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A. An open/shut payment can occur only when the applicant resides in an SA facility for some portion of the application processing period, but is discharged prior to disposition of application. To determine open/shut payment(s), apply the appropriate budgeting procedures below.
1. The applicant is admitted after the first day of the month and discharged prior to the end of the month:
NOTE: The applicant's income for the month of entry is not counted if he/she enters the facility after the first day of the month.
a. Determine date of discharge.
b. Determine date of entry (using day 2 through day 31.)
c. Determine number of days for which payment is needed by subtracting date of entry from the date of discharge and adding 1.
d. Determine SA payment.
e. Determine number of days in the month of entry (28, 29, 30, 31).
f. Divide monthly SA payment by the number of days in the month of entry to determine cost of care per diem (Round to nearest hundredth).
g. Multiply cost of care per diem times the actual number of days of care in the month to compute the cost of care.
h. Add personal needs allowance ($46) to the cost of care.
i. Round amount to nearest dollar for open/shut payment amount.
2. Basic Rate Open/Shut Example
Mr. Smith is admitted to the SA facility on January 8. He applied for SA on January 9. Mr. Smith decided he didn’t like the food and left the facility on January 14. He was discharged the same day. Mr. Smith’s application was still pending when he moved out of the SA facility. The application was completed, and it was determined that he met all eligibility criteria. Mr. Smith is eligible for an open/shut payment for January 8 through January 14. The SA facility Basic Rate is $1,182 and personal needs allowance is $46 a month
Date of Discharge |
14 |
Date of Entry |
- 8 |
Number of days for which payment is needed |
6 + 1= 7 |
SA facility Basic Rate |
$1,182.00 |
Number of days in month |
÷ 31 |
Per Diem Rate |
= 38.129 = 38.13 |
Actual number of days of care |
x 7 |
Cost of Care (7 days) |
$ 266.91 |
Personal Needs Allowance |
+ 46.00 |
SA Open/Shut Payment |
$ 312.91 |
SA Open/Shut Payment (Rounded) |
$ 313.00 |
3. SA facility SCU Rate Open/Shut Example
Mr. Bailey is admitted to the SA facility SCU for Alzheimer’s/dementia on January 8. He applied for SA on January 9. Mr. Bailey’s daughter, also the POA, decided to take him to live out of state on January 14. He was discharged the same day. Mr. Bailey’s application was still pending when he moved out of the SA facility. The application was completed, and it was determined that he met all eligibility criteria. Mr. Bailey is eligible for an open/shut payment for January 8 through January 14. The SA facility SCU Rate is $1,515. The personal needs allowance is $46 a month
Date of Discharge |
14 |
Date of Entry |
- 8 |
Number of days for which payment is needed |
6 + 1= 7 |
SA facility SCU Rate |
$1,515.00 |
Number of days in month |
÷ 31 |
Per Diem Rate |
= 48.870 = 48.87 |
Actual number of days of care |
x 7 |
Cost of Care (7 days) |
$ 342.09 |
Personal Needs Allowance |
+ 46.00 |
SCU Open/Shut Payment (Round to the nearest dollar) |
$ 388.09 |
SCU Open/Shut Payment |
$ 388.00 |
4. The applicant is admitted or residing in the SA facility on the first day of the month and is discharged prior to end of the month:
a. Determine SA rate.
b. Subtract total countable monthly income from maximum SA rate.
c. Divide SA portion of cost of care by number of days in month (28, 29, 30, 31).
d. Multiple SA portion of cost of care per diem by date of discharge.
e. Add personal needs allowance ($46.00) to SA portion of cost of care.
f. Round to nearest dollar for open/shut payment.
Example 1: Ms. Ray is admitted to the SA facility on July 1. She applied for SA on July 3. Her total countable monthly income is $678.00. Ms. Ray died on July 13th and was officially discharged the same day. Ms. Ray’s application was still pending at her death. The application was completed and it was determined that she met all eligibility criteria. Ms. Ray is eligible for an open/shut payment for July 1 through July 13. The SA facility Basic rate is $1,182 and personal needs allowance is $46 a month. The budget for this example is calculated below.
