R414-15. Residents Personal Needs Fund, R414. Health, Health Care Financing, Coverage and Reimbursement Policy, Utah Administrative Code

Utah Administrative Code (Current through November 1, 2019)

R414. Health, Health Care Financing, Coverage and Reimbursement Policy

R414-15-1. Introduction and Authority

Latest version.

(1) This policy ensures proper administration of the personal funds of a Medicaid client who is a resident in a long term care facility. The administrative payee is responsible for using the beneficiary's benefits in his best interest. Flat rate reimbursement shall not be charged to personal funds. The flat rate shall cover the services specified in Attachment 4.19-D, Section 400 of the State Plan.

(2) This rule is authorized by Section 26-1-5 and 42 CFR 442 and 447.

R414-15-2. Definitions

Latest version.

The definitions in R414-1 apply to this rule.

R414-15-3. Facility Responsibilities

Latest version.

(1) For residents who are Medicaid clients, the administration and management of a long term care facility (the facility) must provide the resident, next of kin, or legal guardian:

(a) a written statement at the time of admission explaining:

(i) the resident's rights regarding personal funds; and

(ii) a list of services included in the basic per diem rate;

(b) access to a written record of all financial transactions involving the individual resident funds;

(c) a written itemized statement quarterly of all financial transactions involving the individual resident funds upon written request; and

(d) all funds that were given to the facility for safekeeping, including interest, within 30 days of the resident's discharge.

(2) The facility must notify the Social Security Administration office to have a representative payee appointed for residents who do not have a legal guardian, representative payee, or other authorized individual to manage their personal needs funds.

(3) The facility must serve as a temporary representative payee for the resident until the representative payee is appointed.

(4) The facility must allow the resident to access his funds for at least one hour during business hours.

(5) Upon request, the facility must return funds to the resident from an outside interest-bearing account within one business day.

(6) The facility shall deposit all funds in excess of $50.00:

(a) within 15 calendar days of receipt of the money;

(b) in an interest-bearing account that clearly indicates that the facility's interest is only fiduciary; and

(7) The facility may deposit the resident's Social Security check into the facility's bank account if the personal need portion of the resident's check is transferred to the resident's account on the same day.

(8) The facility must distribute monthly the interest from the resident's interest-bearing accounts by either:

(a) maintaining separate savings accounts for each resident; or

(b) prorating the amount individually if funds are combined in one account for all residents.

(9) The facility may keep up to $50.00 of the resident's money in a non-interest-bearing account that is readily accessible to the resident.

(10) The facility must give any benefits to the resident either personally or through the resident's personal need fund unless there is a written authorization from the resident or legal guardian to do otherwise. This includes resident entitlements from Social Security Supplemental Income, government and private pensions, Veterans Administration, and other similar entitlement programs.

(11) The facility must provide the estate executor or administrator of a deceased resident with a written accounting of the resident's personal funds within 30 days of the resident's death. If the resident has not had an executor or administrator appointed, the facility must provide the accounting to:

(a) the resident's next of kin, legal guardian, representative payee, or other person the resident designated to manage his personal financial affairs while he was living; and

(b) the District Court in the county where the resident died.

(12) If the facility sells or leases the business, it must:

(a) provide the buyer or lessee with a written statement of all of the residents' monies and properties being transferred;

(b) obtain a signed receipt from the new owner or lessee before the sale or lease is final; and

(c) provide each resident's legal guardian, representative payee, or other person the resident authorized to manage his personal funds, a written accounting of all funds held by the facility before any transfer of ownership. The new owner or lessee shall assume full liability for all residents' personal needs accounts.

(13) For medical or supplemental security income recipients, the facility must provide written notification to the resident and the Department ten days before the resident's funds are about to exceed the amount that would jeopardize his Medicaid eligibility.

(14) The facility must maintain the resident's personal funds for safekeeping if requested according to R414-15-4.

R414-15-4. Resident Personal Funds for Safekeeping

Latest version.

The resident shall not be required to give his personal funds to the facility for safekeeping. If the resident (or legal guardian) requests this service of the facility, the request must be a written authorization.