Clearing up Patient Liability reporting

• • Do you serve individuals eligible for Patient Liability?
  • Are you reporting it to DODD correctly?
  • Are you getting reimbursed from the individual/family/guardian?

Patient Liability (PL) is defined in Ohio Administrative Code 5160:1-6-07.1 as a person’s “share of cost when the individual is not living in a medical institution.”

PL is determined and calculated by the local county Department of Job and Family Services as part of the Medicaid eligibility determination process. DODD provides a list of people with Patient Liability–and the amounts–to each local County Board of Developmental Disabilities. The County Board should share this information with applicable providers.

The assigned provider collects PL payments from the individual (or the individual’s guardian) and reports it to DODD through the submission of waiver claims in DODD’s Medicaid Billing System (eMBS).

Wonder why you are the provider chosen to be responsible for PL?

Generally, the provider who is authorized for the majority of waiver services in the Payment Authorization for Waiver Services (PAWS) system is the provider who must collect Patient Liability payments.

This is the only time a person with disabilities or their guardian must pay the provider directly for a portion of the cost of waiver services each month.

Please note that all Patient Liability obligations must be met before any Medicaid funds may be billed. You aren’t just collecting the PL amount; you are charging the individual for the cost of services up to the PL amount. Then you can bill Medicaid-Waiver.

Document in Patient Liability