Tenn. Comp. R. & Regs. 1200-29-01-.01 - DEFINITIONS

The following definitions shall apply:

(1) ADJUSTED ANNUAL INCOME for purposes of this program means an individual's annual income from all sources for the previous calendar year less Projected Annual Nursing Home Expenses.
(2) ANNUAL INCOME generally means the individual's Adjusted Gross Income as reflected on the applicant's federal income tax return on either Forms 1040, 1040A, or 1040EZ for the previous calendar year.
(a) In the absence of having filed a Form 1040, 1040A, or 1040EZ for the previous calendar year, the same methodology that would have been followed in completing such form shall be used in determining the Adjusted Gross Income.
(b) In the event an applicant files a "joint" return he shall have two (2) alternatives to certify his individual income:
1. The applicant may divide the amount shown on the joint return as Adjusted Gross Income by two (2) and certify the result as the individual's income for this grant; or
2. The applicant may determine an allocation of income between the joint filers using appropriate tax principles.
(3) APPLICANT means the nursing home resident or his legally authorized representative.
(4) APPLICATION means the form referenced as the "Nursing Home Resident's Grant Assistance Application Form" by the Department and submitted by the resident for grant assistance.
(5) CERTIFICATION means the applicant's acknowledgment on his application or the nursing home's acknowledgment on the applicant's application or the nursing home's acknowledgment on the Turnaround Document.
(6) COMMISSIONER means the Commissioner of the Tennessee Department of Health or his designee.
(7) DEPARTMENT means the Tennessee Department of Health or contractors authorized to act on behalf of the Department.
(8) FEDERAL POVERTY GUIDELINES means federal poverty guidelines for an individual as published annually by the U.S. Department of Health and Human Services for determining Medicaid eligibility and in effect at the beginning of the state fiscal year during which grant assistance will be requested.
(9) FISCAL YEAR means the State's Fiscal Year which begins on July 1 of each calendar year and ends on June 30 of the next calendar year.
(10) GRANT ASSISTANCE means the financial assistance provided by the Department to an eligible nursing home resident as prescribed in rule 1200-29-1-.06.
(11) GRANT PERIOD means the days the applicant resided in a nursing home for which grant assistance is requested on the application or certified on the turnaround Document. It is the number of days (including paid leave days) which the applicant's nursing home certifies to the department that the applicant has resided in the facility and during which the applicant's per them nursing home care was not reimbursed in whole or in part by a state and/or federal medical care program.
(12) LEGALLY AUTHORIZED REPRESENTATIVE means a person who has been authorized in writing by the nursing home resident or by a court of competent jurisdiction to act on his behalf in financial matters generally or specifically to apply for grant assistance under this program.
(13) NURSING HOME shall have the same meaning as that found in T.C.A. § 68-11-201(15).
(14) NURSING HOME CARE means all care and services required to be provided or normally provided by nursing homes licensed in Tennessee.
(15) PER DIEM EXPENSE/PER DAY EXPENSE means the average daily cost of nursing home care to a resident for only those days for which he is eligible for grant assistance.
(16) PREVIOUS CALENDAR YEAR means the January 1 thru December 31 period immediately preceding the beginning of the state fiscal year during which grant assistance will be requested.
(17) PROJECTED ANNUAL NURSING HOME EXPENSES is calculated by multiplying the average per them nursing home expense for the grant period by 365.
(18) STATE AND/OR FEDERAL MEDICAL CARE PROGRAM means any program funded by any state or the federal government. separately or jointly, which provides financial per them reimbursement for nursing home care. It specifically includes Medicaid, Medicare Part A and the Veterans Administration's contract program for nursing home care (i.e., individual contract medical agreements which pay all per them amounts for nursing home care). It does not include pensions, disability payments, social security and other payments from a state and/or federal government which provide other types of benefits to the resident other than payment of per them nursing home care.
(19) TURNAROUND DOCUMENT means a monthly listing furnished to each nursing home by the Department of all residents in that nursing home who received grant assistance for the previous month during the State's current fiscal year and which shall be used as documentation thereafter for each month's payment to the applicant. The turnaround document as a minimum shall include a certification by the nursing home of.
(a) the number of days during the grant period that the resident received no state and/or federal medical care program assistance: and
(b) the average per them expense for the grant period; and
(c) an identification, if possible, of those patients who applied for state and/or federal medical care program assistance during the report month.

Notes

Tenn. Comp. R. & Regs. 1200-29-01-.01
Original rule filed October 26, 1992; effective December 10, 1992. Amendment filed March 7, 1994; effective May 21, 1994.

Authority: Public Chapter 425, Acts of 1993; T.C.A. §§ 4-5-202, 4-5-204, 68-11-201(15) and 71- 5-1301 et seq.

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