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Effective: December 1, 2006 |
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24.15.25.05ar1 - Remedial Care (Archive) |
Archived: December 1, 2007 |
A remedial care expense is considered:
l A P bill health care expense when applying bills to a medical spenddown.
l An income deduction for clients using an LTC income calculation. For more information on how this is used as a deduction, see LTC Medical Expense Deduction.
GRH Remedial Care Calculation.
RTC Remedial Care Calculation.
Non-GRH Remedial Care Calculation.
The following clients can use the cost of remedial care as a health care expense if they are responsible for payment of the expenses:
Note: Do not include rent expenses as part of the remedial care expense.
l Residents of a group residential housing (GRH) facility who are ineligible for the GRH cash program due to excess income.
Note: This includes clients living in the GRH not eligible for the cash program and receiving Elderly Waiver (EW) or Special Income Standard - Elderly Waiver (SIS-EW).
EW and SIS-EW clients receiving a GRH cash grant have remedial care costs covered by the grant.
l Residents of a residential treatment center (RTC) who have remedial care expenses.
l Residents of non-GRH assisted living residences when they receive one of the following:
n Residential care services.
n Assisted living services received through a home and community-based waiver, such as EW, CADI, or TBI.
Note: Do not allow remedial care expenses to be applied to a spenddown if the client is receiving services through Alternative Care (AC).
Follow these steps to calculate the GRH remedial care expense for clients meeting the criteria for use and are residing in a GRH:
1. Determine the MA room and board rate by subtracting the current clothing and personal needs allowance from the 75% FPG standard for a household of one.
2. Determine the GRH negotiated rate.
3. Compare the MA room and board rate (Step 1) to the GRH negotiated rate (Step 2). If the MA room and board rate is:
l Less than the GRH negotiated rate, subtract the room and board rate from the GRH negotiated rate. The result is the amount of the remedial care expense.
l Equal to or greater than the GRH negotiated rate, then use the GRH negotiated rate as the remedial care expense.
4. Apply the remedial care expense (Step 3) to the medical spenddown as a P bill or use the expense as an income deduction on the LTC income calculation.
Follow these steps to calculate the RTC remedial care expense for clients who meet the criteria for use and reside in an RTC:
1. Contact the RTC Reimbursement Officer for the dollar amount of the client’s remedial care services.
Note: The remedial care service amount can vary for each client and does not include room or board charges.
2. Apply the remedial care expense to the medical spenddown as a P bill or use the expense as an income deduction on the LTC income calculation.
Non-GRH Remedial Care Calculation
Follow these steps to calculate the remedial care expense for a client who lives in a non-GRH assisted living facility and who meets the criteria for use:
1. Determine the amount the client pays for residency in the non-GRH assisted living facility.
2. Determine the cost of rent and/or room and board expenses.
3. Subtract the rental or room and board expenses (Step 2) from the amount the client pays (Step 1). The result is the amount of the remedial care expense.
4. Apply the remedial care expense (Step 3) to the medical spenddown as a P bill or use the expense as an income deduction on the LTC income calculation.