Commonwealth of Massachusetts
Executive Office of Health and Human Services
Office of Medicaid
600 Washington Street
Boston, MA  02111
www.mass.gov/masshealth
	

							MassHealth
							Long Term Care Facility Bulletin 91
							April 2006



TO:	Nursing Facilities, Chronic Disease and Rehabilitation Inpatient Hospitals, and Psychiatric Inpatient Hospitals Participating in MassHealth

FROM:	Beth Waldman, Medicaid Director  

RE:	Annual Accounting for Personal Needs Allowance Funds


Background	

MassHealth regulations at 130 CMR 456.615 require that long-term-care facilities make an accounting of the balances of the personal needs allowance (PNA) funds for each MassHealth member for whom the facility handles funds.  
	

May 31, 2006, Deadline for PNA-1 Submissions

To comply with these regulations, long-term-care facilities must use the PNA-1.  This form must be dated and signed by the facility’s administrator and sent to the following address by May 31, 2006.
	
Financial Compliance Unit
529 Main Street, 3rd Floor
Charlestown, MA  02129

On the PNA-1, state the PNA balance total for each MassHealth member as of March 31, 2006.  Attach to the PNA-1 a copy of the bank statement(s) and reconciliation(s) of the aggregate trustee bank account(s) as of March 31, 2006, and submit these documents to the above address.

Providers may use their own reconciliation form or may use the reconciliation form (PNA-2) attached to this bulletin. This form is available online on the MassHealth Web site at www.mass.gov/masshealthpubs. Click on “Provider Library” then on “MassHealth Provider Forms.”  Please Note:  The reconciled bank balance must agree with the Total PNA Balance on the PNA-1 form.
										
(continued on next page)


      						MassHealth
							Long Term Care Facility Bulletin 91
							April 2006
							Page 2



	

May 31, 2006, Deadline for PNA-1 Submissions (cont.)

Providers using Microsoft Excel or Access to maintain listings of patient balances may submit the files on a 3˝” floppy disk or CD.  It is suggested that these disks be enclosed in a disk-mailer envelope.  Attach the disk or CD to the PNA-1 form and indicate the list as an attachment on the PNA1.  The PNA-1 form can be downloaded from the MassHealth Web site at www.mass.gov/masshealthpubs.  
If the facility does not handle PNA funds for any members, the facility must state this on the PNA-1.  The form must then be dated and signed by the facility administrator, and sent to the address listed on the front of this bulletin.

If a facility does not submit the PNA-1 by May 31, 2006, or if the form is incomplete, the facility may be subject to administrative sanction.

A copy of the PNA-1 and the PNA-2 are enclosed with this bulletin.  These forms may be photocopied as needed.
	

Questions	

If you have any questions about the information in this bulletin, call the MassHealth Financial Compliance Unit at 617-886-8087.





Statement of Members' Personal Needs Accounts 

Commonwealth of Massachusetts • 
Executive Office of Health and Human Services • 
Office of Medicaid 

Name of Facility:  
Provider Number:  
Address:
Business Phone:  
City/Town:
State:  
Zip:
Business Fax:  

I hereby certify under penalty of perjury that the information in this report and any attachments is true and correct to the best of my knowledge and belief. 

Prepared by (please print) 
Signature 
Date 

Administrator (please print) 
Signature 
Date 

Please check here if you do not maintain PNA accounts for MassHealth residents.


THE FOLLOWING INFORMATION IS REQUIRED IN ADDITION TO A COMPLETED PNA-1. 
Please submit the patient balances in one of the following formats. 
(Circle your choice.) 
1. 31/2" Disk 
2. CD 
3. Electronic Printout (Excel, Access) 
4. Handwritten on the enclosed PNA-2 form 


1. A listing of all MassHealth members whose PNA funds are managed by the facility 
This must include: 
Member name (first and last) 
Social security number 
Account balance as of March 31, 2006 
Bank book number or aggregate trustee bank account 
number 

2. A COPY of the aggregate trustee bank statement or individual member account statements as of March 31, 2006 

3. An account reconciliation. If individual accounts are held for members, an account reconciliation is not necessary. 


COMPLETE THIS SECTION 
Total number of MassHealth members listed 
List should NOT include private patients. 

Total PNA balance of MassHealth members
Total PNA balance should equal the reconciled bank balance.
$

Date of PNA Balance:
Date of Bank Statement:
Name of Bank(s) 



Return to: Financial Compliance Unit • 529 Main Street, 3 rd Floor • Charlestown, MA 02129 

PNA-1 (Rev. 03/06) 


Bank Reconciliation for Members' Personal Needs Accounts as of March 31, 2006  

BALANCE PER BANK AS OF MARCH 31, 2006 $ 


ADD DEPOSITS IN TRANSIT  
Date:			  Amount:  




    TOTAL DEPOSITS IN TRANSIT $ 


DEDUCT OUTSTANDING CHECKS  
Date:  	Check Number:  	Amount:  	Date:  	Check Number:  	Amount:  




	TOTAL OUTSTANDING CHECKS $ 


ADD/DEDUCT OTHER RECONCILING ITEMS  
Description:		  		Amount:  

Please indicate any funds that are held in the listed bank account(s) other than those for MassHealth members. For example, if any money is held for private patients, please indicate this amount, as well as any cash on hand, interest, service charges, etc. that may affect the account balance. The reconciled bank balance should equal the total PNA balance as stated on PNA-1.  


	TOTAL OTHER RECONCILING ITEMS $

	ENDING BALANCE $

The reconciled bank balance should equal the total PNA balance as stated on the PNA-1. 

Return to: Financial Compliance Unit • 529 Main Street, 3 rd Floor • Charlestown, MA 02129
 
PNA-2 (Rev. 03/06) 



Listing of Members' Personal Needs Accounts as of March 31, 2006  

MassHealth Member's Name:	  



Social Security Number:	  



PNA Balance:  



Bank Book No. and/or Aggregate Trustee Bank Account No.  



Total This Page  

Return To: Financial Compliance Unit • 529 Main Street, 3rd Floor • Charlestown, MA 02129