MA-LTC Multi-Topic Webinar Session

Health Care Training Team

Health Care Eligibility and AccessNote: This session is being recorded.

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MA-LTC Multi-Topic Webinar Session Sections

Determining the MA-LTC Eligibility Begin Date and Coding MAXIS and MMIS.– Medical hospitals as a long-term care facility.– MA-LTC length of stay requirements.

Asset Verification for MA-LTC. Ending a Transfer Penalty.

– Full return of the transferred assets.– Waiver of the transfer penalty.

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Determining the MA-LTC Eligibility Begin Date and Coding MAXIS and MMIS

References: Health Care Programs Manual (HCPM) 23.30 –

Eligibility Determination and System Coding for MA Payment of LTC Services.

Bulletin #11-25-02, Pre-admission Screening: Required Activity for Nursing Facility Admission and Medical Assistance Payment.

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Section Objectives:

Determining the MA-LTC begin date.– Medical hospitals as a long-term care facility.– MA-LTC length of stay requirements.

Code MAXIS STAT/FACI for clients in an LTCF and STAT/DISA for clients on a home and community-based waiver.

Code MMIS RLVA under the LTC Ineligible Information section with the proper end date for the U span.

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MA Payment of LTC Services

Applicants and Enrollees are not eligible for payment until: The agency receives a request for MA-

LTC. The worker determines the individual

meets the eligibility requirements for basic MA and MA-LTC.

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Begin Date for MA Payment of LTC Services

Determining the begin date varies based on whether the client resides in an long-term care facility (LTCF), or is in the community requesting home and community based waiver services.

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LTCF

The begin date is verified by the DHS-1503, Physician Certification form.

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Medical Hospitals as an LTCF

If the client is in the hospital prior to being admitted into an LTCF and received skilled nursing facility services verify the begin date with a DHS-1503.

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Length of Stay in an LTCF

No effect on MA-LTC eligibility. Need to request MA-LTC for even a one

day stay to be covered by MA-LTC. Need to meet all eligibility requirements for

basic MA and MA-LTC.

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Home and Community-Based Waiver

The anticipated begin date is determined by the case manager. This is documented on the Lead Agency Case Manager/Worker Communication Form (DHS-5181).

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DHS-5181

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Home and Community-Based Waiver Continued

Typically the anticipated begin date is:

Upon approval of MA-LTC eligibility.

As of the LTCC date.

The month after MA-LTC eligibility is approved.

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Worker Action MAXIS

LTCF client: update STAT FACI in the footer month that the skilled nursing facility services began.

Home and community-based waiver client: update STAT DISA in the footer month the services are actually going to begin.

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Worker Action MMIS

When eligibility is opened on RELG with major program MA, EH, NM or RM, a corresponding “U” code is recorded in the LTC Ineligible Information section of RLVA.

Enter an end date for the U code. The U code must have an end date one day prior to the begin date for MA payment of LTC services.

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The “U” Code

Most U spans will have a begin date and an end date.

It will be rare for a U span to actually be deleted. (Unless that individual is eligible for MA payment of LTC services on the first day of the first month that MA is opened on RELG.)

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LTCF Example: Amanda

Enters hospital November 02, 2010. LTCC completed November 20, 2010,

indicating an institutional level of care. Request for MA payment of LTC services

November 21, 2010, no retro need. Enters LTCF November 28, 2010, from

hospital. 17

LTCF Example Continued: Amanda

DHS-1503 - began receiving skilled nursing facility services in the hospital on November 25, 2010.

DHS-1503 from facility - not expected to return home.

Eligibility for basic MA and MA-LTC is approved by the worker on December 8, 2010.

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Amanda MAXISFACI Panel 1:

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Amanda MAXISFACI Panel 2:

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Amanda MAXISFACI Panel 3:

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Amanda MAXISApproval:

MA-LTC eligibility begin date in MAXIS November 1, 2010.

Enter a worker comment to indicate payment of LTC services begins on November 25, 2010.– Note: If a notice cannot be issued, add the

information to the manual notice (DHS-4915). Complete sections 36-38 on DHS-1503

and send with approval communication (DHS-3050) to LTCF. 22

Amanda MMISRELG:

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Amanda MMISRLVA:

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Amanda Completed:

Are there any questions?

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EW Example: Jenny and JoeProcessed the Month After Application

Jenny and Joe are married and live together in the home that they own.

Jenny is requesting MA payment of LTC services through the Elderly Waiver program.

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EW Example Continued: Jenny and Joe

LTCC completed November 12, 2010. DHS-5181 states services are anticipated

to begin upon MA-LTC approval. Request for MA payment of LTC services

November 13, 2010, no retro. Eligibility for basic MA and MA-LTC

approved by the worker on December 9, 2010.

