Sec. R9-28-806 - TEFRA Liens - Recovery

ยง R9-28-806. TEFRA Liens - Recovery

A. AHCCCS shall seek to recover a TEFRA lien for the amount of the medical assistance provided up to the amount of the sale upon the sale or transfer of the real property subject to the lien made prior to the member's death.

B. After the member's death, AHCCCS shall seek to recover a TEFRA lien for the amount of the medical assistance received by the member at the age of 55 years or older from the member's estate after the sale or transfer of the real property subject to the lien. However, AHCCCS shall not seek to recover the TEFRA lien or attempt recovery against any real property subject to the TEFRA lien so long as the member is survived by the member's:

1. Spouse;

2. Child under the age of 21; or

3. Child who receives benefits under either Title II or Title XVI of the Social Security Act as blind or disabled, as defined under 42 U.S.C. 1382c.

C. AHCCCS shall not seek to recover a TEFRA lien on an individual's home if the member is survived by:

1. A sibling of the member who currently resides in the deceased member's home and who has resided in the member's home on a continuous basis since at least one year immediately before the date of the member's admission to the nursing facility, ICF/IID, or other medical institution as defined under 42 CFR 435.1010 and has; or

2. A child of the member who resides in the deceased member's home and who:

a. Was residing in the member's home for a period of at least two years immediately before the date of the member's admission to the nursing facility, ICF/IID, or other medical institution as defined under 42 CFR 435.1010;

b. Provided care to the member that allowed the member to reside at home rather than in an institution; and

c. Has resided in the member's home on a continuous basis since the admission of the deceased member to the medical institution.

D. To determine whether a child of the member provided care under subsection (B)(2), AHCCCS shall require the following information:

1. A physician's written statement that describes the member's physical condition and service needs for the previous two years before the member's death;

2. Verification that the child actually lived in the member's home;

3. A written statement from the child providing the services that describes and attests to the services provided;

4. A written statement, if any, made by the member prior to death regarding the services received; and

5. A written statement from physician, friend, or relative as witness to the care provided.

(New Section made by final rulemaking at 14 A.A.R. 3791, effective November 8, 2008 (Supp. 08-3). Amended by final rulemaking at 24 A.A.R. 670, effective 5/5/2018.)

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