A04793 Summary:

BILL NO    A04793 

SAME AS    No same as 

SPONSOR    Brennan (MS)

COSPNSR    Dinowitz, Gottfried, Ortiz, Rivera, Peoples-Stokes, Cahill, Jaffee

MLTSPNSR   Galef, Lupardo

Amd SS364-i & 368-a, Soc Serv L

Ensures that uninsured persons discharged from mental hospitals have continuous
access to medications; expands the medical assistance presumptive eligibility
program to include persons without insurance who are discharged from
psychiatric inpatient care; requires the department health to submit a report
on the impact of expanding the program to include persons discharged from
psychiatric inpatient care.
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A04793 Actions:

BILL NO    A04793 

02/06/2015 referred to social services
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A04793 Text:

                           S T A T E   O F   N E W   Y O R K
       ________________________________________________________________________

                                         4793

                              2015-2016 Regular Sessions

                                 I N  A S S E M B L Y

                                   February 6, 2015
                                      ___________

       Introduced  by  M.  of  A.  BRENNAN, DINOWITZ, GOTTFRIED, ORTIZ, RIVERA,
         PEOPLES-STOKES, CAHILL, JAFFEE --  Multi-Sponsored  by  --  M.  of  A.
         GALEF,  LUPARDO  --  read once and referred to the Committee on Social
         Services

       AN ACT to amend the social services law,  in  relation  to  the  medical
         assistance presumptive eligibility program

         THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
       BLY, DO ENACT AS FOLLOWS:

    1    Section 1. Subdivisions 1, 2 and 3 of  section  364-i  of  the  social
    2  services law, as amended by chapter 693 of the laws of 1996, are amended
    3  to read as follows:
    4    1.  (A)  An individual, upon application for medical assistance, shall
    5  be presumed eligible for such assistance for a period of sixty days from
    6  the date of transfer from a general  hospital,  as  defined  in  section
    7  twenty-eight  hundred  one  of the public health law to a certified home
    8  health agency or long term home  health  care  program,  as  defined  in
    9  section thirty-six hundred two of the public health law, or to a hospice
   10  as  defined in section four thousand two of the public health law, or to
   11  a residential health care facility as defined  in  section  twenty-eight
   12  hundred  one of the public health law, if the local department of social
   13  services determines that the  applicant  meets  each  of  the  following
   14  criteria: [(a)] (I) the applicant is receiving acute care in such hospi-
   15  tal;  [(b)]  (II)    a physician certifies that such applicant no longer
   16  requires acute hospital care, but still requires medical care which  can
   17  be  provided  by  a  certified home health agency, long term home health
   18  care program, hospice or residential health care facility;  [(c)]  (III)
   19  the  applicant  or his representative states that the applicant does not
   20  have insurance coverage for the required medical care and that such care
   21  cannot be afforded; [(d)] (IV) it reasonably appears that the  applicant
   22  is  otherwise  eligible  to  receive  medical  assistance;  [(e)] (V) it
   23  reasonably appears that the amount expended by the state and  the  local

        EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                             [ ] is old law to be omitted.
                                                                  LBD08831-01-5
       A. 4793                             2

