Bill Text: NY A02284 | 2011-2012 | General Assembly | Introduced
Bill Title: Requires the state to pay medicare part A premiums for persons eligible for medicare part A and medical assistance and requires local commissioners of social services to appeal denial of medicare coverage before approving medical assistance coverage for long term care.
Spectrum: Partisan Bill (Democrat 6-0)
Status: (Introduced - Dead) 2012-01-04 - referred to health [A02284 Detail]
Download: New_York-2011-A02284-Introduced.html
S T A T E O F N E W Y O R K ________________________________________________________________________ 2284 2011-2012 Regular Sessions I N A S S E M B L Y January 14, 2011 ___________ Introduced by M. of A. SCHIMMINGER, GABRYSZAK -- Multi-Sponsored by -- M. of A. HOOPER, J. RIVERA, N. RIVERA, TOWNS -- read once and referred to the Committee on Health AN ACT to amend the social services law, in relation to requiring the state to pay medicare part A premiums for persons eligible for medi- care part A and medical assistance and to require local commissioners of social services to appeal denial of medicare coverage before approving medical assistance coverage for long term care THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM- BLY, DO ENACT AS FOLLOWS: 1 Section 1. Subdivisions 1 and 2 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. An individual, upon application for medical assistance, shall be 5 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) the applicant is receiving acute care in such hospital; 15 (b) a physician certifies that such applicant no longer requires acute 16 hospital care, but still requires medical care which can be provided by 17 a certified home health agency, [long term home health care program,] 18 hospice or residential health care facility; (c) the applicant or his OR 19 HER representative states that the applicant does not have insurance 20 coverage for the required medical care and that such care cannot be 21 afforded; (d) it reasonably appears that the applicant is otherwise EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets [ ] is old law to be omitted. LBD02537-01-1 A. 2284 2 1 eligible to receive medical assistance; (e) it reasonably appears that 2 the amount expended by the state and the local social services district 3 for medical assistance in a certified home health agency, [long term 4 home health care program,] hospice or residential health care facility, 5 during the period of presumed eligibility, would be less than the amount 6 the state and the local social services district would expend for 7 continued acute hospital care for such person; and (f) such other deter- 8 minative criteria as the commissioner shall provide by rule or regu- 9 lation. If a person has been determined to be presumptively eligible for 10 medical assistance, pursuant to this subdivision, and is subsequently 11 determined to be ineligible for such assistance, the commissioner, on 12 behalf of the state and the local social services district shall have 13 the authority to recoup from the individual the sums expended for such 14 assistance during the period of presumed eligibility. 15 2. Payment for up to sixty days of care for services provided under 16 the medical assistance program shall be made for an applicant presumed 17 eligible for medical assistance pursuant to subdivision one of this 18 section provided, however, that such payment shall not exceed sixty-five 19 percent of the rate payable under this title for services provided by a 20 certified home health agency, [long term home health care program,] 21 hospice or residential health care facility. Notwithstanding any other 22 provision of law, no federal financial participation shall be claimed 23 for services provided to a person while presumed eligible for medical 24 assistance under this program until such person has