|
|
|
For transfers that are not exempt under MA903, the value of the compensation received determines whether the transfer affects long term care services. When the compensation received is equal to or more than the resource value, the transfer does not affect long-term care services.
However, if less than full value is received for the transferred resource, the difference is the uncompensated value and may result in a transfer penalty period. During a penalty period, the customer cannot get long-term care services.
Compensation may be received in different ways. Each may have different rules and proof needed to show the amount of compensation received. The compensation may be received:
As real or personal property;
As the assumption of a legal debt;
As personal care services; or
As items or services before the date of the transfer.
The following sections give more details on the ways that compensation is received and counted, and proof needed.
Compensation in cash is the total amount paid to the customer in exchange for a resource. The value of the cash compensation is the gross amount paid to the customer. The value is not reduced by valid expenses attributed to the sale (for example, closing costs or commissions for real estate sales).
When the compensation is real or personal property, the value of compensation is the equity value of the property in the month the customer received it or when a contract for sale was signed and notarized, if earlier.
When a person pays or takes over a legal debt owed by the customer, the value of the compensation is the outstanding principal amount at the time it was taken over. Interest payments are not included.
The value of personal care services provided to the customer can be considered as compensation only when:
There is a valid personal care contract. The contract may be written or oral; and
The contract is executed before the services are provided. A contract is not valid when services were provided before the agreement was made.
If the contract is not valid, the personal care services cannot be allowed as compensation. See definition for valid contract below.
For process instructions see Determining the Value of Personal Care Services
Items or services received before the transfer may be considered as compensation only when Items or services were provided according to the terms of a valid contract.
A contract may be written or oral and must be in place before the items or services are provided. A contract is not valid when the items or services were provided before the agreement was made.
If the contract is not valid, the items or services received before the transfer cannot be allowed as compensation.
|
Term |
Definition |
|
Assumption of a legal debt |
The act of taking over payments for and being legally assigned for someone else’s legal debt. |
|
Compensation |
Something given or received in exchange for services, property, debt, or loss. |
| Direct Care Worker |
The following relatives of a member are defined as family members in the context of what family members may get paid to provide services to AHCCCS members:
|
|
Equity Value |
Means the current market value of a resource less any outstanding loans, mortgages, liens, or legal debts. |
|
Oral Contract |
A legally binding agreement made verbally. Oral contracts are only legally binding for one year in Arizona. NOTE To be considered valid, full payment must be received within one year of the date of the oral contract. |
|
Personal Care Services |
Also called Attendant Care services. A list of these services is available in section 1240 of the AHCCCS Medical Policy Manual; |
|
Valid Contract |
To be considered valid, a contract must meet all of the following:
Personal care contracts have the following additional requirements:
NOTE A representative cannot sign the agreement and also be the one paid for providing services, unless the document that provides the representative’s legal authority to act for the customer specifically states that the representative can self-contract to provide services. |
To determine whether full compensation was received for a transfer proof is needed of the following:
The date of the transfer;
The value of the resource on the date it was transferred; and
Proof of the value of the compensation received.
Proof of the date a transfer was made includes:
Sales receipts;
Property deeds;
Loan agreements;
Financial account statements showing the transfer;
Canceled checks;
Trust documents; and
Other documents and records showing the date of the change in ownership.
NOTE For real property, the date of transfer is the date the document transferring ownership is signed and notarized, not the date it is recorded.
The proof needed to determine the equity value of the resource on the date of transfer depends on the type of resource. See MA705 for examples of proof by resource type.
The proof needed to determine the value of compensation received depends on the type of compensation. The following table gives examples of proof by type of compensation:
|
If the compensation is… |
Then proof is needed of… |
|
Cash |
The amount received. Documents that can be used for proof include:
|
|
Resources other than cash |
Who previously owned the resource and that ownership was transferred to the customer. Proof includes:
|
|
The equity value of the resource when it was received by the customer. See MA705 for proof by resource type. |
|
|
Assumption of legal debt |
The debt being legally assigned to the other person. Proof includes:
|
|
Personal care services |
A valid personal care contract. Proof is needed that all requirements for a valid contract in policy section 4 above are met. Some of the items that may be needed include:
|
|
Compensation received before the transfer |
A valid contract. Proof is needed that all requirements for a valid contract in policy section 5 above are met. Some of the items that may be needed include:
|
|
Program |
Legal Authorities |
|
ALTCS |
42 USC 1396p(c) AAC R9-28-401 and 409 |