SR 15-05 Dated 07/15

STATE OF NEW HAMPSHIRE

INTER-DEPARTMENT COMMUNICATION

SUMMARY

This SR releases an increase from $65 to $70 in the monthly personal needs allowance (PNA) for residents of nursing facilities, community residences, and residential care facilities (RCF). The PNA is used in the determination of:

·      supplemental payments, if any are due, to eligible nursing facility residents whose net income is lower than $70;

·      income allocation to the community spouse or dependents of recipients of nursing facility services;

·      the amount that residential care facility and community residence recipients may retain for personal use; and

·      the patient liability amounts/cost of care for:

-     recipients receiving nursing facility services; and

-     certain recipients of home and community-based care services who are responsible for their cost of care because they have been determined eligible for these services via the special income limit.

DFA Form 799, Spousal Income Protection, DFA Form 799A, Income Computation Worksheet for Allocation of Income for Institutionalized Individuals, and the associated New Heights-generated forms also require updates, but those updates will be released in DFA SR 15-21, effective July 1, 2015.

BACKGROUND

RSA 167:27-a,II and He-W 654.17(b) require updates to the PNA every 5 years to reflect social security increases.

POLICY

Effective July 1, 2015, the monthly personal needs allowance (PNA) increases from $65 to $70. The $5 increase in the PNA impacts:

§     Residents of nursing facilities, community residences, and residential care facilities: Residents in these types of living arrangements are now legally entitled to keep $5 more a month for personal needs expenses.

§     Cost of care determinations for certain medical assistance recipients: The following recipients will now have up to $5 less a month considered available when determining patient liability if no other changes have occurred in their case:

-     all nursing facility recipients; and

-     recipients of Home and Community-Based Care for the Developmentally Disabled (HCBC-DD), Home and Community-Based Care for Individuals with an Acquired Brain Disorder (HCBC-ABD), and Choices for Independence (HCBC-CFI) who are responsible for their cost of care because they have been determined eligible for these services via the special income limit.

§     Supplemental payments to OAA, APTD, and ANB nursing facility residents: Nursing facility residents receiving supplemental payments because their available income was less than the former PNA of $65, will receive up to $5 more a month if no other changes have occurred in their case.

§     Income allocated to the community spouse or dependents: Nursing facility residents will now have $5 less per month to allocate to their community spouse or dependents.

§     OAA, APTD, and ANB nursing facility residents with available income between $65 and $70: Nursing facility residents whose available income is equal to or more than the former $65 PNA but less than the new $70 PNA, are now eligible for supplemental payments.

The PNA will not affect recipients of the In Home Support program (HCBC-IHS).

NEW HEIGHTS SYSTEMS PROCEDURES AND IMPLEMENTATION

The evenings of June 24, 25, and 26, 2015, New HEIGHTS will run all open nursing facility cases through a mass change to apply the increased personal needs allowance.

Notices

·      A Notice of Decision (NOD) will be generated for any OAA, APTD, or ANB nursing facility recipient experiencing a change in their supplemental payment or now newly eligible for a supplemental payment. Individuals eligible for a supplemental check will receive the regular “cash” opening NOD explaining the supplemental checks. All NODs generated will have the following special message added to the regular text:

The amount of money that may be kept by Nursing Home Medicaid recipients for personal needs has increased. This amount is now $70 per month. Because this amount has increased by $5 a month, you may see up to $2.50 more in each check you get from us if no other changes have happened in your case.

·      New HEIGHTS-generated AE0009, Patient Liability Letter, and AE0105, HCBC/CFI Patient Liability Letter, will be generated to any nursing facility, HCBC-DD/ABD, or CFI recipient experiencing a change in liability. The following special message will be added to any notices generated during this mass change:

The amount of money that you may keep for your personal needs has increased. This amount is now $70 per month. Because you can keep $5 more a month, the amount you are responsible for paying to the Nursing Facility on behalf of the care you get has decreased by up to $5.

NF, HCBC-DD/ABD, and CFI Patient Liability

Manual adjustments are necessary for nursing facility, HCBC-DD/ABD, or CFI recipients with liability amounts that have been overridden by the worker. New HEIGHTS reports NMC810RA, MC PT Liab Override RPT, and NMC850RA, HCBC Liab Override RPT, which will be available after the mass change, will identify those cases requiring an adjustment.

