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<chapter num="07" heading="Public Assistance to Adults" title_num="07" subtitle_num="03">
  <regulation prefix="Regulation" num=".01" heading="Purpose.">
    <text>Public Assistance to Adults is a monthly payment of State funds to an individual who has:</text>
    <paragraph num="A.">
      <text>Been certified for a licensed assisted living program, a CARE home, or a Maryland Department of Health  (MDH) rehabilitative residence; and</text>
    </paragraph>
    <paragraph num="B.">
      <text>Allowable needs in excess of total countable income and resources that do not exceed limits.</text>
    </paragraph>
  </regulation>
  <regulation prefix="Regulation" num=".02" heading="Definitions.">
    <paragraph num="A.">
      <text>In this chapter, the following terms have the meanings indicated.</text>
    </paragraph>
    <paragraph num="B.">
      <text>Terms Defined.</text>
      <paragraph num="(1)">
        <text>“Allowable need” means any need as described in Regulation .04 of this chapter as licensed assisted living, Certified Adult Residential Environment (CARE) homes, and personal and incidental needs.</text>
      </paragraph>
      <paragraph num="(2)">
        <text>“Assisted living” means services provided in a licensed protective institutional environment as described in COMAR 10.07.14 to an individual who is aged or disabled, or both, and who cannot manage activities of daily living as described in COMAR 10.07.14.02B(2)(b).</text>
      </paragraph>
      <paragraph num="(3)">
        <text>“CARE home” means a home that provides supervised residential alternatives to an individual who, due to physical or mental disability, cannot live unsupervised in the community and is at risk for institutionalization as described in COMAR 07.02.19.</text>
      </paragraph>
      <paragraph num="(4)">
        <text>"MDH" rehabilitative residence" means a residence that provides residential rehabilitation as described in COMAR 10.21.22 or a supported living program approved by the Mental Hygiene Administration of the Maryland Department of Health.</text>
      </paragraph>
      <paragraph num="(5)">
        <text>“Local department” means a local department of social services in a county or Baltimore City or the Montgomery County Department of Health and Human Services.</text>
      </paragraph>
      <paragraph num="(6)">
        <text>“Net countable income” means gross income less any disregard.</text>
      </paragraph>
      <paragraph num="(7)">
        <text>“Protected living arrangement” means a residential environment that provides care to vulnerable adults who are aged, disabled, or both, and who cannot manage activities of daily living as described in COMAR 10.07.14.02B(2)(b).</text>
      </paragraph>
      <paragraph num="(8)">
        <text>“Resident” means an individual who is living in the State voluntarily and not for a temporary purpose.</text>
      </paragraph>
    </paragraph>
  </regulation>
  <regulation prefix="Regulation" num=".03" heading="Eligibility Criteria.">
    <paragraph num="A.">
      <text>An individual is eligible when, in any month, the individual:</text>
      <paragraph num="(1)">
        <text>Is a resident of the State;</text>
      </paragraph>
      <paragraph num="(2)">
        <text>Is receiving a federal benefit for age, blindness, or disability;</text>
      </paragraph>
      <paragraph num="(3)">
        <text>If not receiving a federal retirement or disability benefit, has filed an application for Supplemental Security Income (SSI) and Social Security Disability Insurance (SSDI), in accordance with §B of this regulation;</text>
      </paragraph>
      <paragraph num="(4)">
        <text>Is in an assisted living program, in a CARE home, or in a MDH rehabilitative residence while continuing to cooperate with all technical and financial requirements of eligibility; and</text>
      </paragraph>
      <paragraph num="(5)">
        <text>Continues to cooperate with all technical and financial requirements of eligibility.</text>
      </paragraph>
    </paragraph>
    <paragraph num="B.">
      <text>Social Security Administration Disability Benefits Applications and Appeals.</text>
      <paragraph num="(1)">
        <text>Applicants who are not receiving a federal retirement or disability benefit shall fully cooperate with the Social Security Administration (SSA) application and appeals processes.</text>
      </paragraph>
      <paragraph num="(2)">
        <text>Failure to cooperate shall render the applicant or recipient ineligible and result in application denial or case closure.</text>
      </paragraph>
    </paragraph>
    <paragraph num="C.">
      <text>If SSA makes a final unfavorable decision, the customer is no longer eligible for assisted living benefits from the PAA program, unless:</text>
      <paragraph num="(1)">
        <text>Good cause exists for continued PAA eligibility, which the DHS Appointing Authority or its designee shall determine following a review; or</text>
      </paragraph>
      <paragraph num="(2)">
        <text>Disability Services Operations (DSO) decides that the person meets the definition of disabled following a consultative exam or coordination with the State Disability Determination Services Agency.</text>
      </paragraph>
    </paragraph>
    <paragraph num="D.">
      <text>Determination of Medical Justification for Placement into an Assisted Living Facility.</text>
      <paragraph num="(1)">
        <text>The Department of Human Services shall establish a process through DSO to determine when medical justification for placement into a protected living environment is sufficient to support an individual’s eligibility for the PAA-Assisted Living program.</text>
      </paragraph>
      <paragraph num="(2)">
        <text>This provision does not apply to individuals participating in PAA-CARE homes and PAA-MDH rehabilitative residences.</text>
      </paragraph>
    </paragraph>
    <paragraph num="E.">
      <text>Temporary Absence from Maryland.</text>
      <paragraph num="(1)">
        <text>An individual remains a resident of the State despite temporary absence from the State if the individual intends to return when the purposes of the absence have been accomplished.</text>
      </paragraph>
      <paragraph num="(2)">
        <text>The local department shall verify, after 30 consecutive days of absence and monthly after that, whether the absence is temporary or permanent.</text>
      </paragraph>
    </paragraph>
    <paragraph num="F.">
      <text>Cooperation with the Eligibility Process.</text>
      <paragraph num="(1)">
        <text>An individual shall:</text>
        <paragraph num="(a)">
