210 R.I. Code R. 210-RICR-40-05-1.11

Current through December 3, 2024

Section 210-RICR-40-05-1.11 - Financial Eligibility Determination

1.11.1Scope and Purpose

To determine a person's eligibility using the SSI methodology, a comparison is made between the countable income and resources of the applicant's FRU and the income limits applicable to the Medicaid eligibility IHCC group. Once these groups have been established, financial eligibility is determined in accordance with the provisions for the SSI treatment of income and resources set forth in §§00-3.1 through 00-3.5 of this Chapter, and/or the special eligibility requirements in § 1.7 of this Part. This section focuses on the financial eligibility determination process for the Community Medicaid pathways in which the State is responsible for initial and continuing eligibility.

1.11.2The Medicaid Eligibility Group

A. The Medicaid eligibility group for Community Medicaid when determined by the State is as follows:

1. Single Adults - A single adult requesting Community Medicaid, including Medicaid LTSS, is treated as an "individual" - that is - Medicaid eligibility group of one (1).

2. Groups for Adults with Spouses - When two (2) spouses are living together, both the person requesting Medicaid and the applicant's spouse are considered members of applicant's Medicaid eligibility group - a "couple" or group of two (2) - unless one (1) of the exceptions specified below applies. This is true whether or not the spouse is also requesting Medicaid.

a. Living together. A couple is also considered living together in any of the following circumstances:

(1) Until the first (1st) day of the month following the calendar month of death or marriage separation, that is, when one (1) spouse dies or the couple separates;

(2) When the number of days one (1) spouse is expected to receive LTSS in an institution or home and community-based setting is fewer than thirty (30) days; and

(3) When the resources of the couple are reassessed and allocated at the point in which the need for continuous LTSS is determined and an application for Medicaid coverage of LTSS is made as indicated in Part 50-00-6 of this Title, Medicaid Long-Term Services and Supports: Financial Eligibility.

b. Exceptions. Adult applicants with spouses are treated as an "individual" for eligibility purposes in the following circumstances:

(1) When one (1) spouse in a couple is receiving long-term care and applying for Medicaid LTSS, the applicant for Community Medicaid is treated as an "individual" - group of one (1) - for the determination of initial and ongoing income eligibility and resource reviews. The couple, whether or not still married, is treated as no longer living together as of the first (1st) day of the calendar month that the spouse receiving LTSS became eligible for Medicaid. This remains true even if the other spouse receiving Community Medicaid begins receiving Medicaid LTSS in a subsequent month.

(2) When both spouses receive Community Medicaid and are residing in a residential care setting serving four (4) persons or more, each spouse is treated as an individual without regard to whether they live together. This applies to Community Medicaid beneficiaries who do not qualify for LTSS while residing in licensed assisted living residences, behavioral health community residences, adult supportive care homes, and supportive living arrangements for adults with developmental disabilities.

c. Dependent child in the household. The Medicaid eligibility group increases in size for any dependent child under age nineteen (19) who is not receiving SSI.

3. Child (Applicable for MN Eligibility Only) - The Medicaid eligibility group for a dependent child up to age nineteen (19) applying for MN coverage using the SSI methodology is a group of one (1). Once reaching age nineteen (19), the Rules related to a single adult apply.

4. Parent-Child - When a parent and dependent child living together are both seeking Medicaid in IHCC groups in which the SSI methodology applies, they are treated as two (2) Medicaid groups of one (1), if the parent is not living with a spouse. If the parent is living with a spouse, the parents are treated as a Medicaid group of two (2) and the child as a Medicaid group of one (1). When a parent/caretaker is seeking MN eligibility, any MAGI-eligible members of the household are excluded from the eligibility group.

