B Determining the Countable Portion of an HCBS Payment

Program	Manual Section
ALTCS	MA803E

Procedures

When the customer makes payments from a STT to an Home and Community Based Services (HCBS) facility, the amount of the payment for room and board must be determined.

For each month in the application period, complete the following steps to determine the countable portion of payments made to an HCBS facility:

Step	Action
1	Did the customer provide a billing statement that breaks down the amount attributable to room and board and the amount attributed to medical expenses? If YES, STOP. You must use the medical expense amount shown on the bill. The 56/44 breakdown does not apply. If NO, continue to step 2.
2	Multiply the amount that the HCBS facility billed the customer in the month under review by 0.56 (56%). This amount is excluded as medical services. NOTE For this step, use the net billed amount (after any discounts).
3	Subtract the amount from Step 2 from the amount actually disbursed from the trust. The difference is the countable room and board disbursement amount. NOTE A negative number is counted as zero.
4	Add together the amount from Step 3, any other countable disbursements from the trust, and any income outside the trust. Is the total less than the ALTCS income limit? If YES, STOP. The customer is income eligible. If NO, deny ALTCS benefits for “Income Exceeds Limit”. Continue to step 5.
5	If the customer would be income-eligible if the amount from Step 3 were not counted as income, approve the customer for the next prospective month. The customer’s case manager will work with the HCBS facility after approval to reduce the ongoing billed HCBS charges. NOTE When the customer has a transfer penalty in the next prospective month, the customer may not be able to pay the entire amount billed by the facility without going over the income limit.