Adult Medicaid Manual MA-2240 TRANSFER OF ASSETS

XV. Tracking Transfer of Assets Sanction Period

An individual who is ineligible for institutional services or CAP due to a transfer of assets sanction may be authorized for other Medicaid covered services. Authorize Medicaid under PLA provided the applicant/recipient meets all other Medicaid eligibility factors. Key an Assets Transfer Screen in EIS for the entire sanction period, including while institutionalized or receiving CAP. The sanction period continues for in-home health services and supplies if the a/r returns to private living.

The Transfer of Assets Tracking Screen must be updated for PACE applicants/recipients with current or past eligibility in EIS. However, if a PACE applicant’s application is denied due to a transfer of assets sanction, and no past EIS eligibility exists on the applicant, asset transfer information cannot be entered on the Assets Transfer Tracking Screen. In these situations the transfer of asset sanction period history and documentation must be manually documented and maintained in the case record for future reference.

The Assets Transfer Tracking Screen should be updated once a transfer of assets evaluation has been completed. This may occur when processing an application, a redetermination for a non-SSI recipient is due, an ex parte review for an SSI recipient is due, requested by the a/r or provider, or notified by any source that a transfer has occurred. Refer to EIS-3900, Assets Transfer Tracking Screen, for data entry instructions.

A. The Assets Transfer Tracking Screen must be updated for all cases except MQB, even if there have been no non-allowable transfers. Update the Assets Transfer Tracking Screen by entering the evaluation indicator and if applicable the sanction period begin and end dates. Include any partial months.

REISSUED 05/01/08 - CHANGE NO. 15-08

(XV.A.)

1. Evaluation Indicator

a. Enter a “Y” to indicate that a transfer of assets evaluation has been completed and a transfer of assets sanction has been imposed, or

b. Enter an “N” to indicate that a transfer of assets evaluation has been completed and no transfer of assets sanction has been imposed because:

(1) There have been no non-allowable transfers, or

(2) A non-allowable transfer has occurred but no sanction applies, or

If the “N” indicator has already been entered due to a previous evaluation and there are no new transfers, do not make another entry.

2. Sanction Period Begin Date

For transfers prior to November 1, 2007, see XII.B. above. For transfers on or after November 1, 2007, see XII.C. above.

a. Applications

For transfers prior to November 1, 2007 the sanction period in EIS begins with the month the total transfers equal $5,500 or the month of application/ retroactive request whichever is later.

b. Ongoing Cases

The sanction period in EIS begins with the month following the month in which the timely notice expires.

3. Sanction Period End Date

The sanction period end date is the specific date on which the sanction actually expires as determined per instructions in XII., above.

B. Once updated, do not make changes to the evaluation indicator or sanction period unless the information entered must be adjusted due to an appeal reversal, transfer of assets rebuttal, incorrect calculation or other information becomes available.

If a change is required, correct the sanction period begin and end dates.

Process override requests if necessary to allow past claims to be paid. Follow procedures in MA-2395, Corrective Action and Responsibility for Errors.

C. The Assets Transfer Tracking Screen allows for the entry of up to 6 sanction periods. Therefore, subsequent non-allowable transfers which result in a new sanction period may be entered.

REVISED 11/01/10 - CHANGE NO. 19-10

(XV.)

D. Reports

When a claim for in-home health services and supplies is submitted to the Medicaid claims contractor for payment, the contractor will search for the transfer of assets indicator.

1. If the Assets Transfer Tracking Screen has been updated with an evaluation indicator and/or a sanction period, the contractor will either pay or deny the claim based on the date of service, evaluation indicator, and/or sanction period in EIS.

For example, a non-allowable transfer results in a 6-month sanction period for June through December. The EIS Assets Transfer Tracking Screen is updated with a “Y” indicator and the sanction period. On September 23^rd, the Medicaid claims contractor receives a claim for in-home health services and supplies with an August 12th date of service. The claim is denied as the assets transfer tracking screen indicates the recipient is not eligible on the date of service due to a transfer of assets sanction.

If a claim is denied, the provider may bill the recipient if the recipient was advised of his responsibility for payment before the service was provided.

2. If the Assets Transfer Tracking Screen has not been updated with an evaluation indicator and/or sanction period, the claims contractor will pay the claim and produce a report in XPTR to notify the county that a claim for in-home health services and supplies has been paid for an individual with a blank evaluation indicator.

3. The Transfer of Assets Evaluation Needed Report DHREJA TRANS ASSET EVAL NEEDED, is generated weekly and sorted by county number, district number, date first appeared on the report, and recipient name. The report is available in XPTR on Wednesday of each week for county viewing and includes individuals receiving MAABD or MQB-Q on the date of service.

Review the report weekly and review the tracking screen for each individual listed.

a. If the case is LTC and the transfer of assets evaluation has been done, key the appropriate code or sanction period. This should have been done at approval.

b. If the case is PLA, key an “N” on the Assets Transfer Tracking screen.

REVISED 11/01/10 - CHANGE NO. 19-10

(XV.D.4.)

4. Transfer of Assets Evaluation Summary Report

The report, DHREJ TRANS ASSET EVAL SUMM, is for county and DMA use. It is sorted by county and district number and provides a summary of the number of individuals pending a transfer of assets evaluation. The report will be generated weekly in XPTR and will be available on Wednesday of each week for county viewing.

5. Transfer of Assets Sanction Period Report

The report, DHREJA TRANS ASSET SANCTIONS, is for county and DMA use. It is sorted by county and sanction thru date. This report provides a listing of individuals who have a sanction period in EIS. The sanction may or may not have expired. This report is based on the transfer of assets sanction indicator being “Y” in EIS. This report is generated once a month on the last workday of the month and is available on XPTR on the first workday of the next month.