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Elizabeth M. Whitehorn, Director

Provider Notice Issued 06/24/2022

Date:  June 24, 2022                                                                                

To:      Long Term Care Facilities - Nursing Facilities (NF), Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IID), Supportive Living Program (SLP), Medically Complex for the Developmentally Disabled Facilities (MC/DD) and Specialized Mental Health Rehabilitation Facilities (SMHRF)

Re:      Group Care Credit and Additional Clarifications during the Public Health Emergency                                                                 

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This notice provides information regarding increased patient credit amounts, otherwise known as group care credits (GCC) and other clarifications associated with the Public Health Emergency (PHE). 

Changes to an individual's GCC should be applied regardless of the status of the PHE. This includes both increases and decreases to the GCC. This notice applies only to income changes or medical expenses that result in a change in GCC. 

  • Changes that result in a decreased GCC will be processed retroactively to when the income changed.
  • Changes that result in an increased GCC will be processed prospectively, beginning with the current effective* month. 

 

When the increased GCC is processed by the Department of Human Services (DHS) caseworker it will be applied prospectively (current effective month) regardless of when the change occurred. This directive applies to all GCCs that were not systematically processed upon submission given the increase remains applicable and has not been processed. 

Examples:

Ex 1.  Reported income increase/GCC increase on 09/01/2021. Supportive documentation was provided to verify income change. Caseworker processes change on 07/01/2022.  The caseworker will update the GCC effective 08/01/2022, which is the current effective month. 

Ex 2. Reported income increase/GCC increase on 09/01/2021. Supportive documentation was in the case record verifying income change. Caseworker processes redetermination on 07/18/2022. The caseworker will update the GCC effective 09/01/2022, which is the current effective month. 

Ex 3. Reported income decrease/GCC decrease on 07/01/2021. Supportive documentation was in the case record verifying income change. Caseworker processes change on 06/12/2022. The GCC decrease will be effective retroactively to the date the decrease occurred on 07/01/2021. 

NOTE: Income changes that were systematically processed upon submission will remain on the Medical Electronic Data Interchange (MEDI) system with the effective month in which the change was submitted. Caseworkers will not be changing the effective month for these GCCs due to the amounts having been processed for the current or next month at the time they were submitted.    

GCC increases that were submitted previously and were automatically updated upon submittal, will not be reverted to the previous amounts unless the required supportive documentation is not on file. 

All supporting verifications must be submitted, in order for the DHS caseworker to process income changes. Refer to the DHS Policy Manual -

PM 02-07-02: Obtaining Verifications for more information. 

Determining the effective* month:

  • Generally, for actions completed during the 1st day through the 15th day of the month, the change will be effective for the next calendar month.  Example: A transaction is processed on March 12th. The change will be effective beginning in April. 
  • Generally, for actions completed during the 16th day through the last day of the month, the change will be effective in the month that follows the next calendar month. Example: A transaction is processed on March 23rd. The change will be effective in May.

 

ADDITIONAL CLARIFICATIONS: 

  • The 2022 annual cost of living adjustment (COLA) file will not be run this year to update GCC systematically. Providers should submit any income changes that are still applicable that have not been previously submitted. Please do not submit income change transactions that are duplicates of ones previously submitted. 
  • The resource test has been temporarily suspended due to the public health emergency.

 

Questions may be directed to the Bureau of Long Term Care toll free at 844-528-8444.

 

 

Kelly Cunningham, Administrator

Division of Medical Programs