Current through Register Vol. 49, No. 18, September 16, 2024
PURPOSE: This amendment clarifies the definition of
"proof of residency" and replaces outdated language throughout the
regulation.
PURPOSE: This rule implements the guidelines for
placement of liens on the property of certain institutionalized MO HealthNet
participants, in accordance with the authority given to states in the Tax
Equity and Fiscal Responsibility Act of 1982 (TEFRA), as
amended.
(1) When an
applicant for MO HealthNet or a MO HealthNet participant is a patient, or will
become a patient, in a nursing facility, intermediate care facility for the
developmentally disabled, or other medical institution, the Department of
Social Services will determine if the placement of a lien against the property
of the applicant or participant is applicable. A lien is imposed on the
property of an individual, in accordance with the authority given states in the
Tax Equity and Fiscal Responsibility Act of 1982 (TEFRA), when-
(A) The MO HealthNet participant is or has
made application to become a patient in a nursing facility, intermediate care
facility for the developmentally disabled, or other medical institution, if
such individual is required, as a condition of receiving services in such
institution, to spend for costs of medical care all but a minimal amount of
his/her income required for personal needs;
(B) The institutionalized MO HealthNet
participant owns property. Property includes the homestead and all other real
property in which the person has a sole legal interest or a legal interest
based upon coownership of the property;
(C) The department has determined after
notice and opportunity for hearing that there is no reasonable expectation that
the person can be discharged from the facility within one hundred twenty (120)
days and return home. The hearing, if requested, will proceed under the
provision of Chapter 536, RSMo, before a hearing officer designated by the
director of the Department of Social Services. The fact that there is no
reasonable expectation that the person can be discharged from the facility
within one hundred twenty (120) days and return home may be substantiated by
one (1) of the following:
1.
Applicant/participant states in writing that he/she does not intend to return
home within one hundred twenty (120) days;
2. Applicant/participant has been in the
institution for longer than one hundred twenty (120) days; or
3. A physician states in writing that the
applicant/participant cannot be expected to be discharged within one hundred
twenty (120) days of admission; and
(D) A lien is imposed on the property unless
one (1) of the following persons lawfully resides in the property:
1. The institutionalized person's
spouse;
2. The institutionalized
person's child who is under twenty-one (21) years of age or is blind or
permanently and totally disabled; or
3. The institutionalized person's sibling who
has an equity interest in the property and who was residing in such
individual's home for a period of at least one (1) year immediately before the
date of the individual's admission to the institution; or
4. The division may require proof of
residency pursuant to this subsection. Proof of residency includes, but is not
limited to, a utility bill, property tax bill, copy of permanent Missouri
driver's license, copy of Missouri voter's registration verification, or copy
of the most recently filed Federal 1040 income tax form in the name of the
institutionalized person's spouse, child, or sibling.
(2) After determining the
applicability of the lien, the MO HealthNet participant is given an Explanation
of TEFRA Lien. A person who objects to the imposition of a lien without good
cause is ineligible for medical assistance. Ineligibility is based on the
person's objection without good cause to the imposition of the lien, which
impedes the department's ability to implement its lien requirements.
(3) A lien may be imposed upon the property
but the department will not seek adjustment or recovery of the costs of medical
assistance correctly paid on behalf of the participant when the participant's
child over the age of twenty-one (21) resides in the home and facts are
established, to the satisfaction of the department, by sworn affidavit of the
participant's child or authorized representative with personal knowledge of the
facts, conclusively showing that-
(A) The
participant's child has lived with and cared for the participant in the
participant's home continuously for the two (2) years immediately prior to the
participant entering a nursing facility, intermediate care facility for the
developmentally disabled, or other medical institution;
(B) By providing that care the participant's
child has allowed the participant to live at home rather than in a nursing
facility, intermediate care facility for the developmentally disabled, or other
medical institution;
(C) The
participant's child continues to reside in the home since the participant
entered into a nursing facility, intermediate care facility for the
developmentally disabled, or other medical institution;
(4) The director of the department or the
director's designee will file for record, with the recorder of deeds of the
county in which any real property is situated, a written Certificate of TEFRA
Lien. The lien will contain the name of the MO HealthNet participant and a
description of the property. The recorder will note the time of receiving such
notice and will record and index the certificate of lien in the same manner as
deeds of real estate are required to be recorded and indexed. The county
recorder shall be reimbursed per certificate or release filed by the
division.
(5) The TEFRA lien shall
be for a debt due to the state for medical assistance paid or to be paid on
behalf of the MO HealthNet participant. The amount of the lien will be for the
full amount due the state at the time the lien is enforced. Fees paid to county
recorder of deeds for filing of the lien will be included in the amount of the
lien.
(6) The TEFRA lien does not
affect ownership interest in a property until it is sold, transferred, or
leased, or upon the death of the individual, at which time the lien must be
satisfied, subject to the following:
(A) Any
costs of sale of the property that are to be paid before the lien must be
approved in advance by the department, and if a HUD-1 statement is prepared for
that sale transaction, then a copy must be provided to the department prior to
the closing for review and approval;
(B) Subject to the provisions of subsection
(6)(A), in any case of a pending probate matter in a court of the state of
Missouri for the administration of the assets and interests of the participant,
including the property subject to the lien, then the following probate costs
and expenses may be paid from the sale of the real estate at closing ahead of
the lien:
1. Filing fees, publication fees,
appraisal fees, personal representative fees, executor fees, attorney's
fees;
2. Costs to maintain and
repair the property for sale, such as insurance premiums, professional lawn
care services, necessary repairs to prepare for sale, customary real estate
sales commissions, or publication of sale notice, and the participant or
authorized representative shall produce documentation to support costs and
incurred expenses; or
3. Burial
costs of the participant; and
(C) The lien shall not be released against
the real estate, except as required in section (7), until all net equity in the
property remaining after closing costs after sale, transfer, or lease has been
paid in satisfaction of the lien to the department, after payment of customary
and approved costs from the sale proceeds as set forth in subsections (6)(A)
and (6)(B). Closing costs are shared equally by all beneficiaries of the net
proceeds of the real estate sale. In no case shall the state directly pay any
costs of the sale or probate.
(7) The lien will be dissolved in the event
the individual is discharged from the institution and returns home. A Notice of
TEFRA Lien Release will be filed within thirty (30) days with the recorder of
deeds of the county in which the original Certificate of TEFRA Lien was
filed.
*Original authority: 208.201, RSMo 1987, amended 2007 and
208.215, RSMo 1981, amended 1982, 1987, 1990, 1993, 1996, 2005, 2007,
2010.
