Current through Register Vol. 35, No. 18, September 24, 2024
A. As a condition for participation in
medicaid, each ICF-MR must establish and maintain an acceptable system of
accounting for a resident's personal funds when a Title XIX (medicaid)
recipient requests that their personal funds be cared for by the facility. See
42 CFR
483.10(c).
(1) Requests for ICFs-MR to care or not care
for a resident's funds must be made in writing and secured by a request to
handle recipient's fund form or a letter signed by the resident or their
representative. The form or letter is retained in the recipient's file at the
facility.
(2) A recipient's
personal fund consists of a monthly maintenance allowance established by MAD.
If the resident receives any income in excess of this allowance, the excess is
applied to the cost of the resident's medical care at the facility. This excess
is reported as a medical care credit to the facility by the local county income
support division (ISD) office, when applicable.
(3) All facilities must have procedures on
the handling of medicaid residents' funds. These procedures must not allow the
facility to commingle medicaid residents' funds with facility funds.
(4) Facilities should use these medicaid
guidelines to develop procedures for handling resident funds.
(5) Residents have the right to manage their
financial affairs and no facility can require residents 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: 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. Another individual, other than those employees who have
daily responsibility for the fund, must do the following:
(1) reconcile balances of the individual
medicaid residents' accounts with the collective bank account;
(2) periodically audit and reconcile the
petty cash fund;
(3) authorize
checks for the withdrawal of funds from the bank account; and
(4) facilities must ensure that there is a
full, complete and separate accounting, based on generally accepted accounting
principles, of each resident's personal funds entrusted to facilities on the
resident's behalf.
C.
Bank account: Facilities must establish a bank account for the deposit of all
medicaid residents who request the facility to handle their funds. Residents'
personal funds are held separately and not commingled with facility funds.
(1) Facilities must deposit any resident's
personal funds of more than $50 in an interest bearing account that is separate
from any of the facility operating accounts and which credits all interest
earned on the resident's account to that account.
(2) Facilities must maintain residents'
personal fund up to $50 in a non-interest bearing account or a petty cash fund.
Residents must have convenient access to these funds.
(3) Individual financial records must be
available on the request of residents or their legal representatives.
(4) Within 30 days of the death of residents
whose personal funds are deposited with the facility, the ICF-MR must convey
the resident's funds and a final accounting of these funds promptly to the
individual or probate jurisdiction administering the resident's estate.
D. Establishment of
individual accounts: Facilities must establish accounts for each medicaid
resident in which all transactions can be recorded. Accounts can be maintained
in a general ledger book, card file, or looseleaf binder.
(1) For money received, the source, amount,
and date must be recorded. Residents or their authorized representatives must
be given receipts for the money. The facility must retain a copy of the deposit
in the resident's individual account file.
(2) The purpose, amount and date of all
disbursements to or on behalf of residents must be recorded. Any money spent
either on behalf of residents or withdrawn by residents or their
representatives must be validated by receipts or signatures on individual
ledger sheets.
(3) Facilities must
notify each medicaid resident when the account balance is $200 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 resident's other nonexempt resources reach the SSI
resource limit for one person, the resident can lose eligibility for medicaid
or SSI.
E. Personal fund
reconciliation: Facilities must balance the individual accounts, the collective
bank accounts and the petty cash fund at least once a month. The facility must
provide medicaid residents or their authorized representatives with an
accounting of the resident's funds at least once a quarter. Copies of
individual account records can be used to provide this information.
F. Petty cash fund: Facilities must maintain
a cash fund to accommodate the small cash requirements of medicaid residents.
Five dollars ($5.00) or less per individual recipient may be adequate. The
amount of money maintained in the petty cash fund is determined by the number
of 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.
(1) To establish
the fund, the ICF-MR 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
individual ledger record; and
(c)
the resident or representative signs an account record and receives a
receipt.
(3) To
replenish the fund, the following procedures should be used:
(a) money in the cash box is counted and
added to the total of all disbursements made since the last replenishment;
and
(b) the total of the
disbursements plus cash on hand equals the beginning amount;
(c) money equal to the amount of
disbursements is withdrawn from the collective bank account.
(4) To reconcile the fund, the
following procedures must be established and used at least 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
the petty cash total.
(5) To close the resident's account, ICFs-MR
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 the
individual account record;
(c) get
signature of the recipient or their authorized representative on the individual
recipient account record, as receipt of payment;
(d) notify the local ISD office if closure is
caused by the death of the recipient so that action can be taken to terminate
assistance; and
(e) within 30 days
of the death of a resident who had no relatives, the ICF-MR conveys the
resident's funds and a final accounting of the funds to the individual or
probate jurisdiction administering the resident's estate; see
42 CFR
483.10(c)(6).
G. Retention of
records: All account records other than financial and statistical cost reports
must be retained until after an audit is complete or six years, whichever is
greater. For details on retention of financial and statistical cost reports,
see Subsection D of
8.313.3.12 NMAC Retention
of Records.
H.
Non-acceptable uses of recipients' personal funds:
(1) Facilities cannot impose charges against
a resident's personal funds for any item or service for which payment is made
by medicaid or for any item residents or their representatives did not request.
Facilities must not require residents or representative to request any item or
services as a condition of admission or continued stay.
(2) Facilities must inform residents or their
representative requesting non-covered items or services that there is a charge
for the item and the amount of the charge.
(3) Non-acceptable uses of residents'
personal funds include the following:
(a)
payment for services or supplies covered by medicaid or medicare; see 8.313.3
NMAC, Cost Related Reimbursement of Intermediate Care Facilities for
the Mentally Retarded;
(b)
difference between the facility billed charge and the medicaid payment;
or
(c) payment for services or
supplies routinely furnished by the facility, such as linens and
nightgowns.
I. State monitoring of residents' personal
funds: Facilities must make all files and records involving residents' personal
funds available for inspection by authorized state personnel or federal
auditors.
(1) The division of health
improvement, health facility licensing & certification bureau of the HCA
verifies that facilities have a system of accounting for residents' personal
funds, including the components described above. Failure to provide an
acceptable accounting system constitutes a deficiency that must be
corrected.
(2) The HCA or its
designee can complete a thorough audit of residents' personal fund accounts at
HCA's discretion.
