LTC Services by qingyunliuliu

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									LTC Services

  Melody Sanders, Health Care Training
  Judie Hughes, Health Care Training

  MFWCAA (Fall 2009)




                                         1
Agenda

  Introduction.
  Have You Ever?
  New LTC Courses!
  MA-LTC Eligibility Determination.
  TPL – Medicare.
  Break
  Asset Assessments.
  Income and Calculations.

                                       2
Have You Ever…

    Had an request for MA-LTC with more
    than 5 transfers?

       Had an MA-LTC receive a lump
       sum income?

            Had a client with LTC
            coverage?

                                          3
Have You Ever…

     Had a client with a high Medicare
      premium?


          Stumped your supervisor?

                Attended the MFWCAA
                conference?

                                         4
Sequencing of LTC Courses

  10 online courses. (40 hours)
  1 classroom course. (4 days)
  5 training cases.




                                   5
LTC Online Courses
    Annuities 101 / Advanced Assets
    Intro to MA-LTC
    MA-LTC Basics
    MA-LTC Requirements
    Asset Assessment
    Annuities and MA-LTC
    MA-LTC Transfers
    LTCP
    Income and MA-LTC
    LTC Training Caseload Summary

                                       6
LTC Handouts and Cases

              REMEMBER!

  Bring online handouts and case materials
        to the MA-LTC Systems course!




                                             7
LTC Resources
             HCPM
             Manual Letters
             Bulletins
             MAXIS POLI/TEMP
             MMIS User Manual
             Health Care Training
              Courses
             HealthQuest


                                     8
Who is covered by MA-LTC?



    LTCF residents.



             HCBS waiver program recipients.



                                            9
Basic MA vs. MA-LTC

 Meet basic MA eligibility requirements first!
    SSN
    Citizenship/Identity

    Immigration Status

    Residency

    Basis of Eligibility


 Then apply MA-LTC eligibility requirements.

                                             10
“Otherwise Eligible”

  All basic MA and MA-LTC eligibility
  requirements are met, but for a transfer
  penalty.
   Verifications provided.
   Asset-eligible.

   Home Equity Limit met.

   DHS named PRB, when required.




                                             11
First Month of MA-LTC Request

    Applying basic MA rules for MA-LTC.

    Applying MA-LTC requirements.

    Requesting appropriate verifications.




                                             12
Request Month Determination

    Date request for MA-LTC received.

      DHS-3531 (Application)
      DHS-3543 (Request)

      HCAPP or CAF with DHS-4803




                                         13
Request Month Determination

    Date of LTCC (HCBS clients).

      DHS-5181.
      Anticipate services within 30 days from
       LTCC or date of request, whichever is later.




                                                      14
Request Month Determination

    Date of LTCF admission and anticipated
     date of discharge.

      DHS-1503
      Must reside for at least 30 consecutive
       days.




                                                 15
Request Month Determination

    Retroactive months requested.

      No limit for MA enrollees residing in LTCF.
       MA begin date or date of admission,
       whichever is later.
      Eligibility for waiver services cannot begin
       earlier than LTCC date (month).



                                                      16
LTCF Example 1

 Rodney requests MA and MA-LTC.
  Request date April 15.
  3 months retro requested.
  Admitted to LTCF on February 10.

   Action:
      February is month of request for
      MA-LTC. January is month of
      request for basic MA.

                                         17
LTCF Example 2

 Chester MA enrollee for 2 years.
  Request date April 15 using DHS-3543.
  No retro requested.
  Admitted to LTCF previous December.

   Action:
      December is month of
      request for MA-LTC.


                                           18
Waiver Example
 Elroy requesting MA and MA-LTC.
  Request date April 3.
  3 months retro requested.
  LTCC completed March 30.
  DHS-5181 indicates services anticipated to
   begin 30 days from LTCC date.

   Action:
             March is month of
             request for MA-LTC.
                                                19
OHC/TPL



   DHS-5590 – LTC/Waiver Case Checklist
   Row for Third Party Liability information
                  available.




                                               20
Types of TPL

    Car Insurance
    Workman’s Compensation
    Homeowner’s Insurance
    Medicare
    Employer Health Care Coverage




                                     21
Medicare

  Part A – Hospitalization
  Part B – Medical
  Part C – Medicare Advantage
  Part D – Prescription Drug




                                 22
Medicare Part A - Hospitalization

    Benefits:
      Inpatient Hospitalization
     Inpatient Care in a Skilled Nursing facility
     

    Hospice

    Limited Home Health Care

  Monthly Premium
  Deductibles (2009 - $1,068)
  Coinsurance / Copayments

                                                    23
Medicare Part B - Medical

    Benefits
      Medically-necessary services for diagnosis
       or treatment of medical condition.
      Preventive services

  Monthly Premium ($96.40/month + or -)
  Deductible ($135/year)
  Coinsurance (20% of services)



                                                    24
Medicare Part C - Advantage

  Part A
  Part B
  Part D (sometimes)




                              25
Medicare Part D – Prescription Drug

 Provided through an insurance or other
 private companies approved by Medicare.

   Medicare Prescription Drug Plans
   Medicare Advantage Plans.




                                           26
Medicare Part D - Benefits

  Formulary determines drugs covered.
  Prior authorization for certain
   prescriptions
  Quantity limits.
  Step Therapy.




                                         27
Medicare Part D - Costs

  Premium (varies based on plan chosen)
  Copayment (based on drugs/plan)
  Deductible (up to $295)
  Extra help or Low-Income Subsidy
  No coverage between $2,700 - $4,350.
  Coverage and copayments begin at
   $4,351.

