4210 Assisted Living Services Introduction

Revision 19-13; Effective November 5, 2019

This section applies to the STAR+PLUS Home and Community Based Services (HCBS) program. Assisted living (AL) services provide a 24-hour living arrangement for persons who, because of physical or mental limitation, are unable to continue independent functioning in their own homes. Services are provided in personal care facilities licensed by the Texas Health and Human Services Commission (HHSC). STAR+PLUS HCBS program members are responsible for their room and board (R&B) charges and, if applicable, copayments for AL.

The purpose of AL services is to promote the availability of appropriate services for elderly and disabled persons in a home-like environment to enhance the dignity, independence, individuality, privacy, choice and decision-making ability of the member. The personal care facility must provide each member a separate living unit to guarantee their privacy, dignity and independence.

4211 Housing Options in Licensed Personal Care Facilities

Revision 19-13; Effective November 5, 2019

An assisted living (AL) apartment may be an efficiency or one- or two-bedroom apartment, and each apartment must have a private bath and cooking facilities. An AL non-apartment setting is defined as a licensed personal care facility which has living units that do not meet the definition of an AL apartment, may be double occupancy, and must be:

  • freestanding; and
  • licensed for 16 or fewer beds.

STAR+PLUS Home and Community Based Services (HCBS) program AL contracts specify whether the facility has contracted to provide services under the housing options of AL or AL non-apartment. The provider may not deliver STAR+PLUS HCBS program services in a housing option for which the provider does not have a contract to deliver services. If a provider wishes to maintain both AL (single occupancy) and AL apartments (double occupancy) in one facility, the member’s contract must specify that information.

If the AL provider wishes to limit the types of apartments in the facility available to STAR+PLUS HCBS program members, the provider must specify these limitations in the contract, either at the time of signature or by amendment. The apartments in question must meet all qualifications as specified in this section. If there are no such specifications in the contract, all types of apartments in the facility must be available to STAR+PLUS HCBS program members.

If the provider limits the type of apartment available for STAR+PLUS HCBS program members and there is no apartment of that size available, they can refuse to accept any STAR+PLUS HCBS program member, based on not having space available. This would apply both for a member wanting to move into the facility from the outside, or to a private pay member currently in the facility who is becoming a STAR+PLUS HCBS program member. The member would then have the option of reviewing other available assisted living facilities (ALFs) in the area or adult foster care (AFC) homes.

"Freestanding" is defined as not physically connected to a licensed nursing facility, hospital or another licensed personal care facility, unless the total licensed capacity of both personal care facilities does not exceed 16 beds. At a minimum, a covered walkway between buildings is required for physical connection.

At the member's request, portable kitchen units may be removed from the living area.

4211.1 Single Occupancy Apartments

Revision 19-13; Effective November 5, 2019

An assisted living (AL) apartment setting is defined as an apartment for single occupancy that is a private space with individual living and sleeping areas, a kitchen, bathroom and adequate storage space, as specified in the following:

  • The apartment must have a minimum of 220 square feet, not including the bathroom. Apartments in pre-existing structures being remodeled must have a minimum of 160 square feet, not including the bathroom.
  • The kitchen is an area equipped with a sink, refrigerator, a cooking appliance that can be removed or disconnected, adequate space for food preparation and storage space for utensils and supplies. A cooking appliance may be a stove, microwave or built-in surface unit.
  • The bathroom must be a separate room in the individual's living area with a toilet, sink and an accessible bath.
  • The bedroom must be single occupancy except when double occupancy is requested by the individual.

4211.2 Double Occupancy Apartments

Revision 19-13; Effective November 5, 2019

An assisted living (AL) apartment must be a double occupancy apartment with a connected bedroom, kitchen and bathroom area that provides a minimum of 350 square feet of space per individual, and meets the following specifications:

  • Indoor common areas used by STAR+PLUS Home and Community Based Services (HCBS) program members may be included in computing the minimum square footage. The portion of the common area allocated must not exceed usable square footage divided by the maximum number of individuals who have access to the common areas.
  • The kitchen must be equipped with a sink, refrigerator, a cooking appliance that can be removed or disconnected, adequate space for food preparation and storage space for utensils and supplies. A cooking appliance may be a stove, microwave or built-in surface unit.

4220 Description of Services

Revision 19-13; Effective November 5, 2019

The assisted living facility (ALF) must provide 24-hour care in a personal care facility licensed by the Texas Health and Human Services Commission (HHSC). Services include:

  • home management;
  • transportation and escort;
  • 24-hour supervision;
  • meal services; and
  • social and recreational activities.

