M E M O R A N D U M

IM-19  01/30/01  INCREASE IN AVERAGE PRIVATE PAY NURSING RATE FOR TRANSFER OF PROPERTY CASES MANUAL REVISION #4: CHAPTER XI, SECTION IX, PAGE 20

SUBJECT:
INCREASE IN AVERAGE PRIVATE PAY NURSING RATE FOR TRANSFER OF PROPERTY CASES MANUAL REVISION #4: CHAPTER XI, SECTION IX, PAGE 20
 
DISCUSSION:
The average private pay nursing care rate is increased from $1,725 to $2,513.  Use $2,513 to determine the number of months of ineligibility for vendor level services for applications taken on or after January 1, 2001.

On Chapter XI, Section IX, Page 20, we have removed the obsolete reference to the 30 month maximum length of ineligibility and added clarification regarding transfer penalties that overlap.  At this time, we are not updating Chapter XI, Section IX to include all of the changes per IM-42 of 1994 regarding transfers of property. 

IM-42 changed the look-back dates, removed the 30 month maximum on the length of ineligibility, and made other changes.  We remind staff to consult IM-42 when handling transfer of property issues. 
 
NECESSARY ACTION:
  • Discuss this memorandum with appropriate staff.
  • Use $2,513 as the average private pay rate effective January 1, 2001.
  • Remove the obsolete page 20, and file the revised page.
LAW
DISTRIBUTION #2
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[ Memorandum Table of Contents ]

 
CHAPTER XI, SECTION IX, PAGE 20
If the worker is satisfied that the loan was bona fide it does not affect eligibility on the factor of property transfer.  However, if the information does not permit the worker to arrive at this conclusion, the payment will be considered as if it were a gift, and thus is a transfer of property without fair and valuable consideration.

If the worker determines that fair and valuable consideration:

1.) Was received without regard as to the type or value of the transferred property, the claimant is eligible on this point.

2.) Was not received, consider the claimant ineligible for VENDOR LEVEL services for the number of months the uncompensated value is divisible by the average statewide private pay rate at the time of application for vendor benefits or the Personal Care Services program.  Once the number of months is established, it cannot be recalculated using an updated average private pay rate if the person reapplies.

NOTE:  Claimants may be approved for a "T" level of care in a vendor institution if ineligible for vendor level of care due to a transfer.  Use regular MA budgeting for these type of situations.

To determine the length of ineligibility, divide the uncompensated value by the statewide average cost to a private pay patient at the time of application of nursing facility services.  The length of ineligibility will be that number of months.  The ineligibility period begins with the date of the transfer, unless the claimant was under a transfer penalty at the time.

Average Private Pay Rate:  January 1, 2001 $2,513

Round the answer to the nearest whole number (a fractional part of less than .5 will be lowered to the nearest whole number; .5 or higher will be raised to the next whole number).

EXAMPLE:  Mr. Lawrence applied for MA vendor on March 2, 2001.  He indicated that on January 5, 2001 he transferred $14,000 without receiving fair and valuable consideration and with the intent of gaining eligibility for assistance.  The private pay average is $2,513.  Mr. Lawrence is ineligible for 6 months.  (14,000 divided by $2,513 = 5.57 rounded to 6).  The period of eligibility for vendor level services is January through June.

In the above example, if the amount transferred was $18,000 the claimant would be ineligible for 7 months.  (18,000 divided by $2,513 = 7.16 rounded to 7).  The client would be ineligible from January through July.

January 2001