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RULE §554.405Additional Requirements for Trust Funds in Medicaid-certified Facilities

(a) Deposit of funds. The facility must keep funds received from a resident for holding, safeguarding, and accounting, separate from the facility's funds.

  (1) This separate account must be identified " (Name of Facility), Resident's Trust Fund Account," or by a similar title that shows a fiduciary relationship exists between a resident and the facility.

  (2) A facility may commingle the trust funds of Medicaid residents and private-pay residents.

  (3) If the funds are commingled, the facility must provide, upon request, the following records to HHSC, the Texas Office of the Attorney General Medicaid Fraud Control Unit, and the U.S. Department of Health and Human Services:

    (A) copies of release forms signed and dated by each private-pay resident or resident representative whose funds are commingled; and

    (B) legible copies of the trust fund records of private-pay residents whose funds are commingled.

  (4) The facility must maintain the forms and records described in paragraph (3) of this subsection in the same manner as the financial records of Medicaid residents as specified in this section.

  (5) A facility must ensure that a release form described in paragraph (3)(A) of this subsection:

    (A) includes permission for the facility to maintain trust fund records of private-pay residents in the same manner as those of Medicaid residents;

    (B) is obtained from a private-pay resident upon admission or at the time of request for trust fund services; and

    (C) includes a provision allowing inspection of the private-pay resident's trust fund records by the agencies described in paragraph (3) of this subsection.

(b) Funds in excess of $50. The facility must deposit any residents' personal funds in excess of $50 in an interest-bearing account (or accounts) that is separate from any of the facility's operating accounts, and that credits all interest earned on the residents' funds to that account. In pooled accounts, there must be a separate accounting for each resident's share.

(c) Funds less than $50. The facility may maintain a resident's personal funds that do not exceed $50 in a noninterest-bearing account, interest-bearing account, or petty cash fund.

(d) Accounting and records.

  (1) The facility must:

    (A) establish and maintain current, written, individual records of all financial transactions involving a resident's personal funds that the facility is holding, safeguarding, and accounting;

    (B) keep these records in accordance with:

      (i) the American Institute of Certified Public Accountants' Generally Accepted Accounting Principles; and

      (ii) the requirements of law for a fiduciary relationship; and

    (C) include at least the following in these records:

      (i) resident's name;

      (ii) identification of the resident's representative payee and resident representative, and payor source;

      (iii) valid letter of guardianship, if any;

      (iv) valid power of attorney, if any;

      (v) resident's admission and discharge dates;

      (vi) resident's trust fund ledger containing the following:

        (I) description of each transaction;

        (II) the date and amount of each deposit and withdrawal;

        (III) the name of the person who accepted any withdrawn funds;

        (IV) the balance after each transaction; and

        (V) amount of interest earned, posted at least quarterly;

      (vii) receipts for purchases and payments, including cash-register tapes or sales statements from a seller;

      (viii) written requests for personal funds from the trust fund account; and

      (ix) written requests for specific brands, items, or services.

  (2) The facility must maintain the following as general trust fund records:

    (A) valid trust fund trial balance;

    (B) petty cash logs;

    (C) bank statements for trust fund and operating accounts;

    (D) trust fund checkbook and register;

    (E) trust fund account monthly reconciliations;

    (F) trust fund bank account agreement form;

    (G) applied income ledgers;

    (H) applied income payment plans from HHSC;

    (I) proof of surety bond;

    (J) written agreements (e.g., bed hold, private room); and

    (K) facility census, admission, discharge, and leave records.

  (3) A resident must approve a withdrawal from the resident's personal funds by signing a document that shows the resident's approval and the date of the approval.

  (4) Except as provided in subparagraph (B) of this paragraph, a facility must obtain a receipt for the purchase of an item or service.

    (A) The receipt must contain:

      (i) the resident's name;

      (ii) the date the receipt was written or created;

      (iii) the amount of funds spent;

      (iv) the specific item or service purchased;

      (v) the name of the business from which the purchase was made; and

      (vi) the signature of the resident.

    (B) A receipt is not required if:

      (i) a purchase is made with funds withdrawn in accordance with paragraph (3) of this subsection;

      (ii) a purchase is made by the resident, a resident representative, or an individual, other than facility personnel, authorized in writing by the resident; or

      (iii) the item purchased costs one dollar or less.

  (5) If a facility cannot obtain the signature of a resident as required by paragraph (3) or (4)(A)(vi) of this subsection, the facility must obtain the signature of a witness. The witness may not be the person responsible for accounting for the resident's trust funds, that person's supervisor, or the person who accepts the withdrawn funds or who sells the item being purchased. The facility and HHSC staff must be able to identify the witness's name, address, and relationship to the resident or facility.

(e) Notice of certain balances. The facility must notify each resident that receives Medicaid benefits:

  (1) if the amount in the resident's account reaches $200 less than SSI resource limit for one person, specified in §1611(a)(3)(B) of the Social Security Act; and

  (2) that, if the amount in the account, in addition to the value of the resident's other nonexempt resources, reaches the SSI resource limit for one person, the resident may lose eligibility for Medicaid or SSI.

