Current through all regulations passed and filed through September 16, 2024
A NF resident's rights concerning his or her personal financial
affairs shall be in accordance with
42 CFR 483.10
(October 4, 2016).
(A) Definitions.
(1) "Personal needs allowance
(PNA) account" means an account or petty
cash fund that holds the money of a NF resident and is managed for the resident
by the NF provider.
(2) "Letters of administration," also known as letters
testamentary, means court papers allowing a person to take charge of the
property of a deceased person in order to distribute it.
(3)
"Surety bond" means an agreement between the principal (i.e., the NF provider),
the surety (i.e., the insurance company), and the obligee (i.e., the resident
and/or the Ohio department of medicaid (ODM) acting on behalf of the resident),
wherein the principal and the surety agree to compensate the obligee for any
loss of the obligee's funds that the principal holds, safeguards, manages, and
accounts for.
The purpose of a surety bond is to guarantee that a NF provider
will pay a resident, or ODM on behalf of a resident, for losses occurring from
any failure by the facility to hold, safeguard, manage, and account for the
resident's funds, including losses incurred as a result of acts of error or
negligence, incompetence, or dishonesty. The principal assumes the
responsibility to compensate the obligee for the amount of the loss up to the
entire amount of the surety bond.
(B) PNA.
(1) A medicaid resident who receives care in
a NF certified to participate in the medicaid program is eligible to retain a
PNA account for the purchase of items and
services of his or her choice.
(2)
The PNA account is the exclusive property of the resident, who may use the
funds in the account as he or she chooses to meet personal needs.
(3) Unless a medicaid resident receives
additional irregular contributions from another source, all of his or her
personal expenses shall be met through the PNA account.
(C) Management of personal funds.
(1) A NF resident has the right to manage his
or her personal financial affairs.
(2) A NF provider shall not require a
resident to deposit his or her PNA funds with the provider. However, if a
resident requests assistance from the NF staff in managing his or her PNA
account, the request shall be in writing.
(3) Upon written authorization from a
resident, a NF shall hold, safeguard, manage, and account for a resident's PNA
funds deposited with the provider.
(4) A NF provider shall explain verbally and
in writing to the resident or the resident's representative that PNA funds are
for the resident to use as he or she chooses. If a representative is the payee
for the resident's PNA account, the representative shall be responsible for
ensuring that the money is used to meet the personal needs of the
resident.
(D) Deposit of
PNA account funds and interest earned.
(1)
Funds of fifty dollars or less.
If a resident's PNA account funds are fifty dollars or less, a
NF provider may deposit the funds in an interest-bearing account, a
non-interest bearing account, or a petty cash fund.
(2) Funds in excess of fifty dollars.
If a resident's PNA account funds are in excess of fifty
dollars, the NF provider shall deposit the funds in an interest-bearing account
(or accounts) that is separate from any of the NF provider's operating accounts
within five banking days from the date the balance exceeds fifty
dollars.
(3) A NF provider
shall credit any interest earned on a resident's PNA funds to the resident's
PNA account balance. If pooled accounts are used, the provider shall prorate
interest per resident on the basis of actual earnings or end-of-quarter
balance.
(4) A NF provider shall
not charge a resident a fee for managing the resident's PNA account. Banks,
however, may charge the resident a fee for handling the account.
(E) Accounting and records.
(1) A NF provider shall establish and
maintain a system that ensures full, complete, and separate accounting of each
resident's PNA account funds.
(2) A
NF provider shall not commingle a resident's accounts or funds with the
provider's accounts or funds, or with the accounts or funds of any individual
other than another NF resident.
(3)
A NF provider shall provide a resident with access to petty cash (less than
fifty dollars) on an ongoing basis and shall arrange for the resident to access
larger funds (fifty dollars or more). A NF provider shall give residents a
receipt for every transaction, and the NF provider shall retain a
copy.
