2018 -- S 2673 | |
======== | |
LC004758 | |
======== | |
STATE OF RHODE ISLAND | |
IN GENERAL ASSEMBLY | |
JANUARY SESSION, A.D. 2018 | |
____________ | |
A N A C T | |
RELATING TO HUMAN SERVICES - MEDICAL ASSISTANCE | |
| |
Introduced By: Senator Erin Lynch Prata | |
Date Introduced: March 20, 2018 | |
Referred To: Senate Health & Human Services | |
It is enacted by the General Assembly as follows: | |
1 | SECTION 1. Section 40-8-6.1 of the General Laws in Chapter 40-8 entitled "Medical |
2 | Assistance" is hereby amended to read as follows: |
3 | 40-8-6.1. Provider care during pendency of application. Long-term care - Provider |
4 | care during pendency of application. |
5 | (a) Definitions. The following terms shall have the meanings indicated: |
6 | "Applied income" -- The amount of income a Medicaid beneficiary is required to |
7 | contribute to the cost of his or her care. |
8 | "Authorized representative" -- An individual who signs an application for Medicaid |
9 | benefits on behalf of a Medicaid applicant. |
10 | "Complete application" -- An application for Medicaid benefits filed by, or on behalf of, |
11 | an individual receiving care and services from a long-term-care provider (LTC provider), |
12 | including attachments and supplemental information as necessary, which provides sufficient |
13 | information for the secretary or designee to determine the applicant's eligibility for coverage. An |
14 | application shall not be disqualified from status as a complete application hereunder except for |
15 | failure on the part of the Medicaid applicant, or his or her authorized representative, to provide |
16 | necessary information or documentation, or to take any other action necessary to make the |
17 | application a complete application. Notwithstanding any provision of this chapter to the contrary, |
18 | for purposes of this section, an application shall be deemed a complete application sixty (60) days |
19 | after the day it is filed, unless within that sixty (60) day period the secretary has requested |
| |
1 | information from the LTC provider that is: |
2 | (1) Within the custody of the LTC provider; |
3 | (2) Necessary for processing of the application; and |
4 | (3) The information has not been submitted by the LTC provider within that sixty (60) |
5 | day period, in which case the application shall be deemed a complete application on the date such |
6 | information is submitted by the LTC provider. |
7 | "Long-term-care provider (LTC provider)" means any of the following: a home care |
8 | provider, home nursing-care provider or nursing facility licensed pursuant to the provisions of |
9 | chapter 17 of title 23; an assisted-living residence provider licensed pursuant to chapter 17.4 of |
10 | title 23; an adult day-services provider licensed pursuant to ยง 23-1-52; or a Program of All- |
11 | Inclusive Care for the Elderly (PACE) as certified by the Centers for Medicare and Medicaid |
12 | Services (CMS) and participating in the Rhode Island medicaid Medicaid program. As used in |
13 | this chapter the terms "long-term-care provider" and "LTC provider" are interchangeable. |
14 | "Medicaid applicant" -- An individual who is receiving care from an LTC provider |
15 | during the pendency of an application for Medicaid benefits. |
16 | "Release" means a written document which: |
17 | (1) Indicates consent to the disclosure to an LTC provider by the secretary or designee; |
18 | (2) Of information concerning an application for Medicaid benefits filed on behalf of a |
19 | resident or patient of that LTC provider; |
20 | (3) For the purpose of assuring the ability to be paid for its services by that LTC provider; |
21 | and |
22 | (4) Which includes the following elements: |
23 | (i) The name of the LTC provider; |
24 | (ii) A description of the information that may be disclosed under the release; |
25 | (iii) The name of the person or persons acting on behalf of the LTC provider to whom the |
26 | information may be disclosed; |
27 | (iv) The period of time for which the release will be in effect, which may extend from the |
28 | date of the application for benefits until the expiration of any appeal, or any appeal period, |
29 | following the determination of that application; and |
30 | (v) The signature of the Medicaid applicant, or authorized representative, or other person |
31 | legally authorized to sign on behalf of the Medicaid applicant, such as guardian or attorney-in- |
32 | fact. |
33 | "Secretary" means the secretary of the Rhode Island executive office of health and human |
34 | services. |
| LC004758 - Page 2 of 5 |
1 | "Uncompensated care" -- Care and services provided by an LTC provider to a Medicaid |