          <text>Provide all necessary information needed for initial or continued program eligibility and ensure that the information is true, correct, and complete; and</text>
        </paragraph>
        <paragraph num="(b)">
          <text>Cooperate with the Agency in all aspects of program administration.</text>
        </paragraph>
      </paragraph>
      <paragraph num="(2)">
        <text>The individual and the individual’s authorized representative are subject to the requirements in COMAR 07.03.14 if they provide false information.</text>
      </paragraph>
    </paragraph>
    <paragraph num="G.">
      <text>After meeting all other program requirements, an individual is eligible for Public Assistance to Adults:</text>
      <paragraph num="(1)">
        <text>While the application for other benefits is pending; and</text>
      </paragraph>
      <paragraph num="(2)">
        <text>After the application for other benefits is denied if the individual meets the conditions described in §A(3) of this regulation.</text>
      </paragraph>
    </paragraph>
    <paragraph num="H.">
      <text>Interim Payment Reimbursement Authorization.</text>
      <paragraph num="(1)">
        <text>Assisted living program and CARE home applicants and recipients shall sign an Interim Payment Reimbursement Authorization which:</text>
        <paragraph num="(a)">
          <text>Permits the Social Security Administration to mail the initial SSI payment to the local department providing the Public Assistance to Adults; and</text>
        </paragraph>
        <paragraph num="(b)">
          <text>Allows the local department to reimburse itself for the assistance granted the recipient.</text>
        </paragraph>
      </paragraph>
      <paragraph num="(2)">
        <text>If the initial SSI payment mailed to the local department is less than or equal to the amount of Public Assistance to Adults received for the months the individual was entitled to SSI, the local department may retain the full amount of the SSI payment.</text>
      </paragraph>
      <paragraph num="(3)">
        <text>If the amount of SSI received by the local department is greater than the amount of assistance paid, the local department shall pay the excess amount to the individual within 10 days of the receipt of the SSI payment and the Supplemental Security Income Notice of Interim Assistance Reimbursement Eligibility and Accountability Report.</text>
      </paragraph>
    </paragraph>
  </regulation>
  <regulation prefix="Regulation" num=".04" heading="Need Requirements.">
    <paragraph num="A.">
      <text>Personal Needs Allowance.</text>
      <paragraph num="(1)">
        <text>The standard for personal and incidental needs is $82 for an individual receiving Public Assistance to Adults for care in an assisted living program, CARE home, or MDH rehabilitative residence or supported living programs.</text>
      </paragraph>
      <paragraph num="(2)">
        <text>The personal needs allowance may not be used for the cost of care.</text>
      </paragraph>
    </paragraph>
    <paragraph num="B.">
      <text>Assisted Living Program.</text>
      <paragraph num="(1)">
        <text>Assisted living cost of care is:</text>
        <paragraph num="(a)">
          <text>Paid up to the maximum allowable amount as set forth in §B(2) of this regulation; and</text>
        </paragraph>
        <paragraph num="(b)">
          <text>An allowable need for the purposes of Public Assistance to Adults.</text>
        </paragraph>
      </paragraph>
      <paragraph num="(2)">
        <text>Payment Schedule for Assisted Living Care. Effective January 1, 2009, the maximum allowable amount paid to a recipient for assisted living program care is $858 per month or $28.22 per diem.</text>
      </paragraph>
      <paragraph num="(3)">
        <text>Per diem amounts are used when the recipient enters care after the first day of the month.</text>
      </paragraph>
      <paragraph num="(4)">
        <text>Benefits are effective on the date of entry into care when the application is made in the same month.</text>
      </paragraph>
    </paragraph>
    <paragraph num="C.">
      <text>CARE Homes.</text>
      <paragraph num="(1)">
        <text>CARE home cost of care is:</text>
        <paragraph num="(a)">
          <text>Paid up to a maximum allowable amount as set forth in §C(2) of this regulation; and</text>
        </paragraph>
        <paragraph num="(b)">
          <text>An allowable need for the purposes of Public Assistance to Adults.</text>
        </paragraph>
      </paragraph>
      <paragraph num="(2)">
        <text>Payment Schedule for CARE Homes. Effective January 1, 2009, the maximum allowable amount paid to a recipient for CARE home care is:</text>
      </paragraph>
      <paragraph num="(3)">
        <text>Per diem amounts are used when the recipient enters care after the first day of the month.</text>
      </paragraph>
      <paragraph num="(4)">
        <text>Benefits are paid from the date of entry into care when the application is made in the same month.</text>
      </paragraph>
    </paragraph>
    <paragraph num="D.">
      <text>Rehabilitative Residences. A resident of a MDH rehabilitative residence or supported living program who meets technical and financial eligibility requirements shall receive the personal needs allowance as described in §A of this regulation.</text>
    </paragraph>
  </regulation>
  <regulation prefix="Regulation" num=".05" heading="Determining Available Resources.">
    <paragraph num="A.">
      <text>Resources Retained.</text>
      <paragraph num="(1)">
        <text>The Public Assistance to Adults applicant or recipient may retain up to $2,000 in countable resources.</text>
      </paragraph>
      <paragraph num="(2)">
        <text>To determine the individual's eligibility, the local department shall measure the individual's countable resources against the maximum allowable amount as described in §A(1) of this regulation.</text>
      </paragraph>
    </paragraph>
    <paragraph num="B.">
      <text>Countable resources include but are not limited to:</text>
      <paragraph num="(1)">
        <text>Cash on hand;</text>
      </paragraph>
      <paragraph num="(2)">
        <text>Money in the bank;</text>
      </paragraph>
      <paragraph num="(3)">
        <text>Stocks;</text>
      </paragraph>
      <paragraph num="(4)">
        <text>Bonds;</text>
      </paragraph>
      <paragraph num="(5)">
        <text>Real property other than the applicant's or recipient's home; and</text>
      </paragraph>
      <paragraph num="(6)">
        <text>Trust fund principal when the individual:</text>
        <paragraph num="(a)">
          <text>Is the beneficiary; and</text>
        </paragraph>
