TN 5 (04-90)
RS 01301.130 One-Half Support — The Maximum Charge Rule
A. POLICY - CLAIMANT IN PUBLIC INSTITUTION DURING PERIOD NH MUST PROVE ONE-HALF SUPPORT
Support is measured in terms of the cost of institutional care and maintenance furnished plus other items of support the claimant may have received.
Contributions for use in the institution's commissary or clothing from a source outside the institution must be included.
C. POLICY - COST OF INSTITUTIONAL CARE AND MAINTENANCE TO USE
Use the maximum amount that may be charged for such care and maintenance pursuant to State law even though a different charge was made in the individual case.
Since the amount of the maximum charge may be changed from time to time to reflect changes in costs, only use the maximum charge for the particular support period.
1. Determining the Maximum Charge
|If maximum charge . . .||Then amount to use is . . .|
|is set by a designated official or institution, as provided by State law, up to a specified limit||the amount the official sets|
|varies depending on who is paying the charges or who placed the patient in the institution||the highest amount|
|depends on the nature of the ailment||the charge appropriate to the claimant's ailment|
|is nonexistent because patient is a State resident, but there is a charge for nonresidents||the nonresident|
2. File Documentation
Document the file to show the maximum charge for the proper support period for the institution in which the claimant was a patient.
Show the authority for the amount used if the file does not contain a responsible official's statement as to the maximum charge.
Document to show that there has been no change in the maximum charge since the prior development if citing as authority a prior case involving the same institution.
3. Determining the Amount of the NH's Contributions
Obtain a statement from an official of the institution or of the State as to the amount of such contributions. This statement will not be necessary if the FO has information as to the maximum charge for the period in question and it is clear from the applicant's allegations as to the amount of the NH's contributions that such contributions did not amount to one-half the claimant's total support.