been determined to 25 be eligible for medical assistance by the local social services 26 district. During the period of presumed medical assistance eligibility, 27 payment for services provided persons presumed eligible under this 28 program shall be made from state funds. Upon the final determination of 29 eligibility by the local social services district, payment shall be made 30 for the balance of the cost of such care and services provided to such 31 applicant for such period of eligibility and a retroactive adjustment 32 shall be made by the department to appropriately reflect federal finan- 33 cial participation and the local share of costs for the services 34 provided during the period of presumptive eligibility. Such federal and 35 local financial participation shall be the same as that which would have 36 occurred if a final determination of eligibility for medical assistance 37 had been made prior to the provision of the services provided during the 38 period of presumptive eligibility. In instances where an individual who 39 is presumed eligible for medical assistance is subsequently determined 40 to be ineligible, the cost for services provided to such individual 41 shall be reimbursed in accordance with the provisions of section three 42 hundred sixty-eight-a of this [article] TITLE. Provided, however, if 43 upon audit the department determines that there are subsequent determi- 44 nations of ineligibility for medical assistance in at least fifteen 45 percent of the cases in which presumptive eligibility has been granted 46 in a local social services district, payments for services provided to 47 all persons presumed eligible and subsequently determined ineligible for 48 medical assistance shall be divided equally by the state and the 49 district. 50 S 2. Paragraph (d) of subdivision 2 of section 365-f of the social 51 services law, as added by chapter 81 of the laws of 1995, is amended to 52 read as follows: 53 (d) meets such other criteria, as may be established by the commis- 54 sioner, which are necessary to effectively implement the objectives of 55 this section. SUCH CRITERIA SHALL INCLUDE, BUT NOT BE LIMITED TO, A 56 REQUIREMENT THAT ANY PERSON WHO IS ELIGIBLE FOR, OR REASONABLY APPEARS A. 2284 3 1 TO MEET THE CRITERIA OF ELIGIBILITY FOR, BENEFITS UNDER SUBCHAPTER XVIII 2 OF THE FEDERAL SOCIAL SECURITY ACT SHALL BE REQUIRED TO APPLY FOR AND 3 FULLY UTILIZE SUCH BENEFITS IN ACCORDANCE WITH THIS CHAPTER TO DEFRAY 4 THE COSTS OF THE PROGRAM. IF SUCH PERSON APPLIES FOR SUCH BENEFITS UNDER 5 SUBCHAPTER XVIII OF THE FEDERAL SOCIAL SECURITY ACT AND SUCH PERSON'S 6 APPLICATION THEREFOR IS DENIED, SUCH PERSON MUST APPEAL SUCH DENIAL OR 7 PERMIT THE LOCAL SOCIAL SERVICES OFFICIAL TO DO SO ON HIS OR HER BEHALF. 8 IF SUCH PERSON RECEIVES SUCH BENEFITS UNDER SUBCHAPTER XVIII OF THE 9 FEDERAL SOCIAL SECURITY ACT AND SUCH PERSON'S CONTINUING RECEIPT THEREOF 10 IS TERMINATED, SUCH PERSON MUST APPEAL SUCH TERMINATION OR PERMIT THE 11 LOCAL SOCIAL SERVICES OFFICIAL TO DO SO ON HIS OR HER BEHALF. 12 S 3. Subparagraph 1 of paragraph (b) of subdivision 2 of section 366 13 of the social services law, as amended by chapter 638 of the laws of 14 1993 and designated by chapter 170 of the laws of 1994, is amended to 15 read as follows: 16 (1) In establishing standards for determining eligibility for and 17 amount of such assistance, the department shall take into account only 18 such income and resources, in accordance with federal requirements, as 19 are available to the applicant or recipient and as would not be required 20 to be disregarded or set aside for future needs, and there shall be a 21 reasonable evaluation of any such income or resources. The department 22 shall not consider the availability of an option for an accelerated 23 payment of death benefits or special surrender value pursuant to para- 24 graph one