Patient’s Personal Allowance 1
Patient’s Personal Allowance Regulations of Connecticut State Agencies (RCSA) Sec. 17-2-140 to 17-2-145 2
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 3
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 4
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. 5
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 6
Patient’s Personal Allowance Non-Facility Administration Relative, Guardian or Conservator Resident/Patient 7
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” 8
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 9
Patient’s Personal Allowance Accounting System Minimum Requirements: Receipts register or equivalent Patient’s Ledger – control card with subsidiary ledger Disbursement vouchers 10
Patient’s Personal Allowance Accounting System Patient Signatures – If a patient cannot sign, then two signatures are needed on payment vouchers 11
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) 12
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 13
Patient’s Personal Allowance Accounting System All receipts and disbursements shall be recorded in compliance with the Sec. 17-2-143 14
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. 15
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 16
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. 17
Patient’s Personal Allowance Specialized Accounting Systems DSS must provide written authorization for any ‘specialized” accounting systems 18
Patient’s Personal Allowance Non-Chargeable Expenses Funds shall not be used to purchase items included in the per diem rate 19
Patient’s Personal Allowance Non-Chargeable Expenses Group activities or parties Drugs, medicines or medical supplies Funeral expenses Room & board to the facility 20
Patient’s Personal Allowance Non-Chargeable Expenses Wheelchair purchase, rental or repair Transportation to obtain medical treatment Medically necessary treatment 21
Patient’s Personal Allowance Non-Chargeable Expenses Gifts to relatives in excess of $25.00 22
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. 23
Patient’s Personal Allowance “At no time may any funds be withdrawn from the Personal Fund account for use in the business or operating expense of the facility or for the personal use of an employee,… 24
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. 25
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. 26
Patient’s Personal Allowance Form W-411 Annually, by each June 1 st , an accounting must be made to DSS reflecting the balances of the PPA for each patient for whom it handles funds 27
Patient’s Personal Allowance Form W-411 Mail completed form to: Myers & Stauffer LLC 7 Waterside Crossing, Suite 202 Windsor, CT 06095 28
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 29
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 30
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. 31
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 32
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. 33
Fraud & Abuse Reporting DSS Hotline 1-800-842-2155 or http://www.ct.gov/dss Report Suspected Fraud and Abuse 34
Patient’s Personal Allowance Questions & Comments 35
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