Bill Text: NY A06658 | 2009-2010 | General Assembly | Amended


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 7-0)

Status: (Introduced - Dead) 2010-03-17 - print number 6658a [A06658 Detail]

Download: New_York-2009-A06658-Amended.html
                           S T A T E   O F   N E W   Y O R K
       ________________________________________________________________________
                                        6658--A
                              2009-2010 Regular Sessions
                                 I N  A S S E M B L Y
                                    March 11, 2009
                                      ___________
       Introduced by M. of A. SCHIMMINGER, DelMONTE -- Multi-Sponsored by -- M.
         of A. HOOPER, J. RIVERA, N. RIVERA, TOWNS -- read once and referred to
         the  Committee  on Health -- recommitted to the Committee on Health in
         accordance with Assembly Rule 3, sec. 2 -- committee discharged,  bill
         amended,  ordered reprinted as amended and recommitted to said commit-
         tee
       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
        EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                             [ ] is old law to be omitted.
                                                                  LBD06787-04-0
       A. 6658--A                          2
    1  HER  representative  states  that  the applicant does not have insurance
    2  coverage for the required medical care and  that  such  care  cannot  be
    3  afforded;  (d)  it  reasonably  appears  that the applicant is otherwise
    4  eligible  to  receive medical assistance; (e) it reasonably appears that
    5  the amount expended by the state and the local social services  district
    6  for  medical  assistance  in  a certified home health agency, [long term
    7  home health care program,] hospice or residential health care  facility,
    8  during the period of presumed eligibility, would be less than the amount
    9  the  state  and  the  local  social  services  district would expend for
   10  continued acute hospital care for such person; and (f) such other deter-
   11  minative criteria as the commissioner shall provide  by  rule  or  regu-
   12  lation. If a person has been determined to be presumptively eligible for
   13  medical  assistance,  pursuant  to this subdivision, and is subsequently
   14  determined to be ineligible for such assistance,  the  commissioner,  on
   15  behalf  of  the  state and the local social services district shall have
   16  the authority to recoup from the individual the sums expended  for  such
   17  assistance during the period of presumed eligibility.
   18    2.  Payment  for  up to sixty days of care for services provided under
   19  the medical assistance program shall be made for an  applicant  presumed
   20  eligible  for  medical  assistance  pursuant  to subdivision one of this
   21  section provided, however, that such payment shall not exceed sixty-five
   22  percent of the rate payable under this title for services provided by  a
   23  certified  home  health  agency,  [long  term home health care program,]
   24  hospice or residential health care facility. Notwithstanding  any  other
   25  provision  of  law,  no federal financial participation shall be claimed
   26  for services provided to a person while presumed  eligible  for  medical
   27  assistance  under  this program until such person has been determined to
   28  be  eligible  for  medical  assistance  by  the  local  social  services
   29  district.  During the period of presumed medical assistance eligibility,
   30  payment for services  provided  persons  presumed  eligible  under  this
   31  program  shall be made from state funds. Upon the final determination of
   32  eligibility by the local social services district, payment shall be made
   33  for the balance of the cost of such care and services provided  to  such
   34  applicant  for  such  period of eligibility and a retroactive adjustment
   35  shall be made by the department to appropriately reflect federal  finan-
   36  cial  participation  and  the  local  share  of  costs  for the services
   37  provided during the period of presumptive eligibility. Such federal  and
   38  local financial participation shall be the same as that which would have
   39  occurred  if a final determination of eligibility for medical assistance
   40  had been made prior to the provision of the services provided during the
   41  period of presumptive eligibility. In instances where an individual  who
   42  is  presumed  eligible for medical assistance is subsequently determined
   43  to be ineligible, the cost for  services  provided  to  such  individual
   44  shall  be  reimbursed in accordance with the provisions of section three
   45  hundred sixty-eight-a of this [article] TITLE.   Provided,  however,  if
   46  upon  audit the department determines that there are subsequent determi-
   47  nations of ineligibility for medical  assistance  in  at  least  fifteen
   48  percent  of  the cases in which presumptive eligibility has been granted
   49  in a local social services district, payments for services  provided  to
   50  all persons presumed eligible and subsequently determined ineligible for
   51  medical  assistance  shall  be  divided  equally  by  the  state and the
   52  district.