Personal care tasks must be provided on Form H2060, Needs Assessment Questionnaire and Task/Hour Guide, or Form H6516, Community First Choice Assessment, as identified on the individual service plan (ISP) and approved by the MCO. A registered nurse (RN) must perform the medication administration assessment.

The AL provider is responsible through its licensure requirements for providing the administration of medications, which is the direct administration of all medications, or the assistance with or supervision of medication. This includes injections, if needed. Only a licensed RN can give injections. The personal care facility may provide more services for the member than are identified in the ISP, but not fewer services.

4221 Requirements Related to Assisted Living Facility

Revision 19-13; Effective November 5, 2019

STAR+PLUS Home and Community Based Services (HCBS) program members who wish to reside in a personal care facility must reside in a licensed assisted living facility (ALF) which is contracted with the managed care organization (MCO) to provide STAR+PLUS HCBS program services. Licensing rules define a personal care facility as a facility that provides food, shelter and personal care services (PCS) to four or more persons who are unrelated to the owner. The member is required to pay room and board (R&B) charges, and possibly a copayment amount based on income in the ALF setting. Refer to Section 3230, Financial Eligibility, for detailed information.

4222 Reserved for Future Use

Revision 23-2; Effective May 15, 2023
 

4223 Reserved for Future Use

Revision 22-3; Effective Sept. 27, 2022

 

4224 Reserved for Future Use

Revision 23-2; Effective May 15, 2023

 

4230 Other Services Available to Members

Revision 19-13; Effective November 5, 2019

Each of the following services are provided according to the needs of the member, as authorized on the individual service plan (ISP), as a STAR+PLUS Home and Community Based Services (HCBS) program service and not included in the assisted living facility (ALF) daily rate:

  • adaptive aids and medical supplies;
  • minor home modifications (MHMs);
  • occupational therapy (OT);
  • physical therapy (PT);
  • speech therapy (ST); or
  • nursing services.

The managed care organization (MCO) makes referrals for the services and coordinates delivery.

The use of self-administered oxygen is allowed in a STAR+PLUS HCBS program ALF. Since oxygen is a flammable substance, precautions must be taken to ensure that smoking is prohibited in or around the area where the oxygen is being self-administered.

4240 Reserved for Future Use

Revision 25-1; Effective Feb. 19, 2025

4241 Personal Leave

Revision 19-13; Effective November 5, 2019

The member is entitled to 14 days of personal leave from the assisted living facility (ALF) each year. The member is responsible for the room and board (R&B) charge and copayment amount for personal leave days.

A day of personal leave is defined as 24 continuous hours. STAR+PLUS Home and Community Based Services (HCBS) program assisted living (AL) members must sign out when leaving the facility and sign in upon returning. The sign-in log must have at minimum the following information:

  • name of the person;
  • time and date of departure;
  • destination;
  • emergency contact; and
  • type of leave (for example, personal leave or hospital leave).

4242 Nursing Services for Members in an ALF

Revision 19-13; Effective November 5, 2019

If a member is residing in an assisted living facility (ALF), all the administration of medications, including injections, is provided by the nurse. It is possible that a member residing in an ALF does not need any nursing tasks that are to be delivered by the STAR+PLUS Home and Community Based Services (HCBS) program. Examples of when this may occur include when the member's only nursing need is for medication administration that is provided by the nurse or when the member is receiving nursing services through Medicare.

4243 Response to ALF Member Condition Change

Revision 19-13; Effective November 5, 2019

If the member experiences a change in health or condition related to the amount and type of care the member requires, the managed care organization (MCO), in conjunction with the other members of the interdisciplinary team (IDT), the provider, and the member or authorized representative (AR) may explore other means to serve the member adequately in his or her current setting. The use of Day Activity and Health Services (DAHS) for daily nursing tasks or the direct provision of nursing by provider nurses may be explored as alternatives that would avoid disrupting the member's living arrangement. Nursing tasks cannot be delegated in an assisted living facility (ALF).

If a member exhibits behavior or degradation of mental health that threatens the health or safety of himself or herself or other residents in the facility, or the member’s needs exceed the licensed capacity of the facility, the ALF provider must take appropriate action and notify the MCO orally by the next business day. The provider must confirm the verbal report in writing within seven days. The MCO must take appropriate actions based on the oral notification to assess the member's continued eligibility for the STAR+PLUS Home and Community Based Services (HCBS) program. Refer to Section 4251, Facility Reporting and Notification Requirements.

