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2. Agreement/contract must be created before an application for Aged, Blind, or Disabled 3. Medicaid is received or before an additional level request (Nursing Home and/or Waiver) is received. 4. Agreement/contract must detail which services are included and which are excluded for the purposes of compensation (e.g., non-medical care only, meal preparation, light housekeeping, bookkeeping, transportation, assistance with activities of daily living). 5. Must be signed by both the care recipient and the person agreeing to perform the services. (If the recipient is unable to sign due to mental incapacity, their power of attorney must sign). 6. Agreement/contract must have a begin date and end date Such as: a. § Contract will end once individual enters the nursing home b. § Contract will end upon individual’s death c. § Contract will end once personal care services are no longer needed 7. Must specify rates for services that are comparable to rates charged by commercial care provider located in the same general area – rates are charged at Fair Market Value. a. Based on the US Bureau of Labor Statistics Occupational Handbook (www.bls.gov) 8. Any unused amount of the contract is to be repaid to Montana Medicaid if the claimant passes away before their actuarial life expectancy. a. Providing that upon the death of the individual, the State Medicaid Program will receive all amounts of unpaid services remaining in the agreement/contract up to the total amount of medical assistance paid on behalf of the individual during his or her lifetime. 9. Services cannot be duplicative a. For example, nursing homes provide dietary services, and, when necessary, assistance in eating; a separate contract paying a third party to also provide assistance in eating is not a valid personal care contract expense. 10. Agreement/Contract is actuarially sound in accordance to the life expectancy table in ABD 016 Life Expectancy Table

Services will be considered an uncompensated asset transfer if: 1. Services are duplicative a. For example, nursing homes provide dietary services, and, when necessary, assistance in eating; a separate contract paying a third party to also provide assistance in eating is not a valid personal care contract expense. b. § Only the specific duplicative service will be looked at as an uncompensated asset transfer 2. Agreement/contract is created after an application for Medicaid is received