Nebraska Administrative Code
Topic - HEALTH AND HUMAN SERVICES SYSTEM
Title 469 - ASSISTANCE TO THE AGED, BLIND, OR DISABLED PROGRAM
Chapter 3 - DETERMINATION OF BENEFITS
Section 469-3-003 - INDIVIDUAL REQUIREMENTS INCLUDED IN ASSISTANCE BUDGETS

Universal Citation: 469 NE Admin Rules and Regs ch 3 ยง 003

Current through September 17, 2024

The individual requirements are:

(A) Standard of need;

(B) Shelter up to the maximum; and

(C) Special requirements.

003.01 STANDARD OF NEED. The standard of need is a consolidation of items necessary for basic subsistence with amounts based on unit size. Included in this standard are food, clothing, sundries, home supplies, utilities, laundry, telephone, garbage collection, and recreation. Also included in this standard amount are meals prepared away from home, therapeutic diet, special clothing allowance, meals furnished to a household employee, transportation for shopping, and special taxes or use charge.

003.01(A) ALTERNATE LIVING ARRANGEMENTS. The standard of need for alternate living arrangements is a consolidated allowance for items necessary for basic subsistence. Included in this standard are:
(1) Board;

(2) Room;

(3) Clothing;

(4) Personal needs;

(5) Laundry; and

(6) Transportation.

003.01(A)(i) LICENSING OF FACILITIES. In determining the appropriate standard to be allowed, verify the current licensure or certification of the facility.

003.01(A)(ii) BOARD AND ROOM. Board and room does not include care or supervision and may be with a relative.

003.01(A)(iii) LICENSED BOARDING HOME. Boarding homes provide the following to four or more individuals who are essentially capable of managing their own affairs:
(1) Sleeping and other living accommodations;

(2) A dining room, cafe, or common kitchen; and

(3) Domestic services requested by the individuals which will assist them in daily living activities.

003.01(A)(iv) LICENSED ASSISTED LIVING FACILITY. An Assisted Living facility provides accommodation and board and care, such as personal assistance in feeding, dressing, and other essential daily living activities, for four or more individuals not related to the owner, occupant, manager, or administrator. These individuals are unable to sufficiently or properly care for themselves or manage their own affairs because of illness, disease, injury, deformity, disability, or physical or mental infirmity.

003.01(A)(v) CERTIFIED ADULT FAMILY HOME. An Adult Family Home is a residential living unit which provides full-time residence with minimal supervision and guidance to not more than three individuals age 19 or older. Service includes board and room with meals, standard furnishings, equipment, household supplies, and facilities to ensure recipient comfort. These individuals are essentially capable of managing their own affairs but are in need of supervision. This may include supervision of nutrition by the facility on a regular, continuing basis, but not necessarily on a consecutive 24-hour basis.

003.01(A)(vi) LICENSED GROUP HOME FOR CHILDREN AND CHILD CARING AGENCY. This group care facility provides 24-hour accommodation for minors including care and supervision. The home provides services to two or more individuals who are developmentally disabled.

003.01(A)(vii) LICENSED CENTER FOR THE DEVELOPMENTALLY DISABLED. A center for the developmentally disabled is any facility, place, or building not licensed as a hospital which provides accommodation, board, training, and other services when appropriate, primarily or exclusively, for four or more persons who are developmentally disabled. Staff in a center for the developmentally disabled may assist individuals residing there in taking routine oral or external medication and also provide for storage and handling of the medication.
003.01(A)(vii)(1) CENTER DEFINED. The term "center" includes:
(a) GROUP RESIDENCE. Any group of rooms located within a dwelling and forming a single habitable unit with living, sleeping, cooking, and eating facilities for 4 through 15 developmentally disabled persons.

(b) INSTITUTION FOR THE DEVELOPMENTALLY DISABLED. Any facility other than a skilled nursing facility or an intermediate care facility I or II where 16 or more developmentally disabled persons reside.

003.01(A)(viii) LONG TERM CARE FACILITY. The payment to a long term care facility includes an allowance for personal needs of the recipient which is determined by the licensure or certification of the facility where the recipient resides.

003.01(A)(ix) ASSISTED LIVING WAIVER. The Standard of Need chart explains the standard for an individual receiving Assisted Living Waiver services. The monthly standard includes an allowance for personal needs of the recipient.

003.01(A)(x) LICENSED MENTAL HEALTH CENTER. Mental health center means a facility where shelter, food, counseling, diagnosis, treatment, care, or related services are provided for a period of more than 24 consecutive hours to persons residing at the facility who have a mental disease, disorder, or disability.