(4) A NF provider shall
obtain a resident's signature upon the resident's receipt of PNA funds. If the
resident is unable to sign his or her name, he or she shall acknowledge receipt
of the money by marking an "X." Two persons shall verify through signature that
they have witnessed the resident's action.
(5) A NF provider shall maintain an
individual ledger account of revenue and expenses for each PNA account managed
by the facility. The ledger account shall meet all the following criteria:
(a) Specify all funds received by or
deposited with the NF provider. For PNA account funds deposited in banks,
monies shall be credited to the resident's bank account within three business
days; and
(b) Specify the dates
and reasons for all expenditures; and
(c) Specify at all times the balance due the
resident, including interest earned as last reported by the bank to the
provider; and
(d) Be available to
the resident or the resident's representative for review.
(6) Upon request, a NF provider shall provide
receipts to a resident or the resident's representative for purchases made with
the resident's PNA funds.
(7)
Within thirty days after the end of the quarter, a NF provider shall provide a
written quarterly statement to each resident or resident's representative of
all financial transactions made by the provider on the resident's
behalf.
(F) Notification
of certain balances or transactions that may affect medicaid eligibility.
(1) Notice to resident.
(a) A NF provider shall give written
notification to each resident who receives medicaid benefits, and whose funds
are managed by the NF provider, when the amount in the resident's PNA account
reaches two hundred dollars less than the supplemental security
income resource limit specified in section 1611(a)(3)(A) or section
1611(a)(3)(B) of the Social Security Act.
(b) The notice shall inform the resident that
he or she may lose medicaid eligibility if the amount in his or her PNA
account, in addition to the value of the other nonexempt resources, reaches the
resource limit amount.
(c) A copy
of the notice to the resident shall be retained in the resident's
file.
(2) Notice to the
county department of job and family services (CDJFS).
(a) A NF provider shall report to the CDJFS
any PNA account balance in excess of the resource limit. The CDJFS shall apply
the excess amount to the routine cost of NF care .
(3) If a
resident is considering using PNA funds to purchase life insurance, grave
space, a burial account, or other item that may be considered a countable
resource, the NF provider shall refer the resident or the resident's
representative to the CDJFS for an explanation of the effect the purchase may
have on the resident's medicaid eligibility.
(G) Release of funds upon discharge.
(1) Upon discharge of a resident, a NF
provider shall release all the resident's funds, up to and including the
maximum resource limit amount.
(2)
Other than for items and services that the resident has requested and that may
be charged to the resident's PNA account in accordance with this rule, a NF
provider shall not withhold PNA account funds to pay any outstanding balance a
resident owes the provider at the time of discharge.
(H) Conveyance of funds upon death.
(1) First thirty days.
A NF provider shall not retain the money in a resident's PNA
account beyond thirty days following the resident's death if letters
testamentary or letters of administration are issued, or an application for
release from administration is filed under section
2113.03 of the Revised Code
concerning the resident's estate within that thirty-day period. In these
circumstances, the provider shall transfer the funds in the resident's PNA
account and a final accounting of those funds to the administrator, executor,
commissioner, or person who filed the application for release from
administration. If these conditions for release are not met, the provider shall
follow paragraph (H)(2) or (H)(3) of this rule.
(2) First sixty days.
If, within sixty days after a resident's death, letters
testamentary or letters of administration are issued, or an application for
release from administration is filed under section
2113.03 of the Revised Code
concerning the resident's estate, the provider shall transfer the resident's
PNA account funds and a final accounting of those funds to the administrator,
executor, commissioner, or person who filed the application for release from
administration.
(3) After
sixty days.
(a) If, within sixty days after a
resident's death, letters testamentary or letters of administration concerning
the resident's estate are not issued, or an application for release from
administration is not filed under section
2113.03 of the Revised Code
concerning the resident's estate, and if the resident was a recipient of
medicaid benefits, the provider shall transfer all the resident's PNA account
funds to ODM no earlier than sixty and no later than ninety days after the
death of the resident, with the exception listed in paragraph (H)(3)(c) of this
rule.
