The Centers for Medicare and Medicaid Services (CMS)
released new guidance
this week to correct an unintended consequence of prior guidance for
determining the penalty start date of an asset transfer for Medicaid applicants
seeking eligibility for home and community-based services (HCBS) delivered
under a 1915(c) waiver.
According to the revised guidance, the penalty period start
date for these applicants is no later than the point at which the applicant
would otherwise be receiving HCBS waiver coverage based on the approved
application for such care, but for the penalty.
Specifically, the penalty
period start date would be no later than the date the state confirms that it has:
(1) Determined that the applicant meets the
financial and non-financial requirements for Medicaid eligibility and the
level-of-care criteria for the 1915(c) waiver;
(2) Developed a person-centered
service plan; and
(3) Identified an available waiver slot.
The earlier guidance (SMDL
#06-018) created a catch-22 for those applying to receive HCBS services under a
1915(c) waiver and who were subject to an asset transfer penalty period.Under
that guidance, the penalty period did not begin to run until the individual
began receiving HCBS waiver services, but the individual could not begin to
receive waiver services until the penalty period has run. The result was an
infinite penalty period.
CMS stated that the new guidance will ensure CMS is
interpreting the provision consistent with statutory intent.
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