Current through Register Vol. 35, No. 18, September 24, 2024
A. As a condition for MAD provider
participation, each NF must establish and maintain an acceptable system of
accounting for an eligible recipient or member resident's personal funds when
an eligible recipient or member requests that his or her personal funds be
cared for by the facility. See
42 CFR Section
483.10(c) and see 7.9.2.22
NMAC.
(1) Requests for a NF to care or not
care for an eligible recipient or member resident's funds must be made in
writing and secured by a request to handle recipient or member funds form or
letter signed by the eligible recipient or member or his or her authorized
representative. The form or letter is kept in the eligible recipient or
member's file at the facility.
(2)
An eligible recipient or member's personal fund consists of a monthly
maintenance allowable, established by MAD. If the eligible recipient or member
resident receives any income in excess of this allowance, the excess is applied
to the cost of the eligible recipient or member resident's medical care at the
NF. This excess is reported as a medical care credit to the facility by the
local county income support division (ISD) office, when applicable.
(3) A NF must have procedures on the handling
of eligible recipient or member residents' funds. These procedures must not
allow the facility to commingle eligible recipient or member residents' funds
with facility funds.
(4) A NF
should use these applicable federal statutes, regulations and state rules to
develop procedures for handling eligible recipient or member resident's
funds.
(5) An eligible recipient or
member resident has the right to manage his or her financial affairs and no NF
can require an eligible recipient or member resident to deposit his or her
personal funds with the NF.
(6) A
NF must purchase a surety bond or furnish self-insurance to ensure the security
of all personal funds deposited with the NF.
(7) Failure of a NF to furnish an acceptable
accounting system constitutes a deficiency that must be corrected by the
provider and verified by DOH survey teams.
B.
Fund custodians: A NF must
designate a full-time employee and an alternate to serve as fund custodians for
handling an eligible recipient or member resident's money on a daily basis; see
7.9.2.22 NMAC.
(1) Another individual, other
than those employees who have daily responsibility for the fund, must do the
following:
(a) reconcile balances of each
eligible recipient or member 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) A NF must ensure that there is a full,
complete and separate accounting, based on generally accepted accounting
principles, of each eligible recipient or member resident's personal funds
entrusted to his or her NF on the eligible recipient or member resident's
behalf.
C.
Bank
account: A NF must establish a bank account for the deposit of all money
for each eligible recipient or member resident who requests the NF to handle
his or her funds. An eligible recipient or member resident's personal funds are
to be held separately and not commingled with the NF funds; see 7.9.2.22 NMAC.
(1) A NF must deposit an eligible recipient
or member's personal funds of more than $50 in an interest bearing account that
is separate from any of the NF operating accounts and which credits all
interest earned on the eligible recipient or member resident's account to that
account. An eligible recipient or member resident must have convenient access
to these funds.
(2) A NF must
maintain an eligible recipient or member resident's personal funds up to $50 in
an interest bearing account or a petty cash fund that is separate from any of
the NF operating accounts. An eligible recipient or member resident must have
convenient access to these funds.
(3) Individual financial records must be
available on the request of an eligible recipient or member resident or his or
her authorized representative.
(4)
Within 30 calendar days of the death of an eligible recipient or member
resident whose personal funds are deposited with the facility, a NF must convey
the deceased eligible recipient or member resident's funds and a final
accounting of these funds to the individual or probate jurisdiction
administering the deceased eligible recipient or member resident's
estate.
D.
Establishment of individual accounts: A NF must establish accounts
for each eligible recipient or member resident in which all transactions can be
recorded. Accounts can be maintained in a general ledger book, card file or
loose leaf binder; see 7.9.2.22 NMAC.
(1) For
money received, the source, amount and date must be recorded. The NF must
provide the eligible recipient or member resident or his or her authorized
representative receipts for the money. The NF stills retains a copy of the
deposit in the eligible recipient or member resident's individual account
file.
