J HCBS and Nursing Facility Refunds

Policy

After ALTCS approval, the nursing facility must refund the amount of payments made by the customer while waiting for the ALTCS approval that is more than the customer’s share of cost for the approved months.

ALTCS Program Contractors are able to refund payments for some HCBS services provided while an ALTCS application was pending. The reimbursement for HCBS is determined by the Program Contractor and depends on whether the services were otherwise approvable.

Any of these refunds received after ALTCS is approved are excluded for six months starting with the month the refund is received.

NOTE      While the refund is excluded for the six-month period it is not an “excluded resource” as described in MA904I.  When the refund is paid to anyone other than the customer or the customer’s spouse evaluate it as a potential transfer.

If the refund is kept in an account with money that counts as a resource, any withdrawals made are assumed taken from the counted money first.  See MA703B for more details on commingled funds.

Definitions

Proof

Proof of the amount of the refund and the date it was received includes:

·         Written statement from the payer;

·         Check stub; or

·         Collateral contact to payer.

Legal Authority