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D.C. Municipal Regulations (Last Updated: September 13, 2017) |
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Title 29. PUBLIC WELFARE |
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Chapter 29-67. MEDICAID PROGRAM - LIENS AND ADJUSTMENTS OR ESTATE RECOVERY |
Section 29-6704. PROCEDURES FOR WAIVING ESTATE RECOVERY
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6704.1The application for Medicaid benefits shall contain language to inform each Medicaid applicant that recoveries against the estate of each Medicaid recipient may be undertaken.
6704.2MAA shall provide written notice of the proposed recovery to the personal representative or attorney of record prior to asserting any claim or recovery against the estate. The written Notice of Proposed Recovery shall include all of the following information:
(a)Itemization of the claim of medical services paid by the Medicaid program;
(b)Legal basis for the claim;
(c)All exemptions from recovery; and
(d)Procedures for applying for undue hardship including appeal rights and time frames.
6704.3The personal representative or attorney of record shall request an Undue Hardship Waiver Application (Application) no later than fifteen (1 5) business days from the date of the Notice of Proposed Recovery.
6704.4The personal representative or attorney of record shall submit the completed application and supporting documentation to MAA no later than thirty (30) calendar days of receipt of the application.
6704.5An application that has not been completed in its entirety or fails to contain documentation in support of the request for hardship waiver shall be considered incomplete. MAA shall deny each incomplete application and issue a denial notice to the personal representative or attorney of record. The denial notice shall contain all of the following information:
(a)A statement explaining why the application is incomplete, including a description of the missing information or documentation;
(b)Appeal rights and procedures for filing an appeal; and
(c)Notification that the personal representative or attorney has five (5) additional working days from the date of the denial notice to submit the completed application and supporting documentation.
6704.6MAA shall mail a formal written response to the personal representative or attorney of record within thirty (30) calendar days of receipt of the completed application and supporting documents. If the application is denied, the written response shall include the reasons for the denial and notify the affected persons of the right to appeal, the time frame and procedures for filing an appeal.
6704.7MAA shall seek recovery of the full amount of the claim if the application is untimely or incomplete as set forth in sections 6704.4 and 6704.5.