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Purpose: To explain the asset verification system (AVS) and new program requirements for applicants and recipients of long-term care services.
NOTE: For detailed AVS procedures please refer to your agency's AVS procedures documentation.
Check for a valid authorization. Clients and those who are financially responsible for them, must provide authorization before a request can be submitted to the AVS. The authorization remains in place until the client, their spouse, or the financially responsible person cancels the authorization in writing, they are no longer eligible for coverage, or the application is withdrawn or denied.
For applications where both spouses apply for LTSS, two searches are needed.
- Create one search for each head of household and add the spouse as the secondary household member on the search query.
At review: only the recipient is checked through AVS. The only exception is at the first review for a married couple, so eligibility staff can be sure that the client allocated all resources in excess of $2,000.00 to their spouse.
Financial staff must contact the applicant or recipient and give them the opportunity to provide the needed information to resolve a discrepancy and determine ongoing eligibility when AVS returns information that indicates:
- Inconsistent withdrawals during the look back period; or
- Bank accounts that are over the resource standard; or
- Accounts not listed on the application, or disclosed during the interview; or
- Any other questionable information.
It is a best practice to call the client or authorized representative to review what is needed and then send a 10-day request letter for explanation.
Financial eligibility staff cannot deny or terminate a case based solely on the information received from AVS or LexisNexis.
If the client is ineligible due to transfers in the 60 month look back period, determine if there is eligibility for another medical program without a look-back period:
- S99 if client is resource eligible
- MSP if the client is resource eligible
- HWD if the client is disabled and working
- TSOA eligibility
At application or eligibility review, once AVS results are received, document the client's resources in ACES.
For approvals: only remarks are needed for documentation. It is the financial worker's responsibility to adequately remark that resource verification was received from AVS.
For denials or terminations: a copy of the AVS report is required in addition to adequate remarks. Print the "Case Summary Report" from the AVS Summary page and send to DMS.
Once a final eligibility determination is made, either approval, denial, or termination; the case eligibility needs to be closed out in AVS.
There are four options for closing the case in the AVS portal:
Closed/Withdrawn: used when an applicant withdraws a case (and worker subsequently needs to withdraw the case) or if the worker determines that an AVS check is no longer needed for an individual.
Eligible: used when an individual is determined as under the resource limit.
Transfer Penalty: used when an applicant or recipient is denied or terminated for a transfer that makes the client ineligible.
Ineligible: for cases being closed due to "ineligible," additional options for reporting will generate. Financial workers are required to select the correct reason at closure:
- Over Resources - Financial Accounts - used when the bank balance was the primary reason for ineligibility.
- Over Resources - Real Property - used when the real property that was known about outside of the AVS was the primary reason for ineligibility.
- Over Resource - Real Property and Financial Accounts - combination of the two items above.
- Other - used when the reason for ineligibility falls outside of the other options. For instance, income ineligibility or citizenship.