Patient surplus or “patient liability” is the participant’s income less certain deductions; i.e., personal allowance, medical insurance and any allotments to a spouse and/or eligible dependents and is computed by an FSD caseworker. It is a federal requirement that the MO HealthNet payment to a nursing home be reduced by the patient surplus. MO HealthNet payment to a nursing home is not collected by the nursing facility the first month a participant is admitted if admission is after the first day of the month. If admission is the first day of the month, then surplus is charged to the participant for the first month.
When there are Medicare and MO HealthNet days in the same month, surplus is applied to the MO HealthNet days only. If the participant is in the hospital on the first day of the month and Medicare covers the cost of the remainder of the month, no surplus is due. For any month following the month of readmission in which there are Medicare and MO HealthNet days, the surplus is applied to the MO HealthNet days in the month regardless of the date of readmission.
If a participant enters a hospital during one month and is not readmitted to the nursing home until after the first day of the following month, surplus is to be billed to the participant or the participant’s representative (responsible party) for the month of readmission. If a participant is out of a nursing home for more than thirty (30) days, the Family Support Division Eligibility Specialist informs the nursing home, and the participant or the participant’s representative, if surplus should be collected for the month of readmission.
For more information on MO HealthNet’s nursing home program, providers can reference Section 13 of the MO HealthNet nursing home manual.