<p> STATE OF WASHINGTON DEPARTMENT OF SOCIAL AND HEALTH SERVICES Aging and Long-Term Support Administration Home and Community Services Division PO Box 45600, Olympia, WA 98504-5600</p><p>H17-055 – Procedure June 29, 2017</p><p>TO: Home and Community Services (HCS) Division Regional Administrators</p><p>FROM: Kathy Morgan, Acting Director, Home and Community Services Division</p><p>SUBJECT: Procedure for Review of Proposed Transfer Penalties for Institutional Medicaid Programs</p><p>PURPOSE: To notify staff of a formalized procedure to review proposed transfer penalties, and to provide staff with a better alternative for requesting guidance on transfer penalty issues.</p><p>BACKGROUND: Not only are transfer penalties for institutional Medicaid programs controversial, but fact patterns can get unduly complicated. This MB is necessary to avoid mistakes, avoid erroneous adverse impacts on clients, impose transfer penalties when appropriate, and to streamline requests for help on transfer penalties.</p><p>Previously, requests for clarification from ALTSA headquarters were completed on an ad-hoc basis. This sometimes led to administrative hearing issues, headquarters’ reversal of actions previously taken, and absorbing additional costs that could have been avoided. </p><p>WHAT’S NEW, Effective July 3, 2017, prior to taking any action regarding a CHANGED, OR penalty period for institutional Medicaid programs, the case must CLARIFIED: be reviewed. This includes whether a penalty is imposed, and whether an exception to a penalty is allowed.</p><p>ALTSA headquarters financial eligibility and policy unit will be tracking the reviews for training and reporting purposes. Results of this new procedure will not be used for any other purpose than to improve the accuracy of our actions, given the world of LTC financial eligibility continues to be one of the most complicated and difficult tasks in Medicaid.</p><p>ACTION: Reviews can be initiated by documenting the case facts and recommended action in an email to the reviewer, and forwarding the email to each review level. The intent of the review is to document the review process, and not meant to add an additional burdensome process.</p><p>The reviews will be tracked using the financial eligibility and policy SharePoint site here (note that only reviewers will have access to the SharePoint list). The procedure below may be revised as data is reviewed and training opportunities are found.</p><p>The procedure for this review will occur as follows:</p><p>(1) First-level review. This includes the recommendation of the financial worker, with or without collaboration with their lead worker or supervisor, on whether to impose or except a transfer penalty. The supervisor will review this recommendation, the facts, the WAC, and decide on an initial action: penalty; no penalty; or clarification needed.</p><p>(2) Intermediate Review. This includes review of the initial recommendation by at least one of the following: SHPC, SME, or SHPM. This review will either concur or non- concur with the initial recommendation, or request additional guidance from ALTSA headquarters financial eligibility and policy unit.</p><p>(3) Regardless of the result of the intermediate review, the initial and intermediate recommendation will be reviewed by ALTSA headquarters financial eligibility and policy unit. The unit will decide whether to impose a penalty, except a penalty for a particular reason under WAC, or remand for further/incomplete information.</p><p>RELATED WAC 182-513-1317, WAC 182-513-1318, WAC 182-513-1363 REFERENCES:</p><p>ATTACHMENT(S): https://teamshare.dshs.wa.gov/sites/hcs/FP/Lists/transfer_review /compact.aspx</p><p>CONTACT(S): Will Reeves, Acting Chief of LTC Financial Eligibility & Policy [email protected] 360-725-2600</p>