Or. Admin. R. 461-160-0620 - Income Deductions and Patient Liability; Long-Term Care Services or Home and Community-Based Care; OSIPM
In the OSIPM program:
(1) Deductions from income are made for an
individual residing in or entering a long-term care facility or receiving
home and community-based care (see OAR 461-001-0030) as
explained in subsections (3)(a) to (3)(h) of this rule.
(2) The liability of an individual is
determined according to subsection (3)(i) of this rule, except as provided
otherwise in OAR 461-160-0610.
(3)
Deductions are made in the following order:
(a) One standard earned income deduction of
$65 is made from the earned income in the OSIPM program.
(b) The deductions under the plan for
self-support as allowed by OAR 461-145-0405.
(c) One of the following need standards:
(A) A $68.77 personal needs allowance for an
individual receiving long-term care services.
(B) A $90 personal needs allowance for an
individual receiving long-term care services who is eligible for VA benefits
based on unreimbursed medical expenses. The $90 allowance is allowed only when
the VA benefit has been reduced to $90.
(C) For an individual who receives
home and community-based care:
(i) Except as provided in subparagraph (ii)
of this paragraph, the OSIPM maintenance standard.
(ii) For an individual who receives in-home
services, the OSIPM maintenance standard plus $500.
(d) A community
spouse (see OAR 461-001-0030) monthly income allowance is deducted
from the income of the institutionalized spouse (see OAR
461-001-0030) to the extent that the income is made available to or for the
benefit of the community spouse, using the following
calculation.
(A) Step 1--Determine the
maintenance needs allowance. $2,288.75 is added to the amount over $686.63 that
is needed to pay monthly shelter expenses for the principal residence of the
couple. This sum or $3,435.00, whichever is less, is the maintenance needs
allowance. For the purpose of this calculation, shelter expenses are the rent
or home mortgage payment (principal and interest), taxes, insurance, required
maintenance charges for a condominium or cooperative, and the full standard
utility allowance for the SNAP program (see OAR 461-160-0420). If an
all-inclusive rate covers items that are not allowable shelter expenses,
including meals or housekeeping in an assisted living facility, or the rate
includes utilities, to the extent they can be distinguished, these items must
be deducted from the all-inclusive rate to determine allowable shelter
expenses.
(B) Step 2--Compare
maintenance needs allowance with community spouse's countable income. The
countable (see OAR 461-001-0000) income of the
community spouse is subtracted from the maintenance needs
allowance determined in step 1. The difference is the income allowance unless
the allowance described in step 3 is greater.
(C) Step 3--If a spousal support order or
exceptional circumstances resulting in significant financial distress require a
greater income allowance than that calculated in step 2, the greater amount is
the allowance.
(e) A
dependent income allowance as follows:
(A) For
a case with a community spouse, a deduction is permitted only
if the monthly income of the eligible dependent is below $2,288.75. To
determine the income allowance of each eligible dependent:
(i) The monthly income of the eligible
dependent is deducted from $2,288.75.
(ii) One-third of the amount remaining after
the subtraction in paragraph (A) of this subsection is the income allowance of
the eligible dependent.
(B) For a case with no community
spouse:
(i) The allowance is the TANF
adjusted income standard (see OAR 461-155-0030) for the individual and eligible
dependents.
(ii) The TANF standard
is not reduced by the income of the dependent.
(f) Costs for maintaining a home if the
individual meets the criteria in OAR 461-160-0630.
(g) Medical deductions allowed by OAR
461-160-0030 and 461-160-0055 are made for costs not covered under the state
plan.
(h) After taking all the
deductions allowed by this rule, the remaining balance is the adjusted
income (see OAR 461-001-0000).
(i) The individual's liability is determined
as follows:
(A) For an individual receiving
home and community-based care (except individuals identified
in section (2) of this rule), the liability is the actual cost of the
home and community-based care or the adjusted income
of the individual, whichever is less. This amount must be paid to the
Department or the home and community-based care facility each
month as a condition of being eligible for home and community-based
care.
(B) For an
individual who resides in a nursing facility, the liability is the actual cost
of services or the adjusted income of the individual,
whichever is less. This amount must be paid to the facility each month as a
condition of being eligible for nursing facility services.
Notes
Statutory/Other Authority: ORS 409.050, 413.085, 411.060, 411.070, 411.404, 414.065, 414.685 & 411.706
Statutes/Other Implemented: ORS 409.010, 413.085, 411.060, 411.070, 411.404, 414.065, 414.685, 42 USC 1396r-5, 411.706 & 42 CFR 435.725- 435.735
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