Conn. Agencies Regs. § 17-2-163

Current through October 16, 2024
Section 17-2-163 - Requirements for skilled nursing, intermediate care and chronic disease facilities in taking deposits or prepayments on behalf of patients who are applicants for Title XIX (Medicaid), who are subsequently determined eligible for Title XIX (Medicaid) and the requirements for these facilities to refund such deposit or prepayment
(a) Any prepayment or deposit made by or on behalf of an applicant for Title XIX (Medicaid), which is accepted by a facility, must be refunded to the payor when Title XIX (Medicaid) eligibility is established.
(b) Any such prepayment or deposit cannot exceed $1,500.00 and such prepayment or deposit shall be placed in escrow as designated by the Department of Income Maintenance.
(c) Upon a determination of eligibility, the payment held in escrow shall be refunded to the payor and the Title XIX payment shall be made to the facility. Upon a determination of ineligibility, the payment held in escrow may be transferred to the facility operating account unless the applicant requests a Fair Hearing, in which case the payment shall continue to be held in escrow until final disposition of the administrative appeal.
(d) One escrow bank account is sufficient to handle the deposits. Documentation in the form of receipts and disbursements by the individual must be available to the Department of Income Maintenance showing dates, purpose and disposition. Subsidiary accounts for each person shall be maintained to provide adequate record of transactions and current balances.
(e) Where a prepayment or deposit is to be refunded, the full amount paid for services rendered during the period of Title XIX eligibility must be refunded. Example: If the Department of Income Maintenance payment was $30.00 for a service toward which the recipient had made a $40.00 deposit or prepayment, the facility must refund the full $40.00 and accept the $30.00 payment as payment in full for that service.
(f) The Department of Income Maintenance shall not pay a facility for services for which a prepayment or deposit is being held in escrow until such time as the escrow account is refunded to the person who made such payment. Any payment for services made by the Department of Income Maintenance is subject to the criteria of existing program policy.

Conn. Agencies Regs. § 17-2-163

Effective May 8, 1980