N.J. Admin. Code § 5A:5-1.2

Current through Register Vol. 56, No. 21, November 4, 2024

Section 5A:5-1.2 - Definitions

The words and terms, as used in this chapter, shall have the following meanings. All other words shall be given their ordinary meaning unless the content of their use clearly indicates otherwise.

"Accountable assets" means all items that have a determined value and are owned solely by the applicant or spouse, or owned jointly with spouse, jointly with others, or jointly by the spouse and others, and must be spent down or liquidated and used toward payment of the resident's care and maintenance fee. IRAs and annuities are considered as accountable assets and will be treated as income.

"Admission" means the procedure for entering one of the New Jersey veterans' memorial facilities.

"Aid and attendance" means supplemental income provided by the U.S. Department of Veterans' Affairs for extended care services.

"Allied veterans" means those veterans of nations allied or associated in conflicts against an enemy of the United States during World War I or II. This is inclusive of members of the armed forces of Czechoslovakia or Poland. Allied veterans are required to have been a citizen of the United States for at least 10 years.

"Allowable deductions" means those approved items which will be subtracted from the gross income, including the personal needs allowance, when calculating care and maintenance fee.

"Asset determination" means an investigation and evaluation of the financial circumstances of a person applying for admission to a New Jersey veterans' memorial facility.

"Care and maintenance" means the actual cost of services for an individual in one of the New Jersey veterans' memorial facilities.

"Community spouse" means the married spouse of a veterans' memorial home resident who does not receive long-term care in a medical institution or nursing facility.

"Conservatorship" means the appointment of a person by the court to manage the financial affairs of a conservatee. A "conservatee" is one who has not been judicially declared incompetent, but who by reason of advanced age, illness, or physical infirmity, is unable to care for or manage his or her property or who has become unable to provide for himself or herself or others dependent upon him or her for support.

"Dependent" means a child of the Veteran Home Resident who is under the age of 21 or a child of any age who is blind or totally and permanently disabled. In the event that the child does not have a determination from the Social Security Administration of blindness or disability, the blindness or disability shall be evaluated by the Disability Review Section of the Division of Medical Assistance and Health Services in accordance with the provisions of 10:71-3.1 3.

"Discharge" means the permanent removal from a New Jersey veterans' memorial facility.

"Durable power of attorney" means a legal document that enables an individual to designate another person(s) to act on his or her behalf, in the event the individual becomes disabled or incapacitated. A health proxy, also known as a durable power of attorney for healthcare, can also be appointed for medical decisions. The durable power of attorney terminates upon the death of the originator.

"Eligible others" as defined and listed in order of priority below will be admitted to a New Jersey veterans' memorial home, as long as the census of non-veterans does not exceed 25 percent of the total population.

1. "Gold Star parent" means the mother or father of a person who was a resident of New Jersey at the time of service entry, and who died an honorable death in time of war or emergency while in the active military service of the United States, provided that the parent has been a resident of New Jersey for at least two years prior to the date of application.

2. "Surviving spouse" means the widow or widower of a person who died an honorable death while in the active military service of the United States, or who was a disabled veteran at the time of death, provided that the surviving spouse was the person's spouse at the time of the person's service or was married to the person not less than 10 years prior to the date of application and has not married since the person's death, and provided that the surviving spouse has been a resident of New Jersey for at least two years prior to the date of application.

3. "Spouse" means the person legally married with a valid marriage license that is in accord with New Jersey law to an individual who has been other than dishonorably discharged from the active military of the United States, provided that the spouse is not less than 50 years of age, has been married to such person for a period of not less than 10 years, and meets the New Jersey residency requirement as described in paragraph 1 of the definition of "veteran" below.

"Extraordinary expense deduction" means a financial deduction as a major excessive expense to maintain the basic household, medical, or transportation needs.

"Facility resident" means an individual residing in a New Jersey veterans' memorial home.