If a STAR+PLUS HCBS program member living in an assisted living (AL) apartment becomes a safety hazard to himself or herself or others due to the member’s operation of the stove or cooking unit in the apartment, the AL provider can disconnect the unit and must notify the MCO by the next business day. The MCO must investigate the situation and document any recent or previous incident which indicates a threat to the health and safety of the member or other residents in the facility. The MCO, in cooperation with the IDT, the AL provider, and the member's family or AR, if any, makes a decision regarding reconnection or continued disconnection of the cooking unit. The MCO’s decision is documented on Form H2067-MC, Managed Care Programs Communication, which is sent to the AL provider within three business days of the IDT meeting.

4244 Hospital and Nursing Facility Stays

Revision 19-13; Effective November 5, 2019

Hospital Stays

To reserve bedhold during hospital stays, the member must pay the daily room and board (R&B) charge.

The facility's bedhold charge or the negotiated bedhold charge for reserving a member's space during hospital stays may not exceed the maximum amount established by the managed care organization (MCO).

The facility does not bill the MCO for days the member is hospitalized. The member's R&B charge, used as a bedhold charge, constitutes the entire payment to the facility when a member is hospitalized.

The facility must notify the MCO on Form H2067-MC, Managed Care Programs Communication, when the member has been in the hospital for 30 days. The MCO monitors the member's situation every month up to four months to determine if the stay will become permanent. The MCO will notify Program Support Unit (PSU) staff by uploading Form H2067-MC to TxMedCentral in the MCOs SPW folder, following the instructions in Appendix XXXIV, STAR+PLUS TxMedCentral Naming Conventions. If the member stays in the hospital longer than four months, the member is systemically disenrolled.

A hospital includes a rehabilitation hospital or a rehabilitation floor or wing of a medical hospital.

Nursing Facility Stays

For issues related to nursing facility (NF) payment, see the Medicaid for the Elderly and People with Disabilities Handbook, Section H-1700, Deduction for Home Maintenance.

The MCO must follow the Uniform Managed Care Contract (UMCC), Attachment B.1, Section 8.3.2.6, Nursing Facilities, related to NF stays.

4245 Reserved for Future Use

Revision 23-2; Effective May 15, 2023

 

4250 Standards for Operation

Revision 19-13; Effective November 5, 2019

Assisted living facilities (ALFs) must:

  • provide each member the choice of a private or semi-private room;
  • reserve space for up to three days from the agreed-upon entry date for each referred member before requesting another referral;
  • designate a separate bedroom area for members in dual facilities where nursing facility (NF) members are co-housed in the facility; and
  • accept all managed care organization (MCO) referrals if space is available.

The only reason a STAR+PLUS Home and Community Based Services (HCBS) program ALF provider could refuse to accept a referral is if the member's condition makes the member inappropriate for the facility according to the facility's personal care licensure.

Having a communicable disease does not necessarily make a member inappropriate for placement in an ALF setting. Transmission of communicable diseases and conditions can be prevented through the implementation of infection control procedures, including universal precautions. Licensure standards for personal care facilities require facilities to have infection control policy and procedures, including universal precautions, in operation to safeguard employees and residents from these and other diseases and contagious conditions. If transmission of the condition or disease cannot be controlled, the member cannot be placed in a STAR+PLUS HCBS program ALF setting.

To receive ALF services under the STAR+PLUS HCBS program, the applicant must first be determined eligible for the STAR+PLUS HCBS program. Program Support Unit (PSU) staff will fax Form H1746-A, MEPD Referral Cover Sheet, to the Medicaid for the Elderly and People with Disabilities (MEPD) specialist, to complete the Medicaid eligibility determination.

The MCO discusses residential options with the member, allowing the member to choose his or her preference. If an ALF is chosen, a verbal referral is made to the provider as an alert that bedhold is needed. The starting date for services is a negotiated date between the MCO, the member and the ALF provider. The initial copayment amount is computed based on the starting date. Form H1700-1, Individual Service Plan (Pg. 1), and applicable attachments are sent as follow-up, along with a copy of Form H2065-D, Notification of Managed Care Program Services, which authorizes the provider to deliver STAR+PLUS HCBS program services, and Form H2067-MC, Managed Care Programs Communication, confirming the negotiated service initiation date.