(b) PNA account funds
transferred to ODM shall be paid by check or money order made payable to
"Attorney General's Office" and shall be accompanied by a
completed ODM 09405 (rev. 4/2017) entitled "Personal Needs Allowance
(PNA) Account Remittance Notice." The payment and
completed ODM 09405 shall be mailed to the Ohio attorney general's
office.
(c) If funeral and/or
burial expenses for a deceased resident have not been paid, and all the
resident's resources other than the PNA have been exhausted, the resident's PNA
account funds shall be used to pay the funeral and/or burial
expenses.
(d) If, sixty-one or more
days after a resident dies, letters testamentary or letters of administration
are issued, or an application for release from administration under section
2113.03 of the Revised Code is
filed concerning the resident's estate, ODM shall transfer all the resident's
PNA account funds received by the department to the administrator, executor,
commissioner, or person who filed the application for release from
administration, unless ODM is entitled to recover the money under section
5162.21 of the Revised Code.
(I)
Financial security.
A NF provider shall purchase a surety bond or provide a
reasonable alternative as described in this rule in order to protect all
resident funds deposited with and managed by the NF provider.
(1) Surety bond.
(a) A surety bond shall be executed by a
licensed surety company pursuant to Chapters 1301., 1341., and 3929. of the
Revised Code.
(b) At a minimum,
surety bond coverage shall protect at all times the full amount of resident
funds deposited with the NF provider, including interest earned and refundable
deposit fees.
(c) The surety bond
shall provide for repayment of funds lost due to any failure of the NF
provider, whether by commission, bankruptcy, omission, or otherwise, to hold,
safeguard, manage, and account for resident funds.
(d) The surety bond shall designate either
the NF provider, or ODM on behalf of the resident, as the obligee.
(e) If an entity purchases a surety bond that
covers more than one of its facilities, the surety bond shall protect the full
amount of all resident funds on deposit in all the entity's
facilities.
(2)
Reasonable alternative to the surety bond.
A reasonable alternative to the surety bond shall provide
protection equivalent to that afforded by a surety bond. Neither self insurance
nor deposit of funds in bank accounts protected by the federal deposit
insurance corporation (FDIC) or a similar entity are acceptable alternatives to
a surety bond. A NF provider electing not to purchase a surety bond shall
submit a proposal for an alternative to ODM for approval. An acceptable
alternative shall meet all of the following criteria:
(a) At a minimum, protect at all times the
full amount of resident funds deposited with the NF provider, including
interest earned and refundable deposit fees; and
(b) Designate either ODM or the residents of
the NF as the entity or entities that will collect payment for lost funds;
and
(c) Guarantee repayment of
funds lost due to any failure of the NF provider, whether by commission,
bankruptcy, omission, or otherwise, to hold, safeguard, manage, and account for
resident funds; and
(d) Be managed
by a third party unrelated in any way to the NF provider or its management;
and
(e) Not name the NF provider as
a beneficiary.
(3)
Provision of assurance to ODM.
A NF provider or entity
that operates multiple facilities shall submit
copies of either the multi-facility surety bond or a reasonable alternative to
the multi-facility surety bond to ODM upon
request for review and approval. If the NF provider, surety company, or
issuer of an ODM-approved surety bond alternative cancels the surety bond or
reasonable alternative to a surety bond, they shall notify ODM by certified
mail thirty days prior to the effective date of cancellation.
(J) Limitations on charges to the
PNA account.
(1) A NF provider shall not
charge a resident's PNA account for items and services that the provider is
required to furnish in order to participate in the medicare and medicaid
programs, and that are included in medicare and medicaid payments made to the
provider.
(2) A NF provider shall
inform residents of the coverage and limitations of the medicare and medicaid
programs. If a resident's representative is the payee for the resident's PNA
account, the NF provider shall also explain the coverage and limitations to the
representative.