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EW Example Continued: Jenny and Joe Verification

Note: Clients will have verified requirements for

MA payment of LTC services back to the month in which a client is applying.

Assume all LTC requirements continue to be met during the processing period unless the client has reported a change.

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Jenny and Joe MAXISDISA:

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Jenny and Joe MAXISApproval:

Determine basic MA eligibility in MAXIS November 1, 2010. (She would be a HH of 2 and spouse’s income and assets would deem for that month).

Determine MA-LTC eligibility with a begin date in MAXIS of December 1, 2010.

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Jenny and Joe MAXISApproval Continued:

Enter a worker comment to the notice to indicate payment of LTC services begins on December 9, 2010.

Complete Part 2 of the DHS-5181.

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Jenny and Joe MMISRELG:

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Jenny and Joe MMISRLVA:

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Jenny and Joe Follow Up:

Note: If applying for a disability waiver STAT/DISA may need to be updated in more than one month.

– Month of application with SSA or SMRT information.

– Month of approval with waiver code information.

Are there any questions?

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CADI Example: Charlie and LoriEligibility the Month After Processed

Charlie and Lori are married and live

together in the home that they own. Charlie is requesting MA payment of LTC

services through the CADI Waiver program.

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CADI Example Continued: Charlie and Lori

LTCC completed November 12, 2010. DHS-5181 states services will begin the

first of the month after MA-LTC approval. Request for MA-LTC November 13, 2010 -

no retro. Eligibility for basic MA and MA-LTC

approved by worker on January 8, 2011 (before the end of 60-day LTCC period).

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CADI Example Continued: Charlie and Lori Verification

Note: Clients will have verified requirements for

MA payment of LTC services back for the month in which a client is applying.

Assume all LTC requirements continue to be met during the processing period unless the client has reported a change.

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Charlie and Lori MAXISDISA 11/10:

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Charlie and Lori MAXISDISA 02/11:

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Charlie and Lori MAXISApproval:

Determine basic MA eligibility in MAXIS for the months of November, December, and January. (He would be a HH of 2 and spouse’s income and assets would deem for those months).

Determine MA-LTC eligibility with a begin

date in MAXIS of February 1, 2011.

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Charlie and Lori MAXISApproval Continued:

Enter a worker comment to indicate payment of LTC services begins on February 1, 2011.

Complete Part 2 of the DHS-5181.

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Charlie and Lori MMISRELG:

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Charlie and Lori MMISRLVA:

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Determining the MA-LTC Begin Date and Coding MAXIS and MMISAre there any questions about this section?

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Asset Verification for MA-LTC

References: HCPM 19.20 - Verification of Assets. HCPM 19.25.40.10 - Verification of Burial

Assets and Life Insurance. HCPM 19.35.10 - MA Excess Assets.

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Verification of Assets at Application

Verify assets for the first day of the first month for which coverage is requested.

Do not request asset verification for each subsequent month unless:– The client reported a change.– If it is known that assets changed.– If needed to verify an asset reduction.

Verify home equity value even if the LTC applicant is exempt from asset limits.

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Verification of Excluded Assets

Special Needs, Supplemental Needs and Pooled Trusts.

Annuities. Face value and cash surrender value of non-

term life insurance. Revocable Burial Agreements. Irrevocable Burial Agreements. Annuity-funded burials. Life insurance-funded burials. Cremation Society Agreements (CSAs). 47

Asset Reduction at Application No Retro Request

Applicants must verify that they have reduced excess countable assets:– By providing bank statements or other

documents that show current asset amounts.– They are not required to provide receipts.

Determine if the client has reduced assets appropriately or if an uncompensated transfer has occurred.

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Asset Reduction at Application Retro Request

If reducing assets by burial fund designation:– Verify the purchase of a burial service or the

designation of funds by a signed and dated statement.

If reducing assets by payment of medical bills from the retroactive period: – Verification may include bank statements,

receipts, or confirmation from the medical provider.

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Verification of Assets at Renewal

Verify assets as of the first day of the month in which the recipient mails or delivers the renewal form to the county agency.

Do not re-verify at renewal if no change is reported.– For example: do not request a new copy of

burial accounts that have not changed.

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MA-LTC Recipient Asset Verification

Review asset eligibility in the month following the month an MA-LTC recipient receives:– A lump sum or periodic payment.– Refund from an LTCF.– A full or partial repayment of an

uncompensated transfer. If not a renewal, act on the change but

verify the change at renewal except for reported changes of excluded assets.

