New Hampshire Code of Administrative Rules
He - Department of Health and Human Services
Subtitle He-W - Former Division of Human Services
Chapter He-W 600 - FINANCIAL ASSISTANCE AND ELIGIBILITY FOR MEDICAL CARE
Part He-W 654 - EVALUATION AND TREATMENT OF INCOME
Section He-W 654.17 - Post-Eligibility Computation of Cost of Care for Nursing Facility Care
Universal Citation: NH Admin Rules He-W 654.17
Current through Register No. 40, October 3, 2024
(a) The amount of income that an individual residing in a nursing facility is liable to contribute toward the cost of his or her nursing facility care shall be computed as follows:
(1) The amount of the applicant or
recipient's gross earned income as defined in He-W 601.81 shall be
determined;
(2) The employment
expense disregard, as specified in
He-W
654.18, shall be subtracted from the individual's
gross earned income to obtain the individual's net earned income;
(3) The total amount of the individual's
unearned income, as defined in He-W 601.176, shall be added to the net earned
income to determine the individual's net income;
(4) The allowable deductions, as defined in
He-W
654.20 and
He-W
654.21, shall be subtracted from the individual's net
income;
(5) The veterans affairs
nursing facility pension, as defined in
38 U.S.C.
5503, if received, or the personal needs
allowance, as defined in (b) below, shall be subtracted from the amount in (4)
above;
(6) The amount of income to
be allocated to a spouse or dependents, as defined in
He-W
654.21, shall be subtracted from the amount in (5)
above;
(7) The cost of the
following medical expenses incurred by the recipient shall be subtracted from
the amount in (6) above:
a. Health insurance
premiums, including Medicare Part B, coinsurance payments, and
deductibles;
b. Necessary and
remedial care that would be covered by medical assistance except that allowable
payment limits have been exceeded;
c. Necessary and remedial care that is
recognized by state law, but not covered by medical assistance; and
d. Currently obligated, unpaid prior medical
debt;
(8) The amount of
any continuing SSI benefits, under
42 USC
1382(e) , shall be
subtracted from the amount in (7) above;
(9) If a physician has verified the stay in
the nursing facility is to be 3 months or less and the individual is expected
to return home, an amount equal to the FANF shelter payment allowance, as
defined in He-W 658.02, shall be subtracted
from the amount in (8) above;
(10)
The veterans affairs aid and attendance allowance shall be added to the amount
in (8) or (9) above as required by
42 CFR
435.733(c) ; and
(11) The result in (10) above shall be the
amount of income for which the individual is liable to remit to the nursing
facility as payment toward the cost of his or her nursing facility
care.
(b) The personal needs allowance (PNA) shall be equal to the minimum amount mandated by RSA 167:27-a,I and, pursuant to RSA 167:27-a,II, updated every 5 years by:
(1) Multiplying the current year's PNA by the
sum of the previous 5 years' cost of living adjustments as described in
20 CFR
416.405;
(2) Rounding up the product derived in (b)
(1) above to the next whole dollar; and
(3) Adding the rounded up product in (b) (2)
above to the current year's PNA.
(c) For all individuals applying for nursing facility care:
(1) Only the following
currently obligated, unpaid prior medical debts shall be allowed:
a. Non-nursing facility-related medical
expenses; and
b. Nursing facility
expenses at the Medicaid provider payment rate for the facility.
(2) Nursing facility expenses
incurred during any penalty period pursuant to He-W 601.1212, or period of
ineligibility pursuant to He-W 601.122, except as noted in (c) (3) below, shall
not be considered an allowable medical debt pursuant to (a) (7) (d) above;
and
(3) Nursing facility expenses
incurred during a period of ineligibility due to excess resources or receipt of
a lump sum shall be considered an allowable medical expense pursuant to (a) (7)
d. above, and in accordance with (c) (1) b. above.
(See Revision Note at Chapter Heading He-W 600) #5171, eff 6-26-91; ss by #6531, INTERIM, eff 6-27-97, EXPIRED: 10-25-97; ss by #6614, eff 10-24-97; ss by #7118, eff 10-16-99; ss by #7342, eff 10-1-00; amd by #8408, eff 9-1-05; amd by #8451, eff 11-1-05; ss by #9276, eff 1-1-08; amd by #9789, eff 10-1-10
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