NAC427A.765. Determination of financial eligibility; determination of portion of cost to be paid by recipient; payment of costs by contractor.

     1. An applicant is not eligible to receive financial assistance pursuant to subsection 1 of NAC 427A.725, if his or her gross monthly income, less the expenses set forth in paragraphs (a) to (d), inclusive, of subsection 2, is more than 800 percent of the federally designated level signifying poverty, divided by 12, for the size of family applicable to the applicant, as determined by the United States Department of Health and Human Services and published annually in the Federal Register.

     2. In determining the financial eligibility of an applicant, one-half of the gross monthly income of the applicant earned through employment, any additional gross monthly income of the applicant and the gross monthly income of the applicant’s spouse must be counted. From the total must be deducted any amount paid directly by the applicant or the applicant’s spouse that is not reimbursed by any other source for:

     (a) Medicine prescribed for the applicant or the applicant’s spouse or dependent child by a physician;

     (b) Medical care provided to the applicant or the applicant’s spouse or dependent child by a doctor, hospital or other medical facility;

     (c) Special equipment, services or supplies to help the applicant or any other member of the household who also has a disability do what a person who is not disabled can do; and

     (d) Health insurance and the cost thereof, including, without limitation, the payment of premiums and copayments for the applicant or the applicant’s spouse or dependent child.

Ê As used in this subsection, “medical facility” has the meaning ascribed to it in NRS 449.0151 and includes a facility for the rehabilitation of persons with physical disabilities.

     3. A recipient whose gross monthly income, less the expenses set forth in paragraphs (a) to (d), inclusive, of subsection 2, is less than 300 percent of the federally designated level signifying poverty, divided by 12, is not required to pay any of the cost for essential personal care. Except as otherwise provided in this section, a recipient whose gross monthly income, less the expenses set forth in paragraphs (a) to (d), inclusive, of subsection 2, is 300 percent or more of the federally designated level signifying poverty, divided by 12, but not greater than 800 percent of the federally designated level signifying poverty, divided by 12, shall pay a portion of the total cost to provide essential personal care to the recipient according to the following formula:

Monthly amount of recipient’s payment for essential personal care =	(A-(B+C)) x (D)
	(A-B)

Ê where “A” is the recipient’s gross monthly income; “B” is the sum, on a monthly basis, of the recipient’s and his or her spouse’s expenses and, if applicable, the expenses of the recipient’s family, set forth in paragraphs (a) to (d), inclusive, of subsection 2; “C” is the amount that equals 300 percent of the federally designated level signifying poverty, divided by 12, for the size of family applicable to the recipient; and “D” is the cost of providing services for essential personal care, on a monthly basis, for that recipient.

     4. Notwithstanding the formula set forth in subsection 3, in no case may the recipient’s payment for essential personal care, on a monthly basis, exceed 20 percent of the amount that equals the difference between A and the sum of B and C.

     5. If there are compelling and urgent circumstances, including, without limitation, the circumstance in which payment of any portion of the cost to provide essential personal care to the recipient will cause severe hardship to the recipient, the contractor, with the approval of the Administrator, or the Division, as applicable, may pay 100 percent of the cost of the essential personal care of a recipient.

     (Added to NAC by Dep’t of Health & Human Services by R005-06, eff. 5-4-2006; A by Aging & Disability Services Div. by R024-10, 7-22-2010; R016-12, 9-14-2012)—(Substituted in revision for NAC 426.765)