All other recipients will automatically receive the New HEIGHTS-generated AE0009, Patient Liability Letter, if a nursing facility recipient, or the AE0105, HCBC/CFI Patient Liability Letter, if a HCBC-DD/ABD or CFI recipient, if a new patient liability is created or a change is made to a current recipient’s patient liability. The new version of New HEIGHTS-generated AE0009 and AE0105 will be released under separate cover at a later date by New HEIGHTS.

POST-MASS CHANGE REPORTS

NMC540RA: AG’s Affected by MC

This report lists all cases that the Mass Change ran successfully through confirmation. It contains the following information: DO, Worker Name, Client Name, and Case Number. This report will be run each night of the Mass Change, June 24, 25, and 26, so will be available the morning following each of those dates.

NMC550RA: MC Exception

This report lists cases that were selected for computation during the Mass Change, but were not confirmed due to some discrepancy in data. These cases require further worker action. The report contains the following information: DO, Worker Name, Client Name, Case Number, Reason for Exception, and Mass Change Type. This report will be run each night of the Mass Change, June 24, 25, and 26, so will be available the morning following each of those dates.

NMC810RA: MC PT Liab Override RPT

The Nursing Facility with Patient Liability Override report lists cases that contain a Patient Liability override and therefore the amount did not change. These cases require further worker action. All cases must have the overridden liability reviewed and adjusted by July 15 to allow AIM enough time to produce a new "Letter 100" to the nursing facility for 7/10 liability. The report contains the following information: DO, Worker ID, Client Name, and Case Number. This report will be run the evening of the last day of the Mass Change, June 26, so will be available June 27, 2015.

NMC850RA: HCBC Liab Override RPT

The HCBC Liability Override report lists cases that contain a CFI or HCBC liability override and therefore the amount did not change. These cases require further worker action. The report contains the following information: RID #, Client Name, Case Number, Casehead Name, Case Status, Client Phone #, and CFI or HCBC type. This report will be run the evening of the last day of the Mass Change, June 26, so will be available June 27, 2015.

DESCRIPTION OF REVISIONS MADE TO FORMS

DFA Form 799, Spousal Income Protection, DFA Form 799A, Income Computation Worksheet for Allocation of Income for Institutionalized Individuals, and the associated New Heights-generated Form AE0017, have been revised to include the increase in the PNA from $65 to $70 per month. These revised forms will be released in DFA SR 15-21, dated July 2015.

POLICY MANUAL REVISIONS

Revised Adult Assistance Manual Topics

Section 215.01  Residential Care Facility Payment

Section 217.01  Community Residence Payment

PART 619  BUDGETING: Nursing Facility

Section 619.01  Cost of Care: Nursing Facility

Section 619.03  Supplemental Payments: Nursing Facility

Section 621.03  CFI Medical Assistance

Section 621.05  Cost of Care: CFI Medical Assistance

Section 621.07  Payment for Cost of Care: CFI Medical Assistance

Section 622.03  HCBC-IHS Medical Assistance

Section 622.05  Cost of Care: HCBC-IHS Medical Assistance

Section 622.07  Payment for 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 623.07  Payment for Cost of Care: HCBC-DD Medical Assistance

Section 624.03  HCBC-ABD Medical Assistance

Section 624.05  Cost of Care: HCBC-ABD Medical Assistance

Section 624.07  Payment for Cost of Care: HCBC-ABD Medical Assistance

Revised Medical Assistance Manual Topics

Section 233.01  Residential Care Facility Payment

Section 235.01  Community Residence Payment

Section 619.01  Cost of Care: Nursing Facility

Section 621.05  Cost of Care: HCBC-CFI Medical Assistance

Section 623.05  Cost of Care: HCBC-DD Medical Assistance

Section 624.05  Cost of Care: HCBC-ABD Medical Assistance

IMPLEMENTATION

The revised policy is effective July 1, 2015, and applies to any cases processed on or after that date.

CLIENT NOTIFICATION

Special text messages were added to the client notices generated by New HEIGHTS and described in the Notices section above. Also, in early July, DFA State Office will be notifying all institutionalized individuals with community spouses and their community spouses about the spousal impoverishment figures that have been updated (see DFA SR 15-21, dated July, 2015 for further information). This letter will also include information about the PNA increase.

TRAINING

No special training is planned or needed.

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 www.dhhs.nh.gov/DFA/publications.htm, effective June 29, 2015. Additionally, this SR, and printed pages with posting instructions, will be distributed under separate cover to all internal hard copy holders of the Adult Assistance and Medical Assistance Manuals.

DFA/JBV:s