Page 12

State of Maryland Medical Assistance Manual Revised April 2014

This is an allowance to enable the person to meet daily living expenses in the long- term care facility that is not covered by the Program. For a person who resides in intermediate care facility for the mentally disabled or mental institution and receives pay for therapeutic work activities, the personal needs allowance is $100.00. If documented work expenses exceed this amount, additional allowance may be made for these up to the medically needy income limit (MNIL). 2. Residential Maintenance Allowance This is a deduction to enable a lone person to maintain a community residence. A lone person is one who does not have a spouse or dependent children at home. This allowance is given if the person must pay expenses such as rent, mortgage, taxes or utilities in order to maintain his community residence. The residential maintenance allowance is applicable in three circumstances: • When a person’s intent to return home within 6 months is supported by • medical documentation; • In the month of admission; and • In the month of discharge to the community. The allowance may be given up to the amount of the MNIL for one person, based on the documented household expenses. If the expenses are less than the MNIL, only the actual monthly amount of expenses is allowed. Application of the Residential Maintenance Allowance: When a Person Intends to Return Home Within Six Months This deduction applies to a person who: • Has resided in a LTCF less than six full months; • Intends to return to his/her community residence within six months of the current admission to the LTCF and his/her ability to do so has been verified by a written physician’s statement. DHMH Form 4245 (LTC) Revised 11/03, Physician Report, is used for this purpose. If the report indicates the person’s anticipated length of stay is six months or less, the Residential Maintenance Allowance is given. A medical review by the Utilization Control Agent is not required for this allowance. If the person has been institutionalized for more than six consecutive months as either private pay and/or MA, the Residential Maintenance Allowance may not be given. The person’s institutional status is not interrupted by transfer from one LTCF to another or by admission to an acute hospital. This allowance is given for a maximum of six months and possibly less, based on the date of institutionalization, and may not be extended regardless of the person’s condition and intent. NOTE: DHMH Form 4245 (LTC) Revised 11/03, Physician Report, is a two purpose form. It is also used in implementing the Medical Review process for LTC home