Resident and/or Sponsor. A Sponsor, usually the Resident’s spouse, as defined in 10 N.Y.C.R.R. §415.2 is “the entity or the person or persons, other than the resident, responsible in whole or in part for the financial support of the Resident, including the costs of care in the Facility.” Accordingly, the Sponsor may be personally responsible for paying for the costs of the Resident’s care in the Facility from his/her own funds. The Resident and/or Sponsor agree to pay, or arrange for payment of, any portion or all of the applicable private pay room and board rate and the ancillary charges incurred for services not covered by third party payors and/or required third party deductibles and/or coinsurance including the monthly income contribution (NAMI) budgeted by the Medicaid program. If the Resident has no third party coverage, or if the Resident remains in the Facility after any such coverage terminates because covered services are deemed no longer “medically necessary” or for any other reason consistent with applicable law, the Resident and/or Sponsor agree to pay or arrange for payment at the private pay rate for room and board and the ancillary charges incurred until discharge or until another source of coverage becomes available. The Resident and/or Sponsor agree to take the necessary steps to ensure that the Facility and its ancillary providers receive payment from all third party payors, including the timely disclosure of available insurance coverage and production of information and documentation needed to meet the eligibility criteria of the Medicaid program (e.g., proof of income, resources, residency, citizenship, and explanation of past financial transactions).
Resident and/or Sponsor. A Sponsor, used herein to refer to the Resident’s spouse, as defined in 10 N.Y.C.R.R. §415.2 is “the entity or the person or persons, other than the resident, responsible in whole or in part forthe financial support of the Resident, including the costs of care in the Facility.” Accordingly, the Sponsor may be personally responsible for paying for the costs of the Resident’s care in the Facility from the funds of the Resident and/or his/her own funds. The Resident and/or Sponsor agree to pay, or arrange for payment of, any portion or all of the applicable private pay room and board rate and the ancillary charges incurred for services not covered by third party payorsand/or required third party deductibles and/or coinsurance including the monthly income contribution (NAMI) budgeted by the Medicaid program. If the Resident has no third-party coverage, or if the Resident remains in the Facility after any such coverage terminates because covered services are deemed no longer “medically necessary” or for any other reason consistent with applicable law, the Resident and/or Sponsor agree to pay or arrange for payment at the private pay rate for room and board and the ancillary charges incurred until discharge or until another source of coverage becomes available. The Resident and/or Sponsor agree to take the necessary steps to ensure that the Facility and its ancillary providers receive payment from all third-party payors, including the timely disclosure of available insurance coverage, timely appeal of insurance coverage denials, and production of information and documentation needed to meet the eligibility criteria of the Medicaid program (e.g., proof of income, resources, residency, citizenship, and explanation of past financial transactions).
