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I. PURPOSE
This Administrative Directive advises social services districts of
a change in methodology necessary to correctly calculate the amount
Medical Assistance (MA) will pay in situations in which the client
liability exceeds the MA rate but is less than the private pay rate
for a hospitalization.
A budgeting methodology has already been established in situations
in which the client liability exceeds the MA per MA per diem diem rate but is
less than the private pay rate for a hospitalization (Watkins
cases). This methodology, outlined in 80 ADM-73, "Treatment of
Excess Income and Catastrophic Budgeting", is still in effect for
excess income cases, and is restated in this Directive.
The budgeting methodology for cases where payment is based on
Diagnostic Related Groups (DRGs) Diagnostic Related Groups (DRGs) has not previously been
addressed. This Directive also explains budgeting procedures for
these cases.
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