Page 64

64 TITLE 16 HEALTH AND SAFETY DELAWARE ADMINISTRATIVE CODE Unit for the financial and technical eligibility determination. The financial and technical eligibility determination is made by using criteria applied to those institutionalized and receiving Long Term Care (LTC) Medicaid. 15 DE Reg. 1718 (06/01/12) 21 DE Reg. 574 (01/01/18) 20700.2 Home And Community Based Waiver For The Elderly And Disabled Effective April 1, 2012, this waiver program is incorporated into the Diamond State Health Plan Plus and referred to as Long Term Care Community Services. See DSSM 20710. 15 DE Reg. 1718 (06/01/12) 20700.3 Home and Community Based Waiver for Individuals With AIDS/HIV Effective April 1, 2012 this waiver program is incorporated into the Diamond State Health Plan Plus and referred to as Long Term Care Community Services. See DSSM 20710. 15 DE Reg. 1718 (06/01/12) 20700.4 Assisted Living Waiver Effective April 1, 2012 this waiver program is incorporated into the Diamond State Health Plan Plus and referred to as Long Term Care Community Services. See DSSM 20710. 15 DE Reg. 1718 (06/01/12) 20700.5 Acquired Brain Injury Medicaid Waiver Program Effective April 1, 2012 this waiver program is incorporated into the Diamond State Health Plan Plus and referred to as Long Term Care Community Services. See DSSM 20710. 11 DE Reg. 1054 (02/01/08) 15 DE Reg. 1718 (06/01/12) 20700.5.1 – 20700.5.8 8 DE Reg. 557 (10/01/04) 11 DE Reg. 1055 (02/01/08) 20700.6 - 20700.6.7 ATTENDANT SERVICES WAIVER PROGRAM Repealed, Effective February 10, 2009. 8 DE Reg. 1625 (05/01/05) 12 DE Reg. 1088 (02/01/09) 20710 Long Term Care Community Services 1 . Individuals must be medically eligible. The Division of Medicaid & Medical Assistance (DMMA) Pre-Admission Screening (PAS) Unit determines medical eligibility. The applicant must be in need of nursing facility level of care as defined by DMMA. See DSSM 20102 for additional information on Medical eligibility. 2 . Individuals must be technically and financially eligible The DMMA Long Term Care Financial Unit determines eligibility using criteria in DSSM 20103. 3 . Individuals must choose a managed care organization once eligibility has been determined. 15 DE Reg. 1718 (06/01/12) 20720 Patient Pay Calculation This policy applies to all individuals receiving Medicaid through the Division of Developmental Disabilities Services (DDDS) Lifespan Waiver and the Long Term Care Community Services (LTCCS) Program. 1. The Medicaid recipient's total income will be used in the post eligibility treatment of income. This includes income that is counted for eligibility and income that is excluded for eligibility. 2. Allowable deductions are given based on an individual's circumstances. Not all deductions will apply to all individuals. 3. Any amount of income remaining after allowable deductions is the patient pay amount. This amount must be paid on a monthly basis as indicated below: • Individuals receiving Residential Habilitation funded by the DDDS waiver will submit their patient pay amount directly to the provider of Residential Habilitation. • Individuals residing in an Assisted Living Facility will submit their patient pay amount directly to the Assisted Living Facility. The following deductions from the Medicaid recipient's total gross income should be taken in the following order: