N.M. Code R. § 8.311.5.16

Current through Register Vol. 35, No. 11, June 11, 2024

Section 8.311.5.16 - RECIPIENT PERSONAL FUNDS ACCOUNTS

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.

N.M. Code R. § 8.311.5.16

2/1/95; 8.311.5.16 NMAC - Rn, 8 NMAC 4.MAD.723.7, 3/1/12