Wyo. Code R. 048-0037-17
Medicaid
Chapter 17: Nursing Facility Residence Trust
Effective Date: 03/21/1990 to 05/29/2012
Rule Type: Superceded Rules & Regulations
Reference Number: 048.0037.17.03211990
This rule is promulgated by the Department of Health and Social Services, pursuant to the Medical Assistance and Services Act of 1967 at W. S. 42-4-101 et seq. (1977), and the Wyoming Administrative Procedures Act at W. S. 16-3-101 et seq. (1977).
This rule applies to all resident trust accounts maintained by facilities.
(a) 'Bank.' A federally or state chartered bank, savings and loan or credit union which is insured by an agency of the United States government.
(b) 'change of ownership.' A change in a facility's ownership, management contract, control or operation.
(c) 'Department.' The Wyoming Department of Health and Social Services or its designee.
(d) 'Facility.' A skilled nursing facility (SNF), an intermediate care facility (ICF) or a nursing facility. 'Facility' may include a distinct part of a hospital or institution which is designated to provide nursing facility services.
(e) 'Generally accepted accounting principles.' Accounting concepts, standards and procedures established by the American Institute of Certified Public Accountants.
(f) 'Generally accepted auditing standards.' Auditing standards, practices and procedures established by the American Institute of Certified Public Accountants.
(g) 'HHS.' The United States Department of Health and Human Services or its designee, including its Office of Inspector General.
(h) 'Medicaid.' Medical assistance and services provided pursuant to Title XIX of the Social Security Act and The Wyoming Medical Assistance and Services Act.
(i) 'Medicaid reimbursement rate.' The facility's per diem rate for Medicaid recipients as determined pursuant to Chapter VII of these rules.
(j) 'Medicare.' The health insurance program for the aged and disabled established pursuant to Title XVIII of the Social Security Act.
(k) 'Missing funds.' Personal funds for which a facility is responsible pursuant to this Chapter which are determined after an audit to be missing or otherwise unaccounted for.
(l) “Nursing facility.” A nursing facility as defined by section 1919 of the Social Security Act (Pub. L. 100-203, section 4211(a)).
(m) “Per diem rate.” The facility’s daily rate or rates for services provided to residents. “Per diem rate” includes the facility’s Medicaid reimbursement rate.
“Personal care allowance.” The allowance to which a recipient is entitled under federal law.
“Personal funds.” All funds which belong to a resident, from whatever source, including the resident’s personal care allowance.
“Recipient.” A person who has been determined eligible for Medicaid.
“Resident.” A Person who resides in a facility.
“Resident’s representative.” The person who is acting on behalf of a resident, whether as legal guardian or otherwise, in the resident’s dealings with the facility.
“Resident trust account.” An account maintained by a facility in which a resident’s personal funds are deposited and held in trust by the facility for the use and benefit of the resident.
(t) “Services.” ICF services as defined in 42 U.S.C 1396d(f), other than intermediate care facility services for the mentally retarded (ICF/MR), SNF services as defined in 42 U.S.C. 1396d(f), or nursing facility services as defined by section 1919 of the Social Security Act (Pub. L. 100-203, Section 4211).
“SSI.” The Supplemental Security Income program established pursuant to Title XVI of the Social Security Act.
“Working day.” Monday through Friday, exclusive of state holidays.
Section 4. Notice to residents. Notice of covered services. At the time of admission, the facility shall provide the resident and the resident’s representative with a written notice that contains the information specified in subsections (a) through (g). Such notice shall also be given at least once every year after admission, and within sixty days after there is any change in the services available to residents, the charges for such services or the services included in the Medicaid reimbursement rate. The notice shall contain:
(a) An itemized statement of the services provided by the facility as part of the facility’s Medicaid reimbursement rate;
(b) An itemized statement of the services provided by the facility that are not covered by the facility’s Medicaid reimbursement rate or Medicare and that may be charged to the resident, including the charge for each such service;
(c) A statement that the recipient is not required to deposit personal funds in a resident trust account;
(d) A description of the resident’s right to select one of the following alternatives for the management of personal funds:
(i) The resident may receive, retain and manage personal funds directly or through a legal guardian;
(ii) The resident may apply to the Social Security Administration for the designation of a representative payee to receive and manage personal funds; or
(iii) The resident may designate, in writing, another person to receive and manage personal funds.
