Section 197-11-09 - CONSUMER PAYMENTS (MAJOR SUBSTANTIVE RULE)(A)Consumer Payments. The authorized agency will use a Department of Health and Human Services approved form to determine income and liquid assets and calculate the monthly payment to be made by the consumer. The agency may require the consumer and his or her spouse to produce documentation of income and liquid assets. A consumer need not complete a financial assessment if he or she pays the full cost of services received. His or her payments, as determined by an annual financial assessment may not exceed the total cost of services provided.(B) Definitions. The following definitions apply to this Section. (1)Dependent Allowances. Dependents and dependent allowances are defined and determined in agreement with the method used in the MaineCare program. The allowances are changed periodically and cited in the MaineCare Eligibility Manual, Chart II, AFDC Related Income Limits. Dependents are defined as individuals who may be claimed for tax purposes under the Internal Revenue Code and may include a minor or dependent child, dependent parents, or dependent siblings of the consumer or consumer's spouse. A spouse may not be included.(2)Disability-related expenses: Disability-related expenses are out-of-pocket costs incurred by the consumer's for their disability, which are not reimbursed by any third-party sources. They include: (a)Home access modifications: ramps, tub/shower modifications and accessories, power door openers, shower seat/chair, grab bars, door widening, environmental controls;(b)Communication devices: adaptations to computers, speaker telephone, TTY, Personal Emergency Response Systems;(c)Wheelchair (manual or power) accessories: lab tray, seats and back supports;(d)Vehicle adaptations: adapted carrier and loading devices, one communication device for emergencies (limited to purchase and installation), adapted equipment for driving;(e)Hearing Aids, glasses, adapted visual aids;(f)Assistive animals (purchase only);(g)Physician ordered medical services and supplies;(h)Physician-ordered prescription and over the counter drugs; (i)Medical insurance premiums, co-pays and deductibles-.; and(j)Unemployment and workers compensation expenses related to employing the PA.(3)Household members: means the consumer and the spouse.(4)Household members income includes:(a) Wages from work, excluding state and Federal taxes and employer mandated or court ordered withholdings of the consumer and the spouse;(b) Benefits from Social Security, Supplemental Security Income, pensions, insurance, independent retirement plans, annuities, and Aid and Attendance;(c) Adjusted gross income from property and/or business, based on the consumer's most recent Federal income tax;(d) Interest and dividends.(e) Regularly occurring payments received from a home equity conversion mortgage. Not included are benefits from: the Home Energy Assistance Program, Food Stamps, General Assistance, Property Tax and Rent Refund, emergency assistance programs, or their successors.
(5)A liquid asset is something of value available to the consumer that can be converted to cash in three months or less and includes: (b) Certificates of deposit(c) Money market and mutual funds;(d) Life insurance policies;(f) Lump sum payments and inheritances; and(g) Funds from a home equity conversion mortgage that are in the consumer's possession whether they are cash or have been converted to another form. Funds which are available to the consumer but which carry a penalty for early withdrawal will be counted minus the penalty. Exempt from this category are mortuary trusts and lump sum payments received from insurance settlements or annuities or other such assets named specifically to provide income as a replacement for earned income. The income from these payments will be counted as income.
(C)Consumer Payment Formula. The Authorized Agent will use the following formula to determine the amount of each consumer's payment. Step (1) Calculate the Monthly Contribution from the Household Income
(a) Total the monthly income of household members.(b) Deduct monthly allowable disability related expenses.(c) Deduct monthly allowable dependent allowances.(d) Multiply the net income by 4%. Step (2) - Calculate the Monthly Contribution from Liquid Assets.
(a) Total the liquid assets of household members.(b) Deduct annual interest and annual dividends counted toward income for the household.(c) Subtract $30,000 from the amount of liquid assets calculated in Step (2)(a&b).(d) Multiply the sum calculated in Step (2)(c) by 3%. The result is the Monthly Contribution from Liquid Assets. If the result is less than zero use zero. Step (3) - Add the result of the calculation in Step (1)(d), to the result of the calculation in Step (2)(d).
Step (4) - The consumer's monthly payment is the lesser of the sum calculated in Step (3) or the actual cost of services provided during the month.
Step (5) - When two persons in a household are both receiving home based care services under this program, collect the required information for each person. Calculate the co-pay for each consumer and combine the total. Divide the amount by two to determine the household monthly co-payment.
(D)Waiver of Consumer Payment. consumer's will be informed that they may apply for a waiver of all or part of the assessed payment when:(1) Monthly income of household members is no more than 200% of the federal poverty level; and(2) Assets are less than $30,000 for the household.14- 197 C.M.R. ch. 11, § 09