"Gross income" means all income and/or revenue received by resident for a given period. Includes, but not limited to, funds received for labor or services, social security, pensions, aid and attendance, net rental income of property, and/or the proceeds of business or enterprises and investments not to include losses. Service connected disability compensation funds shall not be counted as gross income.

"Guardian" means a person who has been entrusted as the legal representative of one who has been adjudicated incapacitated by a court of law and requires a legal representative to act on their behalf for all matters.

"Guardianship" means the process by which an individual is appointed the legal representative of another person who has been adjudicated incapacitated by a court of law and requires a legal representative to act on their behalf for all matters.

"Irrevocable trust" means the funds set aside in a trust not to be recalled, revoked or annulled.

"Lien application" means a process initiated to obtain financial payment for all delinquent accounts for services received.

"Living will" means a legal document that provides instructions and directions regarding healthcare in the event that the individual subsequently lacks such decision-making capability.

"Maximum allowable asset" means that all sources of accountable assets shall not exceed $ 24,000 for a single applicant or $ 110,000 for a married applicant.

"Medicare" means a system of governmental insurance for providing medical and hospital care for the aged from Federal social security funds.

"Net income" means the total gross income received, minus allowable deductions.

"Non-accountable assets" means those items of determined value that are owned solely by the applicant or spouse. The following are considered non-accountable assets:

1. The primary residence and any appurtenance thereto, including proceeds from the sale of the residence. However, if the property is sold, any income earned from the investment of any or all of the proceeds will be counted as income.

2. All of the household effects therein; and

3. An automobile if there is a community spouse.

"Personal needs account" means an account maintained at the veterans' facility for deposit of the personal funds of the resident and which will be considered part of the accountable assets. This account shall be administered by the veterans' facility or treasurer of the State of New Jersey.

"Personal needs allowance" means a set amount received by a resident for individual use and spending. The personal needs allowance shall be as follows:

1. A resident whose source of monthly income exceeds $ 100.00 will retain a minimum of $ 100.00 for personal needs.

2. A resident whose source of monthly income does not exceed $ 100.00 will retain all of their monthly income.

3. A resident who has no source of funds will be provided a monthly allowance for personal needs of $ 50.00.

4. The welfare fee will be reduced to maintain the minimum of $ 100.00 for the resident's personal needs.

"Physician Orders for Life Sustaining Treatment (POLST)" is a New Jersey law designed to provide a mechanism to further define preferences for healthcare concerning life-sustaining treatment of other interventions for progressive illnesses and/or end of life decisions.

"Representative Payor" means a designated person or institution responsible for the payment of the resident's financial obligations.

"Resident" means a legal inhabitant of the state where the primary domicile is located.

"Resident fee" means the monthly charges billed by the veterans' facility to the resident for their cost of care and maintenance.

"Service connected disability" means a disability sustained by veterans who were disabled by an injury or illness that was incurred or aggravated during active military service. These disabilities are considered service-connected. Disability is determined by the United States Department of Veterans' Affairs in accordance with 38 CFR 51.41.

"Spend down" means that which occurs when accountable assets exceed the maximum amount allowed and are liquidated and spent towards the actual care and maintenance cost. This process will continue as long as the accountable assets exceed the maximum amount allowed.

"Transfer" means the placement of a resident to a more suitable environment to meet individual needs.

"Veteran" means:

1. A person who has been other than dishonorably discharged from the active military service (90 days total active duty service, unless discharged early for service connected disability) of the United States and has been a resident of New Jersey for at least two years prior to the date of application;

2. A person who was a citizen of the State of New Jersey at the time of entrance into the active military service of the United States, and who is qualified for admission except for the required period of State residence. Preference shall be given to persons who have been residents of the State for a period of at least two years prior to application; or

3. A person who is not a citizen of the State of New Jersey and who is classified by the Federal Veterans Affairs Administration as Priority I, II, III, or catastrophic Priority IV.

"Veterans' memorial home" means any home, institution, hospital, or part thereof, the admission to which is under the jurisdiction of the Department of Military and Veterans' Affairs, being the facilities at Menlo Park, Paramus, Vineland, and such other veterans' facilities as may be developed.