(e) A statement that any charge for the facility managing the resident’s trust account is included in the Medicaid reimbursement rate;
(f) A statement that the resident is entitled to one accounting per calendar month of the resident’s trust account upon the written request of the resident, the resident’s legal guardian, the resident’s representative payee or such other person as has been designated to manage the resident’s trust account; and
(g) A statement that if the resident is or becomes incapable of managing personal funds and has not designated another person to do so, the facility shall arrange for the management of the resident’s personal funds pursuant to the provisions of this Chapter.
(h) Notice of potential ineligibility for Medicaid or SSI. In addition to the notice described above, the facility shall notify a recipient when the balance of the resident’s trust account is within $200.00 of the amount determined under 42 U.S.C. 1382(a)(3)(B), which is hereby incorporated by reference. The notice shall be in writing and shall inform the recipient that if the amount in the account plus the recipient’s other nonexempt resources reaches the amount determined under 42 U.S.C. 1382(a)(3)(B) the recipient may lose eligibility for Medicaid, SSI or both.
(a) No charges for services included in per diem rate or covered by Medicare. A facility may charge a resident only for services which are not included in the facility’s per diem rate for that resident and which are not covered by Medicare.
(b) Charges to personal care allowance. A facility may seek reimbursement from a resident’s personal care allowance only for services directly related to the resident’s personal needs, including, but not limited to:
(i) Commissary items, such as books, magazines and candy; or
(ii) Premiums on life insurance policies or burial expense policies.
(a) Upon written authorization from the resident, any individual designated pursuant to Section 4 or pursuant to subsection 4(g), the facility shall accept responsibility for:
(i) Receiving personal funds;
(ii) Depositing personal funds in the resident’s trust account;
(iii) Safeguarding the resident’s personal funds; and
(iv) Managing the resident’s trust account, including accounting for all personal funds received by the facility.
(b) Management. The facility may perform the duties specified in this Chapter directly or through a bank. The delegation of such duties to a bank shall not affect the facility’s ultimate responsibility for ensuring that the requirements of this Chapter are met.
(c) Interest. The facility may deposit personal funds in a non-interest bearing account if such funds do not exceed $50.00 Funds in excess of $50.00 shall be transferred to an interest bearing account within 15 days after the date a recipient’s trust account exceeds $50.00. All such interest shall accrue to the resident’s trust account.
(d) Pooled funds. Resident trust accounts may be pooled. If the facility uses a pooled account, it must:
(i) Maintain records adequate to clearly disclose the amount of each resident’s trust account and each transaction involving such account;
(ii) Indicate on the account that the facility does not have an ownership interest in the funds;
(iii) Establish a written policy for the attribution of accrued interest among the pooled accounts. Interest may be prorated by:
(A) End of quarter balance;
(B) End of month balance;
(C) Daily balance; or
(D) Average daily balance.
(e) Record keeping requirements. The facility shall maintain current, written records of each transaction involving each resident’s trust account for which the facility is responsible. The records shall include:
(i) The resident's name; (ii) The name of the resident's representative;
(iii) The date of the resident's admission;
(iv) The date and amount of each deposit and withdrawal, the name of the person who accepted the withdrawn funds, the purpose for which funds were withdrawn, and the balance after each transaction;
(v) Receipts indicating the expenditure of the funds; (vi) All accrued interest; and
(vii) If applicable, the date of discharge, the date the resident's trust account was closed and final disposition of the resident's trust account.
(f) Resident unable to manage funds. When a resident is not capable of managing personal funds for any reason, the facility shall, in addition to the record-keeping required by subsection (c) maintain prenumbered voucher slips which:
(i) Indicate the item(s) purchased with the resident's personal funds; and (ii) Contain two signatures for each withdrawal, one of which shall be that of a supervisory employee of the facility. If the withdrawal is to reimburse another person for the expenditure of funds on behalf of the resident, that person's signature shall appear on the voucher.
(g) Quarterly reports. Within thirty days after the end of each calendar quarter, the facility shall issue a written accounting to each resident for whom the facility maintains a resident trust account, the person designated pursuant to paragraph 4(a)(iv) or the resident's representative which includes:
(i) The balance at the beginning of the quarter; (ii) Total deposits and withdrawals;
(iii) Interest earned;
(iv) The balance at the end of the quarter; and
(v) The location of the resident's trust account and the account's identification number.
(h) Access to resident trust accounts. The facility shall provide access to resident trust accounts:
(i) For at least two hours during normal business hours each working day; and (ii) For a reasonable time on Saturdays and Sundays
(i) Commingling of resident trust accounts. The facility shall not commingle resident trust accounts with any of the facility's funds. Each resident trust account shall state that the facility has no ownership rights in the account and that the funds are held in trust.