Note: Appropriate action must be taken if the facility finds that a member threatens the health and safety of himself or herself or other residents in the facility. If a stove or cooking unit needs to be disconnected, the MCO service coordinator, in cooperation with the interdisciplinary team (IDT), makes this decision. The IDT must also include the MCO, the ALF provider and the member's family or authorized representative (AR), if any.

The ALF provider can disconnect the stove or cooking unit if the member exhibits a behavior that threatens the health and safety of himself or herself or other residents in the facility. The ALF must inform the MCO service coordinator of the disconnection by the next business day after it occurs. The MCO investigates the situation and documents any recent or previous incidents that indicate a threat to the health or safety of the member or other residents in the facility. If the decision is made to approve a disconnection, the MCO service coordinator documents actions on Form H2067-MC that is sent to the ALF provider within three days.

Note: The ALF must make oral notification no later than the first business day after the due date. Within five business days of the MCO receiving notification from the provider that the member has failed to pay the room and board (R&B) charge or copayment amount, the MCO uploads Form H2067-MC to TxMedCentral in the MCO’s SPW folder, following the instructions in Appendix XXXIV, STAR+PLUS TxMedCentral Naming Conventions. Form H2067-MC serves as notification to PSU staff of the member's failure to pay the R&B charge and copayment amount. Within three business days, PSU staff must mail the member Form H2065-D stating services will be terminated if the member fails to pay the R&B charge and/or copayment amount within 30 days of the date on Form H2065-D.

If a STAR+PLUS HCBS program member does not pay the R&B charge and copayment within 30 days of the date on Form H2065-D, the MCO contacts the member to learn the reason the fees were not paid. Even if there is a legitimate reason (such as the member's income check has not been received by the 10th day of the month) for the non-payment of the required fees, the member is still under obligation to pay the fees.

If the member simply refuses to pay the fees, or there is no legitimate reason for his or her failing to pay, the MCO writes a letter to the member, with copies to the ALF manager and to the member's AR, if applicable, explaining the possible consequences of continued refusal to pay.

The MCO is responsible for working with the member during this time period to assure alternative services will be available. If the member refuses to leave the facility when his or her services are terminated, the ALF must follow its written eviction procedures.

In addition, ALFs must:

  • conduct a health assessment with the member within three days of admission to the facility;
  • provide each member with training in the emergency or disaster procedures and evacuation plan within three days from the date of service initiation. The training must be documented in the member's record. The facility must also document all training and orientation provided to members and facility staff;
  • provide services according to the member's health assessment or individual service plan (ISP);
  • document the member's daily activity and service delivery on the daily census record;
  • obtain written approval from the MCO before discharging a member, except when MCO staff cannot be reached and the member threatens the health or safety of himself or herself or other residents in the facility;
  • help the member to prepare for transfer or discharge;
  • provide a minimum of four social and recreational activities per week;
  • collect payment from the member according to R&B and copayment policies. If payment is not made by the 10th day of the month, the facility must send notice to the member by the 11th day of the same month;
  • allow the member to manage his or her finances and/or trust funds. The facility must provide assistance to the member in managing his or her finances only if the member requests assistance in writing;
  • refund, within five business days after the member has been discharged, the full balance of the member's personal funds that the facility deposited in an account. This applies to copayment amounts and trust funds; and
  • inform the member verbally and in writing, before or at the time of admission, of bedhold policies for hospital or nursing facility (NF) stays, personal leave, eviction procedures, all available services in the facility, and charges for services not paid by the MCO and/or not included in the facility's basic daily rate.

Examples of charges not paid by the MCO could be the destruction of facility property or any additional charges, such as pet deposits. Items not required to be provided by the ALF provider through the ALF licensing standards (for example, returned check fees, service deposits) may be charged to the member if listed in the admission agreement. The MCO may contact the Texas Health and Human Services Commission (HHSC) Regulatory Services Division regarding any questionable items charged to the member.

4251 Facility Reporting and Notification Requirements

Revision 19-13; Effective November 5, 2019

The facility must verbally report to the managed care organization (MCO) the following occurrences pertinent to member services by the next business day after they occur. These occurrences must be followed up in writing within five business days after they occur and may lead to MCO intervention and/or termination of services, including but not limited to:

  • significant changes in the member's health and/or condition, such as:
    • the member enters a hospital, nursing facility (NF), state school or state hospital;
    • death of a member; or
    • serious occurrences or emergencies involving the member or facility staff; and
  • changes based on member actions, such as the member:
    • is discharged because he or she threatens the health or safety of himself or herself or other residents in the facility;
    • leaves the state;
    • requests that services end;
    • refuses to comply with the individual service plan (ISP);
    • fails to pay the copayment amount;
    • exceeds personal leave days; and
    • requests to move to another facility.