        <paragraph num="(b)">
          <text>Has unrestricted access to the principal of the trust.</text>
        </paragraph>
      </paragraph>
    </paragraph>
    <paragraph num="C.">
      <text>Ownership of Home.</text>
      <paragraph num="(1)">
        <text>An applicant or recipient may retain the home the applicant or recipient owns if the:</text>
        <paragraph num="(a)">
          <text>Applicant or recipient was living in the home and plans to return to the home within 6 months from the date of the application for assistance; or</text>
        </paragraph>
        <paragraph num="(b)">
          <text>Spouse with whom the applicant or recipient was living when the applicant or recipient entered care is still living in the home.</text>
        </paragraph>
      </paragraph>
      <paragraph num="(2)">
        <text>If neither of the conditions described in §C(1) of this regulation exists, then the equity value of the home is considered a countable resource.</text>
      </paragraph>
    </paragraph>
    <paragraph num="D.">
      <text>Transfer of Property. Transfer of property while receiving assistance with the intent to defeat the purposes of the law and without the consent of the local department shall be dealt with as described in COMAR 07.03.01.</text>
    </paragraph>
  </regulation>
  <regulation prefix="Regulation" num=".06" heading="Excluded Resources.">
    <paragraph num="A.">
      <text>Excluded resources include:</text>
      <paragraph num="(1)">
        <text>The value of burial spaces for the individual, the individual's spouse, or any member of the individual's immediate family;</text>
      </paragraph>
      <paragraph num="(2)">
        <text>Burial funds as described in §B of this regulation;</text>
      </paragraph>
      <paragraph num="(3)">
        <text>Irrevocable burial contracts as described in §C of this regulation;</text>
      </paragraph>
      <paragraph num="(4)">
        <text>Vehicles owned by the individual;</text>
      </paragraph>
      <paragraph num="(5)">
        <text>Life insurance policies;</text>
      </paragraph>
      <paragraph num="(6)">
        <text>Payments under Title I of Public Law 100-383, the Civil Liberties Act of 1988, or Title II of Public Law 100-383, the Aleutian and Pribilof Islands Restitution Act, received by individuals of Japanese ancestry and Aleuts;</text>
      </paragraph>
      <paragraph num="(7)">
        <text>Payments made from the Agent Orange Settlement Fund or any other fund established pursuant to the settlement in the Agent Orange product liability litigation;</text>
      </paragraph>
      <paragraph num="(8)">
        <text>Payments excluded under federal law; and</text>
      </paragraph>
      <paragraph num="(9)">
        <text>Trust fund principal when the individual has no access or only restricted access to the principal of the trust.</text>
      </paragraph>
    </paragraph>
    <paragraph num="B.">
      <text>Burial Funds.</text>
      <paragraph num="(1)">
        <text>In this section, “burial funds” means a revocable burial contract, burial trust, or other burial arrangement, or separately identified fund that is clearly designated as set aside for the individual's or spouse's burial expense.</text>
      </paragraph>
      <paragraph num="(2)">
        <text>Up to $1,500 each of burial funds shall be excluded from resources.</text>
      </paragraph>
      <paragraph num="(3)">
        <text>Funds set aside for burial shall be kept separate from other resources not set aside for burial. Burial funds mixed with other resources shall be treated as nonexcluded resources.</text>
      </paragraph>
      <paragraph num="(4)">
        <text>Interest earned on excluded burial funds is also excluded from income and resources if it is left to accumulate and become part of the separately identified burial fund.</text>
      </paragraph>
      <paragraph num="(5)">
        <text>The burial fund exclusion shall be reduced by:</text>
        <paragraph num="(a)">
          <text>The face value of insurance policies if the cash surrender value of the policies has been excluded from resources; and</text>
        </paragraph>
        <paragraph num="(b)">
          <text>Amounts in an irrevocable burial contract, or other irrevocable agreement, available to meet burial expenses.</text>
        </paragraph>
      </paragraph>
    </paragraph>
    <paragraph num="C.">
      <text>Irrevocable Burial Contracts.</text>
      <paragraph num="(1)">
        <text>“Irrevocable burial contract” means an agreement that does not provide for a refund and that is clearly designated as providing for the individual's or spouse's burial expense.</text>
      </paragraph>
      <paragraph num="(2)">
        <text>An irrevocable burial contract is fully excluded regardless of value.</text>
      </paragraph>
      <paragraph num="(3)">
        <text>Interest earned on irrevocable burial funds is also excluded from income and resources.</text>
      </paragraph>
    </paragraph>
  </regulation>
  <regulation prefix="Regulation" num=".07" heading="Income.">
    <paragraph num="A.">
      <text>In this regulation, “income” means all income from any source.</text>
    </paragraph>
    <paragraph num="B.">
      <text>Countable income includes, but is not limited to:</text>
      <paragraph num="(1)">
        <text>Wages, salaries, tips, and commissions;</text>
      </paragraph>
      <paragraph num="(2)">
        <text>Income from self-employment after deducting costs of materials, equipment, or other items essential to production of the self-employment income;</text>
      </paragraph>
      <paragraph num="(3)">
        <text>Federally funded assistance payments;</text>
      </paragraph>
      <paragraph num="(4)">
        <text>State-funded assistance payments;</text>
      </paragraph>
      <paragraph num="(5)">
        <text>Annuities, pensions, and retirement benefits;</text>
      </paragraph>
      <paragraph num="(6)">
        <text>Workers' compensation or unemployment benefits;</text>
      </paragraph>
      <paragraph num="(7)">
        <text>Social Security benefits;</text>
      </paragraph>
      <paragraph num="(8)">
        <text>Support and alimony payments;</text>
      </paragraph>
      <paragraph num="(9)">
        <text>Educational assistance not excluded under §C of this regulation;</text>
      </paragraph>
      <paragraph num="(10)">
        <text>Payments from government programs, dividends, interest, royalties, or money payments from any source that is a gain or benefit to the individual;</text>
      </paragraph>
      <paragraph num="(11)">
        <text>The contribution for a parent from a son or daughter;</text>
      </paragraph>
      <paragraph num="(12)">
