A. MA-2270, Long Term Care, is revised to clarify when the CPI begins for individuals admitted to a general/acute care hospital, psychiatric unit of a state mental hospital or PRTF for 30 continuous days or more.
B. MA-2360, Medicaid Deductible, is revised to include procedures when meeting a deductible with PRTF charges. Admission to a PRTF is assumed to meet the Medicaid deductible regardless of the length of stay, ultimate amount of charges, Medicare coverage, or other third party liability. Inpatient PRTF charges are not covered under Medicare.
DATE: MARCH 25, 2002
Manual: Aged, Blind, and Disabled Medicaid
Change No: 15-02
To: County Directors of Social Services
Medicaid coverage for individuals under age 21 in Psychiatric Residential Treatment Facilities (PRTF) began in October 2000. Initially, it was expected that claims for these services would process like claims for inpatient psychiatric hospitals. This would require entering a deductible balance in EIS for applicable cases. However, in June 2001, policy was revised to state that PRTF claims processed as nursing facility claims, which required entering a patient monthly liability (PML) in EIS.
Due to modifications to the claims payment system, PRTF claims will now be processed as inpatient hospital claims. Therefore, a deductible balance must be entered in EIS for all cases in which the deductible applies in the month of admission to the PRTF. A PML amount must also be entered in EIS when the inpatient stay exceeds 30 continuous days.
Budgeting under the Aged Blind and Disabled Medicaid program has changed for individuals placed in a general/acute care hospital, psychiatric unit of a state mental hospital or PRTF. The a/r must have begun a continuous period of institutionalization (CPI) in order to budget long term care. Spousal and parental financial responsibility ceases the month the CPI begins for MAABD budgeting.
When an individual is placed in a general/acute care hospital, psychiatric unit of a state mental hospital or PRTF, long term care budgeting begins the month following the month of the 30th continuous inpatient day. With this change in policy, individuals with income above the categorically needy income limit will generally have, at a minimum, a 2-month deductible for the PLA budgeting months.
MA-2360, Medicaid Deductible is also updated with the correct name of the Medicare Part B carrier.
MA-2510 is also revised to state that an application for an incarcerated child that was previously denied because the final placement had not been determined by the application due date, must be reopened as an administrative application once the IMC learns that the final placement was not a public institution.
The change in long term care budgeting and PRTF policy is effective April 1, 2002.
Apply the new long term care budgeting and PRTF policy to applicable individuals admitted to a general/acute care hospital, psychiatric unit of a state mental hospital or PRTF whose eligibility determination (application, re-enrollment, or change in situation) is completed on or after April 1, 2002.
A. Remove: MA-2270, pages 1-4.
Insert: MA-2270, pages 1-4.
On-line Manual: Revised items II. through IV.B.3.
B. Remove: MA-2360, pages 1-2, 5-14, 19-20, 23-24, and Figure 4.
Insert: MA-2360, pages 1-2, 5-14, 19-20, 23-24, and Figure 4.
Online Manual: Revised items III.A. through III.B., IV. through V.C., VI.E. through VII.C., and Figure 4.
C. Remove: MA-2510, pages 1-6 and Figure 1.
Insert: MA-2510, pages 1-6 and Figure 1.
On-line Manual: Revised entire section.
If you have any questions regarding this material, please contact your Medicaid Program Representative.
(This policy was researched and written by Vanessa Broadhurst, Policy Consultant, Medicaid Eligibility Unit.)
MA-2360 Figure 4
MA-2510 Figure 1
For questions or clarification on any of the policy contained in these manuals, please contact your local county office.