If a member exhibits behavior that threatens the health or safety of himself or herself or other residents in the facility, or the member’s needs exceed the licensed capability of the facility, the provider's written notice must explain the situation and the reasons the member is no longer appropriate for the services. With the concurrence of the MCO, discharge can be as soon as practical when:

  • the health and safety of residents in the facility would be endangered if the member would remain in the facility; or
  • the member's medical needs escalate beyond the capability of the facility to meet his or her needs. For example, the member's mental condition may deteriorate to the point that involuntary commitment to a mental institution is necessary.

4252 Member Documentation

Revision 19-13; Effective November 5, 2019

The facility must maintain records for each member that include at least the following information:

  • health assessment;
  • serious occurrences or emergencies involving members or facility staff;
  • incidents when a member threatens the health and safety of himself or herself or other residents in the facility;
  • documentation when the member has used 10 personal leave days during the member's current individual service plan effective period;
  • documentation when the member's needs exceed the licensed capability of the personal care facility;
  • termination of services to a member;
  • hospitalization of a member;
  • death of a member; and
  • documentation when a member requests to move to another facility.

4260 Reserved for Future Use

Revision 23-2; Effective May 15, 2023

 

4270 Copayment and Trust Fund Records

Revision 19-13; Effective November 5, 2019

 

4271 Copayment

Revision 19-13; Effective November 5, 2019

The facility must keep receipts for all copayments collected. The facility must deduct the copayment amount as documented on Form H2065-D, Notification of Managed Care Program Services.

The facility must maintain a current member copayment ledger system that reflects all charges and all payments made by, or on behalf of, each member. This system must reflect all copayment charges, payments and balances; it must be maintained in accordance with generally accepted accounting principles. If a member’s copayment amount is paid from a trust fund, the facility still must prepare a receipt.

The ledger must also reflect room and board (R&B) charges and payments, and the member must be given a receipt for the R&B payments.

4272 Trust Fund Records or Written Receipts

Revision 19-13; Effective November 5, 2019

The facility must maintain trust fund records based on recognized fiscal and accounting principles and have written permission from the member to handle his or her personal financial affairs.

Members must be informed that:

  • funds will be commingled with the funds of other members if the facility will handle the member's trust fund; and
  • the facility may review trust fund records of all members whose funds are commingled.

If the member is unable to sign or initial the transaction, or if the member signs his or her name with a mark (x), the transaction must be signed by a witness. The facility must:

  • keep the member's trust fund accounts separate from the facility's operating accounts. The separate account must be identified "Trustee, (name of facility), Member's Trust Fund Account";
  • make the member's trust records available for review by the facility during work hours without prior notice;
  • not charge the member for services that the facility is expected to provide for the member;
  • refrain from charging the member for banking service costs if the member's trust fund is in a pooled account;
  • obtain and maintain current written individual records of all financial transactions involving the member's personal funds that the facility is handling; and
  • include at least the following in the trust fund records:
    • member's name;
    • identification of member's representative payee or responsible party;
    • transactions; and
    • member's earned interest.

The facility may choose one of the following options:

  • records of the date and amount of each deposit and withdrawal;
  • the name of the person who accepted the withdrawn funds; and
  • the balance after each transaction.

Each withdrawal must be signed by the member. If the member is unable to sign when funds are being withdrawn from his or her trust fund, the transaction or receipt must be signed by a witness or signed receipts indicating the purpose for which any withdrawn funds were spent, the date of expenditure and the amount spent. The receipt must be signed by the person responsible for the funds and the member. If the member is unable to sign his or her name, a witness must sign the transaction or receipt.

Distribute the interest earned on any pooled interest banking account in one of the following options:

  • prorated to each member on an actual interest earned basis;
  • prorated to each member based on his or her end-of-quarter balance; or
  • prorated to each member's account monthly if interest is paid on a monthly basis.

If the facility earns interest on any pooled interest account, the interest earned must be prorated to each member's account. Deposit entries should be documented as "interest" in the member's ledger. All transactions must be posted by the middle of the following month. The facility may:

  • keep a running balance; or
  • compute a balance at the end of the month.

If the facility maintains a trust fund, the facility staff must:

  • give the member a receipt for the money deposited into the trust fund;
  • deposit the member's monthly income into the account; and
  • write a check for the room and board (R&B) charges and copayment amounts out of the trust fund account into the facility operating account.

