Page 2
2
with the transfer of asset evaluation. The evaluation must be completed within the time frames outlined in this policy.
A. Terminology 1. A spouse is financially responsible when: a. They are not institutionalized. b. They have been living with the a/b or temporarily absent from the home for 12 months or less prior to the a/b’s institutionalization. c. A spouse is not financially responsible if the couple has been continuously separated for at least 12 months at the time the institutionalized spouse enters the institution.
2. In this policy institutional services are:
a. Services provided in a nursing facility (NF), intermediate care facility for individuals with intellectual disabilities (ICF-IID), or nursing facility level of care in a Swing bed or in an acute care hospital bed (FL-2 required), Note: nursing facility level of care in an acute care hospital bed was formerly known as inappropriate level of care bed. An FL-2 is required for nursing facility level of care.
b. Services provided through the Community Alternatives Program (CAP), or
c. Services provided through the Program of All-Inclusive Care for the Elderly (PACE).
These services can be sanctioned due to a non-allowable transfer of assets. This does not include acute care in a hospital (not nursing facility level of care) regardless of length of stay.
3. The transfer of assets evaluation for each a/b will follow guidance based on whether the request for institutional services is an initial request or a subsequent request.
a. Initial Request- For transfer of asset policy, an initial request is the first application or request for institutional services for an a/b that results in an approval of institutional services. b. Subsequent Request- a new application or request for institutional services submitted after a previous period of eligibility for institutional services was terminated.
B. Rules for transfer of asset evaluations
1. Transfer rules apply to MAGI and non-MAGI individuals requesting or receiving institutional services.