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Asset Verification for MA-LTC

Are there any question about this section?

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Ending a Transfer Penalty

Effective December 1, 2011: End a transfer penalty if there is a full

return of the transferred assets. The agency approves a waiver of the

transfer penalty due to an undue hardship.

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Ending a Transfer Penalty When Full Return of Transferred

Assets

References: Bulletin #11-21-10, Changes to Medical

Assistance (MA) Transfer Penalty Policy incorporated 1/3/2012 to HCPM 19.40.45 – Ending a Transfer Penalty.

HCPM 19.40.25 – Imposing a Transfer Penalty. 54

Determining the Transfer Penalty Handout:

Identify the MA SAPSNF. Total the uncompensated value. Determine the length of the transfer

penalty. How to end a transfer penalty.

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Full Return of Transferred Assets

The value of the asset upon return must be equal to or greater than the value at the time of transfer.

For non-cash transfers, option to substitute a cash payment in exchange for the return of the transferred asset.

If the value has decreased or the person who received the transfer no longer has the asset it can only end with a cash payment to the client. 56

Full Return of Transferred Assets Continued

Note:– A non-cash asset cannot be substituted in

exchange for the transferred asset.– A direct payment of the client’s obligations is

not considered a return of transferred assets because the assets are never actually available to the client.

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Full Return of Transferred Assets Example:

Hank resides in an LTCF and requests MA-LTC.

Two years ago he transferred his house valued at $130,000 at that time to his son.

Hank was determined otherwise eligible for MA-LTC and was approved basic MA. MA-LTC was denied due to the uncompensated transfer amount of $130,000 and a penalty period was imposed. 58

Full Return of Transferred Assets Example Continued:

The house is still in his son’s name and is now valued at $150,000.

To end the transfer penalty period: – Transfer the house back to Hank. – Pay Hank $130,000 which was the

uncompensated amount used to determine the transfer penalty period.

Hank’s son makes a cash payment this month to Hank in the amount of $130,000.

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Worker Action When Full Return of Transferred Assets

End the transfer penalty beginning the first of the month following the

month of the full return.

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Continued Worker Action When Full Return of Transferred Assets

Determine if an enrollee has excess assets following MA policy, and close MA with timely notice. (Continued eligibility is possible if an enrollee reduces excess countable assets before the effective date of closing.)

Determine MA overpayments for any months after the transfer occurred that the client was enrolled in MA.

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Continued Worker Action When Full Return of Transferred Assets

Eligibility does not automatically begin when a transfer penalty ends.

Client will need to meet all eligibility requirements for MA payment of LTC services.– MA enrollee will need to submit a Request for

Payment of Long-Term Care Services (DHS-3543).

– A non-MA enrollee will need to reapply.

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Worker Action When Full Return of Transferred Assets Example:

Close MA for Hank with timely notice. Determine MA overpayments for the

months he was enrolled in MA. Reapply for MA-LTC.

Are there any questions?

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Transfer Penalty Waiver Information

References: HCPM 19.40.40 – Waiver of Transfer

Penalty.

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Notification of Transfer Penalty Waiver

Notify the client of the transfer penalty waiver when denying or closing MA-LTC due to a transfer penalty.

A cause of action may be brought against the person who received the transfer if a waiver is approved.

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Client Responsibility

A request to waive the transfer penalty received from a client or client’s authorized representative can be verbal or written.

An LTCF may also request a waiver of the transfer penalty if they have:– A signed statement from the client or the

client’s representative acknowledging approval of the request.

– A General Authorization for Release of Information (DHS-2243A).

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Worker Responsibility

Request the information needed. The county needs to make a determination

within 30 days once all the information is received.

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Approving Transfer Penalty Waiver

The agency must grant a waiver when the client provides convincing evidence of all the following:– There is an imminent threat to the client’s

health and well-being and that the waiver will resolve the imminent threat.

– There are no other alternatives to pay for the cost of LTC services.

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Approving Transfer Penalty Waiver Continued

Agency action:– Send a notice to the client informing the client

that the transfer penalty waiver is approved including the effective date.

– Refer the case to the county attorney to file a cause of action against the person who received the transferred asset or income.

– Enter a MAXIS case note.

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Denying Transfer Penalty Waiver

Agency action:– Send the client the Notice of Action for MA

Payment of LTC Services (DHS-4915). The notice must include the client’s right to appeal the decision.

– Enter a MAXIS case note.

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Ending a Transfer Penalty and Transfer Penalty Waiver

Information Any questions on this section?

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MA-LTC Multi-Topic Webinar Session

THE END!

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