55 Pa. Code § 181.453

Current through Register Vol. 54, No. 45, November 9, 2024

Section 181.453 - Determination of MA payment toward cost of care in institutions

(a) A person who is eligible for MA is eligible for a contribution from the Department toward the cost of his skilled nursing care, heavy care/intermediate services or intermediate care or services in an ICF/MR facility, if the amount of his payment determined under § 181.452 (relating to posteligibility determina tion of income available from an MA eligible person toward his cost of care) is less than the MA payment rate multiplied by the total number of days of care received by the MA eligible person.

(b) The contribution from the Department toward the cost of care is the difference between the MA payment rate multiplied by the total number of days of care received by the MA eligible person less the amount of the payment determined under § 181.452.

(c) If an MA eligible person is determined under § 181.452 to have income sufficient to reduce the Department's payment to zero, the MA eligible person is not obligated to pay a greater amount than the Department's payment rate toward his cost of care.

55 Pa. Code § 181.453

The provisions of this §181.453 adopted August 26, 1988, effective 11/1/1988, 18 Pa.B. 3949; amended August 28, 1992, effective upon publication and apply retroactively to October 1, 1989, 22 Pa.B. 4432.

The provisions of this §181.453 issued under section 403(b) of the Public Welfare Code (62 P. S. § 403(b)).

This appendix cited in 55 Pa. Code § 178.91 (relating to deeming of resources); 55 Pa. Code § 178.105 (relating to presumption of disposition of assets to qualify for MA for transfers on or after July 30, 1994); 55 Pa. Code § 181.1 (relating to general policy on MA income common to all categories of MA); 55 Pa. Code § 181.11 (relating to continuing eligibility); 55 Pa. Code § 181.12 (relating to retroactive eligibility); 55 Pa. Code § 181.13 (relating to eligibility under NMP-MA spend-down); 55 Pa. Code § 181.110 (relating to income deemed available from the spouse); and 55 Pa. Code § 181.452 (relating to posteligibility determination of income available from an MA eligible person toward his cost of care).