(j) Return of personal funds. The facility shall, upon written request by a resident or the person designated pursuant to subsection 4(d):
(i) Return the balance of the resident's trust account to the requesting party within five days after receipt of such request; and
(ii) Provide a written accounting including all transactions from the date of the last quarterly report.
(k) Death of resident. Upon the death of a resident for whom the facility is maintaining a resident trust account, the facility shall:
(i) Provide the personal representative of the estate of the resident, or any other person entitled to distribution pursuant to W.S. 2-1-201, with a full, written accounting of the resident's trust account within 30 days after the date of the resident's death; or
(ii) If there is no person entitled to an accounting pursuant to paragraph (i), provide a full, written accounting of the resident's trust account to the person designated pursuant to subsection 4(d) or the resident's representative.
(iii) If the funds in a deceased resident's trust account are not claimed within six months after the resident's death, the funds shall be turned over to Medical Assistance Services of the Department pursuant to W.S. 42-4-109(c).
(l) Change of ownership. A facility shall, within sixty days before a change of ownership:
(i) Provide a written accounting of all resident trust accounts to the new owner; and
(ii) Provide a written accounting to each resident or the person designated pursuant to paragraph 4(a)(iv) of all transactions from the date of the last quarterly report and the balance in the account on the date of the accounting.
(iii) On or before the effective date of the change of ownership, the facility shall surrender all resident trust accounts to the new ownership, obtain a written receipt for such funds and otherwise comply with the provisions of Chapter VII, Section 21(b).
(iv) Failure to comply with the provisions of this subsection shall result in the facility transferring ownership and the new ownership remaining jointly liable for all resident trust accounts entrusted to the facility at or before the time of the change of ownership.
(m) Accounting principles. All accountings required by this Chapter shall be performed in accordance with generally accepted accounting principles.
(a) The Department, the Attorney General of the State of Wyoming, the State Auditor of the State of Wyoming or HHS may conduct an audit of a facility's resident trust accounts, with or without notice to the facility, to determine whether the requirements of this Chapter are being met. Any such audit shall be performed in accordance with generally accepted auditing standards.
(b) Notice of missing funds. If an audit discloses missing funds, the Department shall provide written notice to the facility, by certified mail, return receipt requested, stating the amount of missing funds, the basis for the determination of missing funds and the facility's right to request reconsideration of the audit pursuant to Section 8.
(c) Repayment of missing funds. The facility shall, within ten days after receipt of notice of missing funds, replace such funds and provide a written accounting of such replacement to the Department, even if the facility has requested reconsideration or requested an administrative hearing regarding the determination of missing funds. If the facility does not replace the missing funds, the Department may recover such funds from the facility by:
(i) Withholding all or part of Medicaid payments until the missing funds are recovered;
(ii) Initiating a civil lawsuit against the facility; or
(iii) Any other method of collecting a debt or obligation permitted by law.
(d) Request for reconsideration. A facility which disagrees with the audit results may request reconsideration pursuant to Section 7. Neither a request for reconsideration nor a request for an administrative hearing shall stay the facility's responsibility to repay missing funds pursuant to this Section.
(e) Other sanctions. Action by the Department to recover missing funds pursuant to this Section shall not preclude other sanctions or penalties which may be imposed pursuant to applicable state or federal law.
(a) Request for reconsideration. A facility may request that the Department reconsider a decision that the facility replace missing funds. Such request must be mailed to the Department by certified mail, return receipt requested, within twenty days of the date the facility receives notice pursuant to Section 7. The request must state with specificity the reasons for the request. Failure to provide such a statement shall result in the dismissal of the request with prejudice.
(b) Reconsideration. The Department shall review the decision and send written notice to the facility of its final decision within forty-five days after receipt of the request for reconsideration. The Department may request additional information from the provider as part of the reconsideration process.
(c) Administrative hearing. A facility may request an administrative hearing regarding the final decision pursuant to Chapter I of these rules by mailing by certified mail or personally delivering a request for hearing to the Department within twenty days of the date the facility receives notice of the final decision.
(d) Failure to request reconsideration. A facility which fails to request reconsideration pursuant to this section may not subsequently appeal the decision to replace missing funds pursuant to Chapter I.
Section 9. Severability. If any portion of these rules is found to be invalid or unenforceable, the remainder shall continue in effect.