Current through Register Vol. 35, No. 18, September 24, 2024
A. As a condition for participation in
medicaid, each swing bed provider must establish and maintain an acceptable
system of accounting for a resident's personal funds when a Title XIX
(medicaid) recipient requests that his/her personal funds be cared for by the
facility. See
42 CFR
483.10(c).
(1) Requests for swing bed providers to care
or not care for a recipient's funds must be made in writing and secured by the
request to handle recipient's fund form or a letter signed by the recipient or
his/her representative. The form or letter is kept in the recipient's file at
the facility.
(2) A recipient's
personal fund consists of a monthly maintenance allowable, established by MAD.
If the recipient receives any income in excess of this allowance, the excess is
applied to the cost of the recipient's medical care at the facility. This
excess is reported as a medical care credit to the swing bed provider by the
local county income support division (ISD) office, when applicable.
(3) All swing bed facilities must have
procedures for handling of medicaid recipients' funds. These procedures must
not allow the facility to commingle medicaid recipients' funds with facility
funds.
(4) Swing bed facilities
should use medicaid guidelines to develop procedures for handling recipient
funds.
(5) Recipients have the
right to manage their financial affairs and no facility can require recipients
to deposit their personal funds with the facility.
(6) Facilities must purchase a surety bond or
provide self-insurance to ensure the security of all personal funds deposited
with the facility.
B.
Fund custodians: Swing bed facilities must designate a full-time
employee and an alternate to serve as fund custodians for handling all medicaid
residents' money on a daily basis.
(1) Another
individual, other than those employees who have daily responsibility for the
fund, must do the following:
(a) reconcile
balances of the individual medicaid recipients' accounts with the collective
bank account;
(b) periodically
audit and reconcile the petty cash fund; and
(c) authorize checks for the withdrawal of
funds from the bank account.
(2) Facilities must ensure that there is a
full, complete and separate accounting, based on generally accepted accounting
principles, of each recipient's personal funds entrusted to the facilities on
the recipient's behalf.
C.
Bank account: Swing bed
facilities must establish a bank account for the deposit of all money for
medicaid recipients who request the facility to handle their funds. Recipients'
personal funds are held separately and not commingled with facility funds.
(1) Facilities must deposit any recipient's
personal funds more than fifty ($ 50) dollars in an interest bearing account
that is separate from any of the facility operating accounts and which credits
all interest earned on the recipient's account to that account.
(2) Facilities must maintain recipients'
personal funds up to fifty ($50) in a non-interest bearing account or a petty
cash fund. Recipients must have convenient access to these funds.
(3) Individual financial records must be
available on the request of recipients or their legal
representatives.
(4) Within thirty
(30) days of the death of a recipient whose personal funds are deposited with
the facility, a swing bed provider must convey the recipient's funds and a
final accounting of these funds promptly to the individual or probate
jurisdiction administering the recipient's estate.
D.
Establishment of individual
accounts: Swing bed facilities must establish an account for each
medicaid recipient in which all transactions can be recorded. Accounts can be
maintained in a general ledger book, a card file or looseleaf binder.
(1) For money received, the source, amount
and date is recorded. Recipients or their authorized representatives must be
given receipts for the money. The swing bed facility retains a copy of the
deposit in the recipient's individual account file.
(2) The purpose, amount and date of all
disbursements to or on behalf of recipients must be recorded. Any money spent
either on behalf of recipients or withdrawn by recipients or their
representatives must be validated by receipts or signatures on individual
ledger sheets.
(3) Facilities must
notify each medicaid recipient when the account balance is two hundred ($200)
dollars less than the supplemental security income (SSI) resource limit for one
person specified in section 1611(a)(3)(B) of the Social Security Act. If the
amount of the account and the value of the recipient's other nonexempt
resources reach the SSI resource limit for one person, the recipient can lose
eligibility for medicaid or SSI.
E.
Personal fund reconciliation:
The swing bed facility must balance individual accounts, collective bank
accounts and the petty cash fund at least once a month. The swing bed facility
must provide medicaid recipients or their authorized representatives with an
accounting of the recipients' funds at least once a quarter. Copies of
individual account records can be used to provide this information.
F.
Petty cash fund: A swing bed
facility must maintain a cash fund in the facility to accommodate the small
cash requirements of medicaid recipients. Five dollars ($5.00) or less per
individual recipient may be adequate. The amount of money kept in the petty
cash fund is determined by the number of recipients using the service and the
frequency and availability of bank service. A petty cash fund ledger must be
established to record all action regarding money in this fund.
(1) To establish the fund, the swing bed
facility must withdraw money from the collective bank account and keep it in a
locked cash box.
(2) To use the
petty cash fund, the following procedures should be established:
(a) recipients or their authorized
representatives request small amounts of spending money;
(b) the amount disbursed is entered on the
individual ledger record; and
(c)
the recipient or representative signs an account record and receives a
receipt.
(3) To
replenish the petty cash fund, the following procedures should be used:
(a) the money left in the cash box is counted
and added to the total of all disbursements made since the last replenishment;
and the total of the disbursements plus cash on hand equals the beginning
amount;
(b) money equal to the
amount of disbursements is withdrawn from the collective bank
account.
(4) To
reconcile the fund, the following procedure should be used once each month:
(a) count money on hand; and
(b) total cash disbursed either from receipts
or individual account records. The cash on hand plus total disbursements equals
petty cash total.
(5) To
close the recipient account, the swing bed facility should to the following:
(a) enter date of and reason for closing the
account;
(b) write a check against
the collective bank account for the balance shown on the individual account
record;
(c) get signature of the
recipient or their authorized representative on the individual recipient
account record as receipt of payment; and
(d) notify the local ISD office if closure is
caused by death of a recipient so that prompt action can be taken to terminate
assistance.
(6) Within
thirty (30) days of the death of a recipient who has no relatives, the swing
bed facility conveys the recipient's funds and a final accounting of the funds
to the individual or probate jurisdiction administering the recipient's estate.
See
42 CFR
483.10(c)(6).
G.
Retention of
records: All account records are retained for a minimum of three (3)
years or, in case of an audit, until the audit is completed.
H.
Non-acceptable uses of recipients'
personal funds:
(1) Non-acceptable uses
of recipients' personal funds include the following:
(a) payment or charges for services or
supplies covered by medicaid or medicare-specified as allowable costs; see
Subsection G of 8.312.3.11 NMAC, Costs Related Reimbursement of Nursing
Facilities;
(b) difference
between the swing bed facility's billed charge and the medicaid payment;
and
(c) payment for services or
supplies routinely furnished by the facility, such as linens and
nightgowns.
(2) A swing
bed facility cannot impose charges against recipients' personal funds for any
item or service for which payment is made by medicaid or for any item
recipients or their representatives did not request. Facilities must not
require recipients or representatives to request any item or service as a
condition of admission or continued stay. Swing bed facilities must inform
recipients or representatives who request a noncovered item or service that
there is a charge for the item and the amount of the charge.
I. State monitoring of recipients'
personal funds: Swing bed facilities must make all files and records involving
recipients' personal funds available for inspection by authorized state
personnel or federal auditors.
(1) The
licensing and certification bureau of the DOH verifies that facilities have
established systems to account for recipients' personal funds, including the
components described above. Failure to provide an acceptable accounting system
constitutes a deficiency that must be corrected.
(2) The human services department (HSD) or
its designee can complete a thorough audit of recipients' personal funds at
HSD's discretion.