(3) A NF provider
shall not use a resident's PNA account funds to pay for costs associated with
guardianship proceedings, including but not limited to the costs for
assessments, medical exams, and filing fees.
(K) Items and services covered by medicare or
medicaid.
(1) A NF provider shall not charge a
resident's PNA account for items and services that the provider is required to
furnish in order to participate in the medicare and medicaid
programs.
(2) Items and services
that may not be purchased with PNA account funds include, but are not limited
to, the following:
(a) Nursing services;
and
(b) Dietary services;
and
(c) Activities programs;
and
(d) Room and bed maintenance
services; and
(e) Routine personal
hygiene items and services required to meet the needs of the resident,
including but not limited to hair hygiene supplies, comb, brush, bath soap,
disinfecting soap or specialized cleansing agents when indicated to treat
special skin problems or to fight infection, razor, shaving cream, toothbrush,
toothpaste, denture adhesive, denture cleaner, dental floss, moisturizing
lotion, tissues, cotton balls, deodorant, incontinence care supplies, sanitary
napkins and related supplies, towels, washcloths, hospital gowns, over the
counter drugs, hair and nail hygiene services, bathing, and basic personal
laundry; and
(f) Medically related
social services; and
(g) Medical
supplies such as irrigation trays, catheters, drainage bags, syringes, and
needles; and
(h) Durable medical
equipment; and
(i) Air
conditioners, or charges to residents for the use of electricity; and
(j) Therapy or podiatry services;
and
(k) Charges for telephone
consultation by physicians or other personnel.
(L) Resident requests for items and services.
(1) A NF provider shall not charge a
resident's PNA account for any item or service not requested by the resident,
whether or not the item or service is requested by a physician.
(2) A NF provider shall not require a
resident or the resident's representative to request an item or service as a
condition for admission to or continued stay in the NF.
(3) When a resident requests an item or
service for which a charge to the resident's PNA account will be made, the NF
provider shall inform the resident that there will be a charge and the amount
of the charge.
(M) Items
and services that may be charged to the PNA account.
(1) If a resident clearly expresses a desire
for a particular brand or item not available from the NF provider, PNA funds
may be used as long as a comparable item of reasonable quality is available to
the resident from the NF provider at no charge. The NF provider may charge the
resident only the difference in cost between the available item and the
resident's preferred item.
(2)
Items and services that may be charged to a resident's PNA account include, but
are not limited to, the following:
(a)
Telephone, including a cellular phone;
and
(b) Television,
radio, personal computer, or other electronic device for
personal use; and
(c) Personal
comfort items, including smoking materials, notions, novelties, and
confections; and
(d) Cosmetics and
grooming items and services in excess of those for which payment is made under
the medicaid or medicare programs, including hair cuts, permanent waves, hair
coloring, and relaxing performed by barbers and beauticians; and
(e) Personal reading material; and
(f) Stationary or stamps; and
(g) Personal clothing; and
(h) Specialty laundry services such as dry
cleaning, mending, or hand-washing; and
(i) Flowers or plants; and
(j) Gifts purchased on behalf of a resident;
and
(k) Non-covered special care
services such as privately hired nurses or nurse aides; and
(l) Social events or entertainment offered
outside the scope of the NF provider's activities program; and
(m) Private rooms, except when
therapeutically required for infection control or similar reasons;
and
(n) Specially prepared or
alternative food requested instead of food generally prepared by the NF
provider; and
(o) Burial
plots.
(N)
Monitoring.
The CDJFS is responsible for monitoring PNA accounts. At least
annually, a designated CDJFS employee shall determine
if a NF provider is following the provisions of this rule, and shall report any
questions concerning inappropriate use or inadequate record keeping of PNA
funds to ODM and to the Ohio department of health (ODH) for further action.
Inappropriate use of PNA account funds by a payee or a NF provider does not,
however, reduce the scope or duration of medicaid benefits for a medicaid
recipient.
