5101:3-3-16.9 Personal needs allowance (PNA) accounts and other resident funds for intermediate care facilities for the mentally retarded (ICFs-MR).

An ICF-MR resident’s rights concerning his or her personal financial affairs shall be in accordance with section 3721.15 of the Revised Code and 42 CFR 483.420 (rev. October 1, 2006).

(A) Definitions.

(1) “Personal needs allowance” (PNA) has the same meaning as found in rule 5101:1-39-24 of the Administrative Code.

(2) “PNA account” means an account or petty cash fund that holds the money of an ICF-MR resident and is managed for the resident by the ICF-MR provider.

(3) “Interest bearing” means a rate of return equal to or above the passbook savings rate at local banking institutions in the area.

(4) “Letters of administration,” also known as letters testamentary, means court papers allowing a person to take charge of the property of a deceased person in order to distribute it.

(5) “Surety bond” means an agreement between the principal (i.e., the ICF-MR provider), the surety (i.e., the insurance company), and the obligee (i.e., the resident and/or the Ohio department of job and family services (ODJFS) acting on behalf of the resident), wherein the principal and the surety agree to compensate the obligee for any loss of the obligee’s funds that the principal holds, safeguards, manages, and accounts for.

The purpose of a surety bond is to guarantee that an ICF-MR provider will pay a resident, or ODJFS on behalf of the resident, for losses occurring from any failure by the ICF-MR provider to hold, safeguard, manage, and account for the resident’s funds, including losses occurred as a result of acts of error or negligence, incompetence, or dishonesty. The principal assumes the responsibility to compensate the obligee for the amount of the loss up to the entire amount of the surety bond.

(B) PNA.

(1) A medicaid resident who receives care in an ICF-MR certified to participate in the medicaid program is eligible to retain a PNA account in the amount set forth in rule 5101:1-39-24 of the Administrative Code for the purchase of items and services of his or her choice.

(2) A PNA account is the exclusive property of the resident, who may use the funds in the account as he or she chooses to meet personal needs.

(1) An ICF-MR provider shall allow residents to manage their financial affairs and teach them to do so to the extent of their capabilities.

(2) An ICF-MR provider shall not require a resident to deposit their PNA funds with the provider. However, if a resident requests assistance from the ICF-MR staff in managing his or her PNA account, the request shall be in writing.

(3) Upon written request from a resident, an ICF-MR provider shall hold, safeguard, manage, and account for the resident’s PNA funds deposited with the provider.

(4) Upon written request from a resident, an ICF-MR provider shall furnish written information about the resident’s account to the resident or the resident’s representative.

(5) An ICF-MR provider shall explain both verbally and in writing to a resident or the resident’s representative that PNA funds are for the resident to use as he or she chooses. If a representative is the payee for the resident’s PNA account, the representative shall be responsible for ensuring that the money is used to meet the personal needs of the resident.

(D) Deposit of PNA account funds and interest earned.

(1) Funds of one hundred dollars or less.

If a resident’s PNA account funds are one hundred dollars or less, an ICF-MR provider licensed by the Ohio department of health (ODH) may deposit the funds in an interest-bearing account, a non-interest bearing account, or a petty cash fund.

(2) Funds in excess of one hundred dollars.

If a resident’s PNA account funds are in excess of one hundred dollars, an ICF-MR provider licensed by ODH shall deposit the funds in an interest-bearing account (or accounts) that is separate from any of the provider’s operating accounts within five banking days from the date the balance exceeds one hundred dollars.

(3) An ICF-MR provider shall credit any interest earned on a resident’s PNA funds to his or her PNA account. If pooled accounts are used, the provider shall prorate interest per resident on the basis of actual earnings or end-of-quarter balance.

(4) An ICF-MR provider shall not charge a resident a fee for managing his or her PNA account. Banks, however, may charge the resident a fee for handling the account.

(E) Accounting and records.

(1) An ICF-MR provider shall establish and maintain a system that ensures full and complete accounting of each resident’s funds.