        <text>The contribution for an adult child with a disability from a parent;</text>
      </paragraph>
      <paragraph num="(13)">
        <text>Lump sum income as described in §E of this regulation;</text>
      </paragraph>
      <paragraph num="(14)">
        <text>Trust fund payments made on behalf of the individual when the payment is made:</text>
        <paragraph num="(a)">
          <text>Directly to the individual; or</text>
        </paragraph>
        <paragraph num="(b)">
          <text>To the individual's legal guardian; and</text>
        </paragraph>
      </paragraph>
      <paragraph num="(15)">
        <text>Income from the trust fund principal when the individual has a right to the income as it becomes available.</text>
      </paragraph>
    </paragraph>
    <paragraph num="C.">
      <text>Excluded income includes:</text>
      <paragraph num="(1)">
        <text>Any grant or loan to an undergraduate student for educational purposes made, or insured, under any program administered by the U.S. Secretary of Education;</text>
      </paragraph>
      <paragraph num="(2)">
        <text>Any benefits received under Title VII, Nutrition Program for the Elderly, of the Older Americans Act of 1965, as amended;</text>
      </paragraph>
      <paragraph num="(3)">
        <text>Any stipends, compensation, or expenses received by volunteers from any programs existing or to be set up under the “Domestic Volunteer Service Act of 1973” sponsored by ACTION, such as, but not limited to:</text>
        <paragraph num="(a)">
          <text>Demonstration Project Program for Local Services (PLS);</text>
        </paragraph>
        <paragraph num="(b)">
          <text>Volunteers in Service to America (VISTA);</text>
        </paragraph>
        <paragraph num="(c)">
          <text>University Year for Action;</text>
        </paragraph>
        <paragraph num="(d)">
          <text>Retired Senior Volunteer Program (RSVP);</text>
        </paragraph>
        <paragraph num="(e)">
          <text>Foster Grandparents;</text>
        </paragraph>
        <paragraph num="(f)">
          <text>Older American Community Service Program;</text>
        </paragraph>
        <paragraph num="(g)">
          <text>Service Corps of Retired Executives (SCORE); and</text>
        </paragraph>
        <paragraph num="(h)">
          <text>Active Corps of Executives (ACE);</text>
        </paragraph>
      </paragraph>
      <paragraph num="(4)">
        <text>The value of home produce of an applicant or recipient used by the individual for home consumption;</text>
      </paragraph>
      <paragraph num="(5)">
        <text>Educational loans and grants, such as scholarships, obtained and used under conditions that preclude their use for current living costs, other than those related to educational pursuits, such as books, fees, transportation to and from an educational institution, and the cost of child care while in attendance;</text>
      </paragraph>
      <paragraph num="(6)">
        <text>All training allowances received in a program under the Youth Employment Demonstration Program;</text>
      </paragraph>
      <paragraph num="(7)">
        <text>All training allowances received in a program offered by a public or private organization enabling people to participate in training programs intended to help them acquire job skills;</text>
      </paragraph>
      <paragraph num="(8)">
        <text>Payment received from the U.S. Department of Commerce, the Census Bureau, for short-term employment as a census worker;</text>
      </paragraph>
      <paragraph num="(9)">
        <text>Payment under Title I of Public Law 100-383, the Civil Liberties Act of 1988, or Title II of Public Law 100-383, the Aleutian and Pribilof Islands Restitution Act, received by individuals of Japanese ancestry and Aleuts;</text>
      </paragraph>
      <paragraph num="(10)">
        <text>Payment made from the Agent Orange Settlement Fund or any other fund established pursuant to the settlement in the Agent Orange product liability litigation;</text>
      </paragraph>
      <paragraph num="(11)">
        <text>The value of the benefit amount under the Food Supplement Program; and</text>
      </paragraph>
      <paragraph num="(12)">
        <text>Income from the trust principal when the individual has no right to the income.</text>
      </paragraph>
    </paragraph>
    <paragraph num="D.">
      <text>Income that is excluded may not be considered in determining the need of any other person for assistance.</text>
    </paragraph>
    <paragraph num="E.">
      <text>Receipt of Lump Sum Income.</text>
      <paragraph num="(1)">
        <text>Lump sum income is a nonrecurring money payment received by an applicant or recipient.</text>
      </paragraph>
      <paragraph num="(2)">
        <text>The portion of a lump sum actually available to an applicant or recipient is counted as a resource or income for determining eligibility and amount of payment.</text>
      </paragraph>
      <paragraph num="(3)">
        <text>The lump sum payment is counted in the following way:</text>
        <paragraph num="(a)">
          <text>An amount equal to the resource limit as described in Regulation .05A of this chapter, or an amount which when added to existing resources would equal the resource limit, may be retained;</text>
        </paragraph>
        <paragraph num="(b)">
          <text>The remaining lump sum is considered income and is added to the sum of all other income for the month after work expenses and other allowable disregards have been applied;</text>
        </paragraph>
        <paragraph num="(c)">
          <text>Income resulting from the computation in §E(3)(b) of this regulation is divided by the allowable amount for the individual;</text>
        </paragraph>
        <paragraph num="(d)">
          <text>The recipient is ineligible for the period of months equal to the quotient resulting from the division in §E(3)(c) of this regulation beginning with the first month for which advance notice of termination requirements can be met;</text>
        </paragraph>
        <paragraph num="(e)">
          <text>Any amount remaining which is less than the allowable amount is counted as income in the first month after the ineligibility ends;</text>
        </paragraph>
        <paragraph num="(f)">
          <text>If the lump sum is less than the monthly allowable amount and the asset limitation has been reached, the lump sum is deducted from the grant for the first month for which advance notice of reduction requirements can be met; and</text>
        </paragraph>
        <paragraph num="(g)">
