27-80-02-b: Medical Codes

Countable Income Medical (Excludes QMB Only, SLIB Only, and QI-1 Only)

Use only when Item 20 is coded: 16, 17, 18, or 20.

Entry of 158 CI is required for approvals, REDEs, and when making changes in Item 90 (excluding changes in Item 90 codes 554, 636, 638, 640, 641, 643, 644, 648, 654, 657, 658, 659, 660, 661, 663, 670, 671, 672, and 700).

For each community Medical case (Regular and Spenddown), under AMOUNT enter the amount of monthly countable income. If there is no countable income, enter 0.00. Under PERSONS, enter the 2-digit number for the number of persons included in the MANG Standard.

When Item 20 is coded 20, enter one of the following codes under SUP. BY:

· 3 - Determination made without diverting income

· 4 - Determination made by diverting income

BCC Countable Income

Under AMOUNT enter the amount of monthly countable income in whole dollars. The PERSONS field is to be left blank.

Use only when Item 25 is coded 9.

Pay-in Spenddown First Month - An amount and date (mm/yy in PERSONS field) is entered to show the first month a paid-in amount is to be used to meet spenddown and the amount to be applied for that month.

(Centrally entered. Only the Central Pay-in Unit/LO 250 or EPU can enter, delete or change this code.)

Pay-in Spenddown with Companion Case - Identifies a Pay-in Spenddown case that is connected to a companion case. This code only appears on the Pay-in case.

(Centrally entered. Only LO 250 or EPU can enter, delete or change this code.)

Pay-in Spenddown Asset - Identifies a case for which an asset spenddown was met with a payment.

(Centrally entered. Only LO 250 or EPU can enter, delete or change this code.)

Pay-in Spenddown Enrollment

Under PERSONS, enter the date (mm/yy) that the case is enrolled in Pay-in Spenddown.

(Only LO 250 or EPU can enter, delete or change this code.)

Pay-in Spenddown Last Month - An amount and date (mm/yy in Persons field) is entered to show the total paid-in amount remaining to be used to meet spenddown and the date of the last month for which spenddown is met with a payment.

(Centrally entered. Only LO 250 or EPU can enter, delete or change this code.)

Spenddown - not LTC or SLF

Under AMOUNT, enter the income portion of the spenddown amount in dollars and cents. If the spenddown is only due to excess assets, enter 00.00.

Under PERSONS, enter the following code that applies:

· 1 - Spenddown met - split-bill

· 2 - Spenddown not met

· 3 - Spenddown met - carryover

For cases in met status, the system automatically enters the month and day from Item 77 under TOTAL COST.

Requires entry of 392 AST in Item 80.

Spenddown - LTC or SLF

Under AMOUNT, enter the dollars and cents amount of the countable monthly income. If the spenddown is only due to excess assets, enter 0.00.

Under PERSONS, enter the following code that applies:

· 1 - Spenddown met - split-bill

· 2 - Spenddown not met

· 3 - Spenddown met - carryover

Enter one of the following codes under SUP. BY:

· 3 - Determination made without diverting income

· 4 - Determination made by diverting income

For cases in met status, the system automatically enters the month and year from Item 77 under TOTAL COST.

Requires entry of 392 AST in Item 80.

Excess Assets

Under AMOUNT, enter the amount of nonexempt assets in excess of the case's asset limit. If none, enter zero. Before determining total assets, drop cents from each individual nonexempt asset.

Regular Medical - LTC or SLF Credit

Under AMOUNT, enter the dollars and cents figure of the LTC or SLF credit obligation. Do not make entries under PERSONS or TOTAL COSTS.

Under SUP. BY, enter one of the following codes:

· 3 - Determination made without diverting income

· 4 - Determination made by diverting income

Requires entry of 392 AST in Item 80.

Spenddown Met Ending Date

Under PERSONS, enter the last date (mm/yy) spenddown is met.

Beginning Restriction for Long Term Care

Under PERSONS, enter the beginning date (mm/yy) of the penalty period for LTC, SLF, and DoA services.

Ending Restriction for Long Term Care

Under PERSONS, enter the last date (mm/yy) of the penalty period for LTC, SLF, and DoA services.

Person Awaiting Transplant

Enter this code when a person in a spenddown case is on a waiting list for a transplant. Entry of this code prevents the case from centrally canceling if spenddown is not met.

Exempt Irrevocable Trust

Enter this code for a case with an exempt irrevocable trust. Under PERSONS, enter the 4-digit date (mm/yy) of the referral to the BOC - TRS.