H-3500, When to Reconcile

H-3510 Variable Income

Revision 09-4; Effective December 1, 2009

Retroactive reconciliation is not required for stable variable income with narrow fluctuations. The eligibility specialist will average the variable income received during the preceding six months. If average variable income exceeds $4.99 per month, this average is projected for the following six months. This process is repeated every six months.

Unstable variable income or variable income with wide fluctuations must still be retroactively reconciled.

Notes:

  • Retroactive reconciliation is always required if requested by the authorized representative.
  • Reconciliation performed is for the entire reconciliation period (the block of time considered for reconciliation), and not month-by-month. If the variable income adjustment is a positive number (the person underpaid co-payment), add the adjustment to the co-payment for the most recent month in the reconciliation period.

    Example: If reconciling the period of October through March, the most recent month in the reconciliation period is March. Form H1259, Correction of Applied Income, is sent to the person and nursing facility, and after 12 days the co-payment is adjusted in SAS in the most recent month. There is no month-by-month adjustment in the reconciliation period (October-March) in SAS for this underpayment. Form H1201-A, Client Declaration or Streamline Review Worksheet, Page 2, may be utilized to assist in calculating the correct reconciliation period and the most recent month in the reconciliation period.

 

H-3520 Incurred Medical Expenses (IMEs)

Revision 09-4; Effective December 1, 2009

When IMEs have been projected in the co-payment budget, review the case at least every six months and reconcile the budget according to the monthly IMEs actually paid. If the projected average monthly IMEs and the actual average monthly IMEs are each less than $2, or the difference between the two is less than $1, then reconciliation is not required. (Although reconciliation is optional for these small amounts, reconcile whenever the person requests it.)

Note: Reconciliation performed is for the entire reconciliation period (the block of time considered for reconciliation), and not month-by-month. If the variable income adjustment is a positive number (the person underpaid co-payment), add the adjustment to the co-payment for the most recent month in the reconciliation period.

Example: If reconciling the period of October through March, the most recent month in the reconciliation period is March. Form H1259, Correction of Applied Income, is sent to the person and nursing facility, and after 12 days the co-payment is adjusted in SAS in the most recent month. There is no month-by-month adjustment in the reconciliation period (October-March) in SAS for this underpayment. Form H1201-A, Client Declaration or Streamline Review Worksheet, Page 2, may be utilized to assist in calculating the correct reconciliation period and the most recent month in the reconciliation period.