Facility staff must not deposit the member's monthly income into the operating account and then deposit the personal needs and R&B allowance into the trust fund account. If the member writes a check to be deposited into his or her trust fund account and there are insufficient funds to cover the check, the facility can charge the member only the actual insufficient funds fee charged by the bank.

There is no requirement that the deposit into the trust fund be made on the same date the money is received. However, the facility must ensure that the deposit slip or bank statement reflects the same amount recorded on the receipt.

4273 Records and Receipts

Revision 19-13; Effective November 5, 2019

The facility must ensure that records include written receipts for all purchases made by or for members. A receipt is a written or computer-generated, signed record of payment prepared at the time of payment. If the payment is in person, the written or computer-generated receipt must be signed and contemporaneous with the payment. If the payment is by mail, a statement at the end of the month satisfies the requirement for a written receipt and a bill for the next month. If a single receipt is written for different items, the receipt must clearly describe what the receipt covers.

The record or receipt must include the:

  • name of the member;
  • date the money was received;
  • coverage period;
  • purpose of the payment;
  • amount received;
  • source of the money;
  • amount returned, if any; and
  • signature of the facility representative.

The facility is required to have both a trust fund ledger and a copayment ledger. A current member copayment ledger system must be maintained that reflects all charges and all payments made by, or on behalf of, each member. This system must reflect all copayment charges, payments and balances, and be maintained in accordance with generally accepted accounting principles.

The facility must maintain both receipts for monies received from members and bank deposit slips showing the money deposited. These amounts must correspond to amounts recorded in the member's trust fund ledger. This system must be maintained in accordance with generally accepted accounting principles.

Vendor withdrawal records must be maintained, regardless of how facility staff account for trust fund transactions (withdrawals on a ledger, cash envelope or individual checkbook register). They must retain receipts for any payment out of a trust fund account that is more than $1.00. The receipt, cash register tape or sales statement is documentation of who actually received the money that was withdrawn from the trust fund account, and that the money was spent as authorized. Any unused money returned to the trust fund custodian must be redeposited to the member's trust fund account and appropriately documented. The prerequisites that allow withdrawal from the member's trust fund are:

  • the purchase must be authorized by and for the benefit of the member;
  • the cost must be reasonable; and
  • facility staff do not profit from the transaction. For example, purchasing items in bulk and selling them at a higher price, or the member authorized the purchase of a TV, stereo or refrigerator and staff are using it.

4274 Reserved for Future Use

Revision 23-2; Effective May 15, 2023

 

4275 Reserved for Future Use

Revision 23-2; Effective May 15, 2023

 

4276 Payment of Copayment and Room and Board from Trust Fund

Revision 19-13; Effective November 5, 2019

It is an acceptable and recommended practice to deposit the member's income into the trust fund account and then pay the room and board (R&B) charge and copayment amount from the trust fund account. In this way, the member's monthly payments can be traced to the trust fund. When the R&B charge and copayment amount are paid from the trust fund account, the corresponding member's account receivable ledger must show proper credit to the member's account.

Long-term Payments

For long-term payments, facility staff must obtain a signed statement from the member or responsible party authorizing long-term payments on the member’s behalf. Examples of long-term payments include insurance premiums, church tithe and cable TV. If the facility:

  • has a signed statement from the member authorizing the facility to pay long-term payments on the member’s behalf, they do not need a monthly receipt from the vendor; or
  • does not obtain a signed statement from the member, responsible party or authorized representative (AR) authorizing it to pay the monthly payment on the member's behalf, the facility must have a vendor receipt that includes all items previously identified.

Daily Withdrawals for Minor Purchases or Petty Cash Withdrawals

Members usually require small amounts of money to meet their daily needs for items such as soft drinks, snacks, etc. It is often difficult to keep supporting documents for all such minor purchases.

The member's signature or authorization for a cash withdrawal must be on the member ledger, the cash envelope or on a receipt.

Bulk Purchases

Bulk purchase of the same items may be made by the facility. In this case, the member's signature and the amount of the purchase must be on the member ledger or a receipt.

4277 Member Authorization

Revision 19-13; Effective November 5, 2019

If the member is unable to sign or initial the transaction, or if the member signs his or her name with a mark (X), the transaction must be signed by a witness. A witness is anyone other than the:

  • facility employee who is responsible for managing the trust fund accounts;
  • supervisor of the employee who manages the trust fund account; or
  • person who is receiving payment for services to the member.