Supports for Community Living (SCL). Vendor Payment Procedures for Individuals Admitted to SCL Care. What is SCL?.
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Vendor Payment Procedures for Individuals Admitted to SCL Care
Obtain a PA-1A form, and review these steps on pages 4 and 5 for Step I- MA Eligibility:
If there is an excess in Step I, or in SCL less than 30 days, complete Step II to determine MA eligibility:
Step I- MA Eligibility:
Step II- MA Eligibility for SCL, ABI or ICF/MR/DD
Step III calculations vary depending on living situation.
Both members in the same facility (or both at home):
Each in a different facility (not living together):
Step I- MA Eligibility
Step II- MA Eligibility
Step III- Patient Liability: Use only the income and expenses of the SCL individual in this step.
For Non-SSI individuals, KAMES will complete these steps:
$745- Monthly shelter expenses
-$482- Shelter minimum eff. 7/05
$263- Excess shelter expenses
+$1604- Minimum Comm. Spouse Allowance
$1867- Comm. Sp. Income Allowance
-$1000- Comm. Spouse’s gross income
$867- Amount of SCL member’s income that will be deemed to the Community Spouse
This “deduction” is allowed if there is a minor child, dependent child, dependent parent, or dependent siblings of either the SCL individual or their Community Spouse, who resides with the community spouse.
Calculate the Family Income Allowance as follows:
$1604- Family Income Allowance eff. 7/05
- $825- Dependent’s gross income
$779 ÷ 3= 259.6666…
Step III- Patient Liability Calculations:
Step I- MA Eligibility:
Step II- MA Eligibility:
If there is an excess in Step I or the child in SCL less than 30 days, complete Step II to determine MA eligibility.
If the SCL child’s parents have other children in the home that are not eligible for LTC, complete these calculations on PA-1A Supp. D, Page 2:
On Page 1 of the PA-1A Supp. D- Item I:
Follow these steps listed on PA-1A, Supp. D, Page 1, Item II:
Step III - Patient Liability
If the SCL individual is already receiving MA through SSI, SSP or Pass through:
Example: PRO certified that the individual met SCL level of care on May 12th. MA Eligibility should begin May 1st.