2017 -- H 5797

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LC001657

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     STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2017

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A N   A C T

RELATING TO HUMAN SERVICES -- MEDICAL ASSISTANCE

     

     Introduced By: Representative Patricia A. Serpa

     Date Introduced: March 01, 2017

     Referred To: House Finance

     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. Provider care during pendency of application LTC Provider care during

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pendency of application.

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     (a) Definitions. The following terms shall 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),

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including attachments and supplemental information as necessary, which provides sufficient

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information for the secretary or designee to determine the applicant's eligibility for coverage. An

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application shall not be disqualified from status as a complete application hereunder except for

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failure on the part of the Medicaid applicant, or his or her authorized representative, to provide

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necessary information or documentation, or to take any other action necessary to make the

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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 from an LTC provider during

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the pendency of an application for Medicaid benefits.

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

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services.

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     "Uncompensated care" -- Care and services provided by an LTC provider to a Medicaid

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applicant without receiving compensation therefore from Medicaid, Medicare, the Medicaid

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applicant, or other source. The acceptance of any payment representing actual or estimated

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applied income shall not disqualify the care and services provided from qualifying as

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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-day (30) period.

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

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has been pending for ninety (90) 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 eligibility date requested in the application. Payment under this subsection shall

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not be made for the period prior to the LTC provider's request, but shall continue thereafter until

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the application is decided. In the event the application is denied, the state shall not have any right

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of recovery, offset, or recoupment with respect to payments made hereunder for the period of

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determination. In the event the application is approved, the state may offset payments due for the

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period between the date of the application and the determination eligibility date and the approval

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by any amounts paid hereunder.

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     (c) Process for complete applications.

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     (1) Upon receipt of an application for medicaid coverage that is filed by or on behalf of a

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medicaid applicant as defined herein, the secretary shall, within sixty (60) days of its receipt,

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review the application and notify the applicant and/or authorized representative, in writing and

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with specificity, of any additional information or documentation that is required from the

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applicant in order to make the application a complete application. If the LTC provider furnishing

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care and services to the applicant has supplied the secretary with a release as defined herein

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within that sixty (60) day period, the secretary shall provide the same notification to the LTC

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provider. If the secretary fails to mail or otherwise transmit the notices required hereunder within

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sixty (60) days of receipt of such an application, the application will be considered a complete

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application for the purposes of this section.

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     (2) In the event a complete application has been pending for ninety (90) days or more, an

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LTC provider may submit a written request to the secretary for payment as described under

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subsection (b)(2) of this section. Within fourteen (14) days of the receipt of that request, the

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secretary shall begin payment to the provider for the care provided to the applicant in full as

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though the application were approved, for the period beginning on the eligibility date requested in

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the application in accordance with subsection (b)(2) of this section.

 

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     (3) In the event that the secretary sends notice to the applicant, authorized representative

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(if known) and/or the LTC provider as contemplated under section (c)(l) of this section, then

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those parties may submit the additional information or documentation identified in the

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notification. Once those additional items are submitted to the secretary, the application shall be

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deemed a complete application, unless information ·within the additional items gives rise to the

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need for further information: however, the original application cannot be reassessed for this

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purpose, if the additional items submitted are incomplete, or give rise to the need for

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supplemental information or documents, the secretary shall notify the applicant, authorized

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representative (if known) and the LTC provider within ten (10) days of receiving them. This

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process shall continue until the application is a complete application. To prevent unwarranted

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delay of payment to LTC providers furnishing uncompensated care, after the first submission of

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additional items is received the secretary may not at any time require additional information or

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documentation the need for which could have been determined from the original application.

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     (4) An application that becomes a complete application through the submission of

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additional information or documents (termed a "complete application upon supplementation")

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shall be subject to the same request and payment process described for a complete application

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under subsection (c)(2) of this section, except that the LTC provider may request, and the

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secretary shall begin, payment once such a complete application upon supplementation has been

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pending for thirty (30) days.

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     (5) To the extent that payments to LTC providers required under this section are not

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made in a timely manner in accordance with the deadlines herein, the payments will be subject to

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interest at the rate established annually by the U.S. Secretary of the Treasury for debts owed to

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the United States pursuant to 31 U.S.C. 3717 or successor Federal law.

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     (c) Notice of application status. When an LTC provider is providing uncompensated care

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to a Medicaid applicant, then the LTC provider may inform the secretary or designee of its status,

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and the secretary or designee shall thereafter inform the nursing facility of any decision on the

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application at the time the decision is rendered and, if coverage is approved, of the date that

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coverage will begin. In addition, an LTC provider providing uncompensated care to a Medicaid

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applicant may inquire of the secretary or designee as to the status of that individual's application,

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

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     (i) Without release -- If the LTC provider has not obtained a signed release, the secretary

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or designee must provide the following information, only, in writing: (a) Whether or not the

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application has been approved; (b) The identity of any authorized representative; and (c) If the

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

 

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     (ii) With release -- If the LTC provider has obtained a signed release, the secretary or

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designee must additionally provide any further information requested by the LTC provider, to the

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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 set forth the application process for Medicaid coverage and the review

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procedures to be utilized in reviewing such applications. This act would also establish a process

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for payment to long-term care providers furnishing care and services to person applying for

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Medicaid assistance pending review for an application.

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     This act would take effect upon passage.

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LC001657

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