B. Patient pay methodology.
1. The income level used for 42 CFR 435.211,
42 CFR 435.217, and 42 CFR 435.230 shall be 300% of the current supplemental
security income (SSI) payment standard for one person.
2. Under the DD Waivers, the coverage groups
authorized under § 1902(a)(10)(A)(ii)(VI) of the Social Security Act shall
be considered as if they were institutionalized for the purpose of applying
institutional deeming rules. All individuals under the waivers shall meet the
financial and nonfinancial Medicaid eligibility criteria and meet the
institutional level-of-care criteria for an ICF/IID. The deeming rules shall be
applied to waiver eligible individuals as if the individuals were residing in
an ICF/IID or would require that level of care.
3. The Commonwealth shall reduce its payment
for home and community-based waiver services provided to an individual who is
eligible for Medicaid services under 42 CFR 435.217 by that amount of the
individual's total income, including amounts disregarded in determining
eligibility, that remains after allowable deductions for personal maintenance
needs, other dependents, and medical needs have been made according to the
guidelines in 42 CFR 435.735 and § 1915(c)(3) of the Social Security Act
as amended by the Consolidated Omnibus Budget Reconciliation Act of 1986 (
42 USC §
1395ww) . DMAS shall reduce its payment for
home and community-based waiver services by the amount that remains after the
deductions listed in this subdivision:
a. For
individuals to whom § 1924(d) of the Social Security Act applies and for
whom the Commonwealth waives the requirement for comparability pursuant to
§ 1902(a)(10)(B), DMAS shall deduct the following in the respective order:
(1) The basic maintenance needs for an
individual under the DD Waivers, which shall be equal to 165% of the SSI
payment for one person. Due to expenses of employment, a working individual
shall have an additional income allowance. For an individual employed 20 hours
or more per week, earned income shall be disregarded up to a maximum of both
earned and unearned income up to 300% of SSI; for an individual employed less
than 20 hours per week, earned income shall be disregarded up to a maximum of
both earned and unearned income up to 200% of SSI. If the individual requires a
guardian or conservator who charges a fee, the fee, not to exceed an amount
greater than 5.0% of the individual's total monthly income, shall be added to
the maintenance needs allowance. However, in no case shall the total amount of
the maintenance needs allowance (basic allowance plus earned income allowance
plus guardianship fees) for the individual exceed 300% of SSI.
(2) For an individual with only a spouse at
home, the community spousal income allowance determined in accordance with
§ 1924(d) of the Social Security Act.
(3) For an individual with a family at home,
an additional amount for the maintenance needs of the family determined in
accordance with § 1924(d) of the Social Security Act.
(4) Amounts for incurred expenses for medical
or remedial care that are not subject to payment by a third party including
Medicare and other health insurance premiums, deductibles, or coinsurance
charges, and necessary medical or remedial care recognized under state law but
not covered under the State Plan for Medical Assistance.
b. For individuals to whom § 1924(d)
does not apply and for whom the Commonwealth waives the requirement for
comparability pursuant to § 1902(a)(10)(B), DMAS shall deduct the
following in the respective order:
(1) The
basic maintenance needs for an individual under the DD Waivers, which is equal
to 165% of the SSI payment for one person. Due to expenses of employment, a
working individual shall have an additional income allowance. For an individual
employed 20 hours or more per week, earned income shall be disregarded up to a
maximum of both earned and unearned income up to 300% of SSI; for an individual
employed less than 20 hours per week, earned income shall be disregarded up to
a maximum of both earned and unearned income up to 200% of SSI. If the
individual requires a guardian or conservator who charges a fee, the fee, not
to exceed an amount greater than 5.0% of the individual's total monthly income,
shall be added to the maintenance needs allowance. However, in no case shall
the total amount of the maintenance needs allowance (basic allowance plus
earned income allowance plus guardianship fees) for the individual exceed 300%
of SSI.
(2) For an individual with
a dependent child, an additional amount for the maintenance needs of the child,
which shall be equal to the Title XIX medically needy income standard based on
the number of dependent children.
(3) Amounts for incurred expenses for medical
or remedial care that are not subject to payment by a third party including
Medicare and other health insurance premiums, deductibles, or coinsurance
charges, and necessary medical or remedial care recognized under state law but
not covered under the State Plan for Medical Assistance.