2015 -- H 5712

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LC001353

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     STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2015

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A N   A C T

RELATING TO HEALTH AND SAFETY -- RIGHTS OF NURSING HOME PATIENTS

     

     Introduced By: Representatives Serpa, Shekarchi, and Lima

     Date Introduced: February 26, 2015

     Referred To: House Finance

     It is enacted by the General Assembly as follows:

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     SECTION 1. Section 23-17.5-17 of the General Laws in Chapter 23-17.5 entitled "Rights

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of Nursing Home Patients" is hereby amended to read as follows:

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     23-17.5-17. Transfer to another facility. -- (a) Before transferring a patient to another

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facility or level of care within a facility, the patient shall be informed of the need for the transfer

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and of any alternatives to the transfer.

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      (b) A patient shall be transferred or discharged only for medical reasons, or for the

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patient's welfare or that of other patients or for nonpayment of the patient's stay. A facility

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seeking to discharge a patient for nonpayment of the patient's stay must, if the patient has been a

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patient of the facility for thirty (30) days or longer, provide the patient and, if known, a family

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member or legal representative of the patient, with written notice of the proposed discharge thirty

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(30) days in advance of the discharge.

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     (c) The patient may file an appeal of the proposed discharge with the long-term care

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ombudsperson of the department of elderly affairs, and if the appeal is received by the

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ombudsperson within ten (10) days after the date of written notice, the patient may remain in the

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facility until the decision of the ombudsperson. For appeals where the patient remains in the

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facility:

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     (1) Any hearing on the appeal shall be scheduled no later than thirty (30) days after the

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receipt by the state agency of the request for appeal;

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     (2) No more than one request for continuance by the patient shall be permitted and, if

 

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granted, the hearing on the appeal must be rescheduled for a date and time no later than forty (40)

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days after the receipt by the state agency of the request for appeal; and

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     (3) The decision of the ombudsperson shall be rendered as soon as possible, but in any

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event within five (5) days after the date of the hearing.

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      (c)(d) Reasonable advance notice of transfers to health care facilities other than hospitals

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shall be given to ensure orderly transfer or discharge and those actions shall be documented in the

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medical record.

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      (d)(e) In the event that a facility seeks a variance from the required thirty (30) day notice

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of closure of the facility, reasonable advance notice of the hearing for the variance shall be given

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by the facility to the patient, his or her guardian, or relative so appointed or elected to be his or

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her decision-maker, and an opportunity to be present at the hearing shall be granted to the

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designated person.

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      (e)(f) In the event of the voluntary closure of a facility, which closure is the result of a

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variance from the required thirty (30) day notice of closure, granted by the director of the

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department of health, reasonable advance notice of the closure shall be given by the facility to the

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patient, his or her guardian, or relative so appointed or elected to be his or her decision-maker.

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     (g) Nothing herein shall be construed to relieve a patient from any obligation to pay for

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the patient's stay in a facility.

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     SECTION 2. Chapter 40-8 of the General Laws entitled "Medical Assistance" is hereby

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amended by adding thereto the following sections:

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     40-8-6.1. Nursing facility care during pendency of application. – (a) Definitions. For

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purposes of this section, the following terms shall have the meanings indicated:

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     (1) "Applied income" means 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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     (2) "Authorized representative" means an individual who signs an application for

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Medicaid benefits on behalf of the Medicaid applicant.

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     (3) "Complete application" means an application for Medicaid benefits filed by or on

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behalf of an individual receiving care and services from a nursing facility, including attachments

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and supplemental information as necessary, which provides sufficient information for the director

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or designee to determine the applicant's eligibility for coverage. An application shall not be

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disqualified from status as a complete application hereunder except for failure on the part of the

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Medicaid applicant, his or her authorized representative, or the nursing facility 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.

 

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     (4) "Medicaid applicant" means an individual who is receiving care in a nursing facility

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during the pendency of an application for Medicaid benefits.

