CurrentAlabama MedicaidPolicy N/A

Chapter 33 — Recoupments, Estate Recovery and Liens

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Governs Alabama Medicaid procedures for identifying, recovering, and enforcing repayment of misspent or recoverable Medicaid payments from recipients, providers, and estates; includes liens, time payment plans, civil actions, and appeals affecting recipients, authorized representatives, providers, and estates.

Policy Summary

PayerAlabama Medicaid

PolicyChapter 33 — Recoupments, Estate Recovery and Liens

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateOct 1, 1982

Last ReviewJan 25, 2016

Next Review DateN/A

Key ActionAgency will send a recoupment letter outlining allegations and amount; recipients or providers may submit reimbursement or request a rebuttal.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

7rules in Chapter 33

time-limitedpromissory note durations

55+estate recovery scope

foreclosure possibleliens authority

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CurrentAlabama MedicaidPolicy N/A

Chapter 33 — Recoupments, Estate Recovery and Liens

Customize your policy alerts

Sign up for all Alabama Medicaid policy alerts

Know when Alabama Medicaid releases new policies or updates existing guidance.

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Receive email alerts as soon as relevant payer policies are published or updated.

Policy Summary

PayerAlabama Medicaid

PolicyChapter 33 — Recoupments, Estate Recovery and Liens

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateOct 1, 1982

Last ReviewJan 25, 2016

Next Review DateN/A

Key ActionAgency will send a recoupment letter outlining allegations and amount; recipients or providers may submit reimbursement or request a rebuttal.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

7rules in Chapter 33

time-limitedpromissory note durations

55+estate recovery scope

foreclosure possibleliens authority

Recoupment, Estate Recovery, Liens and Appeals

Recoupment, estate recovery, liens and appeals criteria

Procedures and conditions under which the Agency will pursue recoupment, estate recovery, liens, exemptions, and appeals.

Agency provides notice and opportunity to rebut or remit: At identification of expected recoupment the Agency will send a letter to the recipient/authorized representative or provider stating the allegations, the amount of reimbursement sought, and the specific dates of overpayment or recoverable benefits; the recipient/authorized representative or provider is offered the opportunity to present evidence to rebut or to submit reimbursement; if no rebuttal is offered, the original assessment is presumed correct; Agency will accept direct reimbursement to satisfy recoupment.

If direct reimbursement is not made

Time payment plan may be allowed upon sufficient justification: recipients must sign a promissory note not to exceed two years; providers must sign a promissory note not to exceed one year.
Fiscal agent recoupment: if provider is payee and has received monies to be recouped, or if a provider fails to submit direct reimbursement or agree to/adhere to a time payment plan, the Agency's fiscal agent will recoup the excess amount from a future adjustment payroll.
Civil actions: the Agency may initiate civil actions through the courts when administrative procedures do not resolve recovery of amounts owed.

Estate recovery scope and limitations: Under §1917(b) the Agency shall seek adjustment or recovery of medical assistance correctly paid on behalf of permanently institutionalized recipients of any age and from the estates of recipients who were age 55 or older when they received such medical assistance, subject to federal law and the approved State Plan; amounts disregarded under State Long-Term Care Insurance Partnership are not recoverable to the extent of the disregard.

Delayed recovery and exemptions: Recovery or adjustment may be made only after the death of the recipient's surviving spouse and when there is no surviving child under age 21 or blind/permanently/ totally disabled child; if exemption conditions exist after the recipient's death, recovery is postponed until exemption conditions no longer apply; undue hardship provisions are available per rule.

Liens on real property: The Agency will place a lien and may foreclose upon real property to the extent allowed by 42 U.S.C. § 1396p; liens become due, payable and enforceable in accordance with federal and state law upon sale or transfer of the property or upon death of the grantor; the Agency may not impose a lien on the recipient's home if the recipient's spouse, a child under age 21, a blind or permanently and totally disabled child resides there, or if a sibling with equity has resided continuously in the home for at least one year prior to admission (additional delayed-recovery conditions apply regarding residency of children or siblings who provided care).

Appeals and hearing rights: A person aggrieved by a proposed or actual Agency action may request a hearing in accordance with Chapter 3; a recoupment action will not be abated during the time for requesting a hearing, although the Agency may, in its discretion, suspend a recoupment action until after a hearing is held.

Legal Citations and Age Thresholds

Key legal citationsmixed

42 U.S.C. § 1396p	Federal statute authorizing estate recovery and liens
42 C.F.R. § 433.36	Federal regulation cited for estate recovery procedures

Age threshold for estate recovery

Estate recovery age thresholdAgency shall seek adjustment or recovery from the recipient's estate for recipients who were age 55 or older when they received medical assistance

Permanently institutionalized recipientsAgency shall seek recovery from the estate of permanently institutionalized recipients of any age (inpatients in nursing facility, ICF/IID, or other medical institution)

Exceptions — LTC PartnershipIf assets or resources were disregarded under the State Long-Term Care Insurance Partnership, the Agency will not seek recovery for the disregarded amount

Provider Recoupment, Time Payment Plans, and Civil Actions

Documentation Required

Provider recoupment procedures

When the Agency identifies an expected recoupment amount it will send a letter to the provider outlining the allegations, the amount, and the specific dates when overpayment or recoverable benefits occurred; the provider may submit direct reimbursement or present evidence to rebut the recoupment. If no rebuttal is offered, the original assessment is presumed correct; failure to reimburse or arrange payment may result in fiscal agent recoupment from future adjustment payrolls.

Agency sends recoupment letter stating allegations, amount, and dates of overpayment or recoverable benefits.
Provider may submit direct reimbursement or present evidence to rebut; absent rebuttal the assessment is presumed correct.
If provider does not reimburse or enter an approved payment plan, fiscal agent may recoup from future adjustment payrolls.

Definitions and Special Terms

Undue Hardship (definition and threshold references)

Definition of Undue HardshipAn estate asset (e.g., family farm or family business) that produces 'limited income' (defined as equal to or less than the income limit established in Rule 560-X-25-.14) and is the sole income-producing asset of one or more heirs to the estate

Relief availableThe Agency will waive or delay recovery upon a showing that an undue hardship exists, established by convincing evidence

When undue hardship is not availableUndue hardship relief is not available in specified circumstances (see Rule for exclusions)