Current through Register 1531, September 27, 2024
(A)
Liens. A real estate lien enables the MassHealth
agency to recover the cost of medical benefits paid or to be paid on behalf of
a member. Before the death of a member, the MassHealth agency will place a lien
against any property in which the member has a legal interest, subject to the
following conditions:
(1) per court order or
judgment; or
(2) without a court
order or judgment, if all of the following requirements are met:
(a) the member is an inpatient receiving
long-term or chronic care in a nursing facility or other medical
institution;
(b) none of the
following relatives lives in the property:
1.
a spouse;
2. a child younger than
21 years old, or a blind or permanently and totally disabled child;
or
3. a sibling who has a legal
interest in the property and has been living in the house for at least one year
before the member's admission to the medical institution;
(c) the MassHealth agency determines that the
member cannot reasonably be expected to be discharged from the medical
institution and return home; and
(d) the member has received notice of the
MassHealth determination that the above conditions have been met and that a
lien will be placed. The notice includes the member's right to a fair
hearing.
(B)
Recovery. If property against which the MassHealth
agency has placed a lien under
130
CMR 515.012(A) is sold, the
MassHealth agency may recover all payment for services provided on or after
April 1, 1995. This provision does not limit the MassHealth agency's ability to
recover from the member's estate in accordance with
130
CMR 515.011.
(C)
Exception. No
recovery for nursing-facility or other long-term-care services may be made
under
130
CMR 515.012(B) if the
member
(1) was institutionalized;
(2) notified the MassHealth agency that he or
she had no intention of returning home; and
(3) on the date of admission to a
long-term-care institution, had long-term-care insurance that, when purchased,
or at any time thereafter, met the requirements of
130
CMR 515.014 and the Division of Insurance
regulations at
211
CMR
65.09(1)(e)2.
(D)
Repayment
Deferred.
(1) In the case of a
lien on a member's home, repayment under
130
CMR 515.012 is not required while any of the
following relatives are still lawfully living in the property:
(a) a sibling who has been living in the
property for at least one year before the member's admission to the nursing
facility or other medical institution; or
(b) a son or daughter who
1. has been living in the property for at
least two years immediately before the member was admitted to a nursing
facility or other medical institution;
2. establishes to the satisfaction of the
MassHealth agency that he or she provided care that permitted the parent to
live at home during the two-year period before institutionalization;
and
3. has lived lawfully in the
property on a continual basis while the parent has been in the
institution.
(2) Repayment from the estate of a member
that would otherwise be recoverable under any regulation is still required even
if the relatives described in
130
CMR 515.012(D) are still
living in the property.
(E)
Dissolution. The
MassHealth agency will discharge a lien placed against property under
130
CMR 515.012(A) if the
member is released from the medical institution and returns home.
(F)
Verification.
The applicant or member must cooperate in providing verification as to whether
the conditions under
130
CMR 515.012(A) exist, and
in providing any information necessary for the MassHealth agency to place a
lien.
(G)
Recording
Fee. The MassHealth agency is not required to pay a recording fee
for filing a notice of lien or encumbrance, or for a release or discharge of a
lien or encumbrance under
130
CMR 515.012.