1.11.3Formation of the FRU

A. The financial responsibility group (FRU) consists of the persons whose income and resources are considered available to the applicant or beneficiary in the eligibility determination. The FRU is relevant for deeming purposes for non-LTSS Medicaid and in determining eligibility for certain IHCC Community Medicaid coverage groups. The following subsections set forth the Rules for determining membership in the FRU and the portion of income considered available to the person seeking Medicaid:

1. FRU Composition for Citizens - The FRU for citizens and sponsored non-citizens differs due to deeming requirements. For citizens, the FRU consists of the person seeking Medicaid and, as appropriate, a spouse, parent, and/or dependent child. Other members of the household are not included in the FRU even if they make financial contributions.

a. FRU Single Adults. The FRU for an adult requesting SSI-related Medicaid, including Medicaid LTSS, is the same as the adult's Medicaid eligibility group.

b. FRU Child. The financial responsibility group for a dependent child includes the child and any parents living with the child, until the child reaches the age of nineteen (19) or twenty-one (21) if the child has a disabling impairment. A child's income is never deemed to a parent. If the child is under age nineteen (19) and seeking Medicaid LTSS through the Katie Beckett eligibility pathway, the income and resources of the child's parents are deemed unavailable and the FRU is composed of the child only.

c. FRU Couples. Except in instances in which a member of a couple is a Medicaid LTSS applicant or beneficiary, spouses are considered financially responsible for one another during the financial eligibility determination process. The FRU includes the applicant and spouse, even when the spouse is not applying for Medicaid (NAPP spouse, hereinafter). The child's income is never deemed to a parent or a sibling.

2. FRU for Sponsored Non-citizens - The FRU for a non-citizen admitted to the United States on or after August 22, 1996 based on a sponsorship under the Immigration and Nationality Act (INA), 8 C.F.R. Part 204, includes the income and resources of the sponsor and the sponsor's spouse, if the spouse is living with the sponsor, when all four (4) of the following conditions are met:

a. The sponsor has signed an affidavit of support on a form developed by the United States Attorney General as required by the Personal Responsibility and Work Opportunity Reconciliation Act of 1996, Pub. Law 104-193, (PRWORA) to conform to the requirements of 8 C.F.R. § 213A(b);

b. The non-citizen is lawfully admitted for permanent residence, and a five (5) year period of ineligibility for Medicaid following entry to the United States has ended;

c. The non-citizen is not battered; and

d. The non-citizen is not indigent, defined as unable to obtain food and shelter without assistance, because his or her sponsor is not providing adequate support.

e. The financial responsibility of a sponsor continues until the noncitizen is naturalized or credited with forty (40) qualifying quarters of coverage by the SSA. See: http://policy.ssa.gov/poms.nsf/lnx/0300301315

1.11.4General Rules for Counting Income - Community Medicaid

A. For Community Medicaid, the determination of income eligibility using the SSI methodology follows a set sequence of calculations related to the application of exclusions and disregards as set forth in §00-3.3 of this Chapter. Unearned income exclusions and disregards are applied first.

1. Order of Unearned Income Exclusions and Disregards - Unearned income is countable as income in the earliest month it is received by the person; credited to a person's account; or set aside for the person's use. The order for applying exclusions and disregards is as follows:

a. Federal law. Exclusions mandated in Federal law or Regulations as set forth in §00-3.4 of this Chapter are applied first unless indicated otherwise.

b. Medicaid. The following types of unearned income are excluded or disregarded in the order indicated:

(1) Any refund of taxes;

(2) Assistance based on need which is provided under a program which uses income as a factor of eligibility and is wholly funded by the State or a local government. General Public Assistance (GPA) and the optional State Supplemental Payment (SSP) for SSI beneficiaries and SSI-lookalikes are examples of excluded payments in this category.

(3) Grants, scholarships, fellowships, or gifts used for paying educational expenses are excluded or countable depending upon their use:

(AA) Any portion of a grant, scholarship, fellowship, or gift used for paying tuition, fees, or other necessary educational expenses at any educational institution, including vocational or technical education institutions, is excluded from income.

(BB) Any portion of such educational assistance that is not used to pay current tuition, fees or other necessary educational expenses but is set aside to be used for paying this type of educational expense at a future date is excluded from income in the month of receipt. If these funds are not spent after nine (9) months, they become a countable resource the first (1st) day of the tenth (10th) month following receipt.

(CC) Any portion of a grant, scholarship, fellowship, or gift that is not used or set aside for paying tuition, fees, or other necessary educational expenses is income in the month received and a resource the month after the month of receipt if retained.