    1  social  services  district  for  medical  assistance in a certified home
    2  health agency, long term home health care program, hospice  or  residen-
    3  tial  health  care  facility, during the period of presumed eligibility,
    4  would  be  less  than the amount the state and the local social services
    5  district would expend for continued acute hospital care for such person;
    6  and [(f)] (VI) such other determinative criteria as the commissioner  OF
    7  HEALTH  shall provide by rule or regulation. If a person has been deter-
    8  mined to be presumptively eligible for medical assistance,  pursuant  to
    9  this  subdivision,  and  is subsequently determined to be ineligible for
   10  such assistance, the commissioner OF HEALTH, on behalf of the state  and
   11  the  local  social  services district shall have the authority to recoup
   12  from the individual the sums expended for  such  assistance  during  the
   13  period of presumed eligibility.
   14    (B)  AN  INDIVIDUAL, UPON APPLICATION FOR MEDICAL ASSISTANCE, SHALL BE
   15  PRESUMED ELIGIBLE FOR SUCH ASSISTANCE FOR CARE,  SERVICES  AND  SUPPLIES
   16  RELATED TO THE TREATMENT OF A MENTAL ILLNESS FOR A PERIOD OF NINETY DAYS
   17  FROM  THE  DATE OF DISCHARGE FROM A HOSPITAL, AS DEFINED IN SECTION 1.03
   18  OF THE MENTAL HYGIENE LAW, A CORRECTIONAL FACILITY AS DEFINED  IN  PARA-
   19  GRAPH  (A) OF SUBDIVISION FOUR OF SECTION TWO OF THE CORRECTION LAW OR A
   20  LOCAL CORRECTIONAL FACILITY AS DEFINED IN PARAGRAPH (A)  OF  SUBDIVISION
   21  SIXTEEN OF SECTION TWO OF THE CORRECTION LAW, IF THE LOCAL DEPARTMENT OF
   22  SOCIAL  SERVICES DETERMINES THAT THE APPLICANT MEETS EACH OF THE FOLLOW-
   23  ING CRITERIA: (I) THE APPLICANT IS SEVERELY  AND  PERSISTENTLY  MENTALLY
   24  ILL;  (II)  A  PHYSICIAN  CERTIFIES THAT SUCH APPLICANT REQUIRES MEDICAL
   25  CARE TO TREAT SUCH MENTAL ILLNESS; (III) THE APPLICANT OR HIS  REPRESEN-
   26  TATIVE  STATES  THAT  THE APPLICANT DOES NOT HAVE INSURANCE COVERAGE FOR
   27  THE REQUIRED MEDICAL CARE AND THAT SUCH CARE CANNOT BE AFFORDED; (IV) IT
   28  REASONABLY APPEARS THAT THE APPLICANT IS OTHERWISE ELIGIBLE  TO  RECEIVE
   29  MEDICAL  ASSISTANCE;  (V) IT REASONABLY APPEARS THAT THE AMOUNT EXPENDED
   30  BY THE STATE AND THE LOCAL SOCIAL SERVICES DISTRICT FOR MEDICAL  ASSIST-
   31  ANCE  FOR  TREATMENT  OF  A MENTAL ILLNESS DURING THE PERIOD OF PRESUMED
   32  ELIGIBILITY, WOULD BE LESS THAN THE  AMOUNT  THE  STATE  AND  THE  LOCAL
   33  SOCIAL  SERVICES  DISTRICT  WOULD  EXPEND  FOR CONTINUED OR FUTURE ACUTE
   34  HOSPITAL CARE FOR SUCH PERSON; AND (VI) SUCH OTHER DETERMINATIVE  CRITE-
   35  RIA  AS  THE COMMISSIONER OF HEALTH SHALL PROVIDE BY RULE OR REGULATION.
   36  IF A PERSON HAS BEEN DETERMINED TO BE PRESUMPTIVELY ELIGIBLE FOR MEDICAL
   37  ASSISTANCE, PURSUANT TO THIS SUBDIVISION, AND IS SUBSEQUENTLY DETERMINED
   38  TO BE INELIGIBLE FOR SUCH ASSISTANCE, THE  COMMISSIONER  OF  HEALTH,  ON
   39  BEHALF  OF  THE  STATE AND THE LOCAL SOCIAL SERVICES DISTRICT SHALL HAVE
   40  THE AUTHORITY TO RECOUP FROM THE INDIVIDUAL THE SUMS EXPENDED  FOR  SUCH
   41  ASSISTANCE DURING THE PERIOD OF PRESUMED ELIGIBILITY.
   42    2.  (A)  Payment  for  up  to sixty days of care for services provided
   43  under the medical assistance program shall  be  made  for  an  applicant
   44  presumed  eligible  for  medical assistance pursuant to PARAGRAPH (A) OF
   45  subdivision one of this section provided,  however,  that  such  payment
   46  shall not exceed sixty-five percent of the rate payable under this title
   47  for  services provided by a certified home health agency, long term home
   48  health care program, hospice or residential health care facility.
   49    (B) PAYMENT FOR UP TO NINETY DAYS OF CARE FOR SERVICES PROVIDED  UNDER
   50  THE  MEDICAL  ASSISTANCE PROGRAM SHALL BE MADE FOR AN APPLICANT PRESUMED
   51  ELIGIBLE FOR MEDICAL ASSISTANCE FOR CARE, SERVICES AND SUPPLIES  RELATED
   52  TO THE TREATMENT OF A MENTAL ILLNESS PURSUANT TO PARAGRAPH (B) OF SUBDI-
   53  VISION  ONE  OF  THIS SECTION, PROVIDED HOWEVER, THAT SUCH PAYMENT SHALL
   54  NOT EXCEED ONE HUNDRED PERCENT OF THE RATE PAYABLE UNDER THIS TITLE  FOR
   55  SUCH CARE, SERVICES AND SUPPLIES.
       A. 4793                             3