of subsection (a) of section one thousand one hundred thirteen 25 of the insurance law, or an option to enter into a viatical settlement 26 pursuant to the provisions of article seventy-eight of the insurance 27 law, as an available resource in determining eligibility for an amount 28 of such assistance, provided, however, that the payment of such benefits 29 shall be considered in determining eligibility for and amount of such 30 assistance. There shall not be taken into consideration the financial 31 responsibility of any individual for any applicant or recipient of 32 assistance under this title unless such applicant or recipient is such 33 individual's spouse or such individual's child who is under twenty-one 34 years of age. In determining the eligibility of a child who is categori- 35 cally eligible as blind or disabled, as determined under regulations 36 prescribed by the social security act for medical assistance, the income 37 and resources of parents or spouses of parents are not considered avail- 38 able to that child if [she/he] HE OR SHE does not regularly share the 39 common household even if the child returns to the common household for 40 periodic visits. In the application of standards of eligibility with 41 respect to income, costs incurred for medical care, whether in the form 42 of insurance premiums or otherwise, shall be taken into account. Any 43 person who is eligible for, or reasonably appears to meet the criteria 44 of eligibility for, benefits under [title] SUBCHAPTER XVIII of the 45 federal social security act shall be required to apply for and fully 46 utilize such benefits in accordance with this chapter. IN THE CASE OF A 47 PERSON WHO IS RECEIVING OR SEEKING LONG TERM CARE, BENEFITS UNDER 48 SUBCHAPTER XVIII OF THE FEDERAL SOCIAL SECURITY ACT SHALL BE FULLY 49 UTILIZED IN ACCORDANCE WITH THIS CHAPTER TO DEFRAY THE COSTS OF SUCH 50 LONG TERM CARE. IF SUCH PERSON APPLIES FOR SUCH BENEFITS UNDER SUBCHAP- 51 TER XVIII OF THE FEDERAL SOCIAL SECURITY ACT AND SUCH PERSON'S APPLICA- 52 TION THEREFOR IS DENIED, SUCH PERSON MUST APPEAL SUCH DENIAL OR PERMIT 53 THE LOCAL SOCIAL SERVICES OFFICIAL TO DO SO ON HIS OR HER BEHALF. IF 54 SUCH PERSON RECEIVES SUCH BENEFITS UNDER SUBCHAPTER XVIII OF THE FEDERAL 55 SOCIAL SECURITY ACT AND SUCH PERSON'S CONTINUING RECEIPT THEREOF IS A. 2284 4 1 TERMINATED, SUCH PERSON MUST APPEAL SUCH TERMINATION OR PERMIT THE LOCAL 2 SOCIAL SERVICES OFFICIAL TO DO SO ON HIS OR HER BEHALF. 3 S 4. Subparagraph (v) of paragraph b of subdivision 6-a of section 366 4 of the social services law, as amended by chapter 627 of the laws of 5 2004, is amended to read as follows: 6 (v) meet such other criteria as may be established by the commissioner 7 of health as may be necessary to administer the provision of this subdi- 8 vision in an equitable manner. SUCH CRITERIA SHALL INCLUDE, BUT NOT BE 9 LIMITED TO, A REQUIREMENT THAT ANY PERSON WHO IS ELIGIBLE FOR, OR 10 REASONABLY APPEARS TO MEET THE CRITERIA OF ELIGIBILITY FOR, BENEFITS 11 UNDER SUBCHAPTER XVIII OF THE FEDERAL SOCIAL SECURITY ACT SHALL BE 12 REQUIRED TO APPLY FOR AND FULLY UTILIZE SUCH BENEFITS IN ACCORDANCE WITH 13 THIS CHAPTER TO DEFRAY THE COSTS OF THE PROGRAM. IF SUCH PERSON APPLIES 14 FOR SUCH BENEFITS UNDER SUBCHAPTER XVIII OF THE FEDERAL SOCIAL SECURITY 15 ACT AND SUCH PERSON'S APPLICATION THEREFOR IS DENIED, SUCH PERSON MUST 16 APPEAL SUCH DENIAL OR PERMIT THE LOCAL SOCIAL SERVICES OFFICIAL TO DO SO 17 ON HIS OR HER BEHALF. IF SUCH PERSON RECEIVES SUCH BENEFITS UNDER 18 SUBCHAPTER XVIII OF THE FEDERAL SOCIAL SECURITY ACT AND SUCH PERSON'S 19 CONTINUING RECEIPT THEREOF IS TERMINATED, SUCH PERSON MUST APPEAL SUCH 20 TERMINATION OR PERMIT THE LOCAL SOCIAL SERVICES OFFICIAL TO DO SO ON HIS 21 OR HER BEHALF. 