SA |
$1,182.00 |
Total Countable monthly income |
- 678.00 |
SA Portion of Cost of Care (Personal Needs not included) |
$ 504.00 |
Number of days in the month |
÷ 31 |
SA Portion of Cost of Care Per Diem Amount |
$16.258 = $16.26 |
Date of Discharge |
x 13 |
SA Portion of Cost of Care (13 days) |
$ 215.80 |
Personal Needs Allowance |
+ 46.00 |
SA Open/Shut Payment (Round to the nearest dollar) |
$ 261.80 |
SA Open/Shut Payment |
$ 262.00 |
Example 2: Mr. Bailey is admitted to the SA facility SCU for Alzheimer’s/dementia on July 1. He applied for SA on July 3. His net countable income is $800.00. Mr. Bailey died on July 13 and was officially discharged the same day. Mr. Bailey’s application was still pending at his death. The application was completed and it was determined that he met all eligibility criteria. Mr. Bailey is eligible for an open/shut payment for July 1 through July 13. The SA facility SCU rate is $1,515 and personal needs allowance is $46 a month. The budget for this example is calculated below.
SA facility SCU Rate |
$1,515.00 |
Total Countable monthly income |
- 800.00 |
SA Portion of Cost of Care (Personal Needs not included) |
$ 715.00 |
Number of days in the month |
÷ 31 |
SA Portion of Cost of Care Per Diem Amount |
$ 23.06 |
Date of Discharge |
x 13 |
SA Portion of Cost of Care (13 days) |
$ 299.78 |
Personal Needs Allowance |
+ 46.00 |
SCU Open/Shut Payment (round to the nearest dollar) |
$ 345.78 |
SCU Open/Shut Payment |
$ 346.00 |
B. Example of a Combination of Partial, Full and Open/Shut Payments:
NOTE: Although the example given is for the SA facility Basic rate, the same
budgeting principles apply to the SA facility SCU rate.
a. Partial Payment: The applicant enters the facility after the first day of the month and remains the rest of the month. Applies for SA.
b. Full Payment: The applicant still resides in the facility for the full following month.
c. Open /Shut Payment: The applicant is in SA facility on the first day of the third month and discharged prior to end of the month while the application is still pending.
Example: Ms. Jackson is admitted to the SA facility on September 10. She applied for SA on September 29th. Ms. Jackson had a stroke and was admitted to a nursing facility on November 3rd. Ms. Jackson’s SA application was still pending upon her transfer to a higher level of care. The application was completed and it was determined that she met all eligibility criteria.
Ms. Jackson’s application was processed as an open/shut case. Ms. Jackson is eligible for a partial payment from September 10 through September 30, a full month payment for October, and an open/shut payment for November 1 through November 3. The SA facility rate is $1,182 and the personal needs allowance is $46 a month. The budgeting for this example is calculated below.
Step 1. September (Partial Payment Month)
Number of days in month of entry: 28, 29, 30, 31 |
30 |
Date of entry - Enter the DAY of entry (from 2 through 31) |
- 10 |
Number of eligible days |
= 20 + 1 = 21 |
Monthly SA facility Basic Rate |
$1,182.00 |
Divided by Number of days in month |
÷ 30 |
Per Diem Rate (Round to the nearest hundredth) |
= $ 39.40 |
Multiplied by number of eligible days |
x 21 |
SA facility Basic rate |
= 827.40 |
Add personal needs allowance |
+ 46.00 |
Total needs (Round to nearest dollar.) |
= 873.40 |
Partial Payment |
$ 873.00 |
Step 2. October (Full payment month)
SA facility Basic Rate |
$1,182.00 |
Personal Needs Allowance |
+ 46.00 |
Maintenance Amount |
$ 1,228.00 |
Applicant's Gross Countable Monthly Income |
$ 720.00 |
General Income Exclusion |
- 20.00 |
Total Countable Monthly Income |
$ 700.00 |
Maintenance Amount |
$ 1,228.00 |
Total Countable Monthly Income |
- 700.00 |
Difference |
$ 528.00 |
SA Payment (Rounded) |
$ 528.00 |
Step 3. November (Open/Shut Payment)
SA facility Basic Rate |
$1,182.00 |
Total Countable monthly income |
- 700.00 |
SA Portion of room and board (Personal Needs not included) |
$482.00 |
Number of days in the month |
÷ 30 |
SA Portion of room and board Per Diem Amount |
$ 16.066 = 16.07 |
Date of Discharge |
x 3 |
SA Portion of room and board (3 days) |
$ 48.21 |
Personal Needs Allowance |
+ 46.00 |
SA Open/Shut Payment |
$ 94.21 |
SA Open/Shut Payment (Rounded ) |
$ 94.00 |
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For questions or clarification on any of the policy contained in these manuals, please contact your local county office.
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