(1) Each Medicaid
resident is allowed a monthly amount for personal incidental needs. For
purposes of this rule, personal incidental funds (PIFs) include monthly
payments as allowed and previously accumulated resident savings.
(a) The facility must not charge for items
included in the bundled rate or for other items or services for which funding
can be provided through the Medicaid agency or another non-resident
(b) The facility must hold,
safeguard and account for a resident's funds if he or she requests such
management; or if the case manager requests on Form SDS 0542 that the facility
perform such management.
facility must maintain a record of the request by the resident, case manager or
resident representative on Form SDS 0542, covering all funds it holds or
manages for residents.
facility must manage resident funds in a manner in the resident's best
(A) The facility must not charge
the resident for holding, disbursing, safeguarding, accounting for, or
purchasing from resident funds. Charges for these services are included in the
Nursing Facility Financial Statement, Form SPD 35 or 35A and are considered
allowable costs reimbursable through the bundled rate.
(B) The cost for items charged to resident
funds must not be more than the actual purchase price charged by an unrelated
(C) The facility may not
charge SPD residents or other sources for items or services furnished if all
residents receiving such items or services are not charged. Charges must be for
direct, identifiable services or supplies furnished to individual residents. A
periodic "flat" charge for routine items, such as beverages, cigarettes, etc.,
is not allowed. Charges must be made only after services are performed or items
(D) The facility
must keep any funds received from a resident for holding, safeguarding and
accounting separate from the facility's funds.
(E) The nursing facility may request
technical assistance from SPD/Type B AAA staff, however, responsibility for
managing resident funds in the resident's best interest remains with the
(F) When a facility is a
resident's representative payee, it must fulfill its duties as representative
payee in accordance with applicable federal regulations and state regulations
that define those duties.
Facilities holding resident funds must be insured to cover all amounts held in
DELEGATION OF AUTHORITY.
(a) The resident may
manage his or her personal financial resources, including PIFs, and may
authorize another person or the facility to manage them. If appropriate, the
facility must, upon written authorization by the resident, resident
representative, or case manager on the resident's behalf, accept responsibility
for holding, safeguarding, spending and accounting of the resident's
(b) At the time of
admission, the facility must assure that the resident, or representative
delegating such responsibility to the facility, completes Form SDS 0542,
Designation of Management of Personal Incidental Funds. The facility must sign
the form acknowledging responsibility. The facility must retain the original in
the resident's account records, with copies to the resident and SPD.
(c) The resident wishing to change delegation
must do so by completing a new Form SDS 0542 that must be available at the
(d) SPD cannot be
delegated to account for the resident's funds.
The facility must provide each resident
or resident representative with a written statement at the time of admission
(A) States the facility's responsibility
to pay for all services, supplies and facility equipment required for services
(B) Lists all
services provided by the facility that are not included in the facility's basic
(C) States that there is no
obligation for the resident to deposit funds with the facility;
Describes the resident's right to select
how personal funds will be handled. The following alternatives must be
(i) The resident's right to
receive, retain, and manage his or her personal funds or have this done by a
legal guardian, or conservator;
(ii) The resident's right to delegate on the
SDS 0542 another person to act for the purpose of managing his or her personal
(iii) The facility's
obligation, upon written authorization by the resident or representative, to
hold, safeguard and account for the resident's personal funds in accordance
with these rules;
States that any facility charge for this service is included in the facility's
basic rate, and that the facility cannot charge for resident fund management or
charge residents more than the actual purchase price of items at an unrelated
(F) States that the
facility is permitted to accept a resident's funds to hold, safeguard and
account for, only upon the written authorization of the resident or
representative, or if the facility is appointed as the resident's
representative payee; and
States that if the resident becomes incapable of managing his or her personal
funds and does not have a representative, the facility is required to manage
his or her personal funds if requested on the Form SDS 0542 by the case
facility must obtain documentation on the Form SDS 0542 of:
(A) Resident intention to manage own funds;
(B) Resident, resident
representative, or case manager delegation to another individual or the
facility to manage the resident's funds.