    1    (C)  Notwithstanding  any other provision of law, no federal financial
    2  participation shall be claimed for services provided to a  person  while
    3  presumed  eligible  for medical assistance under this program until such
    4  person has been determined to be eligible for medical assistance by  the
    5  local  social  services  district. During the period of presumed medical
    6  assistance eligibility, payment for services provided  persons  presumed
    7  eligible  under this program shall be made from state funds.  [Upon] (I)
    8  IN THE CASE OF COSTS INCURRED FOR A PERSON  PRESUMPTIVELY  ELIGIBLE  FOR
    9  MEDICAL  ASSISTANCE  UNDER  PARAGRAPH  (A)  OF  SUBDIVISION  ONE OF THIS
   10  SECTION, UPON the final determination of eligibility by the local social
   11  services district, payment shall be made for the balance of the cost  of
   12  such  care  and  services  provided to such applicant for such period of
   13  eligibility and a retroactive adjustment shall be made by the department
   14  OF HEALTH to appropriately reflect federal financial  participation  and
   15  the  local share of costs for the services provided during the period of
   16  presumptive eligibility. Such federal and local financial  participation
   17  shall  be the same as that which would have occurred if a final determi-
   18  nation of eligibility for medical assistance had been made prior to  the
   19  provision  of  the  services  provided  during the period of presumptive
   20  eligibility. In instances where an individual who is  presumed  eligible
   21  for  medical assistance is subsequently determined to be ineligible, the
   22  cost for services provided to such individual  shall  be  reimbursed  in
   23  accordance with the provisions of section three hundred sixty-eight-a of
   24  this [article] TITLE. Provided, however, if upon audit the department OF
   25  HEALTH  determines  that there are subsequent determinations of ineligi-
   26  bility for medical assistance in at least fifteen percent of  the  cases
   27  in  which  presumptive  eligibility  has  been granted in a local social
   28  services  district,  payments  for  services  provided  to  all  persons
   29  presumed  eligible  and  subsequently  determined ineligible for medical
   30  assistance shall be divided equally by the state and the district.
   31    (II) IN THE CASE OF COSTS INCURRED FOR A PERSON PRESUMPTIVELY ELIGIBLE
   32  FOR MEDICAL ASSISTANCE UNDER PARAGRAPH (B) OF SUBDIVISION  ONE  OF  THIS
   33  SECTION  UPON THE FINAL DETERMINATION OF ELIGIBILITY BY THE LOCAL SOCIAL
   34  SERVICES DISTRICT, PAYMENT SHALL BE MADE FOR THE BALANCE OF THE COST  OF
   35  SUCH  CARE  AND  SERVICES  PROVIDED TO SUCH APPLICANT FOR SUCH PERIOD OF
   36  ELIGIBILITY AND A RETROACTIVE ADJUSTMENT SHALL BE MADE BY THE DEPARTMENT
   37  OF HEALTH TO APPROPRIATELY REFLECT FEDERAL FINANCIAL  PARTICIPATION  AND
   38  THE  LOCAL SHARE OF COSTS FOR THE SERVICES PROVIDED DURING THE PERIOD OF
   39  PRESUMPTIVE ELIGIBILITY. SUCH FEDERAL FINANCIAL PARTICIPATION  SHALL  BE
   40  THE  SAME  AS THAT WHICH WOULD HAVE OCCURRED IF A FINAL DETERMINATION OF
   41  ELIGIBILITY FOR MEDICAL ASSISTANCE HAD BEEN MADE PRIOR TO THE  PROVISION
   42  OF  THE  SERVICES PROVIDED DURING THE PERIOD OF PRESUMPTIVE ELIGIBILITY.
   43  THERE SHALL BE NO LOCAL SHARE IN THE COSTS OF SUCH ASSISTANCE DURING THE
   44  PRESUMPTIVE ELIGIBILITY PERIOD; PROVIDED HOWEVER THAT IF UPON AUDIT  THE
   45  DEPARTMENT OF HEALTH DETERMINES THAT THERE ARE SUBSEQUENT DETERMINATIONS
   46  OF  INELIGIBILITY  FOR MEDICAL ASSISTANCE IN AT LEAST FIFTEEN PERCENT OF
   47  THE CASES IN WHICH PRESUMPTIVE ELIGIBILITY HAS BEEN GRANTED IN  A  LOCAL
   48  SOCIAL  SERVICES DISTRICT, PAYMENTS FOR SERVICES PROVIDED TO ALL PERSONS
   49  PRESUMED ELIGIBLE AND SUBSEQUENTLY  DETERMINED  INELIGIBLE  FOR  MEDICAL
   50  ASSISTANCE  SHALL  BE  REIMBURSED  IN  ACCORDANCE WITH THE PROVISIONS OF
   51  SECTION THREE HUNDRED SIXTY-EIGHT-A OF THIS TITLE.
   52    3. On or before March thirty-first,  [nineteen  hundred  ninety-seven]
   53  TWO  THOUSAND  EIGHTEEN,  the  department  OF HEALTH shall submit to the
   54  governor and legislature an evaluation of  the  program,  including  the
   55  program's effects on access, quality and cost of care, and any recommen-
   56  dations for future modifications to improve the program.
       A. 4793                             4