(f) Conveyance upon death.

  (1) Upon the death of a resident with a personal fund deposited with the facility, the facility must convey, within 30 days after the date of the death, the resident's funds and a final accounting of those funds to the individual or probate jurisdiction administering the resident's estate, or make a bona fide effort to locate the resident representative or heir to the estate.

  (2) If a facility is not able to convey funds in accordance with paragraph (1) of this subsection, the facility must, within 30 days after the resident's death;

    (A) hold the funds by depositing them in a separate account or maintaining them in an existing account, designating on the account records that the resident is deceased; or

    (B) submit funds to HHSC in accordance with paragraph (4) of this subsection.

  (3) If the facility holds funds in accordance with paragraph (2)(A) of this subsection:

    (A) the facility must provide HHSC with a notarized affidavit that contains:

      (i) the resident's name;

      (ii) the amount of funds being held;

      (iii) a description of the facility's efforts to locate a resident representative or heir;

      (iv) a statement acknowledging that the funds are not the property of the facility, but the property of the deceased resident's estate; and

      (v) a statement that the facility will hold the funds until they are conveyed to a resident representative or heir or submitted to HHSC in accordance with paragraph (4) of this subsection;

    (B) the facility must submit the funds to HHSC in accordance with paragraph (4) of this subsection within 180 days after the resident's death; and

    (C) funds held by a facility in accordance with this paragraph may be monitored or reviewed by HHSC or the Office of Inspector General.

  (4) A facility must submit unclaimed funds to HHSC, Accounts Receivable.

    (A) The funds must be identified as money that will escheat to the state.

    (B) If the facility held the funds in accordance with paragraph (3) of this subsection, the facility must include the notarized affidavit described in paragraph (3)(A) of this subsection.

(g) Assurance of financial security. The facility must purchase a surety bond, or otherwise provide assurance satisfactory to the Secretary of Health and Human Services to ensure the security of all personal funds of residents deposited with the facility.

  (1) The amount of a surety bond must equal the average monthly balance of all the facility's resident trust fund accounts for the 12-month period preceding the bond issuance or renewal date.

  (2) Resident trust fund accounts are specific only to the single facility purchasing a resident trust fund surety bond.

  (3) If a facility employee is responsible for the loss of funds in a resident's trust fund account, the resident, the resident's family, and the resident representative are not obligated to make any payments to the facility that would have been made out of the trust fund had the loss not occurred.

(h) Items and services that may not be charged to a resident's personal funds.

  (1) The facility may not impose a charge against the personal funds of a resident for any item or service for which payment is made under Medicaid or Medicare.

  (2) Items or services included in Medicare or Medicaid payment that may not be billed to the resident's personal funds by the facility include:

    (A) nursing services as required in §19.1001 of this chapter (relating to Nursing Services);

    (B) dietary services as required in §19.1101 of this chapter (relating to Food and Nutrition Services);

    (C) an activities program as required in §19.702 of this chapter (relating to Activities);

    (D) room and bed maintenance services;

    (E) routine personal hygiene items and services as required to meet the needs of the resident, including:

      (i) hair hygiene supplies, including shampoo, comb, and brush;

      (ii) bath soaps, disinfecting soaps, or specialized cleansing agents when indicated to treat special skin problems or to fight infection;

      (iii) razor and shaving cream;

      (iv) toothbrush, toothpaste, and dental floss;

      (v) denture adhesive and denture cleanser;

      (vi) moisturizing lotion;

      (vii) tissues, cotton balls, and cotton swabs;

      (viii) deodorant;

      (ix) incontinent care and supplies, to include, cloth or disposable incontinent briefs;

      (x) sanitary napkins and related supplies;

      (xi) towels and washcloths;

      (xii) hospital gowns;

      (xiii) over-the-counter drugs;

      (xiv) hair and nail hygiene services; and

      (xv) personal laundry; and

    (F) medically-related social services as required in §19.703 of this chapter (relating to Social Services General Requirements).

  (3) A facility must base necessity for and type of incontinent brief described in paragraph (2)(E)(ix) of this subsection on an assessment of the resident's medical and psychosocial condition and resulting determination.

(i) Items and services that may be charged to a resident's personal funds. The facility may charge a resident for requested services that are more expensive than or in excess of covered services in accordance with §19.2601 of this chapter (relating to Vendor Payment (Items and Services Included)). The following list contains general categories and examples of items and services that the facility may charge to a resident's personal funds if they are requested by a resident, if the facility informs the resident that there will be a charge, and if payment is not made by Medicare or Medicaid:

  (1) telephone;

  (2) television or radio for personal use;

  (3) personal comfort items, including smoking materials, notions and novelties, and confections;

  (4) cosmetics and grooming items and services in excess of those for which payment is made under Medicare or Medicaid;

  (5) personal clothing;

  (6) personal reading material;


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