Revision 12-1; Effective March 1, 2012
Step 1
Determine the total actual and projected co-payment amounts for the reconciliation period.
Actual Co-payment — For each month in the reconciliation period, calculate the actual co-payment (co-payment based on actual variable income received and incurred medical expenses (IMEs) paid). Calculate the personal needs allowance (PNA)/protected earned income (PEI) allowance based on actual earnings received. Total the actual co-payment for the reconciliation period.
Note: For fixed income, do not include an increase that is subject to restitution policy rather than reconciliation policy.
Projected Co-payment — Total co-payment amounts for each month in the reconciliation period.
Example: A review is completed on an ICF-ID case in January, with the preceding six months being July through December.
Actual Co-payment (AI)
Month | Fixed | Earned | Other | IMEs | PNA/PEI | App. Inc. |
---|---|---|---|---|---|---|
July | $250 | $60 | $0 | $0 | $105.00 | $205.00 |
August |
$250 | $75 | $0 | $0 | $112.50 | $212.50 |
September |
$250 | $85 | $0 | $0 | $117.50 | $217.50 |
October |
$250 | $78 | $0 | $0 | $114.00 | $214.00 |
November |
$250 | $65 | $0 | $0 | $107.50 | $207.50 |
December |
$250 | $80 | $0 | $0 | $115.00 | $215.00 |
Total |
$1,271.50 |
Projected AI
Month | From Co-pay Screen |
---|---|
July |
$275 |
August |
$275 |
September |
$275 |
October |
$275 |
November |
$275 |
December |
$275 |
Total |
$1,650 |
Step 2
Determine the co-payment adjustment by subtracting total projected co-payment for the reconciliation period from the total actual co-payment for the reconciliation period. The result is the co-payment adjustment.
A. Total Actual Co-payment (from Step 1) |
$1,271.50 |
B. Total Projected Co-payment (from Step 1) |
– $1,650.00 |
C. Total Co-payment Adjustment |
– $378.50 |
D. Number of Months in Reconciliation Period |
÷ 6 |
E. Average Monthly Adjustment |
– $63.08 |
If the average monthly adjustment is +$4.99 or less, stop. Do not reconcile.
If the average monthly adjustment is +$5 or more, proceed to Step 3.
If the average monthly adjustment is a negative (–) figure in any amount, proceed to Step 3.
Step 3
Reconcile co-payment for the most recent month in the reconciliation period.
If the total co-payment adjustment (from Step 2C) is a positive (+) number, add it to the co-payment for the most recent month in the reconciliation period. The result is the co-payment adjustment.
If the total co-payment adjustment (from Step 2C) is a negative (–) number, subtract it from the co-payment for the most recent month in the reconciliation period. The result is reconciled co-payment.
A. Co-payment Month: December |
$275.00 |
B. Total co-payment adjustment (from Step 2C) |
– $378.50 |
C. Reconciled co-payment |
$–103.50 |
D. If A.-B. is less than $0, enter the negative (–) amount here |
( – $103.50) |
If there is an "excess negative adjustment" from Step 3D, proceed to Step 4.
Step 4
If there is an "excessive negative adjustment" (from Step 3D), subtract the excess amount from the co-payment for the next-to-most-recent month in the reconciliation period.