22 S 5. Subparagraph (viii) of paragraph b of subdivision 9 of section 23 366 of the social services law, as added by chapter 170 of the laws of 24 1994, is amended to read as follows: 25 (viii) meet such other criteria as may be established by the commis- 26 sioner of mental health, in conjunction with the commissioner, as may be 27 necessary to administer the provisions of this subdivision in an equita- 28 ble manner, including those criteria established pursuant to paragraph e 29 of this subdivision. SUCH CRITERIA SHALL INCLUDE, BUT NOT BE LIMITED TO, 30 A REQUIREMENT THAT ANY PERSON WHO IS ELIGIBLE FOR, OR REASONABLY APPEARS 31 TO MEET THE CRITERIA OF ELIGIBILITY FOR, BENEFITS UNDER SUBCHAPTER XVIII 32 OF THE FEDERAL SOCIAL SECURITY ACT SHALL BE REQUIRED TO APPLY FOR AND 33 FULLY UTILIZE SUCH BENEFITS IN ACCORDANCE WITH THIS CHAPTER TO DEFRAY 34 THE COSTS OF THE PROGRAM. IF SUCH PERSON APPLIES FOR SUCH BENEFITS UNDER 35 SUBCHAPTER XVIII OF THE FEDERAL SOCIAL SECURITY ACT AND SUCH PERSON'S 36 APPLICATION THEREFOR IS DENIED, SUCH PERSON MUST APPEAL SUCH DENIAL OR 37 PERMIT THE LOCAL SOCIAL SERVICES OFFICIAL TO DO SO ON HIS OR HER BEHALF. 38 IF SUCH PERSON RECEIVES SUCH BENEFITS UNDER SUBCHAPTER XVIII OF THE 39 FEDERAL SOCIAL SECURITY ACT AND SUCH PERSON'S CONTINUING RECEIPT THEREOF 40 IS TERMINATED, SUCH PERSON MUST APPEAL SUCH TERMINATION OR PERMIT THE 41 LOCAL SOCIAL SERVICES OFFICIAL TO DO SO ON HIS OR HER BEHALF. 42 S 6. The social services law is amended by adding a new section 366-j 43 to read as follows: 44 S 366-J. LONG TERM CARE; OTHER CASES. IN ALL CASES NOT OTHERWISE 45 PROVIDED FOR IN THIS TITLE OF A PERSON WHO IS RECEIVING OR SEEKING LONG 46 TERM CARE, BENEFITS UNDER SUBCHAPTER XVIII OF THE FEDERAL SOCIAL SECURI- 47 TY ACT SHALL BE FULLY UTILIZED IN ACCORDANCE WITH THIS CHAPTER TO DEFRAY 48 THE COSTS OF SUCH LONG TERM CARE. IF SUCH PERSON APPLIES FOR SUCH BENE- 49 FITS UNDER SUBCHAPTER XVIII OF THE FEDERAL SOCIAL SECURITY ACT AND SUCH 50 PERSON'S APPLICATION THEREFOR IS DENIED, SUCH PERSON MUST APPEAL SUCH 51 DENIAL OR PERMIT THE LOCAL SOCIAL SERVICES OFFICIAL TO DO SO ON HIS OR 52 HER BEHALF. IF SUCH PERSON RECEIVES SUCH BENEFITS UNDER SUBCHAPTER 53 XVIII OF THE FEDERAL SOCIAL SECURITY ACT AND SUCH PERSON'S CONTINUING 54 RECEIPT THEREOF IS TERMINATED, SUCH PERSON MUST APPEAL SUCH TERMINATION 55 OR PERMIT THE LOCAL SOCIAL SERVICES OFFICIAL TO DO SO ON HIS OR HER 56 BEHALF. A. 2284 5 1 S 7. Subdivision 3 of section 367-a of the social services law is 2 amended by adding a new paragraph (e) to read as follows: 3 (E) NOTWITHSTANDING ANY INCONSISTENT PROVISION OF THIS SECTION OR OF 4 ANY OTHER LAW, FOR ANY PERSON WHO IS ELIGIBLE FOR MEDICAL ASSISTANCE AND 5 FOR MEDICARE UNDER SUBCHAPTER XVIII OF THE FEDERAL SOCIAL SECURITY ACT, 6 THE COST OF THE PREMIUM FOR MEDICARE PART A SHALL BE BORNE BY THE STATE. 7 S 8. Subdivision 7 of section 367-c of the social services law, as 8 added by chapter 895 of the laws of 1977 and renumbered by chapter 854 9 of the laws of 1987, is amended to read as follows: 10 7. No social services district shall make payments pursuant to [title] 11 SUBCHAPTER XIX of the federal Social Security Act for benefits available 12 under [title] SUBCHAPTER XVIII of such act without documentation that 13 [title] SUBCHAPTER XVIII claims have been filed and denied. UPON SUCH 14 DENIAL, SUCH PERSON MUST APPEAL SUCH DENIAL OR PERMIT THE LOCAL SOCIAL 15 SERVICES OFFICIAL TO DO SO ON HIS OR HER BEHALF. IF SUCH PERSON RECEIVES 16 SUCH BENEFITS UNDER SUBCHAPTER XVIII OF THE FEDERAL SOCIAL SECURITY ACT 17 AND SUCH PERSON'S CONTINUING RECEIPT THEREOF IS TERMINATED, SUCH PERSON 18 MUST APPEAL SUCH TERMINATION OR PERMIT THE LOCAL SOCIAL SERVICES OFFI- 19 CIAL TO DO SO ON HIS OR HER BEHALF. 