Provider Notice issued 01/31/11

Required Reporting of Extra Income

This Notice is to reinforce and clarify an April 15, 2010, notice titled "Reporting Extra Income" regarding move-in incentives provided by SLFs to residents eligible for medical assistance.

SLFs that provide move-in incentives, such as waiving all or some of the room and board charges, giving an enhanced personal needs allowance (PNA) or a one-time payment are responsible for ensuring the money is reported to the Department of Human Services (DHS) caseworker. The amount of the incentive must be reported to DHS by the resident, resident's family or representative, or the SLF.

If a SLF plans to allow residents to keep more than the standard $90 PNA, written notice must be provided to the Bureau of Long Term Care that clearly states the SLF's move-in incentive policy, its begin and end date and the additional amount residents will be allowed to keep.

SLFs that choose to allow residents to retain extra income will be subject to review by the Bureau of Long Term Care to ensure the extra income is being reported to the DHS caseworker and deducted from Medicaid payments.

Generally, a resident is unable to retain extra income provided through a move-in incentive since it is considered available income for the month of receipt, and must be applied toward the department's payment for services. However, the department has been approached about allowing SLFs to absorb the cost of a move-in incentive in order for a resident to keep the extra income offered under the incentive.

For example, as a move-in incentive, a SLF allows a resident to keep $100 of the room and board charge. The $100 is reported to the DHS caseworker, the resident's patient credit is increased by $100 on the department's Recipient Data Base, and is used to reduce the department's payment to the SLF by an additional $100. The SLF takes a $100 loss from the room and board amount and $100 loss from the payment received from the department for services.

As stated in the April 15, 2010 notice, there is an exception to the above policy. Nonexempt income of a resident moving from the community must be applied toward the cost of care starting with the first full month a resident is in the facility. Therefore, the above example does not apply to the first month of residency if a resident is admitted after the first day of the month.

Incentives that do not involve giving cash to a resident, such as gift cards, free phone or cable are not considered income and are not required to be reported.

Questions regarding this notice should be directed to the Bureau of Long Term Care at 217-524-0372.

Theresa A. Eagleson, Administrator

Division of Medical Programs