Policy Transmittal Aging and People with Disabilities Mike McCormick Number: APD-PT-18-053 Authorized signature Issue date: 12/10/2018 Topic: Medical Benefits Due date: Transmitting (check the box that best applies): New policy Policy change Policy clarification Executive letter Administrative Rule Manual update Other: Applies to (check all that apply): All DHS employees Area Agencies on Aging: Types A and B Aging and People with Disabilities Self Sufficiency Programs County DD program managers ODDS Children s Residential Services Child Welfare Programs County Mental Health Directors Health Services Office of Developmental Disabilities Services (ODDS) ODDS Children s Intensive In Home Services Stabilization and Crisis Unit (SACU) Other (please specify): OHA Policy/rule title: 2019 Cost of Living Adjustments Policy/rule number(s): 461-135-0780, 461-145-0220, 461-155-0250, 461-155-0270, 461-160- 0580, and 461-160-0620 Release number: Effective date: January 1, 2019 Expiration date: References: Web address: APD E.5, APD D.10, CCA B.34, MMA B, MMA C, OSIPM WG 2, OSIPM WG 6, OSIPM WG 8, OSIPM WG 9, OSIPM WG 12, OSIPM E.2, OSIPM E.4, OSIPM E.8, CM Tools Pay-In, QMB E.4 http://www.dhs.state.or.us/spd/tools/additional/workergd/index.h tm http://www.dhs.state.or.us/spd/tools/additional/assets/index.htm http://www.dhs.state.or.us/spd/tools/additional/mma/index.htm http://www.dhs.state.or.us/spd/tools/program/osip/index.htm http://www.dhs.state.or.us/spd/tools/program/qmb/index.htm
http://www.dhs.state.or.us/spd/tools/cm/pay_in/index.htm Discussion/interpretation: This Policy Transmittal explains the impact of SSA Cost of Living Adjustments (COLAs) on OSIPM and Medicare Savings Program (QMB/SMB/SMF) eligibility for 2019. Implementation/transition instructions: Effective January 1, 2019, the Social Security Administration (SSA) will implement a 2.8% COLA for Social Security recipients. This includes Social Security payments under Title II of the Social Security Act (both SSB and SSDI) and Supplemental Security Income (SSI) under Title XVI of the Social Security Act. For 2019, the SSI Standard will be $771.00. This COLA will also have the following impact: SSI/OSIPM Related Standards Changes: The 2018 OSIPM standards are as follows: OSIPM Adjusted Income Standards Number in Need Group One Two AB/AD/OAA 771.00 1,157.00 The Long Term Care Countable Income Standard (300% of SSI): $2,313.00 The Home Equity Exclusion Limit for 2019: $585,000.00 Allocating and Deeming: The maximum allocation rate for non-applying children in OSIPM will increase from $386 per month. Room and Board and PIF: For CBC cases other than MH residential treatment, the COLA adjusted Room and Board and Personal Incidental amounts are as follows: CBC Room and Board: $599.00 CBC PIF: Remaining client funds after R&B and client liability are deducted Nursing Facility PIF: The PIF for NF and ICF-MR residents who are not receiving VA aid and attendance benefits is increasing to $63.10.
Residential MH Treatment: For clients in 24-hour residential MH treatment, the R&B rate will be: $599.00 The Children s Room and Board amount: $771.00 The Title IV-E Children s Room and Board Allowance: 4ER Title IV-E funded Room and Board: $599.00 4ES Title IV-E Room and Board Supplement: $172.00 Resource Assessment: The maximum Community Spouse Monthly income allowance in OAR 461-16-0620 (3)(d)(A) will be $ 3,160.50. The Community Spouse s maximum share of the couple s combined countable resources in OAR 461-160-0580 (2)(c)(A) and -0580 (2)(f)(A) will be $ 126,420.00. The Community Spouse s minimum share of the couple s combined countable resources in OAR 461-160-0580 (2)(c)(B) and -0580 (2)(f)(B) will be $ 25,284.00. Medicare Part B Premium The Medicare Part B premium will remain at $135.50 for most of our clients; however, CBI clients who became Medicare-eligible prior to 2019 will have a Medicare Part B premium that may vary anywhere from $120 to $134. All individuals who begin receiving Medicare in 2019 will be charged the higher rate of $135.50. See below for more information about CBI amounts. Medicare Savings Programs The resource limits for the QMB-BAS, QMB-SMB, and QMB-SMF were eliminated effective January 1, 2016. The resource limits for the QMB-DW program are as follows: One in the need group 2 or more in the need group $4,000 $6,000 The Medicare Savings Program (MSP) income standards are based upon the Federal Poverty Level (FPL). The annual FPL increase is generally announced in January or February each year and normally implemented in March. Under federal statute, current MSP eligible have protected eligibility until the month after the month in which the new FPL standards are published. In order to ensure that the January COLA increase does not render current MSP recipients ineligible pending the FPL increase, the Client Maintenance (CM) system will be modified to apply MSP standards that are inflated by the COLA percentage. Current MSP-eligible individuals will retain eligibility in the current program until the FPL changes are implemented, which will likely occur on March 1, 2019; however, the exact date will