(2) An ICF-MR provider shall not combine a resident’s PNA funds with any of the provider’s funds or with the funds of any individual other than another resident of the ICF-MR.

(3) An ICF-MR provider shall furnish a resident with access to petty cash (less than fifty dollars) on an ongoing basis and shall arrange for the resident to access larger funds (fifty dollars or more). The provider shall give the resident a receipt for every transaction.

(4) An ICF-MR provider shall obtain a resident’s signature upon receipt by the resident of money from their PNA account. If the resident is unable to sign his or her name, he or she shall acknowledge receipt of the money by marking an “X.” Two persons shall verify through signature that they have witnessed the resident’s action. PNA funds shall not be withdrawn or utilized by the provider for any purpose other than that requested by the resident to whom the fund belongs.

(5) An ICF-MR provider shall maintain a detailed ledger account of revenue and expenses for each PNA account managed by the facility. The ledger account shall meet all of the following criteria:

(a) Specify all funds received by or deposited with the ICF-MR provider. For PNA account funds deposited in banks, monies shall be credited to the resident’s bank account within three business days; and

(b) Specify the dates and reasons for all expenditures; and

(c) Specify at all times the balance due the resident, including interest earned as last reported by the bank to the provider; and

(d) Be available to the resident or the resident’s representative for review.

(6) Upon request, an ICF-MR provider shall furnish receipts to a resident or the resident’s representative for purchases made with the resident’s PNA funds.

(7) Within thirty days after the end of the quarter, an ICF-MR provider shall furnish a written quarterly statement to each resident or resident’s representative of all financial transactions made by the provider on the resident’s behalf.

(F) Notification of certain balances and transactions that may affect medicaid eligiblity.

(1) Notice to resident.

(a) An ICF-MR provider shall give written notification to each resident who receives medicaid benefits and whose personal funds are managed by the provider when the amount in the resident’s PNA account reaches two hundred dollars less than the resource limits set forth in rules 5101:1-39-05 and 5101:1-39- 01.1 of the Administrative Code.

(b) The notice shall inform the resident that they may lose medicaid eligibility if the amount in their PNA account, in addition to the value of their other nonexempt resources, reaches their resource limit amount.

(2) Notice to the county department of job and family services (CDJFS).

An ICF-MR provider shall report to the CDJFS any PNA account balance in excess of the resource limit. The CDJFS shall apply the excess amount to the routine cost of the resident’s ICF-MR care according to rule 5101:1-38-20 of the Administrative Code.

(3) If a resident is considering using PNA funds to purchase life insurance, grave space, a burial account, or other item that may be considered a countable resource, the ICF-MR provider shall refer the resident or the resident’s representative to the CDJFS for an explanation of the effect the purchase may have on the resident’s medicaid eligibility.

(G) Release of funds upon discharge.

Upon discharge of a resident, an ICF-MR provider shall release all the resident’s PNA account funds, up to and including the resource limit amount.

(H) Conveyance of funds upon death for an ICF-MR provider licensed by ODH.

(1) First thirty days.

An ICF-MR provider shall not retain the money in a resident’s PNA account beyond thirty days following the resident’s death if letters testamentary or letters of administration are issued, or an application for release from administration is filed under section 2113.03 of the Revised Code concerning the resident’s estate within that thirty-day period. In these circumstances, the provider shall transfer the funds in the resident’s PNA account and a final accounting of those funds to the administrator, executor, commissioner, or person who filed the application for release from administration. If these conditions for release are not met, the provider shall follow paragraph (H)(2) or (H)(3) of this rule.

(2) First sixty days.

If, within sixty days after a resident’s death, letters testamentary or letters of administration are issued, or an application for release from administration is filed under section 2113.03 of the Revised Code concerning the resident’s estate, the provider shall transfer the resident’s PNA account funds and a final accounting of those funds to the administrator, executor, commissioner, or person who filed the application for release from administration.

(3) After sixty days.