   53    S 2. Paragraph (d) of subdivision 2 of section  365-f  of  the  social
   54  services  law, as added by chapter 81 of the laws of 1995, is amended to
   55  read as follows:
       A. 6658--A                          3
    1    (d) meets such other criteria, as may be established  by  the  commis-
    2  sioner,  which  are necessary to effectively implement the objectives of
    3  this section. SUCH CRITERIA SHALL INCLUDE, BUT  NOT  BE  LIMITED  TO,  A
    4  REQUIREMENT  THAT  ANY PERSON WHO IS ELIGIBLE FOR, OR REASONABLY APPEARS
    5  TO MEET THE CRITERIA OF ELIGIBILITY FOR, BENEFITS UNDER SUBCHAPTER XVIII
    6  OF  THE  FEDERAL  SOCIAL SECURITY ACT SHALL BE REQUIRED TO APPLY FOR AND
    7  FULLY UTILIZE SUCH BENEFITS IN ACCORDANCE WITH THIS  CHAPTER  TO  DEFRAY
    8  THE COSTS OF THE PROGRAM. IF SUCH PERSON APPLIES FOR SUCH BENEFITS UNDER
    9  SUBCHAPTER  XVIII  OF  THE FEDERAL SOCIAL SECURITY ACT AND SUCH PERSON'S
   10  APPLICATION THEREFOR IS DENIED, SUCH PERSON MUST APPEAL SUCH  DENIAL  OR
   11  PERMIT THE LOCAL SOCIAL SERVICES OFFICIAL TO DO SO ON HIS OR HER BEHALF.
   12  IF  SUCH  PERSON  RECEIVES  SUCH  BENEFITS UNDER SUBCHAPTER XVIII OF THE
   13  FEDERAL SOCIAL SECURITY ACT AND SUCH PERSON'S CONTINUING RECEIPT THEREOF
   14  IS TERMINATED, SUCH PERSON MUST APPEAL SUCH TERMINATION  OR  PERMIT  THE
   15  LOCAL SOCIAL SERVICES OFFICIAL TO DO SO ON HIS OR HER BEHALF.
   16    S  3.  Subparagraph 1 of paragraph (b) of subdivision 2 of section 366
   17  of the social services law, as amended by chapter 638  of  the  laws  of
   18  1993  and  designated  by chapter 170 of the laws of 1994, is amended to
   19  read as follows:
