N.Y. Comp. Codes R. & Regs. Tit. 18 §§ 360-1.4

Current through Register Vol. 46, No. 45, November 2, 2024

Section 360-1.4 - Definitions

When used in this Part, unless expressly stated otherwise or unless the context of subject matter requires a different interpretation:

(a) ADC means aid to dependent children under title 10 of article 5 of the Social Services Law and under Part 369 of this Title.

(b) Allocation means an amount of income set aside, when computing the net available income of an aged, certified blind or certified disabled MA applicant or recipient, to meet the needs of certain other household members.

(c) Chronic care budgeting is a budgeting procedure used for individuals who are in permanent absence status, as defined in subdivision (k) of this section. For recipients in permanent absence status, chronic care budgeting will begin on the first day of the calendar month following the month in which the applicant/recipient is determined to be in permanent absence status.

(d) Days means calendar days.

(e) Deeming refers to a budgeting procedure used in determining the medical assistance eligibility of an aged, certified blind, or certified disabled applicant/recipient, in which certain income and resources of legally responsible relatives are considered available to the applicant/recipient. Legally responsible relative is defined in subdivision (h) of this section.

(f) Homestead means the primary residence occupied by a medical assistance applicant/recipient and/or members of his/her family. Family members may include the applicant's/recipient's spouse, minor children, certified blind or certified disabled children, and other dependent relatives. The homestead includes the home, land and integral parts such as garages and outbuildings. The homestead may be a condominium, cooperative apartment or mobile home. Vacation homes, summer homes or cabins are not considered to be homesteads.

(g) HR means home relief provided under title 3 of article 5 of the Social Services Law and under Part 370 of this Title.

(h) Legally responsible relative means a person who is legally responsible for the support and care of one or more relatives. For medical assistance purposes, a legally responsible relative is:

(1) a spouse of a medical assistance applicant or recipient; or

(2) a parent of a child under the age of 21. A parent is not financially liable for a certified blind or certified disabled child expected to be living separately from the parental household for 30 days or more, even if the child returns to the parental household for periodic visits.

(i) MA means medical assistance for needy persons provided under title 11 of article 5 of the Social Services Law.

(j) Medical facility means any hospital, skilled nursing facility, intermediate care facility, inpatient psychiatric facility or inpatient alcoholism facility where MA may be provided and which operates in accordance with the Public Health Law and/or other applicable laws.

(k) Permanent absence status means that an individual is not expected to return home or that an individual is an institutionalized spouse as defined in section 360-4.10 of this Part. It will be presumed that an individual will not return home if:

(1) a person enters a skilled nursing or intermediate care facility;

(2) a person is initially admitted to acute care and is then transferred to an alternative level of care, pending placement in a residential health care facility (RHCF); or

(3) a person without a community spouse remains in an acute care hospital for more than six calendar months.

Adequate medical evidence may overcome the presumptions set forth in paragraphs (1)-(3) of this subdivision.

(l) Public institution means an institution that is the responsibility of a governmental unit or which is under the administrative control of a governmental unit. The term public institution does not include:

(1) a medical facility;

(2) a community residence serving 16 or fewer residents; or

(3) a child-care institution accommodating 25 or fewer children.

(m) Residential health care facility means a nursing home or a facility providing health-related service. Health-related service means service in a facility which provides or offers lodging, board and physical care including but not limited to the recording of health information, dietary supervision and supervised hygienic services incident to such service.

(n) Social security refers to old age, survivors, and disability insurance.

(o) SSI means supplemental security income, and refers to a federally supported and administered benefit program for eligible individuals or couples who are 65 years of age or older, or who are certified blind or certified disabled.

(p) Temporary absence means a time when a person is absent from his/her primary residence and is expected to return. Reasons for temporary absence may include employment, hospitalization, military service, vacation, education, or visits. A period of temporary absence will be presumed to exist if:

(1) the person is not an institutionalized spouse, as defined in section 360- 4.10 of this Part, and returns to his/her primary residence in the month in which he/she left or the following month;

(2) a person without a community spouse is in an acute care hospital for six calendar months or less;

(3) a person with a community spouse is expected to be in an acute care hospital for less than 30 consecutive days; or

(4) a person with a community spouse is expected to receive home and community-based services provided pursuant to a waiver under section 1915(c) of the Social Security Act for less than 30 consecutive days.

The presumptions set forth in paragraphs (1) and (2) of this subdivision may be overcome by adequate evidence. Adequate medical evidence is required to overcome the presumptions set forth in paragraphs (3) and (4) of this subdivision.

(q) Title IV-E refers to title IV, part E of the Social Security Act which pertains to Federal payments for foster care and adoption assistance.

(r) Poverty line means the Federal income official poverty line applicable to a family of the same size as the applicant's/recipient's family. The Federal Office of Management and Budget defines and annually revises Federal income official poverty lines in accordance with section 673(2) of the Omnibus Budget Reconciliation Act of 1981 ( P.L. 97-35). Section 360-4.7(b) of this Part contains a schedule of poverty lines.

N.Y. Comp. Codes R. & Regs. Tit. 18 §§ 360-1.4