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Effective: October 1, 2007 |
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19.40.30ar2 - Determining Transfer Penalty (Archive) |
Archived: July 1, 2010 |
Determine the transfer penalty for uncompensated transfers made during the lookback period that do not meet a transfer exception.
l See Applying the Transfer Penalty to determine when the penalty period begins.
l See Multiple Transfers for client who have overlapping transfer penalty periods.
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 :
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:
Note: If the transfer was made prior to April 13, 1996, see Archived Transfer Information.
1. Total the uncompensated value of:
l All transfers made in the same month for transfers made on or after April 13, 1996, and before February 8, 2006.
l All transfers made during the lookback period for transfers made on or after February 8, 2006.
2. Determine the transfer penalty by dividing the appropriate total transfer amount from Step 1 by the MA SAPSNF.
l Use the MA SAPSNF in effect on the date of the client’s most recent request for initial or continued MA payment of LTC services.
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.
3. 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.
4. Deny eligibility for payment of LTC services of the partial penalty 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 partial penalty amount is 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).
5. If the total transfer amount from Step 1 is less than the SAPSNF (also known as a fractional transfer), deny payment of LTC services in the amount of the transfer.
Example:
Silvio requested MA payment of LTC services on October 1, 2006. He reported a transfer of $2000 in March 2006 and another transfer of $1000 in May 2006. There were no other transfers during the lookback period.
Action:
Since the total amount transferred ($3000) is less than the SAPSNF, the penalty amount is $3000.
Example:
Amelia requested MA for payment of LTC services in June 2006. She reported two transfers of $1000 each in December 2005 and a transfer of $1500 in January 2006.
Action:
Since the transfers took place before February 8, 2006, determine separate penalties based on the amounts transferred in each month. The penalty amount from December 2005 is $2000. The penalty amount for January 2006 is $1500.
6. Begin the transfer penalty by following the policy detailed in Applying Transfer Penalty and Multiple Transfers.
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 the most recent 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 partial penalty amount. The client is responsible for this amount in the month after the last whole month of the transfer penalty. The partial penalty amount is the truncated result of the decimal value of the transfer penalty figure multiplied by the GAMC SAPSNF.
If the transfer amount is less than the SAPSNF, the penalty amount is the amount transferred.
6. Begin the transfer penalty by following the policy detailed in Applying Transfer Penalty.