A. The
provisions in this Section apply to an institutionalized person who has, or
whose spouse has, transferred assets and received less than the fair market
value (uncompensated value) as specified in A.R.S. §
36-2934(B) and
42 U.S.C.
1396 p(c)(1)(A), July 1, 2009, which is
incorporated by reference and on file with the Administration, and available
from the U.S. Government Printing Office, Mail Stop: IDCC, 732 N. Capitol
Street, NW, Washington, DC, 20401. This incorporation by reference contains no
future editions or amendments.
B. A
person shall report transfer of assets. The Administration shall evaluate all
transfers made during or after the look-back period under
42 U.S.C.
1396 p(c)(1)(B), July 1, 2009, which is
incorporated by reference and on file with the Administration, and available
from the U.S. Government Printing Office, Mail Stop: IDCC, 732 N. Capitol
Street, NW, Washington, DC, 20401. This incorporation by reference contains no
future editions or amendments. The person shall provide verification of any
transfer.
C. Certain transfers are
permitted under
42 U.S.C.
1396 p(c)(2), July 1, 2009, which is
incorporated by reference and on file with the Administration, and available
from the U.S. Government Printing Office, Mail Stop: IDCC, 732 N. Capitol
Street, NW, Washington, DC, 20401. This incorporation by reference contains no
future editions or amendments.
D.
If the Administration determines a disqualification period applies due to a
transfer, and the person is otherwise eligible, the person may remain eligible
for ALTCS acute care services but shall be disqualified for receiving ALTCS
coverage under
42 U.S.C.
1396 p(c)(1)(E), July 1, 2009, which is
incorporated by reference and on file with the Administration, and available
from the U.S. Government Printing Office, Mail Stop: IDCC, 732 N. Capitol
Street, NW, Washington, DC, 20401. This incorporation by reference contains no
future editions or amendments.
E.
The period of disqualification for transfers shall
be computed by dividing the cumulative uncompensated value of the transferred
assets by the average cost for a private pay patient for nursing care services
at the time of application.
1.
For single or multiple transfers occurring in the
same calendar month, the sum of all uncompensated value shall be divided by the
monthly private pay rate. Disregarding fractions, the result of this
calculation equals the number of months of ineligibility.
2.
For multiple transfers occurring in different
calendar months, the total uncompensated value for each transfer of assets
shall be determined under subsection (E)(1) but, if the periods of
ineligibility overlap, the period of ineligibility shall run consecutively.
Fractions are disregarded at the end of the entire period.
3.
For multiple transfers occurring in different
months, the total uncompensated value for each transfer shall be determined
under subsection (E)(1), but if the periods of ineligibility do not overlap,
each period of ineligibility shall be treated under subsection
(E)(1).
E. Period
of disqualification for transfers.
1.
Calculating a period of disqualification at application. The uncompensated
value of all transfers shall be divided by the monthly private pay rate. The
result of this calculation equals the number of months of
ineligibility.
2. Calculating a
period of disqualification after approval:
a.
For one or more transfers occurring in one calendar month or in consecutive
months, the period of disqualification is determined under subsection (E)(1).
The period of disqualification begins with the month that the first transfer
was made.
b. For transfers
occurring in nonconsecutive calendar months, the period of disqualification for
each transfer of assets shall be determined separately under subsection (E)(1)
to determine if the periods of disqualification overlap.
i. Periods of disqualification that overlap
shall be added together and shall run consecutively, beginning with the month
the first transfer was made.
ii.
Periods of disqualification that do not overlap are each applied separately
beginning the month that the transfer was made.
F. Transfers of assets for less
than fair market value are presumed to have been made to establish eligibility
for ALTCS services.
G. Rebuttal of
disqualification.
1. A person found ineligible
for ALTCS services by reason of a transfer of assets for uncompensated value
shall have the right to rebut the disqualification for reasons stated under
42 U.S.C.
1396 p(c)(2)(C), July 1, 2009, which is
incorporated by reference and on file with the Administration, and available
from the U.S. Government Printing Office, Mail Stop: IDCC, 732 N. Capitol
Street, NW, Washington, DC, 20401. This incorporation by reference contains no
future editions or amendments.
2.
The person shall have the burden of rebutting the presumption.
3. If a person rebuts a transfer on the basis
of debt repayment, the Administration shall determine the validity of the debt
and payment amount under A.R.S. §
44-101.
H. Undue hardship.
1.
The person is unable to obtain necessary medical
care without ALTCS eligibility, and
2.
Is in imminent danger of death.
The transfer penalty period may be waived if denial of
eligibility for long term care services creates an undue hardship.
1. The Administration shall consider whether
the transfer penalty period can be waived when:
a. The individual is otherwise eligible for
ALTCS benefits and application of the transfer of assets provision would
deprive the individual of medical care such that the individual's life or
health would be in endangered, or
b. The individual is otherwise eligible for
ALTCS benefits and is deprived of food, clothing, shelter or other necessities
of life as evidenced by the fact that the individual's income is less than or
equal to the Federal Poverty Level (FPL);
2. The transfer penalty period shall be
waived when:
a. The individual is
incapacitated as established by the Court or by a physician; and
b. The individual who had the legal authority
to handle the applicant's finances has violated the terms of that legal
authority; and
c. An individual
acting on the applicant's behalf has exhausted all legal remedies to regain the
asset, such as but not limited to, filing a police report and seeking recovery
through civil court.
3.
The transfer penalty period shall not be waived when:
a. The applicant was mentally competent and
would have been aware of the consequences of the transfers at the time the
transfers occurred; or
b. The
applicant gave another person specific legal authority to make the transfers,
such as a conservator, or a person granted the applicant's financial power of
attorney when the applicant was competent to do so, and the person did not
violate the limits of that authority in making the transfers.
