N.H. Admin. Code § He-W 854.17

Current through Register No. 50, December 12, 2024

Section He-W 854.17 - Post-Eligibility Computation of Cost of Care for Nursing Facility Care

(a) The amount of income that an eligible 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 601.04(m) 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 601.08(k) , shall be added to the net earned income to determine the individual's net income;

(4) The allowable deductions, as defined in He-W 854.20 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 described 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 described 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 described 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 601.06(h) , or period of ineligibility pursuant to He-W 601.06(i) , 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.

N.H. Admin. Code § He-W 854.17

Derived From Volume XXXVI Number 10, Filed March 10, 2016, Proposed by #11042, Effective 2/24/2016, Expires 2/24/2026.