Rhode Island Code of Regulations › Title 210 - Executive Office of Health and Human Services › Chapter 50 - Medicaid Long-Term Services and Supports › Subchapter 00 - Long-Term Services › Part 8 - Post-Eligibility Treatment of Income (PETI) › Section 210-RICR-50-00-8.4 - Definitions

Current through June 14, 2024
A. For the purposes of this section, the
				  following definitions apply:
1. "Authorized
				  representative" means a person whom the applicant or beneficiary has designated
				  to act on his or her behalf on matters related to LTSS Medicaid.
2. "Beneficiary liability" means the LTSS
				  beneficiary's financial obligation toward the Medicaid LTSS cost of care, as
				  determined monthly.
3. "Community
				  spouse housing allowance" means the monthly housing allowance set by the
				  Federal government each year as the minimum amount that must be protected to
				  cover the non-LTSS spouse's shelter expenses for his or her principal place of
				  residence.
4. "Family allowance"
				  means a deduction in the computation of a beneficiary's liability for the needs
				  of dependent family members who are residing with the non-LTSS spouse or
				  guardian.
5. "Family maintenance of
				  needs allowance" means a deduction in the computation of beneficiary liability
				  for the needs of dependent family members when there is no non-LTSS spouse and
				  the dependent resided with the LTSS beneficiary immediately preceding the
				  admission to a health care institution or LTSS community residence or is
				  residing with the LTSS beneficiary at home.
6. "Family member" means a natural, adoptive,
				  step-child, parent, or sibling of the LTSS beneficiary who is under age
				  nineteen (19) and is claimed as a dependent by the LTSS beneficiary, non-LTSS
				  spouse, or the couple for the most recent Federal tax year, or, if a tax return
				  was not filed, could be claimed as a dependent.
7. "Financially responsible relative" means a
				  spouse or, if the person is a minor or older youth with a disability, the
				  person's parent.
8. "HCBS
				  maintenance of needs allowance" means a required deduction in the income of a
				  beneficiary liability to cover the costs of living needs of a Medicaid
				  beneficiary requesting or receiving LTSS in a home or community-based living
				  arrangement.
9. "LTSS beneficiary"
				  means a person who meets all the general, clinical/functional, and financial
				  eligibility requirements for LTSS, or a person receiving Medicaid LTSS of any
				  type regardless of living arrangement. The LTSS beneficiary was previously
				  referred to as the "institutionalized" individual.
10. "Maximum monthly maintenance of need
				  allowance" means the amount established by the Federal government as the
				  maximum amount of income the State must protect to meet the maintenance of
				  needs requirements of beneficiary's spouse living in the community when
				  determining beneficiary liability.
11. "Minimum monthly maintenance of needs
				  allowance" means the amount established by the Federal government as the
				  minimum amount of income that the State must protect to meet the maintenance of
				  needs requirements of beneficiary's spouse living in the community when
				  determining beneficiary liability. Based on one hundred fifty percent (150%) of
				  the FPL for a family of two (2).
12. "Monthly spousal allowance" means the
				  amount of a Medicaid LTSS beneficiary's income that is set aside to meet the
				  monthly maintenance of need expenses of a non-LTSS spouse.
13. "Non-LTSS spouse" means the spouse of an
				  LTSS applicant or beneficiary regardless of LTSS living arrangement. It
				  includes the spouses of anyone requesting or receiving Medicaid LTSS in a
				  health care institution - NF, ICF-ID, or hospital - or in the home and
				  community-based setting. When both spouses in a married couple are seeking or
				  receiving Medicaid LTSS, neither is considered a non-LTSS spouse, irrespective
				  of whether they reside together or separately.
14. "Personal needs allowance" means a
				  required deduction in the computation of beneficiary liability for needs of the
				  LTSS beneficiary and includes the Federally-mandated amount as well as
				  State-only personal needs allowance, paid through the optional State supplement
				  program.
15. "Service plan " means
				  the scope of Medicaid LTSS, including the types of services to be furnished,
				  the amount, frequency and duration of each service and the type of provider to
				  furnish each service.
16. "Standard
				  utility allowance" means an amount that is used in lieu of the actual amount of
				  utility costs. The standard utility allowance is applicable if the non-LTSS
				  spouse is responsible for payment toward the cost of gas, electric, coal, wood,
				  oil, water, sewage, or telephone for the residence and is updated annually, in
				  conjunction with the Supplemental Nutrition Assistance Program (SNAP) in the
				  Rhode Island Department of Human Services' Administrative Code at
				  218-RICR-20-00-1.