          <text>The recipient who receives a lump sum payment in the month of application is ineligible for the period of months equal to the quotient resulting from the division in §E(3)(c) of this regulation beginning with the month of application.</text>
        </paragraph>
      </paragraph>
    </paragraph>
    <paragraph num="F.">
      <text>Shortened Period of Ineligibility for Recipients of Lump Sum Income.</text>
      <paragraph num="(1)">
        <text>The local department shall shorten the period of ineligibility for assistance due to receipt of lump sum income when the lump sum income or a portion of it becomes unavailable to the applicant or recipient due to circumstances beyond the individual's control.</text>
      </paragraph>
      <paragraph num="(2)">
        <text>The lump sum income or a portion of it is considered unavailable when:</text>
        <paragraph num="(a)">
          <text>It is no longer in the possession of the individual and can not be recovered or used for every day expenses; and</text>
        </paragraph>
        <paragraph num="(b)">
          <text>This unavailability has been verified.</text>
        </paragraph>
      </paragraph>
      <paragraph num="(3)">
        <text>Circumstances considered beyond the control of the individual are:</text>
        <paragraph num="(a)">
          <text>Theft of money;</text>
        </paragraph>
        <paragraph num="(b)">
          <text>Disaster defined as fire, flood, tornado, or civil disorder;</text>
        </paragraph>
        <paragraph num="(c)">
          <text>Eviction or foreclosure; or</text>
        </paragraph>
        <paragraph num="(d)">
          <text>Medical expenses.</text>
        </paragraph>
      </paragraph>
      <paragraph num="(4)">
        <text>Allowable medical expenses under §F(3)(d) of this regulation are payments for:</text>
        <paragraph num="(a)">
          <text>Treatment or service rendered in a hospital, clinic, or nursing home;</text>
        </paragraph>
        <paragraph num="(b)">
          <text>Treatment or service rendered by a physician, dentist, certified psychologist, licensed social worker, or any health professional licensed or certified by the State;</text>
        </paragraph>
        <paragraph num="(c)">
          <text>Prescription drugs when prescribed by a health professional licensed under State law to prescribe drugs; and</text>
        </paragraph>
        <paragraph num="(d)">
          <text>Over-the-counter medication, health-related supplies, or appliances recommended by a health professional licensed by the State.</text>
        </paragraph>
      </paragraph>
    </paragraph>
  </regulation>
  <regulation prefix="Regulation" num=".08" heading="Disregards from Income.">
    <paragraph num="A.">
      <text>Net countable income is determined by applying the following disregards to countable income:</text>
      <paragraph num="(1)">
        <text>A disregard of $85 plus 1/2 of the remaining earned income in any month is deducted from the total earned income as described in Regulation .07B(1) and (2) of this chapter of an individual who has no unearned income;</text>
      </paragraph>
      <paragraph num="(2)">
        <text>A disregard of $20 is applied to the unearned income of an individual who has only unearned income; or</text>
      </paragraph>
      <paragraph num="(3)">
        <text>A disregard of $20 in addition to a disregard of $65 plus 1/2 of the remaining earned income in any month is deducted from the total earned income of a person who has both earned and unearned income.</text>
      </paragraph>
    </paragraph>
    <paragraph num="B.">
      <text>A disregard equal to the cost of care is applied to the income of residents of MDH rehabilitative residences.</text>
    </paragraph>
  </regulation>
  <regulation prefix="Regulation" num=".09" heading="Amount of Grant and Payee.">
    <paragraph num="A.">
      <text>The payment in Public Assistance to Adults, in any month, shall be the amount by which the allowable needs exceed the net countable income in that month.</text>
    </paragraph>
    <paragraph num="B.">
      <text>The payee shall be one of the following:</text>
      <paragraph num="(1)">
        <text>An eligible individual;</text>
      </paragraph>
      <paragraph num="(2)">
        <text>An agency-appointed representative payee; or</text>
      </paragraph>
      <paragraph num="(3)">
        <text>A judicially appointed legal representative, guardian, trustee, or committee.</text>
      </paragraph>
    </paragraph>
    <paragraph num="C.">
      <text>Protective payments may be made on behalf of a recipient to an agency-appointed representative payee if:</text>
      <paragraph num="(1)">
        <text>Medical and social findings establish that the recipient is so unable to manage money that making payment to the recipient would be contrary to the recipient's welfare;</text>
      </paragraph>
      <paragraph num="(2)">
        <text>There is available to act as representative payee, a responsible and dependable individual, other than the assisted living facility operator or staff, to receive the check on behalf of a recipient and handle the money for the recipient's interest and well-being;</text>
      </paragraph>
      <paragraph num="(3)">
        <text>The initial and subsequent decisions and plan for protective payments are reviewed and approved by the local department director or an appropriate member of the administrative or supervisory staff designated by the local department director to take this responsibility;</text>
      </paragraph>
      <paragraph num="(4)">
        <text>Services are given to protect the recipient's welfare and to improve, as much as possible, the recipient's care and ability to manage funds;</text>
      </paragraph>
      <paragraph num="(5)">
        <text>Full needs by assistance standards are met; and</text>
      </paragraph>
      <paragraph num="(6)">
        <text>The decision and plan are reviewed at least once in 6 months.</text>
      </paragraph>
    </paragraph>
    <paragraph num="D.">
      <text>Protective payments are terminated immediately when:</text>
      <paragraph num="(1)">
        <text>The recipient is considered able to manage funds;</text>
      </paragraph>
      <paragraph num="(2)">
        <text>Judicial appointment is made of a guardian or other legal representative as serving the best interest of the recipient; or</text>
      </paragraph>
      <paragraph num="(3)">
        <text>The agency learns that the representative payee has a conflict of interest or is handling the recipient’s funds in a fraudulent or exploitative manner.</text>
      </paragraph>
    </paragraph>
    <paragraph num="E.">
      <text>The representative payee may not be an individual whose selection would create a conflict of interest, including:</text>