                                           28
Medicare and MA-LTC

 Costs client is responsible for may be used
  as:
    Deduction on LTC income calculation.
    Health care expense to meet medical
     spenddown.




                                            29
Asset Assessment

    Method of establishing value of assets
     attributed to the LTC spouse.

    Attributed assets used to determine
     asset-eligibility for MA and MA-LTC.




                                              30
Required Asset Assessment

    LTCF residents with a community
     spouse.

    EW clients with a community spouse.




                                           31
Community Spouse Asset
Allowance
  Amount of the couple’s counted assets
  the community spouse may retain at the
  time the LTC spouse requests MA-LTC.

   Estimated (upon requested asset
    assessment)
   Actual (upon request for MA-LTC – required
    asset assessment)


                                                 32
MA-LTC Request

 To determine assets attributable to LTC
 spouse use:
  Actual CSAA.
  Verified assets owned by couple in first
   month of request for MA-LTC.




                                              33
Step 1

    Evaluate assets owned in first month of
     request based on asset assessment
     rules.

    Use evaluation to determine total
     countable assets owned by the couple.



                                               34
Step 2

 Actual CSAA:
  ≥ Total Countable Assets
      All counted asset attributable to CS.
      Only excluded assets owned by LTC
       spouse attributable to LTC spouse.


    < Total Countable Assets
        Go to Step 3.

                                               35
Steps 3a and 3b

 a. Total counted asset owned by CS based
     on evaluation in Step 1.

 b. CS total counted assets is:
         > Actual CSAA, CS must contribute to
          cost of care.
         = Actual CSAA, go to Step 4.
         < Actual CSAA, go to Step 3c.

                                                 36
Steps 3c and 3d

 c. Actual CSAA - CS counted asset total
   (3a) = additional attributable counted
   asset needed.

 d. Attribute LTC spouse’s counted assets
   to CS up to actual CSAA.
    Remaining LTC spouse assets attributable
     to LTC spouse.
    Go to Step 4.


                                                37
Step 4

  Evaluate asset attributable to LTC
  spouse using basic MA eligibility rules.




                                             38
Step 5

 Answer questions.




                     39
Income Basics

  Verification of income mandatory.
  Type of income calculation determined
   by:
      Household composition.
      Basis of eligibility.

      MA-LTC request date.

      The living arrangement.

      Transfer penalty.


                                           40
Monthly Reporting

 Bulletin 09-21-12
  No monthly reporting for medical
   spenddowns.
  Continued monthly reporting for certain
   clients using an LTC income calculation.




                                              41
Frank Example

  Resides in LTCF.
  Receives $1,086.40 RSDI/month.
  Pays Medicare Part B ($96.40).
  Receives land payments 2x/year.
        March ($8,000)
        November ($8,000)
  Land in life estate (unavailable).
  Liability insurance of $465 paid in November.
  Property taxes $1,090 x 2/year.


                                                   42
Receipt of Lump Sum

  Case note facts regarding the amount
   and frequency of payments.
  Set DAIL/WRIT for when a lump sum
   payment is due.
  Calculate obligation using anticipated
   income.
  Recalculate when income actually
   received and review asset-eligibility.

                                            43
Combination LTC/Medical
Spenddown
 1.   Obligation changes from LTC
      spenddown to a combination
      LTC/Medical spenddown.
 2.   Do not close eligibility unless client
      requests closure. (Even if medical
      spenddown portion not met.)
 3.   Review of assets in the month following
      the month in which the combination
      spenddown occurred.

                                            44
Frank Example

  Resides in LTCF.
  Receives $1,086.40 RSDI/month.
  Pays Medicare Part B ($96.40/month).
  Receives land payments 2x/year.
        March ($8,000)
        November ($8,000)
  Land in life estate (unavailable).
  Liability insurance of $465 paid in November.
  Property taxes $1,090 x 2/year.


                                                   45
Rental Income Deductions
    Interest and escrow portions of a mortgage payment.
    Real estate insurance.
    Repairs (minor corrections to an existing structure)- example for
     Frank’s repairs to a tile – but not putting in new tile.
    Property taxes
    Lawn care.
    Snow removal.
    Advertising for tenants.
    Utilities.
    Property management fees paid to a third party.

     Do not carry excess expenses over to other tax years or use
     excess expenses to offset other income.



                                                                         46
Sally Example

  Owns a home ($15,000 equity) and will
   not return.
  Resides in LTCF.
  RSDI recipient - $834/month.
  Granddaughter moves into home – pays
   $50/month rent.



                                           47
Considerations

    Assets.
      Homestead exclusion after six months.
      Care of enrollee exclusion.

      Up for sale.

      Income-producing asset. $6000, 6%.

    Expenses.
      Up keep expenses.
      Available income.


                                               48
Income-Producing Property

 Exclude up to $6,000 in equity value.
    Limited to combined equity of all property
     meeting 6% rule.

    Each property must meet 6% rule.

    Continue to exclude up to 24 months if
     earnings on property drop below 6%.
                                              49
Allowable Rental Expenses

  Interest and escrow of mortgage
   payment.
  Homeowner’s insurance.
  Repairs as needed.
  Property taxes.




                                     50
Sally’s Allowable Expenses

  $455 home owner’s insurance
  $560 property taxes.
   $1,015 total expense

    $50 rent X 12 months = $600




                                   51
Thank you


 Thank you for sharing your experiences!

                Questions?




                                           52

								
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