2017 -- S 0744 SUBSTITUTE A

========

LC001618/SUB A/3

========

     STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2017

____________

A N   A C T

RELATING TO HUMAN SERVICES -- MEDICAL ASSISTANCE

     Introduced By: Senators Lynch Prata, and Coyne

     Date Introduced: April 12, 2017

     Referred To: Senate Health & Human Services

     It is enacted by the General Assembly as follows:

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

Assistance" is hereby amended to read as follows:

     40-8-6.1. Provider care during pendency of application LTC Provider care during

pendency of application.

     (a) Definitions. The following terms shall have the meanings indicated:

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

contribute to the cost of his or her care.

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

benefits on behalf of a Medicaid applicant.

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

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

including attachments and supplemental information as necessary, which provides sufficient

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

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

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

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

application a complete application.

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

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

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

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

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

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

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

     "Medicaid applicant" -- An individual who is receiving care from an LTC provider during

the pendency of an application for Medicaid benefits.

     "Release" means a written document which:

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

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

resident or patient of that LTC provider;

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

and

     (4) Which includes the following elements:

     (i) The name of the LTC provider;

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

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

information may be disclosed;

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

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

following the determination of that application; and

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

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

fact.

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

services.

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

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

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

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

uncompensated care.

     (b) (1) Uncompensated care during pendency of an application for benefits. A nursing

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

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

LC001618/SUB A/3 - Page 2 of 5

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

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

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

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

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

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

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

has been pending for ninety (90) days or longer, then upon the request of an LTC provider

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

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

of such request eligibility date requested in the application. Payment under this subsection shall

not be made for the period prior to the LTC provider's request eligibility date requested, but shall

continue thereafter until the application is decided. In the event the application is denied, the state

shall not have any right of recovery, offset, or recoupment with respect to payments made

hereunder for the period of determination. In the event the application is approved, the state may

offset payments due for the period between the date of the application and the determination

eligibility date and the approval by any amounts paid hereunder.

     (c) Process for complete applications.

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

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

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

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

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

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

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

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

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

application for the purposes of this section.

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

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

subsection (b)(2) of this section. Within thirty (30) days of the receipt of that request, the

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

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

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

LC001618/SUB A/3 - Page 3 of 5

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

pending for thirty (30) days.

     (5) The director shall submit a report every thirty (30) days to the president of the senate

and the speaker of the house that documents compliance with this section.

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

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

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

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

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

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

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

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

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

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

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

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

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

LC001618/SUB A/3 - Page 4 of 5

extent that the release permits its disclosure.

     SECTION 2. This act shall take effect September 1, 2017.

========

LC001618/SUB A/3

========

LC001618/SUB A/3 - Page 5 of 5

EXPLANATION

BY THE LEGISLATIVE COUNCIL

OF

A N   A C T

RELATING TO HUMAN SERVICES -- MEDICAL ASSISTANCE

***

     This act would set forth the application process for Medicaid coverage and the review

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

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

Medicaid assistance pending review for an application.

     This act would take effect September 1, 2017.

========

LC001618/SUB A/3

========

LC001618/SUB A/3 - Page 6 of 5