2018 -- S 2673

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LC004758

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     STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2018

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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:

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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. Long-term care - Provider

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care during 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. Notwithstanding any provision of this chapter to the contrary,

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for purposes of this section, an application shall be deemed a complete application sixty (60) days

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after the day it is filed, unless within that sixty (60) day period the secretary has requested

 

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information from the LTC provider that is:

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     (1) Within the custody of the LTC provider;

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     (2) Necessary for processing of the application; and

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     (3) The information has not been submitted by the LTC provider within that sixty (60)

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day period, in which case the application shall be deemed a complete application on the date such

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information is submitted by the LTC provider.

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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 ยง 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 Medicaid program. As used in

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this chapter 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

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during 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) thirty (30) days or longer, then upon the request of an LTC

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

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care provided to the applicant in full as though the application were approved, for services

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beginning on the date of such request eligibility date requested in the application. Payment under

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this subsection shall not be made for the period prior to the LTC provider's request eligibility date

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requested, 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

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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 eligibility date and approval by any amounts paid hereunder.

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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 (5) 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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     (d) The secretary shall make eligibility for Medicaid coverage effective no later than the

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first day of the third month before the filing of the application if the applicant:

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     (1) Received uncompensated care from a LTC provider of a type that would otherwise be

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covered by Medicaid during that period; and

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     (2) Would have been eligible for Medicaid coverage at the time they received the

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uncompensated care, if they had applied for Medicaid coverage.

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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 amend certain provisions relating to Medicaid benefits and the process

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and timing requirements of filing a complete application and the coverage provided while the

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application is pending.

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     This act would take effect upon passage.

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