360-1.4 Definitions. When used in this Part, unless expressly stated otherwise or
unless the context of subject matter requires a different interpretation:
(a) ADC means Aid to Dependent Children under Title 10 of Article 5 of
the Social Services Law and under Part 369 of this Title.
(b) Allocation means an amount of income set aside, when computing the
net available income of an aged, certified blind or certified disabled MA applicant or
recipient, to meet the needs of certain other household members.
(c) Chronic care budgeting is a budgeting procedure used for
individuals who are in permanent absence status, as defined in subdivision (k) of this
section. For recipients in permanent absence status, chronic care budgeting will begin on
the first day of the calendar month following the month in which the applicant/recipient
is determined to be in permanent absence status.
(d) Days means calendar days.
(e) Deeming refers to a budgeting procedure used in determining the
Medical Assistance eligibility of an aged, certified blind, or certified disabled
applicant/recipient, in which certain income and resources of legally responsible
relatives are considered available to the applicant/recipient. Legally responsible
relative is defined in subdivision (h) of this section.
(f) Homestead means the primary residence occupied by a medical
assistance applicant/recipient and/or members of his/her family. Family members may
include the appliant's/recipient's spouse, minor children, certified blind or certified
disabled children, and other dependent relatives. The homestead includes the home, land
and integral parts such as garages and outbuildings. The homestead may be a condominium,
cooperative apartment or mobile home. Vacation homes, summer homes or cabins are not
considered to be homesteads.
(g) HR means Home Relief provided under Title 3 of Article 5 of the
Social Services Law and under Part 370 of this Title.
(h) Legally responsible relative means a person who is legally
responsible for the support and care of one or more relatives. For Medical Assistance
purposes, a legally responsible relative is:
(1) a spouse of a Medical Assistance applicant
or recipient; or
(2) a parent of a child under the age of 21. A
parent is not financially liable for a certified blind or certified disabled child
expected to be living separately from the parental household for 30 days or more, even if
the child returns to the parental household for periodic visits.
(i) MA means Medical Assistance for Needy Persons provided under Title
11 of Article 5 of the Social Services Law.
(j) Medical facility means any hospital, skilled nuhsing facility,
intermediate care facility, inpatient psychiatric facility or inpatient alcoholism
facility where MA may be provided and which operates in accordance with the Public Health
Law and/or other applicable laws.
(k) Permanent absence status means that an individual is not expected
to return home or that an individual is an institutionalized spouse as defined in section
360-4.10 of this Part. It will be presumed that an individual will not return home if:
(1) a person enters a skilled nursing or
intermediate care facility;
(2) a person is initially admitted to acute
care and is then transferred to an alternative level of care, pending placement in a
residential health care facility (RHCF); or
(3) a person without a community spouse remains
in an acute care hospital for more than six calendar months. Competent medical evidence
may overcome the presumptions set forth in paragraphs (1) through (3) of this subdivision.
Adequate medical evidence may overcome the presumptions set forth in
paragraphs (1) through (3) of this subdivision.
(l) Public institution means an institution that is the responsibility
of a governmental unit or which is under the administrative control of a governmental
unit. The term "public institution" does not include:
(1) a medical facility;
(2) a community residence serving 16 or fewer
residents; or
(3) a child-care institution accommodating 25
or fewer children.
(m) Residential health care facility means a nursing home or a facility
providing health-related service. Health-related service means service in a facility which
provides or offers lodging, board and physical care including but not limited to the
recording of health information, dietary supervision and supervised hygienic services
incident to such service.
(n) Social Security refers to Old Age, Survivors, and Disability
Insurance.
(o) SSI means Supplemental Security Income, and refers to a federally
supported and administered benefit program for eligible individuals or couples who are 65
years of age or older, or who are certified blind or certified disabled.
(p) Temporary absence means a time when a person is absent from his/her
primary residence and is expected to return. Reasons for temporary absence may include
employment, hospitalization, military service, vacation, education or visits. A period of
temporary absence will be presumed to exist if:
(1) the person is not an institutionalized
spouse, as defined in section 360-4.10 of this Part, and returns to his/her primary
residence in the month in which he/she left or the following month;
(2) a person without a community spouse is in
an acute care hospital for six calendar months or less;
(3) a person with a spouse in the community is
expected to be in an acute care hospital for less than thirty consecutive days; or
(4) a person with a spouse in the community is
expected to receive home and community-based services provided pursuant to a waiver under
Section 1915(c) of the Social Security Act for less than thirty consecutive days.
The presumptions set forth in paragraphs (1) and (2) of this
subdivision may be overcome by adequate evidence. Adequate medical evidence is required to
overcome the presumptions set forth in paragraphs (3) and (4) of this subdivision. The
presumptions set forth in paragraphs (1) through (4) of this subdivision may be overcome
by competent evidence. Competent medical evidence is required to overcome the presumption
set forth in paragraphs (2), (3) and (4).
(q) Title IV-E refers to Title IV, Part E of the Social Security Act
which pertains to federal payments for foster care and adoption assistance.
(r) Poverty line means the federal income official poverty line
applicable to a family of the same size as the applicant's/recipient's family. The federal
Office of Management and Budget defines and annually revises federal income official
poverty lines in accordance with Section 673(2) of the Omnibus Budget Reconciliation Act
of 1981 (P.L. 97-35). Subdivision (b) of section 360-4.7 of this Part contains a schedule
of poverty lines.