A04793 Summary:

BILL NOA04793
 
SAME ASNo Same As
 
SPONSORBrennan
 
COSPNSRDinowitz, Gottfried, Ortiz, Rivera, Peoples-Stokes, Cahill, Jaffee
 
MLTSPNSRGalef, 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 NOA04793
 
02/06/2015referred to social services
01/06/2016referred to social services
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A04793 Text:



 
                STATE OF NEW YORK
        ________________________________________________________________________
 
                                          4793
 
                               2015-2016 Regular Sessions
 
                   IN ASSEMBLY
 
                                    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    §  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    § 3. This act shall take effect April 1, 2017.
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