2016 -- S 2532

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LC004804

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     STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2016

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A N   A C T

RELATING TO HUMAN SERVICES -- MEDICAL ASSISTANCE

     

     Introduced By: Senator Erin P. Lynch Prata

     Date Introduced: February 25, 2016

     Referred To: Senate Health & Human Services

     It is enacted by the General Assembly as follows:

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     SECTION 1. Section 40-8-6.1 of the General Laws in Chapter 40-8 entitled "Medical

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Assistance" is hereby amended to read as follows:

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     40-8-6.1. Nursing facility care during pendency of application Provider care during

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pendency of application. -- (a) Definitions or purposes of this section, the following terms shall

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have the meanings indicated:

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      "Applied Income" -- The amount of income a Medicaid beneficiary is required to

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contribute to the cost of his or her care.

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      "Authorized Representative" -- An individual who signs an application for Medicaid

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benefits on behalf of a Medicaid Applicant

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      "Complete Application" -- An application for Medicaid benefits filed by or on behalf of

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an individual receiving care and services from a long-term care provider (LTC provider) nursing

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facility, including attachments and supplemental information as necessary, which provides

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sufficient information for the director secretary or designee to determine the applicant's eligibility

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for coverage. An application shall not be disqualified from status as a complete application

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hereunder except for failure on the part of the Medicaid applicant, or his or her authorized

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representative, to provide necessary information or documentation, or to take any other action

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necessary to make the application a complete application.

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     "Long-term care provider (LTC provider)" means any of the following: a home care

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provider, home nursing care provider or nursing facility licensed pursuant to the provisions of

 

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chapter 17 of title 23; an assisted living residence provider licensed pursuant to chapter 17.4 of

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title 23; an adult day services provider licensed pursuant to §23-1-52; or a Program of All-

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Inclusive Care for the Elderly (PACE) as certified by the Centers for Medicare and Medicaid

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Services (CMS) and participating in the Rhode Island Medicaid program. As used in this chapter

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the terms "long-term care provider" and "LTC provider" are interchangeable.

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      "Medicaid Applicant" -- An individual who is receiving care in a nursing facility from an

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LTC provider during the pendency of an application for Medicaid benefits.

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     "Secretary" means the secretary of the Rhode Island executive office of health and human

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services.

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      "Nursing Facility" -- A nursing facility licensed under Chapter 17 of Title 23, which is a

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participating provider in the Rhode Island Medicaid program.

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     "Release" means a written document which:

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     (1) Indicates consent to the disclosure to an LTC provider by the secretary or designee;

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     (2) Of information concerning an application for Medicaid benefits filed on behalf of a

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resident or patient of that LTC provider;

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     (3) For the purpose of assuring the ability to be paid for its services by that LTC provider;

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and

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     (4) Which includes the following elements:

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     (i) The name of the LTC provider;

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     (ii) A description of the information that may be disclosed under the release;

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     (iii) The name of the person or persons acting on behalf of the LTC provider to whom the

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information may be disclosed;

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     (iv) The period of time for which the release will be in effect, which may extend from the

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date of the application for benefits until the expiration of any appeal, or any appeal period,

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following the determination of that application; and

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     (v)The signature of the Medicaid applicant, or authorized representative, or other person

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legally authorized to sign on behalf of the Medicaid applicant, such as guardian or attorney-in-

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fact.

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      "Uncompensated Care" -- Care and services provided by a nursing facility an LTC

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provider to a Medicaid applicant without receiving compensation therefore from Medicaid,

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Medicare, the Medicaid applicant, or other source. The acceptance of any payment representing

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actual or estimated applied income shall not disqualify the care and services provided from

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qualifying as uncompensated care.

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      (b)(1) Uncompensated Care During Pendency of an Application for Benefits. - A nursing

 

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facility may not discharge a Medicaid applicant for non-payment of the facility's bill during the

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pendency of a complete application; nor may a nursing facility charge a Medicaid applicant for

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care provided during the pendency of a complete application, except for an amount representing

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the estimated applied income. A nursing facility may discharge a Medicaid applicant for non-

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payment of the facility's bill during the pendency of an application for Medicaid coverage that is

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not a complete application, but only if the nursing facility has provided the patient (and his or her

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authorized representative, if known) with thirty (30) days' written notice of its intention to do so,

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and the application remains incomplete during that thirty (30) day period.

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     (2) Uncompensated care while determination is overdue. - When a complete application

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has been pending for sixty (60) days or longer, then upon the request of an LTC provider

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providing uncompensated care, the state shall make payment to the LTC provider for the care

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provided to the applicant in full as though the application were approved, beginning on the date

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of such request. Payment under this subsection shall not be made for the period prior to the LTC

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provider’s request, but shall continue thereafter until the application is decided. In the event the

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application is denied, the state shall not have any right of recovery, offset, or recoupment with the

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respect to payments made hereunder for the period of determination. In the event the application

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is approved, the state may offset payments due for the period between the date of the application

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and the determination by any amounts paid hereunder.

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      (c) Notice Of Application Status. - When a nursing facility an LTC provider is providing

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uncompensated care to a Medicaid applicant, then the nursing facility LTC provider may inform

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the director secretary or designee of its status, and the director secretary or designee shall

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thereafter inform the nursing facility of any decision on the application at the time the decision is

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rendered and, if coverage is approved, of the date that coverage will begin. In addition, a nursing

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facility an LTC provider providing uncompensated care to a Medicaid applicant may inquire of

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the director secretary or designee as to the status of that individual's application, and the director

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secretary or designee shall respond within five business days as follows:

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      (i) Without Release -- If the nursing facility LTC provider has not obtained a signed

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release authorizing disclosure of information to the facility, the director secretary or designee

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must provide the following information only, in writing: (a) whether or not the application has

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been approved; (b) the identity of any authorized representative; and (c) if the application has not

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yet been decided, whether or not the application is a complete application.

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      (ii) With Release -- If the nursing facility LTC provider has obtained a signed release,

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the director secretary or designee must additionally provide any further information requested by

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the nursing facility LTC provider, to the extent that the release permits its disclosure.

 

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     SECTION 2. This act shall take effect upon passage.

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EXPLANATION

BY THE LEGISLATIVE COUNCIL

OF

A N   A C T

RELATING TO HUMAN SERVICES -- MEDICAL ASSISTANCE

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     This act would define "long-term care provider (LTC provider)" relative to applications

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for Medicare benefits. This act also would allow for the release of information from the secretary

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of the RI executive office of health and human services to LTC providers and would provide that

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after sixty (60) days of uncompensated care of an LTC patient, the LTC provider may apply to

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the state for relief.

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     This act would take effect upon passage.

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