   20    (1) In establishing standards  for  determining  eligibility  for  and
   21  amount  of  such assistance, the department shall take into account only
   22  such income and resources, in accordance with federal  requirements,  as
   23  are available to the applicant or recipient and as would not be required
   24  to  be  disregarded  or set aside for future needs, and there shall be a
   25  reasonable evaluation of any such income or  resources.  The  department
   26  shall  not  consider  the  availability  of an option for an accelerated
   27  payment of death benefits or special surrender value pursuant  to  para-
   28  graph one of subsection (a) of section one thousand one hundred thirteen
   29  of  the  insurance law, or an option to enter into a viatical settlement
   30  pursuant to the provisions of article  seventy-eight  of  the  insurance
   31  law,  as  an available resource in determining eligibility for an amount
   32  of such assistance, provided, however, that the payment of such benefits
   33  shall be considered in determining eligibility for and  amount  of  such
   34  assistance.  There  shall  not be taken into consideration the financial
   35  responsibility of any individual  for  any  applicant  or  recipient  of
   36  assistance  under  this title unless such applicant or recipient is such
   37  individual's spouse or such individual's child who is  under  twenty-one
   38  years of age. In determining the eligibility of a child who is categori-
   39  cally  eligible  as  blind  or disabled, as determined under regulations
   40  prescribed by the social security act for medical assistance, the income
   41  and resources of parents or spouses of parents are not considered avail-
   42  able to that child if [she/he] HE OR SHE does not  regularly  share  the
   43  common  household  even if the child returns to the common household for
   44  periodic visits. In the application of  standards  of  eligibility  with
   45  respect  to income, costs incurred for medical care, whether in the form
   46  of insurance premiums or otherwise, shall be  taken  into  account.  Any
   47  person  who  is eligible for, or reasonably appears to meet the criteria
   48  of eligibility for, benefits  under  [title]  SUBCHAPTER  XVIII  of  the
   49  federal  social  security  act  shall be required to apply for and fully
   50  utilize such benefits in accordance with this chapter. IN THE CASE OF  A
   51  PERSON  WHO  IS  RECEIVING  OR  SEEKING  LONG  TERM CARE, BENEFITS UNDER
   52  SUBCHAPTER XVIII OF THE FEDERAL  SOCIAL  SECURITY  ACT  SHALL  BE  FULLY
   53  UTILIZED  IN  ACCORDANCE  WITH  THIS CHAPTER TO DEFRAY THE COSTS OF SUCH
   54  LONG TERM CARE. IF SUCH PERSON APPLIES FOR SUCH BENEFITS UNDER  SUBCHAP-
   55  TER  XVIII OF THE FEDERAL SOCIAL SECURITY ACT AND SUCH PERSON'S APPLICA-
   56  TION THEREFOR IS DENIED, SUCH PERSON MUST APPEAL SUCH DENIAL  OR  PERMIT
       A. 6658--A                          4
    1  THE  LOCAL  SOCIAL  SERVICES OFFICIAL TO DO SO ON HIS OR HER BEHALF.  IF
    2  SUCH PERSON RECEIVES SUCH BENEFITS UNDER SUBCHAPTER XVIII OF THE FEDERAL
    3  SOCIAL SECURITY ACT AND SUCH  PERSON'S  CONTINUING  RECEIPT  THEREOF  IS
    4  TERMINATED, SUCH PERSON MUST APPEAL SUCH TERMINATION OR PERMIT THE LOCAL
    5  SOCIAL SERVICES OFFICIAL TO DO SO ON HIS OR HER BEHALF.
    6    S 4. Subparagraph (v) of paragraph b of subdivision 6-a of section 366
    7  of  the  social  services  law, as amended by chapter 627 of the laws of
    8  2004, is amended to read as follows:
    9    (v) meet such other criteria as may be established by the commissioner
   10  of health as may be necessary to administer the provision of this subdi-
   11  vision in an equitable manner. SUCH CRITERIA SHALL INCLUDE, BUT  NOT  BE
   12  LIMITED  TO,  A  REQUIREMENT  THAT  ANY  PERSON  WHO IS ELIGIBLE FOR, OR
   13  REASONABLY APPEARS TO MEET THE CRITERIA  OF  ELIGIBILITY  FOR,  BENEFITS
   14  UNDER  SUBCHAPTER  XVIII  OF  THE  FEDERAL  SOCIAL SECURITY ACT SHALL BE
   15  REQUIRED TO APPLY FOR AND FULLY UTILIZE SUCH BENEFITS IN ACCORDANCE WITH
   16  THIS CHAPTER TO DEFRAY THE COSTS OF THE PROGRAM.  IF SUCH PERSON APPLIES
   17  FOR SUCH BENEFITS UNDER SUBCHAPTER XVIII OF THE FEDERAL SOCIAL  SECURITY
   18  ACT  AND  SUCH PERSON'S APPLICATION THEREFOR IS DENIED, SUCH PERSON MUST
   19  APPEAL SUCH DENIAL OR PERMIT THE LOCAL SOCIAL SERVICES OFFICIAL TO DO SO
   20  ON HIS OR HER BEHALF.   IF SUCH  PERSON  RECEIVES  SUCH  BENEFITS  UNDER
   21  SUBCHAPTER  XVIII  OF  THE FEDERAL SOCIAL SECURITY ACT AND SUCH PERSON'S
   22  CONTINUING RECEIPT THEREOF IS TERMINATED, SUCH PERSON MUST  APPEAL  SUCH
   23  TERMINATION OR PERMIT THE LOCAL SOCIAL SERVICES OFFICIAL TO DO SO ON HIS
   24  OR HER BEHALF.
   25    S  5.  Subparagraph  (viii) of paragraph b of subdivision 9 of section
   26  366 of the social services law, as added by chapter 170 of the  laws  of
   27  1994, is amended to read as follows:
