N.C. Medicaid Clinical Coverage Policy No. 3D § 7.3.2.2

The hospice provider shall include the collection of PML in the

contractual agreement. The nursing facility may act as the hospice

provider in collecting the PML if this arrangement is contained in the

contractual agreement.

According to 10A NCAC 23E.0210 the Patient Monthly Liability (PML)

is the amount the beneficiary is responsible for toward their monthly cost

of care. Upon determination of Medicaid eligibility for long term care

services by the county Department of Social Services (DSS), the

Medicaid provider shall receive notification of the applicant or

beneficiary’s PML. The DMA-5016, Notification of Eligibility for

Medicaid/Amount and Effective Date of Patient’s Liability, is used to

notify nursing facility or institution and the state of the amount and any

changes to the PML amount. Nursing facility and hospice providers are

required to retain the DMA-5016 for audit purposes. The dates and the

amounts on the DMA5016 must match the information on the

beneficiary’s eligibility detail in NCTracks.

Note: According to 10A NCAC 23E.0210 PATIENT LIABILITY (d)- The

county department of social services shall notify the client, the institution

and the state of the amount of the monthly liability and any changes or

adjustments.

Hospice agencies verify the PML amounts in NC Tracks prior to billing

for long term care services. Providers may experience discrepancies with

the beneficiary’s current eligibility which prevents them from billing for

long term care services. The discrepancies may include but are not limited

to:

a. No patient monthly liability listed on the beneficiary’s file in

NCTracks

b. No DMA-5016 received by the Hospice provider

c. Dates or amounts listed on the DMA-5016 do not align with the dates

or amounts on the beneficiary’s eligibility detail in NCTracks

Nursing facilities and hospice providers experiencing any discrepancies

must contact the DSS in the beneficiary’s county of residence to have the

information corrected.

Those with questions about PML should contact the N.C. Medicaid

Contact Center at 1-888-245-0179