(4) Food which a person or his/her spouse raises if it is consumed by the household;

(5) Assistance received under the FEMA Disaster Assistance Reform Act of 2015, H.R. 1471, (as in effect on February 1, 2016), and assistance provided under any Federal statute because of a presidentially declared disaster;

(6) The first sixty dollars ($60.00) of infrequent or irregular unearned income received in a calendar quarter;

(7) Alaska longevity bonus payments;

(8) Foster care payments that are not funded through § IV-E of the Social Security Act (42 U.S.C. §§ 671 - 679b);

(9) Any interest earned on excluded burial funds and any appreciation in the value of an excluded burial arrangement which are left to accumulate and become a part of that burial fund;

(10) Support and maintenance assistance based on need:

(AA) Provided in-kind by a private nonprofit agency; or

(BB) Provided in cash or in-kind by a supplier of home heating oil or gas, or by a private or municipal utility company.

(11) One-third (1/3) of child support payments made by a non-custodial absent parent, unless exempt in accordance with §00-3.3 of this Chapter;

(12) Twenty dollar ($20.00) general income disregard. The disregard does not apply to program payments when income is used as an eligibility factor and the payment is wholly or partially funded by the Federal government or by a non-governmental agency such as Catholic Charities or the Salvation Army.

(13) Unearned income used to fulfill an approved plan to achieve self-support (PASS);

(14) Federal housing assistance provided by:

(AA) An office or program of the U.S. Department of Housing and Urban Development (HUD); or

(BB) The U.S. Department of Agriculture's Rural Housing Service (RHS), formally known as the Farmers Home Administration (FHA);

(15) Any interest on excluded burial space purchase agreement if left to accumulate as part of the value of the agreement;

(16) The value of any commercial transportation ticket which is received as a gift and is not converted to cash;

(17) Payments from a State compensation fund for victims of crime;

(18) Relocation assistance provided under Title II of the Uniform Relocation Assistance and Real Property Acquisition Policies Act of 1970 in accordance with 42 U.S.C. § 301 (as in effect on February 1, 2016) provided to individuals displaced by any Federal or Federally-assisted project or State or local government or through a State-assisted or locally-assisted project involving the acquisition of real property;

(19) Combat fire pay received from the uniformed services;

(20) Interest on a dedicated account in a financial institution, the sole purpose of which is to receive and maintain past-due SSI benefits which are required or allowed to be paid into such an account, and the use of which is restricted by 42 U.S.C. § 1631(a)(2)(F);

(21) Gifts to children with life-threatening conditions from an organization described in §501(c)(3) of the Internal Revenue Code of 1986, Pub. Law 99-514, (as in effect on February 1, 2016), within the following limitations:

(AA) In-kind gifts are not converted to cash;

(BB) No more than the first two thousand dollars ($2,000.00) of any cash gifts within a calendar year may be excluded;

(CC) Interest and dividend income from a countable resource or from a resource excluded under a Federal statute other than 42 U.S.C. § 1613(a) (as in effect on February 1, 2016);

(DD) An annuity paid by a State, to a person and/or the person's spouse, on the basis of the State's determination that the person is a veteran and is blind, sixty-five (65) or older and/or living with a disabling impairment.

2. Order of Earned Income Exclusions - In general, earned income disregards and exclusions are applied in the following order:

a. Federal law. Exclusions mandated in Federal law or Regulations as set forth in §00-3.4 of this Chapter are applied first, unless indicated otherwise.

b. SSI Methodology. The following types of earned income are excluded or disregarded in order:

(1) Earned income tax credit payments and child care tax credit payments;

(2) The first (1st) thirty dollars ($30.00) of infrequent or irregular earned income received in a calendar quarter;

(3) Student earned income exclusion (SEIE) up to the monthly limit, and not more than the yearly limit as indicated in § 00-3.1.7 of this Chapter.

(4) Any portion of the twenty dollars ($20.00) monthly general income disregard which has not been excluded from unearned income in that same month;

(5) The first (1st) sixty-five dollars ($65.00) of earned income in a month;

(6) Earned income of a person with disabilities used to pay impairment-related work expenses (IRWEs), as described in 20 C.F.R. § 404.1576;

(7) One half (1/2) of remaining earned income in a month;

(8) Work expenses of a person who is blind;

(9) Earned income used to fulfill an approved Plan to Achieve Self-Support (PASS).

3. Unused exclusions and disregards - When calculating countable income, the limitations below apply:

a. Exclusions never reduce earned or unearned income below zero (0).

b. Unused portions of a monthly disregard or exclusion cannot be carried over for use in subsequent months.

c. Unused earned income disregards and exclusions are never applied to unearned income.

d. Other than the twenty dollars ($20.00) general income disregard, no unused unearned income exclusion may be applied to earned income.

e. The twenty dollars ($20.00) general and sixty-five dollars ($65.00) earned income exclusions are applied only once to a couple, even when both members have income, since the couple's earned income is combined in determining Medicaid eligibility.