RESIDENT ACCOUNT RECORDS.
(a) The facility must maintain a Resident
Account Record (Form SDS 713), on an ongoing, day-to-day basis, for each
resident for whom the facility is holding funds. Each receipt or disbursement
of funds must be posted to the resident's account. Posting from supporting
documentation must be done within seven days after the transaction
(b) The resident account
record must show, in detail with supporting documentation, all monies received
on behalf of the resident and the disposition of all funds so received. Persons
shopping for residents must provide a list showing description and price of
items purchased, along with payment receipts for these items.
(c) Individual resident accounts must be
reconciled and listed by the facility at the end of each calendar
(d) Petty cash accounts must
be reconciled within ten days of receipt of the bank statement.
(e) The facility must maintain a monthly list
that separately lists the petty cash and savings account balances for each
resident for whom the facility is managing funds.
(f) Records and supporting documentation must
be retained for at least three years following the death or discharge of the
Accumulations of $50
(A) The facility must, within 15
days of receipt of the money, deposit in an individual interest-bearing account
any funds held in excess of $50 for an individual resident, unless this money
is being managed in a Trust and Agency Account by SPD.
(B) The account must be individual to the
resident, must be in a form that clearly indicates that the facility does not
have an ownership interest in the funds, and must be insured under federal or
Accumulations of Under $50.
(A) The facility
may accumulate no more than $50 of a resident's funds in a pooled bank account
or petty cash fund that must be separate from facility funds.
(B) The interest earned on any pooled
interest-bearing account containing residents' petty cash must be either
prorated to each resident on an actual interest-earned basis, or prorated to
each resident on the basis of his or her end-of-quarter balance.
(a) The resident must be allowed to manage
his or her own funds, or to delegate their management to another, unless the
resident has been determined to be incompetent by a court of law. A resident
who was not adjudicated incompetent may always decide how to spend his or her
(b) Facility staff
delegated to manage resident funds must follow guidelines outlined in this rule
and other state and federal laws and regulations that may apply in order to
assure that decisions not made by the resident are made in his or her best
(c) The resident, family
or friends has the right to be free from solicitation from the facility to
purchase items that are included in the facilities daily rate.
The resident must not be charged for any
item included in the facility's daily rate unless the facility can show at
least one of the following:
(A) The resident
made an informed decision to purchase the item, understanding that a similar
and appropriate item is included in the daily rate;
(B) The family requested that the facility
purchase the item, understanding that a similar and appropriate item is
included in the daily rate; or
The resident is not currently able to make an informed decision to purchase the
item, but did so prior to current incapacity.
(e) The resident, family or friends must not
be charged for any drug designated by the Food and Drug Administration as
less-than-effective unless it can show that both the physician and the resident
made an informed decision to continue use of the drug.
(f) Prior to purchasing an item that is
included in the facility's daily rate or is over $50, the facility must consult
with the SPD/Type B AAA case manager.
(g) The facility must not charge resident
funds for any item or service that benefits the facility, facility staff or
relatives or friends of facility staff, unless it can show that the resident
made an informed decision to purchase the item or service.
(h) When the facility or SPD is of the
opinion that a resident is incapable of managing personal funds and the
resident has no representative, the facility must refer the resident to the
case manager in the local SPD/Type B AAA, who will consult with the resident
regarding resident preference. If the attending physician agrees, as documented
on the Form SDS 544, Physician's Statement of Resident's Capacity to Manage
Funds, that the resident is incapable of handling funds, the case manager will
attempt to find a suitable delegate to manage the resident's funds. If no
delegate can be found, the facility must assume the responsibility. If the
resident disagrees with the designation of a delegate, the designation cannot
be made, and the resident retains the right to manage, delegate, and direct use
of his own money, if not adjudicated incompetent.
ACCESS TO FUNDS, RECORDS.
(a) The facility must provide each resident
or delegate reasonable access to his or her own financial records and funds.