"Welfare fund" means an account established at each facility pursuant to 38A:3-6.1 6 for the specific purpose of accepting monies that will be spent for and on behalf of residents' programs, special events and services. It is composed of interest, funds specifically donated, and from monies which have escheated to the welfare fund from the personal needs account of deceased residents leaving no will or next of kin. This fund will provide for and maintain a quality of life which might otherwise not be possible for the residents and shall be administered by the Adjutant General in accordance with the provisions of 38A:3-6.1 6.

"Working spouse" means the married spouse of an individual residing in a New Jersey veterans' memorial home who finds it necessary to continue employment to meet financial needs.

N.J. Admin. Code § 5A:5-1.2

Amended by R.1998 d.3, effective 1/5/1998.
See: 29 N.J.R. 4215(b), 30 N.J.R. 63(a).
Amended "Accountable assets", "Allowable deductions", "Care and maintenance", "Community Spouse", "Dependent", "Eligible others", "Needy veteran", "New resident", "Nonaccountable assets", "Personal needs account", "Personal needs allowance", "Veteran", and "Welfare fund"; added "Discharge", "Gross income", "Irrevocable trust", "Maximum allowable asset", "Medicare" and "Transfer"; and deleted "Income".
Amended by R.2003 d.244, effective 6/16/2003.
See: 35 N.J.R. 62(a), 35 N.J.R. 2641(a).
In "Accountable assets", added the last sentence; added "Allied veterans", "Extraordinary expense deduction", "Indigent", "Lien application", "National Guard/Reserve Component", "Respite Care Program" and "Working spouse"; in "Eligible others", rewrote 3i and added 3iii through 3iv.
Amended by R.2006 d.209, effective 6/5/2006.
See: 38 N.J.R. 1271(a), 38 N.J.R. 2418(b).
In definition "Eligible others" substituted "20" for "five" and inserted "by the Director, Veterans Healthcare Services" in the introductory paragraph, inserted present 1, recodified 1 through 3 as 2 through 4, deleted "Spousal priority is as follows:" from the end of 4 and deleted 4i through 4iv; in definition "Maximum allowable asset", substituted "$ 20,000" for "$ 15,000" and "$ 45,000" for "$ 40,000"; added the last sentence in definition "National Guard/Reserve Component"; deleted definition "New resident"; substituted "healthcare and respite care services" for "long term and respite care services as defined in this chapter" in definition "Respite Care Program"; and in definition "Veteran", deleted "or" from end of 1, substituted "; or" for a period at end of 2 and inserted 3.
Recodified from N.J.A.C. 5A:5-2.1 and amended by R.2008 d.298, effective 10/6/2008.
See: 40 N.J.R. 3782(a), 40 N.J.R. 5580(a).
In definition "Maximum allowable asset", substituted "$ 80,000" for "$ 45,000".
Amended by R.2014 d.022, effective 1/21/2014.
See: 45 N.J.R. 2065(a), 46 N.J.R. 204(a).
Rewrote definitions "Accountable assets", "Community spouse", "Durable power of attorney", "Eligible others", and "Resident"; in definition "Extraordinary expense deduction", deleted "one time" preceding "major", and inserted a comma following "medical"; in definitions "Guardian" and "Guardianship", substituted "incapacitated" for "incompetent"; in definition "Maximum allowable asset", deleted "as defined above" following "assets", and substituted "$ 24,000" for "$ 20,000" and "$ 110,000" for "$ 80,000"; in definition "Transfer", deleted "within the Department of Military and Veterans Affairs" following "environment"; added definitions "Facility resident", "Living will", "Physician Orders for Life Sustaining Treatment (POLST)", and "Service connected disability"; deleted definitions "Indigent", "Medically needy applicants", "National Guard/Reserve Component", "Needy veteran", and "Respite Care Program"; and substituted definition "Non-accountable assets" for definition "Nonaccountable assets" and definition "Veterans' memorial home" for definition "Veterans' facility"; and rewrote definition "Non-accountable assets".