Reporting Individual Financial Information/Third Party Payments

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Purpose

This Information Bulletin serves as a reminder and official notice that Medicaid Waiver and non-waiver residential community-based agencies have a fiduciary and contractual responsibility to accurately report individual financial information in the Reporting of Community Services (ROCS) system, per the DDD Waiver Manual.

1. Waiver settings include: 
   • Community Integrated Living Arrangement (CILA)
   • Community Living Facility (CLF),  16-bed and under
   • Children's Group Home (CGH)
2. Non-Waiver settings include:
   • Child Care Institution (CCI)
   • Community Living Facility, 17-bed or greater

Please be aware that inaccurate reporting of an individual's income by a Waiver community-based residential agency will create inaccurate payments for services and an inaccurate Medicaid claim. Inaccurate reporting of an individual's earned or unearned income (SSI, SSA, Railroad Retirement, etc.) is fraud and will be treated as such.

Process and Procedure

The reporting of an individual's income in ROCS should be done as follows:

1. Each individual's financial information reported in ROCS is to be entered as monthly amounts.
2. Each individual's benefits and income changes must be done on the client income screen in ROCS no later than five calendar days after the change.
3. The unearned income information entered in ROCS needs to include the total amount of unearned income received by the individual from such sources as Social Security, Social Security Disability, Railroad Retirement, etc. The total unearned income should be reported as the net amount after any Medicare or Champus premium deduction if applicable.
4. The earned income information is reported as a net amount after taxes and other required deductions as the amount received by the individual.
5. HUD assistance granted on behalf of the individual is to also be reported and updated no later than five calendar days after the change.

The individual's third party payment is based on the individual's financial information entered by the community-based agency in ROCS. The third party payment is comprised of: 

• Earned Income
• Unearned Income
• HUD Assistance
• Food Stamp Credit

The third party payment offsets the Department's reimbursement on certain residential programs. The Department's payment for services is then used to make a Medicaid claim to the federal government for Federal Financial Participation (FFP).

It is also the community-based agency's responsibility to contact the local Social Security Administration and Department's Family Community Resource Center (FCRC) offices to report the individual as receiving Department-funded services and help secure eligible benefits. Additional information regarding the process to report an individual's benefits and income changes can be found in the DDD Waiver Manual (See Provider Requirements).

The Division will randomly audit reported individual financial information reported by agencies through the ROCS reporting system. Agencies that incorrectly report individual financial information will be notified of inaccurate reporting and given an opportunity to correct the individual's reported financial information. The Division will also recoup excess funding from agencies if payments were made to an agency in error because the agency did not submit correct financial information.

Effective Date

This procedure has been a long standing and is a current Department practice. This is procedure is effective immediately.