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Provider Notice Issued 09/17/2018
- Changes in medical insurance premiums;
- Changes to monthly income amounts (pension, Social Security, etc.); and
- Allowable medical expenses.
Date: September 17, 2018
To: Long Term Care Facilities - Nursing Facilities (NF), Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IID), Supportive Living Program (SLP) and Specialized Mental Health Rehabilitation Facilities (SMHRF)
Re: Medical Electronic Data Interchange (MEDI) System – Automatic Updates for Increases and Decreases to the Resident’s Patient Credit Amount
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This Notice informs Long Term Care (LTC) providers of a change to the functionality in the Medical Electronic Data Interchange (MEDI) system when reporting income changes which affect the monthly amount a resident is responsible for paying towards the cost of their care (patient credit). This change now allows the submission of an income change transaction to automatically increase or decrease the patient credit amount in MEDI.
Historically, only changes reported that “increased” the patient credit have updated automatically. “Decreases” to the patient credit have required additional processing by the Department of Human Services (DHS) LTC caseworker before the updated amount has been reflected in MEDI.
Changes in a resident’s income affecting the patient credit must be electronically reported through MEDI within 45 calendar days from the date of the income change. LTC providers must continue to submit all supporting documentation that verifies a change in the resident’s income to DHS. Please refer to the Provider Notice dated 05/10/2017 to locate the appropriate DHS LTC office.
The DHS caseworker will review the submitted income change transaction with the supporting documentation. The DHS caseworker will determine the final patient credit calculation and send the Form HFS 2500, “LTC/SLF Resource Calculation” to the resident, their Authorized Representative (if appropriate) and the LTC Provider, indicating the patient credit amount with the effective date(s). Automatic adjustments to claims that have received reimbursement will be completed based upon changes associated with the DHS caseworker’s final determination.
Changes that may affect the resident’s income include, but are not limited to:
Incorrect patient credit calculations due to missing or incorrect information must be reported to the appropriate DHS LTC office with a request for recalculation. Requests for recalculation must include all supporting documentation and the Transaction Audit Number (TAN) in order to be considered for review.
Questions regarding this Notice may be directed to the Bureau of Long Term Care at
1-844-528-8444.
Teresa T. Hursey
Medicaid Director