Section 210-RICR-50-00-4.4 - Summary of LTSS Eligibility Determination ProcessA. Eligibility Factors. Evaluations of all applications for Medicaid LTSS are based on eligibility requirements or factors that fall into the following three categories: 1. General Eligibility Factors - Residency, citizenship and immigration status, third-party health coverage, age, health coverage, marital status, dependents (§40-05-1.9 of this Title).2. Financial Eligibility Factors - Varies by eligibility pathway and the method for determining income eligibility in accordance with Part 40-00-3 of this Title.3. Clinical/functional Eligibility - An applicant's health care and functional health care needs are evaluated based on information obtained from providers using pre-set needs-based criteria. The needs-based criteria for the NF, ICF-ID, and LTHR vary in accordance with the needs of the population served. Separate criteria related to disability status and LOC are also used for children seeking Katie Beckett eligibility. (Subchapter 10 Part 3 of this Chapter).B. Planning and the Cost of Care. LTSS applicants/beneficiaries are also in engaged in several on-going and post-eligibility processes that ensure they participate in decisions about their care, and that necessary and appropriate services are authorized. Calculation of their liability to pay a share of the cost of LTSS care includes the spouse's and/or dependents' needs and other allowable expenses. 1. Person-centered Planning (PCP) - The person-centered planning process begins when an applicant decides to apply for Medicaid LTSS and continues throughout the eligibility determination process. The applicant/beneficiary and their health care preferences and goals drive the development of the plan (42 C.F.R. § 441, Subpart M).2. Service Plan and Authorization - The service plan identifies the scope, amount and duration of services necessary to meet the new beneficiary's needs as articulated in the PCP process and other assessments; authorization allows payments to be made for these services. 3. Post-eligibility Treatment of Income (PETI) -- This is the process in which the State determines how much money a beneficiary must pay each month toward the cost of care. Income is calculated and deductions are then taken (also known as "allowances") to cover personal needs and non-Medicaid covered or incurred and unpaid health care expenses. The spousal impoverishment requirements in federal law are also applied, if appropriate, to exclude any of the beneficiary's income that must be set aside to provide financial support for a spouse and/or dependents in the community. (Part 8 of this Subchapter; 42 C.F.R. §§ 435.217; 435.726; 435.236).210 R.I. Code R. 210-RICR-50-00-4.4