Page 5

Official source

Aged, Blind and Disabled Manual Policy Manual Number: 110.032 Section: Financial Eligibility Requirements Chapter: ABD In-Kind Support and Maintenance

January 5, 2026 Division of TennCare 5

8. Verification TennCare accepts self-attestation of ISM, and applies the VTR rule or the PMV rule, depending on a person’s living arrangement. If an individual alleges that his contribution towards household expenses is within $20 of the pro rata share or alleges that the actual value of ISM is less than the PMV, and he wishes to rebut the PMV, written documentation is required. Written documentation may include any of the following: a written statement from another adult household member other than the person’s spouse, a written statement from the person paying for or providing the shelter, a copy of a bill, receipt or canceled check showing the actual value of the shelter item. If written documentation is not provided, ISM is counted based on the VTR or PMV rule.

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Page 5

Official source

Aged, Blind and Disabled Manual Policy Manual Number: 110.032 Section: Financial Eligibility Requirements Chapter: ABD In-Kind Support and Maintenance

January 5, 2026 Division of TennCare 5

8. Verification TennCare accepts self-attestation of ISM, and applies the VTR rule or the PMV rule, depending on a person’s living arrangement. If an individual alleges that his contribution towards household expenses is within $20 of the pro rata share or alleges that the actual value of ISM is less than the PMV, and he wishes to rebut the PMV, written documentation is required. Written documentation may include any of the following: a written statement from another adult household member other than the person’s spouse, a written statement from the person paying for or providing the shelter, a copy of a bill, receipt or canceled check showing the actual value of the shelter item. If written documentation is not provided, ISM is counted based on the VTR or PMV rule.