Reasonable access is defined as seven business days for records and one
business day for funds.
facility must provide a written statement, at least quarterly, to each
resident, delegate, or a person chosen by the resident to receive the
statement. The quarterly statement must reflect separately all of the
resident's funds that the facility has deposited in an interest-bearing account
plus the resident funds held by the facility in a petty cash account or other
account. The statement must include at least the following:
(A) Identification number and location of any
account in which that resident's personal funds have been deposited;
(B) Balances at the beginning of the
deposits with source and withdrawals with identification;
(D) Interest earned, if any;
(E) Ending balances; and
(c) The facility must provide a quarterly
Resident Account Record on Form SDS 713 to the local SPD/Type B AAA within 15
days following the end of the calendar quarter and provide a copy to the
resident or an individual delegated by the resident to receive the
The resident or delegate
must have access to funds in accordance with OAR 411-085-0350
(e) Within ten business days of the
resident's transfer or discharge, or appointment of a new delegate as
documented on the Form SDS 0542, the facility must provide a final accounting
and return to the resident, or the delegate, all of the resident's funds that
the facility has received for holding, safeguarding, and accounting, and that
are maintained in a petty cash fund or individual account.
CHANGE OF OWNERSHIP.
(a) The facility must give each resident or
delegate a written accounting of any personal funds held by the facility before
any transfer of facility ownership occurs, with a copy to the local SPD/Type B
(b) The facility must provide
the new owner and the local SPD/Type B AAA with a written accounting of all
resident funds being transferred and must obtain a written receipt for those
funds from the new owner.
LOCAL SPD/TYPE B AAA RESPONSIBILITY. The
local SPD/Type B AAA must:
receipt of SDS 713 forms and review them quarterly for appropriateness of
(b) Monitor resident
resources for resources over the current Medicaid limit;
(c) For residents incapable of managing their
own funds and having no one to delegate to do so, attempt to determine resident
wishes, seek physician input on the physician statement, and find a delegate,
delegating the facility if necessary and not in conflict with resident
(d) Notify the facility of
inappropriate expenditures and report uncorrected problems to SPD Central
Office and assist residents in obtaining legal counsel; and
(e) Track expensive or reusable items
purchased for residents through resident funds or by SPD and assure their
appropriate use after resident death.
DEATH OF RESIDENT.
Within five business days following a
resident's death, the facility must send a written accounting of the resident's
funds to the executor or administrator of the resident's estate. If a deceased
resident has no executor or administrator, the facility must provide the
(A) The resident's next of
(B) The resident's
(C) The clerk of
probate court of the county in which the resident died; and
(D) Estate Administration Unit, Seniors and
People with Disabilities, P.O. Box 14021, Salem, OR 97309-5024.
Within five business days
following a resident's death, the facility must:
(A) Send a written accounting of the
resident's funds and a listing of resident personal property, including
wheelchairs, television sets, walkers, jewelry, etc., to the local SPD Estate
personal property for 90 days, unless otherwise instructed by the SPD Estate
Administration Unit; and
with the laws of Oregon regarding disbursal of resident funds, and any advance
payments, or contact the Estate Administration Unit, SPD, for more detailed
Or. Admin. R.
PWC 847(Temp), f. & ef.
7-1-77; PWC 859, f. 10-31-77, ef. 11-1-77; AFS 35-1980, f. 6-30-80, ef. 7-1-80;
Renumbered from 461-017-0160, AFS 69-1981, f. 9-30-81, ef. 10-1-81; SSD 6-1984,
f. 7-20-84, ef. 9-1-84; SSD 1-1989, f. 1-27-89, cert. ef. 2-1-89; SSD 6-1989,
f. & cert. ef. 5-1-89; SSD 20-1990, f. & cert. ef. 10-4-90; SPD 9-2006,
f. 1-26-06, cert. ef. 2-1-06; SPD 15-2007(Temp), f. & cert. ef. 9-10-07
thru 3-8-08; SPD 2-2008, f. 2-29-08, cert. ef.
Forms referenced are available from the
Stat. Auth.: ORS
Stats. Implemented: ORS