when reducing net income by allowable deductions during the CFI cost of care determination process depends upon the recipient’s living arrangement:

§   If the living arrangement is "Residential Care," "Enhanced Family Care," or "Community Residence," then the $56 "Personal Needs Allowance" figure is used.

§   For Independent Living arrangements, use the "Nursing Facility CAP," currently $1,911, but $2,022 as of January 1, 2009, as the "Maintenance Allowance."

Because the cost of care determination process for CFI was not formerly a DFA calculation, the steps for calculating the CFI cost of care recipient liability is described below:

1. Subtract the following from the gross earned income:

- Employment Expense Disregard (EED), in accordance with Adult Assistance Manual (AAM) 603.03, Employment Expense Disregard.

- Earned Income Disregard (EID) in accordance with AAM 603.01, Earned Income Disregard.

 The result is net earned income.

2. Add countable gross unearned income and SSI payments to the net earned income. The result is net income.

3. Subtract allowable deductions.

4. Subtract an additional "Maintenance Allowance" based on the following:

- $56, the "Personal Needs Allowance," if the CFI individual’s living arrangement is "Residential Care," "Enhanced Family Care," or "Community Residence."

- The current "Nursing Facility CAP" if the CFI individual’s living arrangement is Independent Living.

5. Subtract all Medicare Premiums if the individual:

- receives Medicare Part A, Part B, Part C, or Part D; and

- is not eligible for the Qualified Medicare Beneficiary (QMB), Specified Low-Income Medicare Beneficiary (SLMB) programs, or the Low Income Subsidy (LIS) for Medicare Part D.

6. Subtract other medical expenses incurred and not subject to third-party payment including:

- health insurance premiums, deductibles, or coinsurance; and

- necessary medical or remedial care recognized under state law but not covered by medical assistance.

7. Subtract SSI.

8. Add the Veteran’s Aid and Attendance Allowance.

9. The result is the amount of income the individual must apply toward their cost of care.

The examples that follow illustrate how the policy is to be applied based on case circumstances.

EXAMPLE 1: CFI Cost of Care Liability

CFI recipient lives in a Community Residence, pays a Part B premium, and receives a gross monthly SSA benefit of $1,012 and $200 in monthly A &A benefits.

 $1,012.00 countable gross unearned income

 - $591.00 standard allowance (PIL) for 1

  $421.00

 - $56.00 additional Maintenance Allowance (PNA, due to living in a community residence)

  $365.00

 - $96.40 Medicare Part B

  $268.60

 + $200.00 VA Aid and Attendance Allowance

  $468.60 cost share

The CFI recipient has a $468.60 monthly cost of care liability.

EXAMPLE 2: No CFI Cost of Care Liability

CFI recipient lives with non-CFI spouse, pays a Part B premium, and receives a gross monthly SSA benefit of $1,012 and $200 in monthly A &A benefits.

  $1,012.00 countable gross unearned income

 - $675.00 standard allowance (PIL) for 2

  $337.00

 -$1,911.00 additional Maintenance Allowance (current Nursing Facility CAP)

 -$1,574.00

 - $96.40 Medicare Part B

 -$1,670.40

 + $200.00 VA Aid and Attendance Allowance

 -$1,470.40 cost share

Because this figure is less than or equal to $0, the CFI recipient has no cost of care liability.

NEW HEIGHTS SYSTEMS PROCEDURES AND IMPLEMENTATION

New HEIGHTS has automated the cost of care determination process for all categories of HCBC as well as CFI as of December 8, 2008. Calculation of HCBC and CFI cost of care liability for previous months will be available back to October 2008.

Additionally, New HEIGHTS-generated client letter AE0105, HCBC/CFI Patient Liability Letter, was created to notify CFI and HCBC recipients of their cost of care liability. The AE0105 will be released by New HEIGHTS under separate cover for inclusion in the New HEIGHTS Letters and NOD binder.

DESCRIPTION OF REVISIONS MADE TO FORMS

Form 517C, HCBC/CFI Patient Liability Letter, and its associated instructions were greatly revised and will now act as the paper backup to the New HEIGHTS-generated AE0105. The New HEIGHTS generated AE0105 will be automatically generated to all HCBC or CFI clients with a cost of care, so District Office workers only need to use the revised Form 517C when New HEIGHTS is unavailable. The form and instructions have been attached to this SR for reference and a small supply, as the need for the form will be rare, will be sent to each office.

Form DDS 517-B, Area Agency Information Release to DFA District Office, Home and Community-Based Care Waiver, was obsoleted as this form is no longer needed in the cost of care determination process. Destroy both Form DDS 517-B and Form DDS 517-C upon receipt of this SR. A Certificate of Destruction has been included at the end of this SR.

POLICY MANUAL REVISIONS

Revised Family Assistance Manual Topics

Part 614  COST OF CARE: (HCBC-DD/ABD/IHS)

Section 614.01  Cost of Care: HCBC-DD/ABD

Section 614.03  Cost of Care: HCBC-IHS

Revised Adult Assistance Manual Topics

Section 621.01  CFI Financial Assistance

Section 621.03  CFI Medical Assistance

Section 621.05  Cost of Care: CFI Financial or Medical Assistance

Section 621.07  Payment for Cost of Care: CFI Financial or Medical Assistance

Section 622.03  HCBC-IHS Medical Assistance

Section 622.05  Cost of Care: HCBC-IHS Medical Assistance

Section 623.03  HCBC-DD Medical Assistance

Section 623.05  Cost of Care: HCBC-DD Medical Assistance

Section 624.03  HCBC-ABD Medical Assistance

Section 624.05  Cost of Care: HCBC-ABD Medical Assistance

IMPLEMENTATION

The policy released in this SR will be implemented during the daily production run the evening of December 5, 2008.

CLIENT NOTIFICATION

Notification of the change in the cost of care policy was published in the NH Rulemaking Register, Office of Legislative Services, on September 26, 2008. A public hearing on the amended Administrative Rules was held on October 21, 2008. Generation of the new AE0105, HCBC/CFI Patient Liability Letter, began in November 2008. No other client notification is planned.

TRAINING

No special training is planned.

FORMS MANUAL POSTING INSTRUCTIONS

DISPOSITION

This SR may be destroyed or deleted after its contents have been noted and the revised manual topics released by this SR have been posted to the On-line manuals.

DISTRIBUTION

This SR will be distributed according to the electronic distribution list for Division of Family Assistance policy releases. This SR, and revised On-Line Manuals, will be available for agency staff in the On-Line Manual Library, and for public access on the Internet at http://www.dhhs.nh.gov/DHHS/DFA/LIBRARY, effective January 5, 2009.

This SR, and printed pages with posting instructions, will be distributed under separate cover to all hard copy holders of the Adult Assistance, Family Assistance, and Forms Manuals.

DFA/JBV:s

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CERTIFICATE OF DESTRUCTION

I certify that all copies of Form DDS 517-B, Form DDS 517-C, and their associated instructions, all dated 5/03, SR 03-28, have been destroyed.

District Office Manager of Operations:                

District Office                       

Return this certificate to the DFA Policy Unit, 129 Pleasant St, Concord, NH 03301, after the instructions in the SR have been carried out.