(a) If, within sixty days after a resident’s death, letters testamentary or letters of administration concerning the resident’s estate are not issued, or an application for release from administration is not filed under section 2113.03 of the Revised Code concerning the resident’s estate, and if the resident was a recipient of medicaid benefits, the provider shall transfer all the resident’s PNA account funds to ODJFS no earlier than sixty and no later than ninety days after the resident’s death, with the exception listed in paragraph (H)(3)(c) of this rule.

(b) PNA account funds transferred to ODJFS shall be paid by check or money order made payable to “Attorney General of Ohio” and shall be accompanied by a completed JFS 09405 (rev. 7/2005) entitled “Personal Needs Allowance Account Remittance Notice.” The payment and completed JFS 09405 shall be mailed to the Ohio attorney general’s office.

(c) If funeral or burial expenses for a deceased resident have not been paid and the only resource left to pay those expenses are the resident’s PNA account funds, or all other resources of the resident are inadequate to pay the full amount, the resident’s PNA account funds shall be used to pay the expenses.

(d) If, sixty-one or more days after a resident dies, letters testamentary or letters of administration are issued, or an application for release from administration under section 2113.03 of the Revised Code is filed concerning the resident’s estate, ODJFS shall transfer all the resident’s PNA account funds received by the department to the administrator, executor, commissioner, or person who filed the application for release from administration, unless ODJFS is entitled to recover the money under section 5111.11 of the Revised Code.

(4) Developmental centers.

For an ICF-MR provider operating as an Ohio department of mental retardation and development disabilities (ODMRDD) developmental center, conveyance upon death requirements shall be in accordance with section 5123.28 of the Revised Code.

(5) Residential facilities.

For an ICF-MR provider licensed to operate a residential facility, conveyance upon death requirements shall be in accordance with rule 5123:2-3-14 of the Administrative Code.

(I) Financial security.

An ICF-MR provider licensed by ODH shall purchase a surety bond or provide other necessary assurances to the director of ODJFS to ensure the security of all resident funds deposited with and managed by the provider.

(1) Surety bond.

(a) A surety bond shall be executed by a licensed surety company pursuant to Chapters 1301., 1341., and 3929. of the Revised Code.

(b) At a minimum, surety bond coverage shall protect at all times the full amount of resident funds deposited with the ICF-MR provider, including interest earned and refundable deposit fees.

(c) The surety bond shall provide for repayment of funds lost due to any failure of the ICF-MR provider, whether by commission, bankruptcy, omission, or otherwise, to hold, safeguard, manage, and account for resident funds.

(d) The surety bond shall designate either the ICF-MR provider, or ODJFS on behalf of the resident, as the obligee.

(e) If an entity purchases a surety bond that covers more than one of its facilities, the surety bond shall protect the full amount of all resident funds on deposit in all the entity’s facilities.

(2) Reasonable alternative to the surety bond.

A reasonable alternative to the surety bond shall provide protection equivalent to that afforded by a surety bond. Neither self insurance nor deposit of funds in bank accounts protected by the federal deposit insurance corporation (FDIC) or a similar entity are acceptable alternatives to a surety bond. An ICF-MR provider electing not to purchase a surety bond shall submit a proposal for an alternative to the ODJFS office of Ohio health plans (OHP) for approval. An acceptable alternative shall meet all of the following criteria:

(a) At a minimum, protect at all times the full amount of resident funds deposited with the ICF-MR provider, including interest earned and refundable deposit fees; and

(b) Designate either ODJFS or the residents of the ICF-MR as the entity or entities that will collect payment for lost funds; and

(c) Guarantee repayment of funds lost due to any failure of the ICF-MR provider, whether by commission, bankruptcy, omission, or otherwise, to hold, safeguard, manage, and account for resident funds; and.

(d) Be managed by a third party unrelated in any other way to the ICF-MR provider or its management; and

(e) Not name the ICF-MR provider as a beneficiary.

(J) Limitations on charges to the PNA account.

(1) An ICF-MR provider shall not charge a resident’s PNA account for items and services that the provider is required to furnish in order to participate in the medicaid program, and that are included in medicaid payments made to the provider.