      <paragraph num="(1)">
        <text>A Family Investment Program staff member; or</text>
      </paragraph>
      <paragraph num="(2)">
        <text>An entity that deals with the recipient for profit, such as an assisted living home operator or other vendor.</text>
      </paragraph>
    </paragraph>
    <paragraph num="F.">
      <text>Any program payments that are obtained or used in a fraudulent manner shall be considered an overpayment and shall be subject to recoupment in accordance with Regulation .13 of this chapter.</text>
    </paragraph>
  </regulation>
  <regulation prefix="Regulation" num=".10" heading="Reconsideration.">
    <paragraph num="A.">
      <text>The purpose of a reconsideration is to review all requirements for a Public Assistance to Adults grant in order to determine eligibility for continuing assistance and, if eligible, amount of assistance.</text>
    </paragraph>
    <paragraph num="B.">
      <text>Timing. Every case receiving assistance shall be reconsidered once in every 12 months.</text>
    </paragraph>
    <paragraph num="C.">
      <text>The Reapplication Process.</text>
      <paragraph num="(1)">
        <text>A recipient shall have an opportunity to file a signed application for assistance to continue and shall be given, in writing or orally, information pertinent to filing the application.</text>
      </paragraph>
      <paragraph num="(2)">
        <text>When the signed application is filed, the local department shall take steps to ascertain and record the facts and any other information required to make a decision as to continuing eligibility for benefits.</text>
      </paragraph>
    </paragraph>
    <paragraph num="D.">
      <text>A decision as to eligibility for continuing assistance is to be made as promptly as possible and in accordance with requirements set forth in COMAR 07.03.01.</text>
    </paragraph>
    <paragraph num="E.">
      <text>The case record shall show accurately and completely that the requirements of this regulation with respect to reconsiderations have been met.</text>
    </paragraph>
  </regulation>
  <regulation prefix="Regulation" num=".11" heading="Interim Change.">
    <paragraph num="A.">
      <text>The recipient shall report any change in circumstances to the local department within 10 days of the change.</text>
    </paragraph>
    <paragraph num="B.">
      <text>The local department shall:</text>
      <paragraph num="(1)">
        <text>Give, in writing or orally, information pertinent to the recipient's filing of a signed statement regarding the change; and</text>
      </paragraph>
      <paragraph num="(2)">
        <text>Take steps as indicated by the facts and other information reported by either the recipient or another responsible source to make a decision as to eligibility for continuing assistance.</text>
      </paragraph>
    </paragraph>
  </regulation>
  <regulation prefix="Regulation" num=".12" heading="Advance Notice of Termination or Reduction.">
    <paragraph num="A.">
      <text>Except as expressly provided in §§C and D of this regulation, the local department may not reduce, suspend, or terminate a benefit unless timely and adequate advance notice has been given to the recipient.</text>
    </paragraph>
    <paragraph num="B.">
      <text>Except as expressly provided in §D of this regulation, in this regulation the following terms have the meanings indicated:</text>
      <paragraph num="(1)">
        <text>“Adequate” means a written notice that includes a statement of:</text>
        <paragraph num="(a)">
          <text>What action the agency intends to take;</text>
        </paragraph>
        <paragraph num="(b)">
          <text>The reasons for the intended agency action;</text>
        </paragraph>
        <paragraph num="(c)">
          <text>The specific regulations supporting this action;</text>
        </paragraph>
        <paragraph num="(d)">
          <text>The explanation of the individual's right to request a fair hearing; and</text>
        </paragraph>
        <paragraph num="(e)">
          <text>The circumstances under which assistance is continued, if a hearing is requested.</text>
        </paragraph>
      </paragraph>
      <paragraph num="(2)">
        <text>“Timely” means that the notice is mailed at least 10 days before the first day of the calendar month in which the action becomes effective.</text>
      </paragraph>
    </paragraph>
    <paragraph num="C.">
      <text>The local department may dispense with timely notice but shall send adequate notice no later than the date of action, when:</text>
      <paragraph num="(1)">
        <text>The local department has factual information confirming the death of a recipient;</text>
      </paragraph>
      <paragraph num="(2)">
        <text>The local department receives a clear written statement signed by the recipient that:</text>
        <paragraph num="(a)">
          <text>The recipient no longer wishes assistance; or</text>
        </paragraph>
        <paragraph num="(b)">
          <text>Gives information which requires termination or reduction of assistance and the recipient has indicated in writing the recipient's understanding that this is the consequence of supplying the information;</text>
        </paragraph>
      </paragraph>
      <paragraph num="(3)">
        <text>The recipient's whereabouts are unknown;</text>
      </paragraph>
      <paragraph num="(4)">
        <text>A recipient has been accepted for assistance in a new jurisdiction and that fact has been established by the jurisdiction previously providing assistance;</text>
      </paragraph>
      <paragraph num="(5)">
        <text>The local department has factual information confirming that the recipient was admitted to a public institution; or</text>
      </paragraph>
      <paragraph num="(6)">
        <text>The local department has confirmed that the recipient and assisted living facility operator are using the program funds in fraudulent manner.</text>
      </paragraph>
    </paragraph>
    <paragraph num="D.">
      <text>When changes in either State or federal law require automatic grant adjustments for classes of recipients, the local department shall give timely and adequate notice of an adjustment to assistance which includes:</text>
      <paragraph num="(1)">
        <text>A statement of the intended action;</text>
      </paragraph>
      <paragraph num="(2)">
        <text>The reasons for that action;</text>
      </paragraph>
      <paragraph num="(3)">
        <text>A statement of a specific change in law requiring that action; and</text>
      </paragraph>
      <paragraph num="(4)">
        <text>A statement of the circumstances under which a hearing may be obtained and assistance continued.</text>