1.11.5Income Deeming

A. To deem income is to attribute one (1) person's countable income in the calculation of another person's countable income. Income deeming requirements are based on the FRU rather than the Medicaid eligibility group rule. A person may be included in the Medicaid eligibility group without being included in the FRU - (e.g., the sibling of a child seeking MN eligibility -) and having their income deemed to an applicant or non-applicant in the household. The general rules for determining countable income related to the application of earned and unearned income exclusions identified above in §1.11.4 of this Part are applied. In addition:

1. The person seeking initial or continuing Medicaid eligibility is referred to as the "applicant;" members of the household who are not covered by or applying for Medicaid are referred to in this subsection as "non-applicants" or NAPPs.

2. Whose income is deemed to an applicant is determined separately for each member of the FRU.

3. Income based on need, in which income is a factor in determining eligibility, provided by any local, State or Federal agency and any income which was taken into account in determining eligibility and which affected the amount of such assistance or payment is excluded in the income deeming process, unless specifically indicated otherwise. Includes: SSI; SSP; RI Works and GPA cash assistance; Veteran's Administration (VA) pensions; or in-kind support and maintenance.

B. Spouse-to-Spouse - Except as indicated in the situations noted below, the income of a NAPP spouse is deemed to an applicant if the spouses live together. If an applicant is not divorced but is legally separated from his or her spouse, and continues to live in the same household, the NAPP spouse's income is deemed. In the following situations, spouse-to-spouse income deeming does not apply:

1. The spouses do not live together.

2. The applicant is seeking coverage under the Sherlock Plan as a working adult with a disability in accordance with Medicaid Code of Administrative Rules, Section 1373: Medicaid for Working People with Disabilities Program, Subchapter 15 Part 1 of this Chapter.

a. Deeming. The amount of income that is deemed to the applicant spouse is calculated by subtracting from the NAPP spouse's gross income:

(1) An amount equal to the deeming standard for each dependent child in the household. The "deeming standard" is the difference between the Federal Benefit Rate (FBR) for a couple and the limit for a single person, as indicated in § 00-3.1.7 of this Chapter, less any countable income from the child. The difference between the two (2) is the living allowance for the NAPP child, as indicated herein.

(2) Any portion of the NAPP spouse's income paid in court-ordered child support for a child living in another household.

(3) Exclusions and disregards that apply when calculating countable income for the applicant spouse.

(4) If the NAPP spouse's remaining income after exclusions and disregards are applied is greater than the deeming standard, then the couple's income is calculated according to the general Rules for determining countable income using SSI methodology. That income is then compared against the Medicaid eligibility group income limit for the family size involved - i.e., household size.

b. Treatment of deemed income. The deemed amount is counted as unearned income in determining the applicant's income eligibility for Medicaid.

C. Parent-to-Child - Except in the situations noted below for MN eligibility, the income of a biological or adoptive parent is deemed to a child who is under age eighteen (18) and living with a parent as long as the child has not been legally emancipated. When the father is not married to the child's mother, the father' s income is only deemed to the child if they reside together and paternity has been established.

1. In the following situations, the income of a parent is NOT deemed to a child:

a. The child is not eligible for SSI, but is participating in a foster care or adoption subsidy program administered by the State.

b. The child is seeking LTSS through the Katie Beckett eligibility option in accordance with the Medicaid Code of Administrative Rules, Global Consumer Choice Waiver.

