55 Pa. Code § 178.101 - Disposition of property and fair consideration provisions for transfers during the period of January 4, 1991, through July 29, 1994
(a) If property was disposed of during the
period of January 4, 1991, through July 29, 1994, §§
178.102 and
178.103 (relating to presumption
of disposition of property to qualify for MA for transfers during the period of
January 4, 1991, through July 29, 1994; and reestablishment of MA eligibility
after transfers made during the period of January 4, 1991, through July 29,
1994) and this section apply to an applicant/recipient who is applying for or
receiving NFC as defined in §
178.2 (relating to definitions),
including services in an ICF/MR facility, if the property was transferred for
less than FMV.
(b) An
institutionalized applicant/recipient who transferred property for less than
FMV is ineligible only for NFC for a period not to exceed 30 months from the
date of the transfer. The person continues to be eligible for other MA
services.
(c) A transfer of property
by the community spouse to a person other than the institutionalized spouse is
treated, and affects the eligibility of the institutionalized spouse, the same
as transfers by the institutionalized spouse.
(d) The CAO shall evaluate a transfer
completed during or after the 30-month period immediately before the date:
(1) The person is institutionalized, if the
person was MA eligible on that date.
(2) The person applies for MA while
institutionalized.
(e) The
transfer of excluded personal property is not subject to the fair consideration
provisions. The applicant/recipient shall promptly report the transfer and the
compensation received shall be verified and treated as a resource subject to
other resource requirements in this chapter.
(f) The transfer of the resident property is
subject to the fair consideration provisions. The institutionalized person does
not lose eligibility for payment of nursing facility services or ICF/MR
services because of the transfer of the resident property if the resident
property was transferred to:
(1) The
spouse.
(2) A child who is under 21
years of age or a child who is blind or permanently and totally disabled
regardless of age.
(3) A sibling
who has equity interest in the resident property and who resided in the
resident property for at least 1 year immediately before the person was
admitted to the nursing facility or ICF/MR.
(4) A son or daughter, other than those
described in paragraph (2), who resided in the resident property for at least 2
years immediately before the parent's admission to a nursing facility and who
provided care during the 2-year period which permitted the parent to stay in
the resident property rather than be admitted to the nursing facility or
ICF/MR.
(i) Sufficient evidence shall be
presented by the child and the parent, or the parent's representative, for the
Department to determine if the conditions are met.
(ii) Otherwise, a written statement from the
parent's physician, a visiting nurse or other health professional familiar with
the case is needed to determine if the conditions are met.
(g) An institutionalized person
does not lose eligibility for payment of nursing facility or ICF/MR services
because of a transfer of resources for less than fair consideration if one of
the following applies:
(1) The transfer was
to, or for the benefit of, the community spouse, or to a child who is blind or
permanently and totally disabled regardless of age, or to another person for
the sole benefit of the person's spouse if the spouse does not transfer the
resource to another person other than the institutionalized spouse for less
than fair consideration.
(2) The
person, a family member or someone else acting on behalf of the person can show
that:
(i) The transfer was with the intention
of receiving FMV or other valuable consideration.
(ii) The transfer was exclusively for a
purpose other than to qualify for MA.
(3) The Department determines that the denial
would cause undue hardship.
(h) The period of ineligibility for MA
nursing facility services begins with the month of transfer and is the lesser
of:
(1) Thirty months.
(2) The number of months, rounded to the next
lowest whole month, arrived at by dividing the UV by the average monthly cost
of private NFC in this Commonwealth. The average monthly private rate for
nursing facility services is available upon request at the CAOs.
(i) During the period of
ineligibility for MA nursing facility services, the nursing facility may charge
the private pay rate.
Notes
The provisions of this § 178.101 amended under sections 201(2) and 403(b) of the Public Welfare Code (62 P. S. §§ 201(2) and 403(b)).
This section cited in 55 Pa. Code § 178.5 (relating to treatment of irrevocable burial reserves for all categories of MA); 55 Pa. Code § 178.103 (relating to reestablishment of MA eligibility after transfers made during the period of January 4, 1991, through July 29, 1994); 55 Pa. Code § 178.121 (relating to general); and 55 Pa. Code § 178.125 (relating to transfer of resources from the institutionalized spouse to the community spouse).
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