DETERMINING LIABILITY AND ASSESSMENTS
§ 4310.7. Determining client monthly liability.
The extent of a client’s liability for costs of services provided over and above that paid by third-party payors, other agencies, or LLR’s is determined as follows:
(1) During the first six months of care, clients have their liability determined in the following manner:
(i) The client’s liability is all income less $60 per month personal use monies, except when the client is maintaining a home to which he plans to return on discharge from the facility. A liability exemption to maintain a home is allowable six months from the date service began.
(A) The home could be owned by the client or rented from a landlord. If rented, the client must continue to pay the rent, utilities, and other expenses associated with maintaining a property or rental property. The roomer or roomer/boarder situation would also be included if the client continues to pay the landlord to hold the room during the period of hospitalization, not to exceed 6 months.
(B) If the home maintenance exemption is applied, the client’s liability is all income less the home maintenance exemption and $60 a month personal use monies.
(ii) If the client is responsible for paying insurance premiums obtained prior to institutionalization, the amount of these premiums are exempted. Liability would be all income less the insurance premiums and $60 per month personal use monies.
(iii) If the client is receiving a veteran’s benefit for which an institutional award request has been acted upon by the Veteran’s Administration, the amount exempted for personal use is that portion specified by the Veteran’s Administration.
(2) Following the first 6 months of care, all income is considered available to meet the cost of care except:
(i) $60 monthly income for personal care items.
(ii) Veteran’s benefits for which an institutional award request has been acted upon by the Veteran’s Administration. The amount exempted is that portion of the benefit the Veteran’s Administration specifies is to be reserved for the beneficiary’s personal use.
(iii) Health insurance or life insurance premiums, or both, obtained prior to hospitalization.
(iv) The patient’s resident property, household furnishings, clothing, personal effects.
(v) $1,500 combined value of other real or personal property or both. ‘‘Other’’ includes accumulated reserves in institutional representative payee/guardian or client accounts or both that are not legally restricted for the patient’s personal future needs. If these limits are exceeded, any amount over the limit is available to meet the costs of service.
Source The provisions of this § 4310.7 adopted December 3, 1982, effective December 4, 1982, 12 Pa.B. 4149.
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