(2) An ICF-MR provider shall inform each medicaid eligible resident of the medicaid program’s coverage and limitations.

(K) Items and services covered by medicaid.

(1) An ICF-MR provider shall not charge a resident’s PNA account for items and services that the provider is required to furnish in order to participate in the medicaid program.

(2) Items and services that may not be purchased with PNA account funds include, but are not limited to, the following:

(a) Nursing services; and

(b) Dietary services; and

(d) Room and bed maintenance services; and

(e) Routine personal hygiene items and services required to meet the needs of the resident, including but not limited to hair hygiene supplies, comb, brush, bath soap, disinfecting soap or specialized cleansing agents when indicated to treat special skin problems or to fight infection, razor, shaving cream, toothbrush, toothpaste, denture adhesive, denture cleaner, dental floss, moisturizing lotion, tissues, cotton balls, deodorant, incontinence care supplies, sanitary napkins and related supplies, towels, washcloths, hospital gowns, over the counter drugs, hair and nail hygiene services, bathing, and basic personal laundry; and

(f) Medically related social services; and

(g) Medical supplies such as irrigation trays, catheters, drainage bags, syringes, and needles; and

(h) Durable medical equipment; and

(i) Air conditioners or charges to resident for the use of electricity; and

(j) Therapy or podiatry services; and

(k) Charges for telephone consultation by physicians or other personnel.

(L) Resident requests for items and services.

(1) A resident’s PNA account funds may be used to purchase only those items and services requested by the resident, even if the items or services are requested by a physician.

(2) When a resident requests an item or service for which a charge to the resident’s PNA account will be made, the ICF-MR provider shall inform the resident that there will be a charge and the amount of the charge.

(3) An ICF-MR provider shall not require a resident to request an item or service as a condition for admission to or continued stay in the ICF-MR.

(M) Items and services that may be charged to the PNA account.

(1) An ICF-MR provider shall accept medicaid payment as payment in full for items and services that are covered by the medicaid program. If a resident clearly expresses a desire for a particular brand or item not available from the ICF-MR provider, the resident’s PNA funds may be used as long as a comparable item of reasonable quality is available from the provider at no charge. The ICF-MR provider may charge the resident only the difference in cost between the available item and the resident’s preferred item.

(2) Items and services that may be charged to a resident’s PNA account include, but are not limited to, the following:

(a) Telephone; and

(b) Television or radio for personal use; and

(d) Cosmetics and grooming items and services in excess of those for which payment is made under the medicaid program; and

(e) Personal reading material; and

(f) Stationary or stamps; and

(g) Personal clothing; and

(h) Specialty laundry services such as dry cleaning, mending, or hand-washing; and

(i) Flowers or plants; and

(j) Gifts purchased on behalf of a resident; and

(k) Non-covered special care services such as privately hired nurses or nurse aides; and

(l) Social events or entertainment offered outside the scope of the facility’s activities program; and

(m) Private rooms, except when therapeutically required for infection control or similar reasons; and

(n) Specially prepared or alternative food instead of food generally prepared by the facility; and

(o) Burial plots.

(N) Monitoring.

The CDJFS is responsible for monitoring PNA accounts. At least once a quarter, a designated CDJFS employee shall determine if an ICF-MR provider is following the provisions of this rule, and shall report any questions concerning inappropriate use or inadequate record keeping of PNA funds to ODJFS and to ODH for further action. Inappropriate use of PNA account funds by a payee or an ICF-MR provider does not, however, reduce the scope or duration of medicaid benefits for a medicaid recipient.

Replaces: 5101:3-3-93

Effective: 09/15/2007

R.C. 119.032 review dates: 09/01/2012

Promulgated Under: 119.03

Statutory Authority: 5111.02

Rule Amplifies: 3721.15, 5111.11, 5111.12

Prior Effective Dates: 7/1/80, 7/1/88 (Emer), 9/25/88, 10/10/90 (Emer), 12/31/90, 1/1/95, 7/1/02