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Effective: December 1, 2006 |
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19.40.30ar1 - Determining Transfer Penalty (Archive) |
Archived: October 1, 2007 |
Once the uncompensated value of an improper transfer has been determined, an ineligibility period, or transfer penalty, can be determined.
l See Applying the Transfer Penalty to determine when the penalty period begins.
l See Multiple Transfers for client who have more than one transfer penalty period established which are overlapping.
Reminder: MA may remain open during a penalty period. Transfer penalty periods for MA result in ineligibility for only certain MA services. See Transfers for a list of services that are not paid in a penalty period.
SAPSNF is an acronym for the Statewide Average Payment for a Skilled Nursing Facility. This is the average amount paid for a person in an LTCF on a monthly basis. There are two different SAPSNF rates: one for MA and one for GAMC.
A transfer with an uncompensated amount less than the SAPSNF.
There are no transfer provisions for MinnesotaCare or GHO.
Follow these steps to determine a transfer penalty:
1. Total the uncompensated value of transfers made in the same month.
Note: If the transfer was made prior to April 13, 1996, see Archived Transfer Information.
2. Determine if the total transfers made in a month is considered a fractional transfer by comparing the monthly transfer amount to the MA SAPSNF in effect at the time of application.
l For fractional transfers made on or after April 13, 1996 and prior to February 8, 2006, go to Step 5.
l For fractional transfers made on or after February 8, 2006, total the amount of all fractional transfers made on or after February 8, 2006 to calculate a single transfer amount. Go to Step 3.
Example:
Silvio and his wife Irma apply for MA payment of LTC services for Silvio on August 19, 2006. He reports three improper transfers: $2500 in March 2006, $3000 in April 2006 and $5000 in May 2006. Silvio meets all eligibility requirements except for the improper transfers.
Action:
Silvio has two transfer amounts that will be used to determine two different transfer penalties.
The first transfer amount is the total of all the fractional transfers made on or after February 8, 2006; $5500 ($2500 for March 2006 + $3000 for April 2006). Determine a transfer penalty for this amount.
The second transfer amount is $5000 for May 2006, because it is greater than the MA SAPSNF at the time of application. Determine a transfer penalty for this amount.
l If the monthly transfer amount is equal to or greater than the MA SAPSNF determine a penalty period separately for that transfer amount. Go to Step 3.
3. Determine the transfer penalty by dividing the total transfer amount by the MA SAPSNF.
l Use the MA SAPSNF in effect on the date of the client’s application.
l Round the resulting figure to the nearest hundredth.
Example:
The resulting figure is 23.876.
Action:
Round 23.876 to the nearest hundredth: 23.88.
4. Deny eligibility for payment of LTC services for the number of months equal to the whole number of the transfer penalty figure.
Example:
LuAnn has a penalty period of 12.82 months.
Action:
LuAnn will be ineligible for the payment of LTC services for 12 months and the partial amount in the 13th month.
5. Deny eligibility for payment of LTC services of the dollar specific amount. The client is responsible for this amount in the month after the last whole month of the transfer penalty.
l If a client does not incur LTC services equal to or greater than the total partial penalty, do not carry the penalty over to the next month.
l Add the dollar amount of the partial penalty to the client’s LTC spenddown or medical spenddown, whichever applies, for the partial month of ineligibility.
The dollar specific amount for the partial penalty is either:
l The amount of the fractional transfer for fractional transfers made on or after April 13, 1996 and prior to February 8, 2006.
l The truncated result of the decimal value of the transfer penalty figure multiplied by the MA SAPSNF.
Example:
LuAnn has a transfer penalty of 12.82 months. She applied in August 2006. LuAnn will be ineligible for the payment of LTC services for 12 months and the partial amount in the 13th month.
Action:
To determine the partial amount multiply the decimal portion of the transfer penalty by the MA SAPSNF. LuAnn’s partial penalty in this instance is $3639 (.82 X $4438 MA SAPSNF as of July 2006).
6. Begin the transfer penalty by following the policy detailed in Applying Transfer Penalty.
Follow these steps to determine a transfer penalty period:
1. Total the uncompensated value of transfers made in the same month.
2. Determine if the total transfers made in a month is considered a fractional transfer by comparing the monthly transfer amount to the GAMC SAPSNF in effect at the time of application. If it is a fractional transfer go to Step 5.
3. Determine the transfer penalty by dividing the total transfer amount by the GAMC SAPSNF.
l Use the GAMC SAPSNF amount in effect on the date of either:
n An applicant’s current application.
n An enrollee’s application used to set up a current period of GAMC eligibility.
l Round the resulting figure to the nearest hundredth.
Example:
The resulting figure is 14.0589.
Action:
Round 14.0589 to the nearest hundredth: 14.06.
4. Deny GAMC eligibility for the number of months equal to the whole number of the transfer penalty figure. There is no limit to the number of months in a GAMC penalty period.
Example:
Waldo has a penalty period of 12.82 months.
Action:
Waldo will be ineligible for GAMC for 12 months and the partial amount in the 13th month.
5. Deny GAMC eligibility for payment the dollar specific amount. The client is responsible for this amount in the month after the last whole month of the transfer penalty.
The dollar specific amount for the partial penalty is either:
l The amount of the fractional transfer.
l The truncated result of the decimal value of the transfer penalty figure multiplied by the GAMC SAPSNF.
6. After determining the transfer penalty period, the next step is to apply the penalty period. See Applying Transfer Penalty for more information on when to start the penalty period.