003.01(B) ASSISTANCE TO THE AGED, BLIND, OR DISABLED OR STATE DISABILITY PROGRAM STANDARD OF NEED. The standard of need for independent living and shelter costs, or the consolidated standard for alternate living, when Social Security determines that the recipient will continue to receive full Supplemental Security Income payment for up to three months because the individual is likely to return to the previous living arrangement. Follow procedures for allowing shelter and utilities when:
(i) Supplemental Security Income reduces or terminates the payment at the end of the three-month extension;

(ii) Supplemental Security Income determines that the individual does not qualify for the full benefit for the three-month period; or

(iii) The recipient was not receiving Supplemental Security Income before admission to the medical facility.

003.02 SHELTER. The item shelter includes rent and the expenses of home ownership.

003.02(A) MAXIMUM SHELTER ALLOWANCE.
(1) The single shelter amount for one; or

(2) The multiple shelter amount for:
(a) A married couple who are living together;

(b) An Assistance to the Aged, Blind, or Disabled or State Disability Program parent living with a minor child; or

(c) An Assistance to the Aged, Blind or Disabled, or State Disability Program recipient living with other essential persons whose needs are included in the budget.

003.02(A)(i) RENT. The allowance for rent should be sufficient to provide the family with decent quarters comparable to the standard for persons of modest circumstances in the same community.

003.02(A)(ii) HOME OWNERSHIP.
003.02(A)(ii)(1) EXPENSES. Expenses of home ownership may be allowed if the recipient or spouse owns the home in which the individual lives, provided the allowance does not exceed the maximum shelter limit allowed.
(a) If the recipient or spouse has only a life interest in the home, the terms of the conveyance must be examined in determining whether the recipient or the title-holder is responsible for the expenses of home ownership. The case record must contain an explanation if an allowance is included in the budget.

003.02(A)(ii)(2) STANDARDS FOR DETERMINING COSTS. The cost of interest or payments on mortgages or contract purchases, current taxes, and insurance may be allowed in the assistance budget as follows:
(a) Interest and payments on the mortgage or purchase contract on the home may be included in the budget.

(b) Current taxes on the home occupied by the recipient may be allowed on a monthly prorated basis unless the payment of taxes is included in the monthly payment on the mortgage or contract purchase.

(c) If taxes have been allowed in an earlier budget but not paid, they may not be included in the budget again.

(d) The amount of the homeowner's insurance is included in the budget on a prorated or lump sum basis, unless insurance is a part of the payment on the mortgage or purchase contract.

(e) The total cost of home ownership must not exceed the maximum shelter allowance.

003.03 SPECIAL REQUIREMENTS. Special requirements are those items that are essential because of the particular circumstances of an individual's situation.

003.03(A) ITEMS THAT MAY BE ALLOWED AS SPECIAL REQUIREMENTS. The following items may be used as a special requirement:
(i) Transportation;

(ii) Household furniture and appliances;

(iii) Expenses of moving;

(iv) Back taxes;

(v) Subsistence to obtain medical care;

(vi) Maintenance for a service animal;

(vii) Guardian or conservator fee of $10 per month;

(viii) Medical expenses of an essential person;

(ix) Cost of home repair;

(x) Automobile liability insurance;

(xi) Lifelines;

(xii) Vehicle repair;

(xiii) Home modification and assistive technology equipment; and

(xiv) Specialized diet allowance.

003.03(B) ITEMS THAT ARE NOT ALLOWED AS SPECIAL REQUIREMENTS. The following items are not allowed as special requirements:
(i) Personal computers because they are considered a vocational rehabilitation and educational item;

(ii) Smoking cessation programs because there are no national standards or official oversight of these programs. Guaranteed one time, long term smoking cessation success is not demonstrated by current programs;

(iii) Health club memberships and exercise or fitness equipment because these are related to weight loss and rehabilitation and essential components to assess the success of the individual program and to monitor the recipient's progress are unavailable;

(iv) Weight loss programs because there are no national recommendations and standards for these programs. Safety and efficacy issues are unresolved on the national level with no federal Department of Agriculture or official oversight of this industry. Essential components for individualization for each person's special circumstances are not available;

(v) Lawn care service, snow removal, and the equipment and supplies for them; and

(vi) Medical services and goods which are not covered by Medicaid or State Disability Medical Program because of limits on amount, scope, or duration established by the Department.

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