      </paragraph>
    </paragraph>
    <paragraph num="E.">
      <text>Unless continuation of assistance pending a hearing decision is required, the local department shall take action to reduce, suspend, or end the assistance:</text>
      <paragraph num="(1)">
        <text>When a conference with the recipient or the recipient's representative confirms that the action is appropriate;</text>
      </paragraph>
      <paragraph num="(2)">
        <text>When one or more of the conditions set forth in §C or D of this regulation are met; or</text>
      </paragraph>
      <paragraph num="(3)">
        <text>Following the end of the required notice period.</text>
      </paragraph>
    </paragraph>
  </regulation>
  <regulation prefix="Regulation" num=".13" heading="Payment Irregularities.">
    <text>Payment irregularities which include overpayments, underpayments, fraud, and recoupment of funds are handled according to COMAR 07.03.14.</text>
  </regulation>
  <regulation prefix="Regulation" num=".14" heading="Replacement of Checks Lost, Stolen, or Not Received.">
    <paragraph num="A.">
      <text>The local department shall issue a new check to replace an assistance check that is lost, stolen, or not received if the:</text>
      <paragraph num="(1)">
        <text>Recipient notified the local department within 30 calendar days from the date the check was mailed that the check was lost, stolen, or not received;</text>
      </paragraph>
      <paragraph num="(2)">
        <text>Check was stolen, and the recipient has filed a complaint with the local law enforcement officials and can provide a valid complaint number; or</text>
      </paragraph>
      <paragraph num="(3)">
        <text>Check was cashed, and the recipient has signed a completed forgery affidavit form.</text>
      </paragraph>
    </paragraph>
    <paragraph num="B.">
      <text>The local department shall issue the replacement check within 5 working days of satisfaction of the conditions in §A of this regulation.</text>
    </paragraph>
  </regulation>
  <regulation prefix="Regulation" num=".15" heading="Appeals and Complaints of Discrimination.">
    <paragraph num="A.">
      <text>Appeal from Local Department Decision.</text>
      <paragraph num="(1)">
        <text>The local department shall give written notification of the right to and the procedures for requesting and obtaining an administrative hearing to each applicant or recipient of public assistance:</text>
        <paragraph num="(a)">
          <text>At the time of application; and</text>
        </paragraph>
        <paragraph num="(b)">
          <text>Whenever the local department notifies the applicant or recipient of any action that might deny, delay, suspend, reduce, or terminate benefits.</text>
        </paragraph>
      </paragraph>
      <paragraph num="(2)">
        <text>The appeal procedures are set forth in COMAR 07.01.04.</text>
      </paragraph>
    </paragraph>
    <paragraph num="B.">
      <text>Complaints of Discrimination. An applicant, recipient, authorized representative, or someone acting on behalf of the customer who believes the local department has discriminated on the basis of age, race, color, sex, disability, religion, national origin, or political beliefs may file a written complaint in accordance with COMAR 07.01.03.08.</text>
    </paragraph>
  </regulation>
  <annotations>
    <annotation type="Authority">Human Services Article, §§5-205(a), 5-207(a), 5-403—5-407, and 5-409, Annotated Code of Maryland</annotation>
    <annotation type="History" subtype="Administrative History">Effective date: January 1, 1974</annotation>
    <annotation type="History" subtype="Administrative History">Regulations .01—.06 amended effective July 27, 1979 (6:15 Md. R. 1270)</annotation>
    <annotation type="History" subtype="Administrative History">Regulation .01 amended effective January 16, 1984 (11:1 Md. R. 41); December 14, 1987 (14:25 Md. R. 2658); October 30, 1989 (16:21 Md. R. 2261)</annotation>
    <annotation type="History" subtype="Administrative History">Regulations .02A, .03A, .04A, B amended effective January 5, 1977 (4:1 Md. R. 15)</annotation>
    <annotation type="History" subtype="Administrative History">Regulation .02A amended effective May 24, 1982 (9:10 Md. R. 1019); January 16, 1984 (11:1 Md. R. 41); August 26, 1985 (12:17 Md. R. 1702); October 30, 1989 (16:21 Md. R. 2261)</annotation>
    <annotation type="History" subtype="Administrative History">Regulation .02B amended effective March 20, 1981 (8:6 Md. R. 561)</annotation>
    <annotation type="History" subtype="Administrative History">Regulation .02C adopted effective March 20, 1981 (8:6 Md. R. 561)</annotation>
    <annotation type="History" subtype="Administrative History">Regulation .02D amended effective August 26, 1985 (12:17 Md. R. 1702); October 30, 1989 (16:21 Md. R. 2261)</annotation>
    <annotation type="History" subtype="Administrative History">Regulation .02D—E adopted effective January 16, 1984 (11:1 Md. R. 41)</annotation>
    <annotation type="History" subtype="Administrative History">Regulation .02 amended effective December 14, 1987 (14:25 Md. R. 2658)</annotation>
    <annotation type="History" subtype="Administrative History">Regulation .03A amended effective May 24, 1982 (9:10 Md. R. 1019)</annotation>
    <annotation type="History" subtype="Administrative History">Regulation .03B amended effective March 20, 1981 (8:6 Md. R. 561)</annotation>
    <annotation type="History" subtype="Administrative History">Regulation .03D amended effective October 30, 1989 (16:21 Md. R. 2261)</annotation>
    <annotation type="History" subtype="Administrative History">Regulation .04 amended effective May 24, 1982 (9:10 Md. R. 1019)</annotation>
    <annotation type="History" subtype="Administrative History">Regulation .04A amended effective January 16, 1984 (11:1 Md. R. 41); December 14, 1987 (14:25 Md. R. 2658); October 3, 1988 (15:20 Md. R. 2333); November 27, 1989 (16:23 Md. R. 2504); April 25, 1994 (21:8 Md. R. 672); December 19, 1994 (21:25 Md. R. 2104)</annotation>
    <annotation type="History" subtype="Administrative History">Regulation .04B amended effective July 28, 1978 (5:15 Md. R. 1186); March 20, 1981 (8:6 Md. R. 561); December 6, 1982 (9:24 Md. R. 2389); October 10, 1983 (10:20 Md. R. 1784); August 27, 1984 (11:17 Md. R. 1490); August 12, 1985 (12:16 Md. R. 1604); October 6, 1986 (13:20 Md. R. 2209); October 5, 1987 (14:20 Md. R. 2141); October 3, 1988 (15:20 Md. R. 2333); November 27, 1989 (16:23 Md. R. 2504); April 25, 1994 (21:8 Md. R. 672)</annotation>
