26 Tex. Admin. Code § 554.2316 - Collection of Applied Income
(a) Nursing
facilities may collect from the recipient only the applied income that is
specified on the recipient's payment plan forms, except when that amount
exceeds the monthly vendor rate. In this event, the facility may collect only
an applied-income amount equal to the maximum monthly Medicaid vendor
rate.
(b) If a payment plan appears
incorrect, the facility administrator should contact the local Texas Department
of Human Services (DHS) worker to correct the plan. Even if a recipient's
income increases, the administrator must not collect an increased payment until
the plan is changed. The administrator should not collect an increased payment
in anticipation of a payment plan increase.
(c) If an admitted recipient does not have a
payment plan, the administrator should contact the local worker for help in
determining how much applied income is owed. If the forthcoming forms indicate
a lesser payment, the administrator should refund the excess immediately and
notify the worker.
(d) Facilities
that collect payments (part applied income, part Medicaid) in excess of the
vendor rate are in violation of DHS regulations and of Public Law 95-142 which
makes "solicitation of supplementation" a felony.
(e) Regional DHS staff must report any
violations. If an investigation shows that the facility has violated this
standard, a recommendation for withholding vendor payments, contract
termination, referral to the courts, or other contract action may be
made.
(f) The nursing facility must
refund the recipient's prorated applied income money when the recipient has
paid in advance for the full month and is discharged from the facility any time
during the month. The facility must make the refund within 30 calendar days
from and including the date of discharge, even when vendor payment has not been
received from DHS.
Notes
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