depend on when the annual FPL increase is announced. New MSP applicants must be assessed under the MSP standards published in OAR, which will not be inflated by the COLA percentage. EPD Participant Fee To avoid the disruption of EPD participant fee calculations pending the implementation of the 2019 FPL standards, Central Office is adding a 2.8% increase to the participant fee calculation standards. Effective January 1, the new income ranges will be as follows: Client Income Participant Fee Under $781 $0 $781 - $1040.99 $50.00 $1041 - $2600.99 $100.00 $2601 and above $150.00 Client Liability The application of the client liability will occur at different times, depending upon the Long-Term Care placement. Nursing Facilities: New liability amounts for January 2019 will be automatically calculated using the COLA adjusted income figures and the new PIF and applied to January service months. The 458 will not be auto-generated, so staff will have to create and mail updated forms for January 2019. Community Based Care Facilities: New liability amounts for January 2019 will be automatically calculated using the COLA adjusted income figures and applied to the January service month 512s for the month of January will be generated and mailed by central office. If corrections to SSA benefits or CBI amounts are needed, these should be made between January 1 st 24 th. The 512 should be touched the next business day effective January 1, 2019. In-home Care Settings: For clients in existing in-home placements as of December 31, 2018: o Client liability will be automatically calculated using the new COLA adjusted income figures for January 2019. This means the new amount should not be applied to the pay-in system (SFMU) until January 1, 2019 or later for the February 2019 service date. Changes to liability due to the COLA and any CBI adjustments will be implemented at the same time for the February service month. o There may be circumstances in which the worker must make a change to liability/pay-in for January for an ongoing in-home client to accommodate an approved cost. In these instances, add the approved cost into the appropriate
tab in Oregon ACCESS, but do not use the Oregon ACCESS Pay-InN worksheet to determine the January pay-in amount, since it will already have been updated with the new figures. Instead, determine the January pay-in by subtracting the approved cost from the December pay-in listed in SFMU. Notice Information Remember that OAR 461-175-0230 was amended effective December 1, 2017 to make an exception to the timely notice requirement when a service liability increases for COLA-related changes and when other mass changes or changes in federal policy occur. The exception allows for a continuing benefit decision. System Updates: SSA COLA The CM system is scheduled to automatically update SSI and SSB amounts at EOM processing near the end of December. A transmittal will be released soon that will provide more information on how the changes are applied to CMS and ACCESS. Please do not manually update SSI and SSB amounts for on-going clients in December. Doing so will create system inaccuracies when the automatic conversion happens. CBI Again, Medicare Part B premiums in 2019 for most people will be $135.50, which will be a change for most. Some premiums may vary greatly for those currently coded as Client Buy-In (CBI), depending on the individual s Medicare eligibility date and income level. The CM system will not automatically convert CBI need/resource amounts for 2019. After the COLA update, eligibility staff should verify the actual Part B premium, update any incorrect CBI amounts in Oregon ACCESS, integrate the case, and make any necessary adjustments to client liability and LDS amounts. Staff are encouraged to generate ACCESS reports to identify cases with the CBI case descriptor; remember that Oregon ACCESS reports can also be filtered by living situation. Note: SSA screens and MMIS usually show the 2019 premium amounts near the middle of December. Adjustments after COLA update The system does not recognize cents, so any SSA benefit amount in CMS or ACCESS with cents is automatically rounded down to the nearest whole dollar. The COLA update will also round down. This means that there may be some discrepancies between the auto updates and the actual 2019 SSA benefit amount, particularly with individuals who are coded as CBI and have a Medicare Part B premium and SSA gross benefit that is not a whole dollar amount.
In addition, if the 2018 SSA benefit amounts were inaccurate in ACCESS and CMS, then the COLA update will result in an inaccurate 2019 benefit. The updates are made separately to both systems they are not made in ACCESS and integrated to CMS, so if ACCESS and CMS do not match now, they will not match after the updates are made. If the updates result in an incorrect SSA benefit amount, staff can choose to correct the amount in Oregon ACCESS and integrate to synchronize with CMS between January 1 and CMS cutoff in January or wait until the annual redetermination. If corrections to the CBI amount are needed, any SSA benefit discrepancies should be corrected at the same time. Do not update SSA benefit amounts before January 1, 2019. Please remember that notice and due process requirements do not allow retroactive adverse actions, this includes retroactive increases in service liability, pay-in, or program reduction or closure. Training/communication plan: APD policy manuals, training material, forms, and systems will be updated. sdf Local/branch action required: Please review this policy transmittal with staff who determine eligibility for OSIPM and Medicare Savings Programs. Central office action required: Update worker guides and training materials and provide technical assistance as needed. Field/stakeholder review: Yes No If yes, reviewed by: APD Operations, APD Policy Filing instructions: If you have any questions about this policy, contact: Contact(s): APD.MedicaidPolicy@dhsoha.state.or.us Phone: Fax: Email: