Chapter 158

2016 -- H 7773 SUBSTITUTE A Enacted 06/27/2016

A N   A C T

RELATING TO HUMAN SERVICES -- MEDICAL ASSISTANCE

Introduced By: Representatives Serpa, Ackerman, Fellela, Tobon, and Lima

Date Introduced: February 26, 2016

It is enacted by the General Assembly as follows:

SECTION 1. Section 40-8-6.1 of the General Laws in Chapter 40-8 entitled "Medical

Assistance" is hereby amended to read as follows:

40-8-6.1. Nursing facility care during pendency of application Provider care during

pendency of application. -- (a) Definitions or purposes of this section, the following terms shall

have the meanings indicated:

"Applied Iincome" -- The amount of income a Medicaid beneficiary is required to

contribute to the cost of his or her care.

"Authorized Rrepresentative" -- An individual who signs an application for Medicaid

benefits on behalf of a Medicaid Aapplicant.

"Complete Aapplication" -- An application for Medicaid benefits filed by, or on behalf

of, an individual receiving care and services from a long-term-care provider (LTC provider)

nursing facility, including attachments and supplemental information as necessary, which

provides sufficient information for the director secretary or designee to determine the applicant's

eligibility for coverage. An application shall not be disqualified from status as a complete

application hereunder except for failure on the part of the Medicaid applicant, or his or her

authorized representative, to provide necessary information or documentation, or to take any

other action necessary to make the application a complete application.

"Long-term-care provider (LTC provider)" means any of the following: a home care

provider, home nursing-care provider or nursing facility licensed pursuant to the provisions of

chapter 17 of title 23; an assisted-living residence provider licensed pursuant to chapter 17.4 of

title 23; an adult day-services provider licensed pursuant to §23-1-52; or a Program of All-

Inclusive Care for the Elderly (PACE) as certified by the Centers for Medicare and Medicaid

Services (CMS) and participating in the Rhode Island medicaid program. As used in this chapter

the terms "long-term-care provider" and "LTC provider" are interchangeable.

"Medicaid Aapplicant" -- An individual who is receiving care in a nursing facility from

an LTC provider during the pendency of an application for Medicaid benefits.

"Nursing Facility" -- A nursing facility licensed under Chapter 17 of Title 23, which is a

participating provider in the Rhode Island Medicaid program.

"Release" means a written document which:

(1) Indicates consent to the disclosure to an LTC provider by the secretary or designee;

(2) Of information concerning an application for Medicaid benefits filed on behalf of a

resident or patient of that LTC provider;

(3) For the purpose of assuring the ability to be paid for its services by that LTC provider;

and

(4) Which includes the following elements:

(i) The name of the LTC provider;

(ii) A description of the information that may be disclosed under the release;

(iii) The name of the person or persons acting on behalf of the LTC provider to whom the

information may be disclosed;

(iv) The period of time for which the release will be in effect, which may extend from the

date of the application for benefits until the expiration of any appeal, or any appeal period,

following the determination of that application; and

(v) The signature of the Medicaid applicant, or authorized representative, or other person

legally authorized to sign on behalf of the Medicaid applicant, such as guardian or attorney-in-

fact.

"Secretary" means the secretary of the Rhode Island executive office of health and human

services.

"Uncompensated Ccare" -- Care and services provided by a nursing facility an LTC

provider to a Medicaid applicant without receiving compensation therefore from Medicaid,

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

actual or estimated applied income shall not disqualify the care and services provided from

qualifying as uncompensated care.

(b)(1) Uncompensated Ccare Dduring Ppendency of an Aapplication for Bbenefits. - A

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

during the pendency of a complete application; nor may a nursing facility charge a Medicaid

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

representing the estimated, applied income. A nursing facility may discharge a Medicaid

applicant for non-payment of the facility's bill during the pendency of an application for Medicaid

coverage that is not a complete application, but only if the nursing facility has provided the

patient (and his or her authorized representative, if known) with thirty (30) days' written notice of

its intention to do so, and the application remains incomplete during that thirty- (30) day (30)

period.

(2) Uncompensated care while determination is overdue. - When a complete application

has been pending for ninety (90) days or longer, then upon the request of an LTC provider

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

provided to the applicant in full as though the application were approved, beginning on the date

of such request. Payment under this subsection shall not be made for the period prior to the LTC

provider’s request, but shall continue thereafter until the application is decided. In the event the

application is denied, the state shall not have any right of recovery, offset, or recoupment with

respect to payments made hereunder for the period of determination. In the event the application

is approved, the state may offset payments due for the period between the date of the application

and the determination by any amounts paid hereunder.

(c) Notice Oof Aapplication Sstatus. - When a nursing facility an LTC provider is

providing uncompensated care to a Medicaid applicant, then the nursing facility LTC provider

may inform the director secretary or designee of its status, and the director secretary or designee

shall thereafter inform the nursing facility of any decision on the application at the time the

decision is rendered and, if coverage is approved, of the date that coverage will begin. In addition,

a nursing facility an LTC provider providing uncompensated care to a Medicaid applicant may

inquire of the director secretary or designee as to the status of that individual's application, and

the director secretary or designee shall respond within five business days as follows:

(i) Without Rrelease -- If the nursing facility LTC provider has not obtained a signed

release authorizing disclosure of information to the facility, the director secretary or designee

must provide the following information, only, in writing: (a) wWhether or not the application has

been approved; (b) tThe identity of any authorized representative; and (c) iIf the application has

not yet been decided, whether or not the application is a complete application.

(ii) With Rrelease -- If the nursing facility LTC provider has obtained a signed release,

the director secretary or designee must additionally provide any further information requested by

the nursing facility LTC provider, to the extent that the release permits its disclosure.

SECTION 2. This act shall take effect upon passage.

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LC005236/SUB A

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