    <annotation type="History" subtype="Administrative History">Regulation .04C amended effective March 20, 1981 (8:6 Md. R. 561); December 6, 1982 (9:24 Md. R. 2389); October 10, 1983 (10:20 Md. R. 1784); August 27, 1984 (11:17 Md. R. 1490); August 12, 1985 (12:16 Md. R. 1604); October 6, 1986 (13:20 Md. R. 2209); October 5, 1987 (14:20 Md. R. 2141); November 27, 1989 (16:23 Md. R. 2504); October 29, 1990 (17:21 Md. R. 2526); April 25, 1994 (21:8 Md. R. 672); December 19, 1994 (21:25 Md. R. 2104)</annotation>
    <annotation type="History" subtype="Administrative History">Regulation .04D amended effective February 16, 1977 (4:4 Md. R. 280)</annotation>
    <annotation type="History" subtype="Administrative History">Regulation .04D repealed effective February 10, 1978 (5:3 Md. R. 137)</annotation>
    <annotation type="History" subtype="Administrative History">Regulation .04D repealed and .04E recodified to .04D effective October 30, 1989 (16:21 Md. R. 2261)</annotation>
    <annotation type="History" subtype="Administrative History">Regulation .04D amended effective November 18, 1996 (23:23 Md. R. 1555)</annotation>
    <annotation type="History" subtype="Administrative History">Regulation .04E adopted effective December 14, 1987 (14:25 Md. R. 2658)</annotation>
    <annotation type="History" subtype="Administrative History">Regulation .05 amended effective April 7, 1978 (5:7 Md. R. 521)</annotation>
    <annotation type="History" subtype="Administrative History">Regulation .05A amended effective October 30, 1989 (16:21 Md. R. 2261)</annotation>
    <annotation type="History" subtype="Administrative History">Regulation .05B amended effective July 29, 1985 (12:15 Md. R. 1512); July 28, 1986 (13:15 Md. R. 1733); April 20, 1987 (14:8 Md. R. 938); December 14, 1987 (14:25 Md. R. 2658); May 2, 1988 (15:9 Md. R. 1108); April 17, 1989 (16:7 Md. R. 811); April 25, 1994 (21:8 Md. R. 672)</annotation>
    <annotation type="History" subtype="Administrative History">Regulation .05D-1 adopted effective April 25, 1994 (21:8 Md. R. 672)</annotation>
    <annotation type="History" subtype="Administrative History">Regulation .05E amended effective August 25, 1978 (5:17 Md. R. 1326); June 27, 1980 (7:13 Md. R. 1276); March 20, 1981 (8:6 Md. R. 561); May 24, 1982 (9:10 Md. R. 1019); January 16, 1984 (11:1 Md. R. 41); May 5, 1986 (13:9 Md. R. 1023); December 14, 1987 (14:25 Md. R. 2658); April 25, 1994 (21:8 Md. R. 672); December 19, 1994 (21:25 Md. R. 2104)</annotation>
    <annotation type="History" subtype="Administrative History">Regulation .05E amended as an emergency provision effective February 1, 1987 (14:4 Md. R. 412); amended permanently effective May 4, 1987 (14:9 Md. R. 1079)</annotation>
    <annotation type="History" subtype="Administrative History">Regulation .05E amended as an emergency provision effective April 1, 1990 (17:8 Md. R. 968); amended permanently effective August 6, 1990 (17:15 Md. R. 1855)</annotation>
    <annotation type="History" subtype="Administrative History">Regulation .05H, I adopted effective February 10, 1986 (13:3 Md. R. 271)</annotation>
    <annotation type="History" subtype="Administrative History">Regulation .05J adopted effective June 15, 1987 (14:12 Md. R. 1349)</annotation>
    <annotation type="History" subtype="Administrative History">Regulation .05J amended effective April 25, 1994 (21:8 Md. R. 672)</annotation>
    <annotation type="History" subtype="Administrative History">Regulation .06D adopted effective June 3, 1985 (12:11 Md. R. 1047)</annotation>
    <annotation type="History" subtype="Administrative History">Regulation .06D repealed as an emergency provision effective February 1, 1987 (14:4 Md. R. 412); repealed permanently effective May 4, 1987 (14:9 Md. R. 1079)</annotation>
    <annotation type="History" subtype="Administrative History">Regulation .07F amended effective July 1, 1980 (7:13 Md. R. 1275); April 25, 1994 (21:8 Md. R. 672)</annotation>
    <annotation type="History" subtype="Administrative History">Regulation .07F-1 adopted effective June 27, 1980 (7:13 Md. R. 1276); repealed effective December 14, 1987 (14:25 Md. R. 2658)</annotation>
    <annotation type="History" subtype="Administrative History">Regulation .07G amended effective July 1, 1980 (7:13 Md. R. 1275); March 6, 1981 (8:5 Md. R. 472)</annotation>
    <annotation type="History" subtype="Administrative History">Regulation .09 amended effective January 18, 1982 (9:1 Md. R. 18)</annotation>
    <annotation type="History" subtype="Administrative History">Regulation .09-1 adopted effective March 26, 1984 (11:6 Md. R. 548)</annotation>
    <annotation type="History" subtype="Administrative History">Regulation .10A adopted effective September 17, 1975 (2:21 Md. R. 1340)</annotation>
    <annotation type="History" subtype="Administrative History">Regulation .10A amended effective October 10, 1983 (10:20 Md. R. 1783)</annotation>
    <annotation type="History" subtype="Administrative History">Regulation .10B adopted effective December 10, 1975 (2:28 Md. R. 1666)</annotation>
    <annotation type="History" subtype="Administrative History">Regulation .10B amended effective January 16, 1984 (11:1 Md. R. 41)</annotation>
    <annotation type="History" subtype="Administrative History">Regulations .01—.10 repealed and new Regulations .01—.15 adopted effective December 10, 2001 (28:24 Md. R. 2127)</annotation>
    <annotation type="History" subtype="Administrative History">Regulation .02B amended effective December 22, 2014 (41:25 Md. R. 1477)</annotation>
    <annotation type="History" subtype="Administrative History">Regulation .03 amended effective December 22, 2014 (41:25 Md. R. 1477)</annotation>
    <annotation type="History" subtype="Administrative History">Regulation .04B, C amended effective July 19, 2004 (31:14 Md. R. 1078); February 25, 2008 (35:4 Md. R. 512); October 6, 2008 (35:20 Md. R. 1773); December 28, 2009 (36:26 Md. R. 1994)</annotation>
    <annotation type="History" subtype="Administrative History">Regulation .05B amended effective February 25, 2008 (35:4 Md. R. 512)</annotation>
    <annotation type="History" subtype="Administrative History">Regulation .06A amended effective February 25, 2008 (35:4 Md. R. 512)</annotation>
    <annotation type="History" subtype="Administrative History">Regulation .07B amended effective February 25, 2008 (35:4 Md. R. 512)</annotation>
    <annotation type="History" subtype="Administrative History">Regulation .07C amended effective February 25, 2008 (35:4 Md. R. 512); December 28, 2009 (36:26 Md. R. 1994)</annotation>
    <annotation type="History" subtype="Administrative History">Regulation .09 amended effective December 22, 2014 (41:25 Md. R. 1477)</annotation>
    <annotation type="History" subtype="Administrative History">Regulation .12C amended effective December 22, 2014 (41:25 Md. R. 1477)</annotation>
  </annotations>
</chapter>