55 Pa. Code § 178.121 - General

(a) This section and §§ 178.122-178.126 apply when an institutionalized spouse has a community spouse.

(b) Except as modified by this section and §§ 178.122-178.126, the requirements in Subchapter A (relating to general provisions for MA resources common to all categories of MA) and §§ 178.51, 178.61-178.81, 178.91 and 178.101-178.103 apply to married couples with one member in an institution.

(c) These requirements apply to persons institutionalized for a continuous period of institutionalization beginning on or after September 30, 1989. The requirements do not apply if the continuous period of institutionalization began on or before September 29, 1989, and the person is still institutionalized on and after September 30, 1989.

(d) A continuous period of institutionalization is a period of NFC including services in an ICF/MR facility that is uninterrupted and likely to last at least 30 days. Continuity is broken by absences from the institution of 30 or more consecutive days.

(e) If the person is discharged for at least 30 consecutive days and is readmitted to an institution, the requirements in subsection (a) apply beginning with the date of the new admission.

(f) The requirements for an institutionalized spouse as defined in § 178.2 (relating to definitions) with a community spouse as defined in § 178.2 no longer apply beginning the first full calendar month following changes in circumstances which end the community spouse/institutionalized spouse relationship.

(g) A spousal share of resources is determined by the Department upon a request from either member of the couple or a person acting on behalf of either spouse. The spousal share is one half of the total countable verified resources owned by the couple when one of them is admitted to an institution for NFC including services in an ICF/MR facility and is set within minimum and maximum limits as specified by section 303(a) of the MCCA (42 U.S.C.A. § 1396r-5). This determination is called a resource assessment.

(h) Resources of the community spouse are not deemed available to the institutionalized spouse beginning the month following the month of the initial eligility determination as specified in § 178.91(c) (relating to deeming of resources).

Notes

55 Pa. Code § 178.121

The provisions of this § 178.121 adopted August 28, 1992, effective upon publication and apply retroactively to October 1, 1989, 22 Pa.B. 4432.