11126 Collecting the Claim - Once the household has been notified of the overstatement of eligibility and repayment requested, collection action shall be initiated. Recovery may only be initiated if there are countable resources that are currently available. This includes any resources counted toward the allowable resource limit outlined in 5130.
11126.1 Methods of Collection - Agency Error and Client Error claims shall be collected in one of the following ways:
1. If the household responds with a payment on the claim, the payment shall be accepted according to established procedures. If the claim is paid in full, no further collection action is required. If the claim is only partially paid, further action is necessary to collect the remaining amount of the claim.
2. If the household responds with a promise to make payments, the payments shall be accepted according to established procedures. If the payments continue or the claim is paid in full, no further collection action is required. If the household fails to begin making payments or to continue making payments, further action is necessary to collect the remaining amount of the claim.
3. If the household is unable or unwilling to make a voluntary repayment to the agency, a special spenddown shall be imposed. The special spenddown shall be created in an amount equal to the amount to be recovered and shall be considered in the current eligibility base period.
Medical expenses may be allowed against the special spenddown if the expense is verified, medically necessary and reported to the agency on at least a 6 month basis. Medical expenses shall be counted against the regular spenddown (if any) and then the special spenddown.
A special spenddown may be used for both automatic and determined eligible. There is no requirement that the client have a regular spenddown. However, a special spenddown shall not be used in the Medicaid poverty level or CHIP programs.
If a special spenddown is imposed on a regular
spenddown, the amount of both spenddowns must be met before the overstated
eligibility claim is considered satisfied. If unmet, the special
spenddown may extend over more than one base period.
11126.2 Fraud Claims - A claim that has been determined to be fraudulent through a court of appropriate jurisdiction shall be collected in the same manner as other types of claims. A repayment agreement shall be sent to the household as indicated in 11125.
1. Method of Collection – If the court has not imposed the method of collection, the provisions of 11125 apply. If the court has established how the claim is to be repaid, the agency shall follow that collection method.
2. Disqualification Penalty – An individual
who has been convicted of medical assistance fraud under 42 U.S.C. Sec.
1320a-7b shall be ineligible for medical assistance for one year from
the date of conviction. Convictions under state law do not carry
a disqualification period.
11126.3 Bankruptcy Discharge - If the agency becomes aware of any bankruptcy proceedings concerning a household with an uncollected medical assistance claim, KDHE-DHCF Legal Division shall be notified immediately. Legal division will provide instruction on how to proceed. Legal division will provide notification when the bankruptcy action is complete. Collection action should then be initiated, resumed or terminated (see 11127) in accordance with the outcome of the final bankruptcy action.
11126.4 Reserved
11126.5 Reserved
11126.6 Reserved
11127 Terminating Claims - An uncollected claim shall be terminated when either of the following occur:
1. The only remaining household member responsible for the claim is deceased; or
2. The claim has been discharged through a bankruptcy proceeding, see 11126.3.
11128 Reserved