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     (5) "Nursing facility" means a nursing facility licensed under chapter 17 of title 23, which

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is a participating provider in the Rhode Island Medicaid program.

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     (6) "Uncompensated care" means care and services provided by a nursing facility to a

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

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

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

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uncompensated care.

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     (b) Uncompensated care during pendency of an application or benefits. A nursing facility

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

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

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

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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 (30) day period.

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     (c) Notice of application status. When a nursing facility if providing uncompensated care

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to a Medicaid applicant, then the nursing facility may inform the director or designee of its status,

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and the director 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, a nursing facility providing uncompensated care to a Medicaid

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

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and the director or designee shall respond within five (5) business days as follows:

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     (1) Without release – If the nursing facility has not obtained a signed release authorizing

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disclosure of information to the facility, the director or designee must provide the following

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information only, in writing:

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     (i) Whether or not the application has been approved;

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     (ii) The identity of any authorized representative; and

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     (iii) If the application has not yet been decided, whether or not the application is a

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complete application.

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     (2) With release – If the nursing facility has obtained a signed release, the director or

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designee must additionally provide any further information requested by the nursing facility, to

 

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the extent that the release permits its disclosure.

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     40-8-20.2. Support for certain patients of nursing facilities. – (a) Definitions. For

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purposes of this section:

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     (1) "Applied income" means 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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     (2) "Authorized individual" means a person who has authority over the income of a

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patient of a nursing facility such as a person who has been given or has otherwise obtained

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authority over a patient's bank account, has been named as or has rights as a joint account holder,

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or is a fiduciary as defined in this section:

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     (3) "Costs of care" means the costs of providing care to a patient of a nursing facility,

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including nursing care, personal care, meals, transportation and any other costs, charges, and

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expenses incurred by a nursing facility in providing care to a patient. Costs of care shall not

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exceed the customary rate the nursing facility charges to a patient who pays for his or her care

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directly rather than through a governmental or other third-party payor.

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     (4) "Fiduciary" means a person to whom power or property has been formally entrusted

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for the benefit of another such as an attorney-in-fact, legal guardian, trustee, or representative

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payee.

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     (5) "Nursing facility" means a nursing facility licensed under chapter 17 of title 23, which

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is a participating provider in the Rhode Island Medicaid program.

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     (6) "Penalty period" means the period of Medicaid ineligibility imposed pursuant to 42

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U.S.C. 1396p(c), as amended from time to time, on a person whose assets have been transferred

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for less than fair market value.

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     (7) "Uncompensated care" means care and services provided by a nursing facility to a

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

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

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

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uncompensated care.

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     (b) Penalty period resulting from transfer. Any transfer or assignment of assets resulting

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in the establishment or imposition of a penalty period shall create a debt that shall be due and

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owing to a nursing facility for the unpaid costs of care provided during the penalty period to a

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patient of that facility who has been subject to the penalty period. The amount of the debt

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established shall not exceed the fair market value of the transferred assets at the time of transfer

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that are subject of the penalty period. A nursing facility may bring an action to collect a debt for

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the unpaid costs of care given to a patient who has been subject to a penalty period, against either

 

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the transferor or the transferee, or both. The provisions of this section shall not affect other rights

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or remedies of the parties.

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     (c) Applied income. A nursing facility may provide written notice to a patient who is a

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Medicaid recipient and any authorized individual of that patient of:

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     (1) The amount of applied income due;

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     (2) The recipient's legal obligation to pay the applied income to the nursing facility; and

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     (3) That the recipient's failure to pay applied income due to a nursing facility not later

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than thirty (30) days after receiving such notice from the nursing facility may result in a court

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action to recover the amount of applied income due.

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     A nursing facility that is owed applied income may, in addition to any other remedies

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authorized under law, bring a claim to recover the applied income against a patient and any

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authorized individual. If a court of competent jurisdiction determines, based upon clear and

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convincing evidence, that a defendant willfully failed to pay or withheld applied income due and

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owing to a nursing facility for more than thirty (30) days after receiving notice pursuant to

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subsection (d) of this section, the court may award the amount of the debt owed, court costs and

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reasonable attorneys' fees to the nursing facility.

