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Long-Term Care Tips to Deal with Deliquent Facility Accounts
(Some information edited from a document produced by the March 1994 Minnesota
“Mini-Conference on Resident Discharge Cases: Part 1 - Issues Dealing with Non-payment”)
provided by the office of Adult Protective Services.
This Guide suggests strategies that long-term care facilities may find helpful to avoid or more effectively respond to non-payment problems with new residents and their responsible parties, i.e., family members, representative payees, conservators or guardians. The timeframe of the suggestions spans the interactions of the facility with the resident and responsible party from orientation and admission to 30 days following the first notice of non-payment. The concluding section suggests optional actions to address unresolved non-payment issues.
I. Admission Process:
* A specific staff member(s) may be designated by the facility to assist with the resident’s admission and to be the “point person(s)” for follow up with the resident and responsible party.
* It is suggested that during the admission process (or as soon following an emergency admission as possible) the facility provide considerable focus on the topic of payment, by discussing and providing in writing:
o Clarification of charges
o Clarification of payment expectations
o Who will be responsible for payments
o Payment methods
o Consequences of late or non-payment, as detailed in the facility’s (or corporation’s) collection policies and procedures
o A request that the resident’s income/benefit sources be officially notified of the resident’s change of address to the facility address. Copies of the official notification(s) may be requested for the resident’s facility records.
o Name and contact information for:
* The designated facility staff person who monitors residents’ accounts
* Appropriate SRS office
* Other pertinent payment sources (see also “How do I Pay for my Nursing Home Care” brochure)
* Resident and family issues that may be addressed by the facility at admission:
o Request that copies of any court or other official documentation of designated financial authority held over the resident by a guardian, conservator, trust administrator, representative payee, agent with power of attorney, or other be provided for facility records. Also provide copies to the facility when any change in authority occurs.
o Review the limitations of the resident’s payment sources.
o Provide a basic explanation of Medicare benefits and requirements.
o Review terms of resident’s long term care insurance policy, if applicable.
o Emphasize the importance of the resident’s/responsible party’s communications with the eligibility worker regarding Medicaid eligibility, including changes in the resident’s status, income or resources.
o Offer to the resident and responsible party information about and direct assistance with medical assistance application, such as the time-limited appeal period, should assistance be denied.
* Follow up with the resident and responsible party 30 days prior to the expiration of any previous payment source to determine how future payments will be made.
II. 30 Days Post-Admission/Payment Transition
* Determine whether payment was made for the first month.
* If no payment was received for the first month, it is suggested that the designated facility
staff person:
o Contact the resident and, if possible, the responsible party to discuss the non-payment issue.
* If included in the business policy, the facility may:
o Contact the responsible party by registered mail, reminding him/her of the contract agreement to remain current on the account and the consequences of failing to do so.
o Encourage the resident or responsible party to petition for a court appointment of a conservator for the resident to better assure the proper use and monitoring of the resident’s assets.
III. 30 Days after Non-Payment Determined
It is suggested the facility conduct an internal assessment to determine:
* The name and location of the responsible party, if different from the resident.
* If the non-payment is due to Medicaid application/eligibility issues, the following process may be followed:
o Obtain resident/responsible party consent for the facility to assist in the Medicaid eligibility application process, or find a reputable and qualified person outside the facility who will assist with the application process.
o Obtain a release from the resident/responsible party and send it to the SRS office, asking for the status of the medical assistance application. While Medicaid is in “pending” status, the facility may need to check with SRS on a weekly basis to determine the status of the application.
o If necessary, file the initial Medicaid application on behalf of the resident, with appropriate resident/responsible party permission and signatures. This action secures the date for determining eligibility for Medicaid.
o If the facility is aware that the resident has been determined ineligible for Medicaid, it may remind the resident and responsible party of the time-limited period during which an appeal must be made.
* If the non-payment is related to problems with other payer sources, facility staff
may assist the resident or responsible party with the appropriate appeal or complaint process.
IV. Unresolved Payment Issues
Eviction due to non-payment is always a last resort response. In order to avoid or
postpone the eviction of a resident, the facility may consider the following options:
* Request that civil action for non-payment be initiated by the legal representative
for the facility/corporation against the resident/responsible party.
* Consult with the long term care ombudsman, who may:
o Review the interventions attempted by the facility and suggest alternatives
o Assist, with the resident’s permission to follow up on the Medicaid eligibility process with the appropriate SRS office
o Refer refusal to process a Medicaid application or, in a timely fashion, denial of Medicaid eligibility, to Office of Customer Service at SRS at 1-888-369-4777.
* If established in the facility business policy, notify the court that the resident’s
assets are not being used for his/her care, request that the resident’s financial
status be reviewed by the court and that a conservator be appointed for the
resident.
* Contact and provide proof of non-payment due to the misuse of the resident’s
assets to:
o The Attorney General’s office
o Local Law Enforcement
o Social Security Administration (800-772-1213)
* Refer the case to APS for a determination of eligibility for protective services.
* Refer the case to law enforcement and/or the district attorney’s office.
* If none of the above result in payment, issue the 30 day notice of discharge
(eviction) due to non-payment.
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