2 | applicant without receiving compensation therefore from Medicaid, Medicare, the Medicaid |
3 | applicant, or other source. The acceptance of any payment representing actual or estimated |
4 | applied income shall not disqualify the care and services provided from qualifying as |
5 | uncompensated care. |
6 | (b) (1) Uncompensated care during pendency of an application for benefits. A nursing |
7 | facility may not discharge a Medicaid applicant for non-payment of the facility's bill during the |
8 | pendency of a complete application; nor may a nursing facility charge a Medicaid applicant for |
9 | care provided during the pendency of a complete application, except for an amount representing |
10 | the estimated, applied income. A nursing facility may discharge a Medicaid applicant for non- |
11 | payment of the facility's bill during the pendency of an application for Medicaid coverage that is |
12 | not a complete application, but only if the nursing facility has provided the patient (and his or her |
13 | authorized representative, if known) with thirty (30) days' written notice of its intention to do so, |
14 | and the application remains incomplete during that thirty-day (30) period. |
15 | (2) Uncompensated care while determination is overdue. When a complete application |
16 | has been pending for ninety (90) thirty (30) days or longer, then upon the request of an LTC |
17 | provider providing uncompensated care, the state shall make payment to the LTC provider for the |
18 | care provided to the applicant in full as though the application were approved, for services |
19 | beginning on the date of such request eligibility date requested in the application. Payment under |
20 | this subsection shall not be made for the period prior to the LTC provider's request eligibility date |
21 | requested, but shall continue thereafter until the application is decided. In the event the |
22 | application is denied, the state shall not have any right of recovery, offset, or recoupment with |
23 | respect to payments made hereunder for the period of determination. In the event the application |
24 | is approved, the state may offset payments due for the period between the date of the application |
25 | and the determination eligibility date and approval by any amounts paid hereunder. |
26 | (c) Notice of application status. When an LTC provider is providing uncompensated care |
27 | to a Medicaid applicant, then the LTC provider may inform the secretary or designee of its status, |
28 | and the secretary or designee shall thereafter inform the nursing facility of any decision on the |
29 | application at the time the decision is rendered and, if coverage is approved, of the date that |
30 | coverage will begin. In addition, an LTC provider providing uncompensated care to a Medicaid |
31 | applicant may inquire of the secretary or designee as to the status of that individual's application, |
32 | and the secretary or designee shall respond within five (5) business days as follows: |
33 | (i) Without release -- If the LTC provider has not obtained a signed release, the secretary |
34 | or designee must provide the following information, only, in writing: (a) Whether or not the |
| LC004758 - Page 3 of 5 |
1 | application has been approved; (b) The identity of any authorized representative; and (c) If the |
2 | application has not yet been decided, whether or not the application is a complete application. |
3 | (ii) With release -- If the LTC provider has obtained a signed release, the secretary or |
4 | designee must additionally provide any further information requested by the LTC provider, to the |
5 | extent that the release permits its disclosure. |
6 | (d) The secretary shall make eligibility for Medicaid coverage effective no later than the |
7 | first day of the third month before the filing of the application if the applicant: |
8 | (1) Received uncompensated care from a LTC provider of a type that would otherwise be |
9 | covered by Medicaid during that period; and |
10 | (2) Would have been eligible for Medicaid coverage at the time they received the |
11 | uncompensated care, if they had applied for Medicaid coverage. |
12 | SECTION 2. This act shall take effect upon passage. |
======== | |
LC004758 | |
======== | |
| LC004758 - Page 4 of 5 |
EXPLANATION | |
BY THE LEGISLATIVE COUNCIL | |
OF | |
A N A C T | |
RELATING TO HUMAN SERVICES - MEDICAL ASSISTANCE | |
*** | |
1 | This act would amend certain provisions relating to Medicaid benefits and the process |
2 | and timing requirements of filing a complete application and the coverage provided while the |
3 | application is pending. |
4 | This act would take effect upon passage. |
======== | |
LC004758 | |
======== | |
| LC004758 - Page 5 of 5 |