16 Del. Admin. Code § 20000-20660

Current through Register Vol. 28, No. 7, January 1, 2025

Section 20000-20660 - Interim Changes

Interim changes are any changes in circumstances which could result in a change in eligibility (i.e. discharge, income increases or decreases, death). Interim changes must be evaluated at the time they occur or at the time they are reported to determine the effect on eligibility. Unreported changes could cause loss of Medicaid and/or overpayment. Interim changes which do not affect eligibility may affect monthly patient pay amounts (i.e. health insurance premium change, increases or decreases in income, COLA). Unreported changes may also affect payment to providers such as nursing facilities, hospitals, doctors, etc.

20660.1 Interim Changes Procedures

If the nursing facility recipient's income changes anytime during the year, perform the following:

update the eligibility system, and

notify the recipient/representative and facility.

20660.2 Termination of Medicaid Vendor Payments

If a Medicaid nursing facility recipient becomes ineligible due to a change in income or resources and remains in the facility, give 30 days notice of termination to the recipient and the facility. For example, a Medicaid nursing facility resident is determined ineligible on May 10. DSS must give 30 days notice (i.e. June 10).

20660.3 Interim Changes Due to Transfer

If a Medicaid nursing facility recipient is transferred to another facility, the following steps are required:

1. compute the pro-rated patient pay amount for each facility

2. update DCIS

3. notify recipient's representative and the facility.

20660.4 Interim Changes Due to Discharge

When a Medicaid recipient leaves the nursing facility and is discharged by the facility, the following steps must be taken:

1. complete budget to determine pro-rated patient pay amount

2. update DCIS. The case would be closed effective the last day of discharge month if the client received 10 days notice. Vendor payment would stop the day prior to discharge.

3. notify the recipient's representative and facility.

20660.5 Interim Changes Due to Death

When a Medicaid nursing facility recipient expires the following steps must be taken:

1. complete budget to determine pro-rated patient pay amount

2. update DCIS. The case would be closed effective the date of death; vendor payment would stop the day prior to death.

3. notify the recipient's representative and facility.

16 Del. Admin. Code § 20000-20660