Section 210-RICR-50-00-8.4 - DefinitionsA. For the purposes of this section, the following definitions apply:1. "Authorized representative" means a person whom the applicant or beneficiary has designated to act on his or her behalf on matters related to LTSS Medicaid.2. "Beneficiary liability" means the LTSS beneficiary's financial obligation toward the Medicaid LTSS cost of care, as determined monthly.3. "Community spouse housing allowance" means the monthly housing allowance set by the Federal government each year as the minimum amount that must be protected to cover the non-LTSS spouse's shelter expenses for his or her principal place of residence.4. "Family allowance" means a deduction in the computation of a beneficiary's liability for the needs of dependent family members who are residing with the non-LTSS spouse or guardian.5. "Family maintenance of needs allowance" means a deduction in the computation of beneficiary liability for the needs of dependent family members when there is no non-LTSS spouse and the dependent resided with the LTSS beneficiary immediately preceding the admission to a health care institution or LTSS community residence or is residing with the LTSS beneficiary at home.6. "Family member" means a natural, adoptive, step-child, parent, or sibling of the LTSS beneficiary who is under age nineteen (19) and is claimed as a dependent by the LTSS beneficiary, non-LTSS spouse, or the couple for the most recent Federal tax year, or, if a tax return was not filed, could be claimed as a dependent.7. "Financially responsible relative" means a spouse or, if the person is a minor or older youth with a disability, the person's parent.8. "HCBS maintenance of needs allowance" means a required deduction in the income of a beneficiary liability to cover the costs of living needs of a Medicaid beneficiary requesting or receiving LTSS in a home or community-based living arrangement.9. "LTSS beneficiary" means a person who meets all the general, clinical/functional, and financial eligibility requirements for LTSS, or a person receiving Medicaid LTSS of any type regardless of living arrangement. The LTSS beneficiary was previously referred to as the "institutionalized" individual. 10. "Maximum monthly maintenance of need allowance" means the amount established by the Federal government as the maximum amount of income the State must protect to meet the maintenance of needs requirements of beneficiary's spouse living in the community when determining beneficiary liability.11. "Minimum monthly maintenance of needs allowance" means the amount established by the Federal government as the minimum amount of income that the State must protect to meet the maintenance of needs requirements of beneficiary's spouse living in the community when determining beneficiary liability. Based on one hundred fifty percent (150%) of the FPL for a family of two (2).12. "Monthly spousal allowance" means the amount of a Medicaid LTSS beneficiary's income that is set aside to meet the monthly maintenance of need expenses of a non-LTSS spouse.13. "Non-LTSS spouse" means the spouse of an LTSS applicant or beneficiary regardless of LTSS living arrangement. It includes the spouses of anyone requesting or receiving Medicaid LTSS in a health care institution - NF, ICF-ID, or hospital - or in the home and community-based setting. When both spouses in a married couple are seeking or receiving Medicaid LTSS, neither is considered a non-LTSS spouse, irrespective of whether they reside together or separately.14. "Personal needs allowance" means a required deduction in the computation of beneficiary liability for needs of the LTSS beneficiary and includes the Federally-mandated amount as well as State-only personal needs allowance, paid through the optional State supplement program.15. "Service plan " means the scope of Medicaid LTSS, including the types of services to be furnished, the amount, frequency and duration of each service and the type of provider to furnish each service.16. "Standard utility allowance" means an amount that is used in lieu of the actual amount of utility costs. The standard utility allowance is applicable if the non-LTSS spouse is responsible for payment toward the cost of gas, electric, coal, wood, oil, water, sewage, or telephone for the residence and is updated annually, in conjunction with the Supplemental Nutrition Assistance Program (SNAP) in the Rhode Island Department of Human Services' Administrative Code at 218-RICR-20-00-1.210 R.I. Code R. 210-RICR-50-00-8.4
Amended effective 6/3/2021
Amended effective 9/2/2021
Amended Effective 11/3/2021
Amended effective 7/29/2023(EMERGENCY)
Amended effective 11/22/2023