Patients Personal Allowance 1 Patients Personal Allowance - - PowerPoint PPT Presentation

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Patient’s Personal Allowance

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Patient’s Personal Allowance

Regulations of Connecticut State Agencies (RCSA)

• Sec. 17-2-140 to 17-2-145

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Patient’s Personal Allowance

Definition:

PPA is the amount of money that patients who are recipients of Medical Assistance in LTC facilities have accumulated from the amount allowed each month

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Patient’s Personal Allowance

The monthly PPA is $60.00 for nursing facilities and ICFMR

• facilities. The monthly PPA is

$262.65 for RCH facilities and CLA facilities

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Patient’s Personal Allowance

PPA can have a balance of up to $1,600. The patient’s burial trust fund can have a balance up to $5,400.

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Patient’s Personal Allowance

Authorization

There must be a statement on file signed by the patient, guardian, conservator or legally liable relative authorizing the facility to manage the PPA

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Patient’s Personal Allowance

Non-Facility Administration

 Relative, Guardian or Conservator  Resident/Patient

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Patient’s Personal Allowance

Facility as Trustee for Funds Banking System “Trustee account shall be entirely separate at all times from the facility business account”

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Patient’s Personal Allowance

Banking System

…need not be interest bearing, but if it is, interest shall accrue to the patients in an equitable manner, which is clearly stated

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Patient’s Personal Allowance

Accounting System

Minimum Requirements:

 Receipts register or equivalent  Patient’s Ledger – control card with

subsidiary ledger

 Disbursement vouchers

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Patient’s Personal Allowance

Accounting System

Patient Signatures – If a patient cannot sign, then two signatures are needed on payment vouchers

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Patient’s Personal Allowance

Accounting System



Bank statements and ledgers must be reconcilable at any point in time



All personal funds must be deposited in a timely manner (no later than two weeks)

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Patient’s Personal Allowance

Accounting System

 All receipts and disbursements shall

be individually recorded in the patient’s account

 All disbursements must be supported

by a voucher

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Patient’s Personal Allowance

Accounting System



All receipts and disbursements shall be recorded in compliance with the

• Sec. 17-2-143

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Patient’s Personal Allowance

Petty Cash Sec. 17-2-143(C)

A facility may utilize a petty cash account with certain restrictions

 Can not exceed $5.00 per patient or 5 times the

number of patients for whom the facility handles funds;

 However, $250.00 is allowable regardless of the

number of patients.

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Patient’s Personal Allowance

Documentation

All PPA records including bank statements, cancelled checks & invoices must be kept in the facility at all times and provided to DSS upon request

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Patient’s Personal Allowance

Documentation

All accounting records are subject to the seven year retention requirement. Bank statements & cancelled checks must be kept for three years.

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Patient’s Personal Allowance

Specialized Accounting Systems

DSS must provide written authorization for any ‘specialized” accounting systems

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Patient’s Personal Allowance

Non-Chargeable Expenses

Funds shall not be used to purchase items included in the per diem rate

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Patient’s Personal Allowance

Non-Chargeable Expenses

 Group activities or parties  Drugs, medicines or medical supplies  Funeral expenses  Room & board to the facility

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Patient’s Personal Allowance

Non-Chargeable Expenses

 Wheelchair purchase, rental or repair  Transportation to obtain medical

treatment

 Medically necessary treatment

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Patient’s Personal Allowance

Non-Chargeable Expenses Gifts to relatives in excess of

$25.00

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Patient’s Personal Allowance

Personal Funds Transferred to Families

The facility will be held responsible for such transfers. Money gifts to relatives at Christmas and relative birthdays are an exception, but must be reasonable.

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Patient’s Personal Allowance

“At no time may any funds be withdrawn from the Personal Fund account for use in the business or

• perating expense of the facility or

for the personal use of an employee,…

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Patient’s Personal Allowance

…administrator, owner or relative

• thereof. The Personal Funds are not

available for loan to anyone.” Individuals who make inappropriate use of resident funds may be referred for civil or criminal investigation.

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Patient’s Personal Allowance

Special rules for patients who are unable to use the monthly PPA. Excess amount are applied to the monthly cost of care for the patient.

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Patient’s Personal Allowance

Form W-411

Annually, by each June 1st, an accounting must be made to DSS reflecting the balances of the PPA for each patient for whom it handles funds

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Patient’s Personal Allowance

Form W-411

Mail completed form to: Myers & Stauffer LLC 7 Waterside Crossing, Suite 202 Windsor, CT 06095

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Patient’s Personal Allowance

Common Audit Issues

 Reconciliations  Negative Funds/ Credit Balances  Non-resident balances  W-411  Insufficient dated documentation/

signature authority for disbursements to residents

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Patient’s Personal Allowance

Contracted Services

A growing number of facilities have contracted with a third party to manage resident funds, including applied income and PPA

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Patient’s Personal Allowance

Contracted Services

Fees are being taken directly from the resident trust account and the facility is not reimbursing the account. This is a violation of Regulation.

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Patient’s Personal Allowance

“The facility must notify each resident…when the amount in the resident’s account reaches $200 less than the SSI resource limit “($1,600) 42 CFR Sec. 483.10

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Patient’s Personal Allowance

DSS notice dated July 6, 2015: Resident Trust Fund balances for expired residents become part of the decedent’s

• estate. The Department of

Administrative Services (DAS) will provide instructions for checks payable to the estate.

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Fraud & Abuse Reporting

DSS Hotline 1-800-842-2155

• r

http://www.ct.gov/dss Report Suspected Fraud and Abuse

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Patient’s Personal Allowance

Questions & Comments