| SUBJECT: |
| MENTAL HEALTH RESIDENTIAL PERSONAL CARE PROGRAM AND spend down |
| DISCUSSION: |
| The Department of Mental Health (DMH)
has recently established the Residential Personal Care Program as a new
Medicaid service. This service provides medically oriented assistance
with activities of daily living to certain DMH facility residents, and
can be used by Medicaid recipients to meet spend down.
These services are specified in a plan of care developed for each recipient, and include such activities as assistance with feeding/eating, assistance with an exercise program, individual instruction in order to become self-sufficient in personal care, and application of medications and dressings. Each service has a specific charge which is listed on the plan of care. The charges are totaled for one month and then averaged for a daily rate. This is the method by which Medicaid will pay. Allow the daily rate amount as an incurred expense to meet spend down. DMH will provide the plan of care
form, listing the daily rate for each recipient. Attached Note: In order to be used toward spend down, the daily charge must actually be incurred by the claimant. Do not project future charges toward spend down. For example, the daily rate charge for the sample form (attached) is $6.62. The beginning date is 09-08-1993. The ending date of the plan is 06-30-1994. The claimant applies for Medicaid spend down on 09-10-93 and has a quarter of September, October and November 1993. The claimant’s spend down amount is $200.00. Allow 23 days at $6.62 (September 8 thru September 30) for a total of $152.26 in Residential Personal Care for September. On October 8, the claimant will have incurred 8 additional days at $6.62 for a charge of $52.96. $152.26 + $52.96 = $205.22. Assuming no other charges were claimed, claimant meets spend down on October 8, 1993. Do not approve the application before October 8, 1993, as sufficient charges are not incurred until then.When an application for spend down is made, obtain the Personal Care Plan form from the DMH case manager. DMH is responsible to provide the plan of care to Family Services' staff, either by mail or in person. |
| NECESSARY ACTION: |
Distribution #1 |
to this memorandum is a facsimile of a typical plan of care.
At the bottom of the form, following the statement "Resulting Fee per Day
for Personal Care" is the daily rate amount. Near the top of the
form are the beginning and ending dates for this plan of care.
Assume that the recipient incurs this charge for each day included in the
plan.