    1    S  2.  Subdivision  1  of  section 368-a of the social services law is
    2  amended by adding a new paragraph (aa) to read as follows:
    3    (AA)  NOTWITHSTANDING ANY INCONSISTENT PROVISION OF LAW, REIMBURSEMENT
    4  BY THE STATE FOR PAYMENTS MADE, WHETHER BY THE DEPARTMENT OF  HEALTH  ON
    5  BEHALF  OF  A  LOCAL  SOCIAL SERVICES DISTRICT PURSUANT TO SECTION THREE
    6  HUNDRED SIXTY-SEVEN-B OF THIS  TITLE  OR  BY  A  LOCAL  SOCIAL  SERVICES
    7  DISTRICT  DIRECTLY,  FOR  MEDICAL  ASSISTANCE FURNISHED TO AN INDIVIDUAL
    8  PRESUMED ELIGIBLE FOR MEDICAL ASSISTANCE UNDER PARAGRAPH (B) OF SUBDIVI-
    9  SION ONE OF SECTION THREE HUNDRED SIXTY-FOUR-I OF THIS TITLE, DURING THE
   10  PRESUMPTIVE ELIGIBILITY PERIOD,  SHALL  BE  MADE  FOR  THE  FULL  AMOUNT
   11  EXPENDED FOR SUCH ASSISTANCE, AFTER FIRST DEDUCTING THEREFROM ANY FEDER-
   12  AL FUNDS PROPERLY RECEIVED OR TO BE RECEIVED ON ACCOUNT OF SUCH EXPENDI-
   13  TURE;  PROVIDED  THAT  IF UPON AUDIT THE DEPARTMENT OF HEALTH DETERMINES
   14  THAT THERE ARE SUBSEQUENT DETERMINATIONS OF  INELIGIBILITY  FOR  MEDICAL
   15  ASSISTANCE IN AT LEAST FIFTEEN PERCENT OF THE CASES IN WHICH PRESUMPTIVE
   16  ELIGIBILITY  HAS  BEEN  GRANTED  IN  A  LOCAL  SOCIAL SERVICES DISTRICT,
   17  PAYMENTS FOR SERVICES PROVIDED TO  ALL  PERSONS  PRESUMED  ELIGIBLE  AND
   18  SUBSEQUENTLY DETERMINED INELIGIBLE FOR MEDICAL ASSISTANCE SHALL BE REIM-
   19  BURSED IN ACCORDANCE WITH PARAGRAPH (D) OF THIS SUBDIVISION.
   20    S 3. This act shall take effect April 1, 2017.
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