Adult Medicaid Manual MA-2360 MEDICAID DEDUCTIBLE
VII. AUTHORIZATION AND REPORTING OF DEDUCTIBLE BALANCE
A. Determining the Deductible Balance
1. The deductible balance is the total amount of the deductible remaining to be met on the date the case is authorized. This is the amount entered in EIS.
2. Inpatient Hospitalization - The deductible balance is reported to the hospital as the liability on the DMA-5020, and must be the same as the deductible balance entered in EIS. Determine the deductible balance as follows:
a. No Medicare Part A
If the hospitalization meets the Medicaid deductible on the date of admission because there is no Medicare Part A, the deductible balance is the amount of the deductible remaining to be met on the date of admission after subtracting non-covered medical expenses. (See IV.D.-E., above.)
b. Medicare Part A Deductible Meets Medicaid Deductible on Date of Admission
If the Medicare Part A deductible meets the Medicaid deductible on the date of admission, the deductible balance is the amount of the Medicare Part A deductible, or the amount of the Medicaid deductible remaining on the date of admission, whichever is less. (See IV.D.-E., above.)
REVISED 11/01/11 - CHANGE NOTICE 17-11
c. Deductible Met After Date of Admission But During Hospitalization
If the Medicaid deductible is met during the hospital stay but after the date of admission, the deductible balance is always the amount of the Medicare Part A deductible which was applied to the Medicaid deductible. This is the amount owed by the a/b to the hospital.
If the a/b's Part A deductible was met in a previous hospitalization and was not applied to the current hospitalization, the deductible balance is $0.
d. If the deductible is not met during the hospital stay, continue to apply charges as incurred.
B. Case Authorization (See EIS USERS MANUAL)
1. Authorize the case when documented medical expenses equal the amount of the deductible. Enter in EIS the deductible balance amount on the date of authorization.
a. If the deductible is met by an a/b's inpatient hospitalization or PRTF admission, enter the same deductible balance into the deductible balance field in EIS that is reported to the hospital or PRTF on the DMA-5020. (Refer to IV.D. and E., above.)
b. If inpatient hospitalization of the a/b is not involved, report the total deductible balance in EIS as the amount of deductible met on the date of authorization.
2. Do not report a deductible balance in EIS when medical bills incurred prior to the current c.p. were used to meet the deductible on the first day of the c.p.
C. Reporting the Deductible Balance
1. Report to the hospital or PRTF on DMA-5020 the amount of "Patient due the hospital" in item 5.a. (Refer to MA-5000)
2. See IV.E.2.b. and VII.A.2. above for how this amount is calculated.
3. This amount must be the same amount that is entered on the computer input document as deductible balance.
D. Covered And Non-Covered Expenses
When both covered and non-covered medical expenses are incurred on the same day, all non-covered medical expenses are to be counted toward the deductible before covered expenses are counted. (See IV.C.4., above.)
ISSUED 11/01/11 – CHANGE NOTICE 17-11