UPM P-1570.26 - Adjustment of MMNA -- Exceptional Expenses/Significant Financial Duress

CONNECTICUT DEPARTMENT OF SOCIAL SERVICESPRIVATE UNIFORM POLICY MANUAL ______________________________________________________________________________ Date: 02-13-01 Transmittal: UP-01-04 P-1570.26 ______________________________________________________________________________ Section: Type: The Eligibility Process PROCEDURES ______________________________________________________________________________ Chapter: Program: MAABD Fair Hearings _______________________________________________________________ Subject: Adjustment of MMNA -- Exceptional Expenses/Significant Financial Duress ______________________________________________________________________________

P-1570.26 1. Use these procedures if the Fair Hearing involves the issue of adjusting the CSPA or the CSA because of the claim that the community spouse has exceptional circumstances resulting in significant financial duress.

2. Consider first the issue of exceptional circumstances.

° What are these circumstances?

° Are they unusual and extreme?

° Do they prevent the community spouse from taking care of his or her activities of daily living (bathing, dressing, transferring, toileting, feeding, preparing meals, administering medication, ambulating, controlling bladder and bowel)?

° Do they directly threaten the community spouse's ability to remain in the community, or do they involve the community spouse's providing constant and essential care for a disabled child, sibling or other immediate relative (other than the institutionalized spouse)?

3. Do not consider expenses in themselves to be exceptional circumstances. Rather, look for conditions or sets of conditions affecting the community spouse, as described in step 2.

4. Do not consider a situation relating to household upkeep (replacement of a roof or appliance, lawn maintenance, snow removal, etc.) to be an exceptional circumstance unless caused by a natural disaster or other extreme situation.

5. Do not consider the normal frailties of old age, or the need for increased costs relating to medical insurance to be an exceptional circumstance.

6. Do consider an exceptional circumstance a severe medical condition that:

° completely confines the community spouse to bed; or

° prevents him or her from taking care of activities of daily living; or

° requires constant care by others.PRIVATE tc \l 1 ""

CONNECTICUT DEPARTMENT OF SOCIAL SERVICES UNIFORM POLICY MANUAL ______________________________________________________________________________ Date: 02-13-01 Transmittal: UP-01-04 P-1570.26 page 2 ______________________________________________________________________________ Section: Type: The Eligibility Process PROCEDURES ______________________________________________________________________________ Chapter: Program: MAABD Fair Hearings _______________________________________________________________ Subject: Adjustment of MMNA -- Exceptional Expenses/Significant Financial Duress ______________________________________________________________________________

P-1570.26 7. Do consider an exceptional circumstance the community spouse's providing constant and essential care to his or her disabled child, sibling or other immediate relative (other than institutionalized spouse).

8. Using the above steps as guidelines, determine whether there are exceptional circumstances.

9. If you find that there is no exceptional circumstance, stop here. Do not adjust the MMNA. If you find that there is an exceptional circumstance, go on to step 10.

10. If you found that there is an exceptional circumstance in step 9, ask the following questions:

° What are the community spouse's expenses directly arising from the exceptional circumstance?

° Are these expenses severe and unusual, and beyond what is covered in the MMNA?

° Can the community spouse reasonably meet these expenses from his or her own income and assets?

° Must the community spouse meet these expenses either to continue to remain in the community, or to continue to care for his or her disabled child, sibling or other immediate relative (other than institutionalized spouse)?

° Is there any other way to meet these expenses, such as insurance or other third party coverage?

11. If the expense or set of expenses is not related to the exceptional circumstance, stop here. Do not increase the MMNA.

12. Do not consider expenses related to costs already factored into the MMNA as examples of significant financial duress. Such costs include, but are not limited to:

° rent or mortgage payments

° utility costs

° condominium fees

CONNECTICUT DEPARTMENT OF SOCIAL SERVICES UNIFORM POLICY MANUAL ______________________________________________________________________________ Date: 02-13-01 Transmittal: UP-01-04 P-1570.26 page 3 ______________________________________________________________________________ Section: Type: The Eligibility Process PROCEDURES ______________________________________________________________________________ Chapter: Program: MAABD Fair Hearings _______________________________________________________________ Subject: Adjustment of MMNA -- Exceptional Expenses/Significant Financial Duress ______________________________________________________________________________

P-1570.26 ° real estate and personal property taxes

° real estate, life and medical insurance.

13. Do not consider expenses for the upkeep of a home (lawn maintenance, snow removal, replacement of roof, furnace, appliance, etc.) as examples of significant financial duress unless:

° they are the direct result of the exceptional circumstance determined in step 9; and

° they are severe and unusual, and cannot be reasonably expected to paid from the community spouse's income or assets.

14. Do not consider expenses for medical costs including prescriptions as examples of significant financial duress unless:

° they are severe and unusual; and

° they are the direct result of the exceptional circumstance determined in step 9; and

° they cannot be reasonably expected to paid from the community spouse's income or assets.

15. If you find that there is significant financial duress as a result of the exceptional circumstance, evaluate the related expenses as presented by the requester. Allow those that are reasonable and necessary.

16. Recompute the MMNA as follows:

° Follow steps 1 through 7 at P-5035.10;

° Add the expenses from step 15 above to the figure calculated at P-5035.10, step 6 or 7, whichever is appropriate.

17. Adjust the MMNA by using the figure from step 16. You are not bound by the limits defined in P-5035.10.