2. Deeming Rules: The amount of income deemed from parent to child requires a multi-step calculation of income that must be followed in the sequence below:

a. The earned and unearned income of the parents of the applicant child is calculated allowing the standard exclusions EXCEPT for the standard twenty dollar ($20.00) and sixty-five dollar ($65.00) plus one half (1/2) disregards.

b. The living allowance allocated to NAPP children is determined by multiplying their number by the deeming standard. Any children receiving SSI or RI Works cash assistance are not included in this calculation. The income of each NAPP child is deducted from this sum, if any.

c. The total of the unearned income of the parents is calculated and then any remaining allowance for NAPP children in the household not met by their own income is subtracted.

d. The earned income of the parents is totaled and any remaining living allowance for NAPP children is subtracted. If there is no remainder, there is no income to deem. If there is income remaining, deeming is applicable.

e. Deemed income from parent to child is then calculated by: deducting the twenty dollar ($20.00) income disregard from any remaining parental unearned income; subtracting sixty-five dollars ($65.00), plus any of the remainder of the twenty dollar ($20.00) disregard and one half (1/2) of the still remaining parental earned income. The remaining unearned and earned income is added and, from this total, so too is the individual FBR (for a one (1) parent household) or the couple FBR (for a two (2) parent household).

f. The remaining income is deemed to be unearned income to the child. Note: If more than one (1) child is applying, deemed income is divided equally.

D. Other Household Members - When determining a person's initial or continuing eligibility, income is NOT deemed from a:

1. Child to a parent;

2. Sibling to another sibling, or other children under twenty-one (21) living in the household;

3. Stepparent to a stepchild;

4. Grandparent to a grandchild; or

5. Relative caretaker to a child.

E. Sponsor Deeming - Sponsor deeming rules apply to non-citizens who are sponsored by one (1) or more individuals under a signed Affidavit of Support (USCIS I-1864), unless one (1) of the following exceptions applies:

1. Exceptions to Sponsor Deeming. Sponsor deeming does not apply to sponsored non-citizens when:

a. The non-citizen is under age twenty-one (21).

b. The non-citizen is pregnant. This exception ends when the sponsored pregnant woman's sixty (60) day postpartum period ends. Sponsor deeming applies the month following the end of the postpartum period.

c. The non-citizen has sponsorship deferred by USCIS when their immigration status is changed to "Battered Non-citizen."

d. If the non-citizen needs placement in a facility and placement is jeopardized by the sponsor's failure or inability to provide support, or inability of the non-citizen to locate the sponsor.

2. General rules of sponsor deeming. Income of a sponsor and the sponsor's spouse is deemed to each non-citizen covered by the affidavit regardless of whether the sponsor actually contributes to the non-citizen's support and maintenance needs. Income is deemed even if the sponsor or the sponsor's spouse is receiving public assistance in Rhode Island or another State. The following types of income of the sponsoring individual/couple are deemed:

a. Gross income, including any cash assistance received by the sponsor or the sponsor's spouse;

b. Net self-employment income, minus self-employment expenses;

c. If the sponsor is a member of the FRU, the sponsor's income is already deemed to the sponsored non-citizen spouse and family members in accordance with income deeming rules contained in §1.11.5(E) of this Part.

3. If the sponsor is not a member of the FRU or is a member of the Medicaid eligibility group whose income is not deemed under income deeming rules in §1.11.5(E) of this Part, the following apply:

a. The total gross income of the sponsor and the sponsor's spouse is deemed to each sponsored non-citizen.

b. The sponsor or the sponsor's spouse's income are considered available and are not excluded.

1.11.6General Rules for Counting Resources - Community Medicaid

A. The State uses a more simplified process for counting resources for Community Medicaid, as explained in §00-3.5.1 of this Chapter, which permits attestations about the value of certain resources during the application process when determining financial eligibility. For Medicaid LTSS eligibility, full verification of resources and a transfer of asset review are required for IHCC group members prior to the determination of eligibility and authorization of services. There is no review of the transfer of assets for Community Medicaid.

1. Process - The process rules identified in §00-3.6.2 of this Chapter are used in evaluating resources to determine which are included in the calculation.

2. Application of Exclusions - Both federally mandated and program specific exclusions are applied for resources of a Community Medicaid applicant or beneficiary, the following items are excluded in the following order in the amounts indicated:

a. The home and adjoining land;

b. Household goods and personal effects;

c. One (1) automobile and the equity value of a second (2nd) vehicle above four thousand five hundred dollars ($4,500.00);

d. Property of a trade or business which is essential to the means of self-support;

e. Non-business property which is essential to the means of self-support;

f. Resources of person who is blind or living with a disabling impairment which are necessary to fulfill an approved PASS;

g. Stock in regional or village corporations held by natives of Alaska during the twenty (20) year period in which the stock is inalienable pursuant to the Alaska Native Claims Settlement Act; 43 U.S.C. §§ 1601 - 1624,

