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Service Authorization System Online (SASO) reflects future co-payment amounts. These amounts are based on the amount of each individual's income that is reported.
If a recipient is living in a long-term care facility other than a state supported living center or a state center, use Form H1259, Correction of Applied Income, to correct co-payment amounts in TIERS.
Note: The nursing facility is required to refund co-payment overcharged to the recipient. Reconciliation does not apply to home and community based waivers or assisted living facilities.
H-8110 Adjustments from Income Averaging
Revision 12-1; Effective March 1, 2012
When income is averaged, review the case at least every six months and reconcile the budget according to the monthly income actually received. If both the projected average income and the actual monthly income are each less than $2, or if the difference between the two is less than $1, then reconciliation is not required. If co-payment must be increased or decreased because of income averaging, use Form H1259, Correction of Applied Income, to correct retroactive periods. Notify the recipient about the correction to co-payment. Send copies of this notice and Form H1259 to the nursing facility. For ongoing adjustments, submit through the automated system.
Note: Make corrections in the Service Authorization System Online (SASO).
Although reconciliation is not required for certain small amounts, reconcile whenever the recipient requests it.
If the variable income adjustment is a positive number (the recipient 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 is sent to the recipient and nursing facility, and after 12 days the co-payment is adjusted in SASO in the most recent month.
There is no month-by-month adjustment in the reconciliation period (October-March) in SASO for this underpayment. Page 2 of Form H1202-A, MAO Worksheet – Income Changes, may be used to assist in calculating the correct reconciliation period and the most recent month in the reconciliation period.
H-8120 Other Adjustments
Revision 12-3; Effective September 1, 2012
When adjustments for retroactive periods are needed for reasons other than to reconcile for income averaging, use the following procedures:
For MEPD cases, use Form H1259, Correction to Applied Income, only to report retroactive decreases in a recipient's co-payment. If the recipient's correct co-payment is more than that reported on the Service Authorization System Online (SASO) see H-8200, Procedures Relating to Overpayments, through H-8230, Cases Not Submitted for Prosecution. To update a recipient's co-payment for future months, process through the automated system. The effective date of the change shown in SASO is based on the effective date of the disposition action in the automated system.
For SSI cases, use Form H1259 to report any changes in co-payment. Increases in co-payment are effective the first day of the month after the date Form H1259 is completed. If the recipient's correct co-payment is more than that reported on SASO, use procedures in H-8200. The procedures for correcting co-payment do not apply to cases of fraud. In conducting a review or verifying co-payment, do not submit Form H1259 if fraud is indicated. Follow fraud procedures outlined in the Fair and Fraud Hearings Handbook.