(2) The purpose, amount and
date of all disbursements to or on behalf of an eligible recipient or member
resident must be recorded. All money spent either on behalf of the eligible
recipient or member resident or withdrawn by the eligible recipient or member
resident or his or her authorized representative must be validated by receipts
or signatures on each eligible recipient or member resident's individual ledger
sheet.
(3) The NF must notify each
eligible recipient or member resident when the account balance is $200 less
than the supplemental security income (SSI) resource limit for one person
specified in Subparagraph (a) of Paragraph (3) of Subsection B of Section 1611
of the Social Security Act. If the amount of the account and the value of the
eligible recipient or member resident's other nonexempt resources reach the SSI
resource limit for one person, the eligible recipient or member resident can
lose eligibility for a medical assistance program (MAP) or SSI.
E.
Personal fund
reconciliation: The NF must balance each eligible recipient or member
resident's individual accounts, the collective bank accounts and the petty cash
fund at least once each month. The NF must furnish each eligible recipient or
member resident or his or her authorized representative with an accounting of
the eligible recipient or member residents' funds at least quarterly. Copies of
each eligible recipient or member resident's individual account records can be
used to furnish this information; see 7.9.2.22 NMAC.
F.
Petty cash fund: The NF must
maintain a cash fund in the facility to accommodate the small cash requirements
of an eligible recipient or member resident. $5 or less per each eligible
recipient or member resident may be adequate. The amount of money kept in the
petty cash fund is determined by the number of NF residents using the service
and the frequency and availability of bank service. A petty cash fund ledger
must be established to record all actions regarding money in this fund; see
7.9.2.22 NMAC.
(1) To establish the fund, the
NF 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) an eligible recipient or member resident
or his or her authorized representative request small amounts of spending
money;
(b) the amount disbursed is
entered on each eligible recipient resident's individual ledger record;
and
(c) the eligible recipient or
member resident or his or her authorized 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 procedures should be used once each month:
(a) count money at hand; and
(b) total cash disbursed either from receipts
or each eligible recipient or member resident's individual account records; the
cash on hand plus total disbursements equals petty cash total.
(5) To close each eligible
recipient or member resident account, the NF should do 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 each eligible recipient or
member resident's individual account record;
(c) get signature of the eligible recipient
resident or his or her authorized representative on the eligible recipient or
member resident's individual account record, as receipt of payment;
and
(d) notify the local ISD office
if closure is caused by death of an eligible recipient or member resident so
that prompt action can be taken to terminate assistance; within 30 calendar
days of the death of an eligible recipient or member resident who has no
relatives; the NF conveys the eligible recipient or member resident's funds and
a final accounting of the funds to the individual or probate jurisdiction
administering the eligible recipient or member resident's estate; see
42 CFR Section
483.10(c)(6).
G.
Retention of
records: All account records are retained for at least six years or, in
case of an audit, until the audit is completed.
H.
Non-acceptable uses of residents'
personal funds: Non-acceptable uses of an eligible recipient or member
resident's personal funds include the following:
(1) payment or charges for services or items
covered by MAD or medicare specified as allowable costs; see 8.312.3
NMAC;
(2) difference between the
NF's billed charge and the MAD payment; and
(3) payment for services or supplies
routinely furnished by the NF, such as linens or nightgowns;
(4) a NF cannot impose charges against
eligible recipient resident's personal funds for any item or service for which
payment is made by MAD or for any item the eligible recipient or member
resident or his or her authorized representative did not request;
(5) a NF must not require eligible recipient
or member resident or his or her authorized representative to request any item
or service as a condition of admission or continued stay;
(6) a NF must inform an eligible recipient or
member resident or his or her authorized representative who requests
non-covered items or services that there is a charge for the item and the
amount of the charge.
I.
Monitoring of residents' personal funds: NFs must make all files
and records involving an eligible recipient or member resident's personal funds
available for inspection by authorized state or federal auditors. DOH survey
teams verify that a NF has established systems to account for an eligible
recipient or member resident's personal funds, including the components
described above. Failure to furnish an acceptable accounting system constitutes
a deficiency that must be corrected; see 7.9.2.22 NMAC.