h. Whole life insurance owned by a person and/or spouse but only when the combined face value of all policies per person is at or below one thousand five hundred dollars ($1,500.00) for EAD or four thousand dollars ($4,000.00) for medically needy;

i. Restricted allotted Indian lands;

j. Payments or benefits provided under a Federal statute other than Title XVI (OASDI, including RSDI and SSD) of the Social Security Act, 42 U.S.C. §§ 1381 - 1383f, where an exclusion is required by such statute as indicated in §00-3.6 of this Chapter;

k. Disaster relief assistance;

l. Burial expense funds and set asides to the extent allowed up to one thousand five hundred dollars ($1,500.00) for EAD and four thousand dollars ($4,000.00) for persons who are MN;

m. Title XVI (OASDI) or Title II (SSI) of the Social Security Act, 42 U.S.C. §§ 1381 - 1383f, retroactive payments;

n. Housing assistance;

o. Refunds of Federal income taxes and advances made by an employer relating to an earned income tax credit;

p. Payments received as compensation for expenses incurred or losses suffered as a result of a crime;

q. Relocation assistance from the State or a local government;

r. Dedicated financial institution accounts;

s. Gifts to children under age eighteen (18) with life-threatening conditions;

t. Restitution of SSI, Title VIII, 42 U.S.C. §§ 1001 - 1013, or RSDI benefits because of misuse by certain representative payees;

u. Any portion of a grant, scholarship, fellowship, or gift used or set aside for paying tuition, fees, or other necessary educational expenses;

v. Payment of a refundable child tax credit, as provided; and

w. Any annuity paid by a State to a person (or his or her spouse) based on the State's determination that the person is a veteran (as defined in 38 U.S.C. § 101) and blind, living with a disabling impairment, or aged.

1.11.7Resource Deeming

A. To deem resources is to count one (1) person's resources in the calculation of another person's countable resources. As with income deeming, resource deeming requirements apply to members of the FRU, which is not always the same as the Medicaid eligibility group. Only the resources of the applicant's spouse or the parent(s) of a child are considered for the purposes of deeming resources. The deeming process proceeds as follows:

1. Spouse-to-Spouse - In deeming resources from one (1) spouse to the other, only the resources of the couple are considered.

a. Living together. When an applicant and NAPP spouse live together, all resources are combined and the couple is permitted resources up to the amount allowed for the Medicaid eligibility group of two (2). The couple's resource limitation is not affected by whether the spouse of the applicant is applying for or receiving Medicaid or is a non-applicant.

b. Living apart. When an applicant and spouse are no longer living together, each person is considered as an individual living alone beginning the month after separation and the individual resource limit applies. For the month of separation, the spouses are treated as a couple, as long as they were living together at some point during the month.

2. Single individual - When an applicant is not living in a home with a spouse or parent(s), only the resources of the applicant are considered. The resource limits for an "individual" or Medicaid eligibility group of one (1) apply.

3. Parent-to-child - In deeming resources from a parent to a child, the resources of a child consist of whatever resources the child has in his or her own right plus whatever resources are deemed to the child from his or her parent(s).

a. In determining the amount of resources to be deemed to an applicant child, the resources of the child and of the parents are computed separately and both the child and the parents are each allowed all of the resource exclusions they would normally be eligible to receive in their own right. Only one (1) home and one (1) vehicle are completely excluded, however. The equity value of a second (2nd) vehicle is counted in accordance with § 00-3.5.5(A)(1)(d) of this Chapter.

b. It does not matter whether a parent(s) is or is not eligible for Medicaid.

c. After the exclusions are applied, only the countable resources over the resource exclusion of the parent(s) living in the home are deemed to the child when there is only one (1) child.

d. When there is more than one (1) applicant/eligible child, the resources available for deeming are shared equally among the eligible children.

e. None of the parents' resources are deemed to any other non- applicant/ineligible children.

f. A child is not eligible for Medicaid as MN if his or her own countable resources plus the value of the parents' resources deemed to the child exceed the resource limit for an individual - Medicaid Eligibility group of one (1) - of four thousand dollars ($4,000.00).

210 R.I. Code R. 210-RICR-40-05-1.11

Amended effective 11/5/2020
Amended effective 6/3/2021
Amended effective 4/9/2023
Amended effective 7/29/2023(EMERGENCY)
Amended effective 11/27/2023