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     (d) Effects. Nothing contained in this section shall prohibit or otherwise diminish any

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other causes of action possessed by any such nursing facility. The death of the person receiving

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nursing facility care shall not nullify or otherwise affect the liability of the person or persons

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charged with the costs of care rendered or the applied income amount as referenced in this

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section.

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     SECTION 3. Chapter 15-10 of the General Laws entitled "Support of Parents" is hereby

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amended by adding thereto the following section:

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     15-10-8. Support for certain patients of nursing facilities. – The uncompensated costs

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of care provided by a licensed nursing facility to any person may be recovered by the nursing

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facility from any child of that person who is above the age of eighteen (18) years, to the extent

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that the child previously received a transfer of any interests or assets from the person receiving

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such care, which transfer resulted in a period of Medicaid ineligibility imposed pursuant to 42

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U.S.C. 1396p(c), as amended from time to time, on a person whose assets have been transferred

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for less than fair market value.

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     Recourse hereunder shall be limited to the fair market value of the interests or assets

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transferred at the time of transfer. For the purposes of this section, "the costs of care" means the

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costs of providing care, including nursing care, personal care, meals, transportation and any other

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costs, charges, and expenses incurred by the facility. Costs of care shall not exceed the customary

 

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rate the nursing facility charges to a patient who pays for his or her care directly rather than

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through a governmental or other third-party payor. Nothing contained in this section shall prohibit

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or otherwise diminish any other causes of action possessed by any such nursing facility. The

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death of the person receiving nursing facility care shall not nullify or otherwise affect the liability

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of the person or persons charged with the costs of care hereunder.

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     SECTION 4. Section 40-5-13 of the General Laws in Chapter 40-5 entitled "Support of

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the Needy" is hereby amended to read as follows:

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     40-5-13. Obligation of kindred for support. – (a) The kindred of any poor person, if

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any he or she shall have in the line or degree of father or grandfather, mother or grandmother,

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children or grandchildren, by consanguinity, or children by adoption, living within this state and

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of sufficient ability, shall be holden to support the pauper in proportion to their ability.

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     (b) The uncompensated costs of care provided by a licensed nursing facility to any person

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may be recovered by the nursing facility from any person who is obligated to provide support to

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that patient under subsection (a) of this section, to the extent that the individual so obligated

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received a transfer of any interests or assets from the patient receiving such care, which transfer

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resulted in a period of Medicaid ineligibility imposed pursuant to 42 U.S.C. 1396p(c), as

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amended from time to time, on a person whose assets have been transferred for less than fair

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market value.

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     Recourse hereunder shall be limited to the fair market value of the interests or assets

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transferred at the time of transfer. For the purposes of this section, "the costs of care" means the

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costs of providing care, including nursing care, personal care, meals, transportation and any other

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costs, charges, and expenses incurred by the facility. Costs of care shall not exceed the customary

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rate the nursing facility charges to a patient who pays for his or her care directly rather than

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through a governmental or other third-party payor. Nothing contained in this section shall prohibit

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or otherwise diminish any other causes of action possessed by any such nursing facility. The

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death of the person receiving nursing facility care shall not nullify or otherwise affect the liability

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of the person or persons charged with the costs of care hereunder.

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     SECTION 5. This act shall take effect upon passage.

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EXPLANATION

BY THE LEGISLATIVE COUNCIL

OF

A N   A C T

RELATING TO HEALTH AND SAFETY -- RIGHTS OF NURSING HOME PATIENTS

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     This act would provide appeal rights to patients who are being discharged from a nursing

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home for nonpayment of charges. The uncompensated costs of care provided by a licensed

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nursing facility may in some cases be recovered from a child of that patient.

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     This act would take effect upon passage.

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