20 S 9. Subdivision 3 of section 367-e of the social services law, as 21 added by chapter 622 of the laws of 1988, is amended to read as follows: 22 3. The commissioner shall apply for any waivers, including home and 23 community based services waivers pursuant to section nineteen hundred 24 fifteen-c of the social security act, necessary to implement AIDS home 25 care programs. Notwithstanding any inconsistent provision of law but 26 subject to expenditure limitations of this section, the commissioner, 27 subject to the approval of the state director of the budget, may author- 28 ize the utilization of medical assistance funds to pay for services 29 provided by AIDS home care programs in addition to those services 30 included in the medical assistance program under section three hundred 31 sixty-five-a of this [chapter] TITLE, so long as federal financial 32 participation is available for such services. Expenditures made under 33 this subdivision shall be deemed payments for medical assistance for 34 needy persons and shall be subject to reimbursement by the state in 35 accordance with the provisions of section three hundred sixty-eight-a of 36 this [chapter] TITLE. ANY PERSON WHO IS ELIGIBLE FOR, OR REASONABLY 37 APPEARS TO MEET THE CRITERIA OF ELIGIBILITY FOR, BENEFITS UNDER SUBCHAP- 38 TER XVIII OF THE FEDERAL SOCIAL SECURITY ACT SHALL BE REQUIRED TO APPLY 39 FOR AND FULLY UTILIZE SUCH BENEFITS IN ACCORDANCE WITH THIS CHAPTER TO 40 DEFRAY THE COSTS OF THE PROGRAM. IF SUCH PERSON APPLIES FOR SUCH BENE- 41 FITS UNDER SUBCHAPTER XVIII OF THE FEDERAL SOCIAL SECURITY ACT AND SUCH 42 PERSON'S APPLICATION THEREFOR IS DENIED, SUCH PERSON MUST APPEAL SUCH 43 DENIAL OR PERMIT THE LOCAL SOCIAL SERVICES OFFICIAL TO DO SO ON HIS OR 44 HER BEHALF. IF SUCH PERSON RECEIVES SUCH BENEFITS UNDER SUBCHAPTER 45 XVIII OF THE FEDERAL SOCIAL SECURITY ACT AND SUCH PERSON'S CONTINUING 46 RECEIPT THEREOF IS TERMINATED, SUCH PERSON MUST APPEAL SUCH TERMINATION 47 OR PERMIT THE LOCAL SOCIAL SERVICES OFFICIAL TO DO SO ON HIS OR HER 48 BEHALF. 49 S 10. Subdivision 2 of section 367-f of the social services law, as 50 added by chapter 659 of the laws of 1997, is amended to read as follows: 51 2. Notwithstanding any inconsistent provision of this chapter or any 52 other law to the contrary, the partnership for long term care program 53 shall provide Medicaid extended coverage to a person receiving long term 54 care services if there is federal participation pursuant to such treat- 55 ment and such person: (a) is or was covered by an insurance policy or 56 certificate providing coverage for long term care which meets the appli- A. 2284 6 1 cable minimum benefit standards of the superintendent of insurance and 2 other requirements for approval of participation under the program; and, 3 (b) has exhausted the coverage and benefits as required by the program. 4 ANY SUCH PERSON WHO IS RECEIVING MEDICAL ASSISTANCE AND WHO IS ELIGIBLE 5 FOR, OR REASONABLY APPEARS TO MEET THE CRITERIA OF ELIGIBILITY FOR, 6 BENEFITS UNDER SUBCHAPTER XVIII OF THE FEDERAL SOCIAL SECURITY ACT SHALL 7 BE REQUIRED TO APPLY FOR AND FULLY UTILIZE SUCH BENEFITS IN ACCORDANCE 8 WITH THIS CHAPTER TO DEFRAY THE COSTS OF THE PROGRAM. IF SUCH PERSON 9 APPLIES FOR SUCH BENEFITS UNDER SUBCHAPTER XVIII OF THE FEDERAL SOCIAL 10 SECURITY ACT AND SUCH PERSON'S APPLICATION THEREFOR IS DENIED, SUCH 11 PERSON MUST APPEAL SUCH DENIAL OR PERMIT THE LOCAL SOCIAL SERVICES OFFI- 12 CIAL TO DO SO ON HIS OR HER BEHALF. IF SUCH PERSON RECEIVES SUCH BENE- 13 FITS UNDER SUBCHAPTER XVIII OF THE FEDERAL SOCIAL SECURITY ACT AND SUCH 14 PERSON'S CONTINUING RECEIPT THEREOF IS TERMINATED, SUCH PERSON MUST 15 APPEAL SUCH TERMINATION OR PERMIT THE LOCAL SOCIAL SERVICES OFFICIAL TO 16 DO SO ON HIS OR HER BEHALF. 17 S 11. This act shall take effect on the one hundred twentieth day 18 after it shall have become a law; provided that the commissioner of 19 health is authorized to promulgate any and all rules and regulations and 20 take any other measures necessary to implement this act on its effective 21 date on or before such date.