*** The Health Care Programs Manual (HCPM) has been replaced by the Minnesota Health Care Programs Eligibility Policy Manual (EPM) as of June 1, 2016. Please refer to the EPM for current health care program policy information. ***
Effective: June 1, 2011 |
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19.40.15 - Lookback Period |
Archived: June 1, 2016 (Previous Versions) |
The lookback period is a specific period of time before the date a person requests Medical Assistance (MA) payment of long-term care (LTC) services and is either residing in an LTCF or has been screened and been found to need services provided through a home and community-based services waiver program.
All transfers made during the lookback period must be evaluated to determine if the transfer was uncompensated and if a transfer penalty applies.
Determining the MA Lookback Period.
Establishing a New MA Lookback Period.
The lookback period for transfers into client-funded trusts is 60 months prior to the baseline date. For non-trust transfers the lookback period is February 8, 2006, through the day prior to the baseline date.
Note: Effective February 1, 2011, the lookback period for non-trust transfers will also be 60 months.
Determining the MA Lookback Period
The lookback period is a specific period of time prior to a baseline date. A new lookback period is established each time a person requests MA payment of LTC services following a break in long-term care (LTC) services. The baseline date is the date in which both of the following conditions are met:
n a person is residing in an LTCF or, for a person requesting services through a home and community-based waiver program, the date a screening occurred that indicated a need for services provided through a home and community-based services waiver program and
n the person’s initial request month for MA payment of LTC services.
Example:
Abby entered an LTCF on October 5, 2009, and submitted a Minnesota Health Care Programs Application for Payment of Long-Term Care Services (DHS-3531) on January 30, 2010, requesting MA payment of LTC services to begin effective January 2010.
Action:
Abby’s baseline date is January 1, 2010, the first date that she was both residing in an LTCF and requesting MA payment of LTC services. Abby’s lookback period for transfers to a trust is January 1, 2004, through December 31, 2009. Abby’s lookback period for non-trust transfers is February 8, 2006, through December 31, 2009.
Note: Abby’s lookback period will change if she requests and is eligible for retroactive coverage of MA payment of LTC services.
Example:
Ben entered an LTCF on October 5, 2009, and submitted a DHS-3531 on January 30, 2010, requesting MA payment of LTC services to begin effective October 2009.
Action:
Ben’s baseline date is October 5, 2009, the first date that he was both residing in an LTCF and requesting MA payment of LTC services. Ben’s lookback period for transfers to a trust is October 5, 2004, through October 4, 2009. Ben’s lookback period for non-trust transfers is February 8, 2006, through October 4, 2009.
Example:
Clara is a current MA enrollee. Her screening for EW on December 7, 2009, documented a level of care need for EW. She submitted a Request for Payment of Long-term Care Services (DHS-3543) on January 26, 2010, requesting MA payment of LTC services to begin effective December 2009.
Action:
Clara’s baseline date is December 7, 2009, the first date she was documented to need EW services and requested MA payment of LTC services. Clara’s lookback period for transfers to a trust is December 7, 2004, through December 6, 2009. Clara’s lookback period for non-trust transfers is February 8, 2006, through December 6, 2009.
Establishing a New MA Lookback Period
A new lookback period is established with each new request for MA payment of LTC services following a break in LTC services.
Example:
Javier entered an LTCF on August 12, 2009, and submitted a DHS-3531 on August 16, 2009, requesting MA payment of LTC services effective August 2009.
Action:
Javier’s baseline date is August 16, 2009, the first date he was both residing in an LTCF and requesting MA payment of LTC services. Javier’s lookback period for transfers to a trust is August 16, 2004, through August 15, 2009. His lookback period for non-trust transfers is February 8, 2006, through August 15, 2009.
Example continued:
Javier was discharged from the LTCF to his home on January 12, 2010. He was readmitted to the LTCF on March 29, 2010, and submitted a DHS-3531 on April 2, 2010, requesting MA payment of LTC services effective March 2010.
Action:
Javier’s new baseline date is March 29, 2010, the new date that he was both residing in an LTCF and requesting MA payment of LTC services. Javier’s new lookback for transfers to a trust is March 29, 2005, through March 28, 2010. His new lookback period for non-trust transfers is February 8, 2006, through March 28, 2010.
Example:
Juliet entered an LTCF on March 1, 2010, and submitted a DHS-3531 on March 20, 2010, requesting MA payment of LTC services to begin effective March 2010. Juliet is otherwise eligible for MA payment of LTC services beginning March 2010. She made an uncompensated transfer in April 2009 which would result in a 13.67 month transfer penalty period.
Action:
Juliet’s lookback period for trust transfers is March 1, 2005, through February 28, 2010. Juliet’s lookback period for non-trust transfers is February 8, 2006, through February 28, 2010. Since she is otherwise eligible for MA payment of LTC services, Juliet’s transfer penalty period begins March 2010, and she has a partial penalty amount for April 2011. In order to begin MA payment of LTC services when her transfer penalty period ends, Juliet will need to submit a DHS-3543 to request MA payment of LTC services. A new lookback period will be established.
Note: Create a TIKL in MAXIS to send the DHS-3543 to Juliet in the month before the month the transfer penalty ends.
Example continued:
Juliet submits a DHS-3543 in April 2011 requesting MA payment of LTC services to begin effective April 2011. Juliet is otherwise eligible for MA payment of LTC services beginning April 2011. The partial penalty amount (.67) is added to her April 2011 LTC spenddown.
Action:
Juliet’s lookback period for all transfers is April 1, 2006, through March 31, 2011. Any uncompensated transfers made during the lookback period are subject to a new transfer penalty period.
Note: Juliet already served a transfer penalty period for the transfer that occurred in April 2009, so a new transfer penalty period is not established for that transfer.