   28    (viii)  meet  such other criteria as may be established by the commis-
   29  sioner of mental health, in conjunction with the commissioner, as may be
   30  necessary to administer the provisions of this subdivision in an equita-
   31  ble manner, including those criteria established pursuant to paragraph e
   32  of this subdivision. SUCH CRITERIA SHALL INCLUDE, BUT NOT BE LIMITED TO,
   33  A REQUIREMENT THAT ANY PERSON WHO IS ELIGIBLE FOR, OR REASONABLY APPEARS
   34  TO MEET THE CRITERIA OF ELIGIBILITY FOR, BENEFITS UNDER SUBCHAPTER XVIII
   35  OF THE FEDERAL SOCIAL SECURITY ACT SHALL BE REQUIRED TO  APPLY  FOR  AND
   36  FULLY  UTILIZE  SUCH  BENEFITS IN ACCORDANCE WITH THIS CHAPTER TO DEFRAY
   37  THE COSTS OF THE PROGRAM. IF SUCH PERSON APPLIES FOR SUCH BENEFITS UNDER
   38  SUBCHAPTER XVIII OF THE FEDERAL SOCIAL SECURITY ACT  AND  SUCH  PERSON'S
   39  APPLICATION  THEREFOR  IS DENIED, SUCH PERSON MUST APPEAL SUCH DENIAL OR
   40  PERMIT THE LOCAL SOCIAL SERVICES OFFICIAL TO DO SO ON HIS OR HER BEHALF.
   41  IF SUCH PERSON RECEIVES SUCH BENEFITS  UNDER  SUBCHAPTER  XVIII  OF  THE
   42  FEDERAL SOCIAL SECURITY ACT AND SUCH PERSON'S CONTINUING RECEIPT THEREOF
   43  IS  TERMINATED,  SUCH  PERSON MUST APPEAL SUCH TERMINATION OR PERMIT THE
   44  LOCAL SOCIAL SERVICES OFFICIAL TO DO SO ON HIS OR HER BEHALF.
   45    S 6. The social services law is amended by adding a new section  366-i
   46  to read as follows:
   47    S  366-I.  LONG  TERM  CARE; OTHER CASES.   IN ALL CASES NOT OTHERWISE
   48  PROVIDED FOR IN THIS TITLE OF A PERSON WHO IS RECEIVING OR SEEKING  LONG
   49  TERM CARE, BENEFITS UNDER SUBCHAPTER XVIII OF THE FEDERAL SOCIAL SECURI-
   50  TY ACT SHALL BE FULLY UTILIZED IN ACCORDANCE WITH THIS CHAPTER TO DEFRAY
   51  THE COSTS OF SUCH LONG TERM CARE.  IF SUCH PERSON APPLIES FOR SUCH BENE-
   52  FITS  UNDER SUBCHAPTER XVIII OF THE FEDERAL SOCIAL SECURITY ACT AND SUCH
   53  PERSON'S APPLICATION THEREFOR IS DENIED, SUCH PERSON  MUST  APPEAL  SUCH
   54  DENIAL  OR  PERMIT THE LOCAL SOCIAL SERVICES OFFICIAL TO DO SO ON HIS OR
   55  HER BEHALF.   IF SUCH PERSON RECEIVES  SUCH  BENEFITS  UNDER  SUBCHAPTER
   56  XVIII  OF  THE  FEDERAL SOCIAL SECURITY ACT AND SUCH PERSON'S CONTINUING
       A. 6658--A                          5
    1  RECEIPT THEREOF IS TERMINATED, SUCH PERSON MUST APPEAL SUCH  TERMINATION
    2  OR  PERMIT  THE  LOCAL  SOCIAL  SERVICES OFFICIAL TO DO SO ON HIS OR HER
    3  BEHALF.
    4    S  7.  Subdivision  3  of  section 367-a of the social services law is
    5  amended by adding a new paragraph (e) to read as follows:
    6    (E) NOTWITHSTANDING ANY INCONSISTENT PROVISION OF THIS SECTION  OR  OF
    7  ANY OTHER LAW, FOR ANY PERSON WHO IS ELIGIBLE FOR MEDICAL ASSISTANCE AND
    8  FOR  MEDICARE UNDER SUBCHAPTER XVIII OF THE FEDERAL SOCIAL SECURITY ACT,
    9  THE COST OF THE PREMIUM FOR MEDICARE PART A SHALL BE BORNE BY THE STATE.
   10    S 8. Subdivision 7 of section 367-c of the  social  services  law,  as
   11  added  by  chapter 895 of the laws of 1977 and renumbered by chapter 854
   12  of the laws of 1987, is amended to read as follows:
   13    7. No social services district shall make payments pursuant to [title]
   14  SUBCHAPTER XIX of the federal Social Security Act for benefits available
   15  under [title] SUBCHAPTER XVIII of such act  without  documentation  that
   16  [title]  SUBCHAPTER  XVIII  claims have been filed and denied. UPON SUCH
   17  DENIAL, SUCH PERSON MUST APPEAL SUCH DENIAL OR PERMIT THE  LOCAL  SOCIAL
   18  SERVICES OFFICIAL TO DO SO ON HIS OR HER BEHALF. IF SUCH PERSON RECEIVES
   19  SUCH  BENEFITS UNDER SUBCHAPTER XVIII OF THE FEDERAL SOCIAL SECURITY ACT
   20  AND SUCH PERSON'S CONTINUING RECEIPT THEREOF IS TERMINATED, SUCH  PERSON
   21  MUST  APPEAL  SUCH TERMINATION OR PERMIT THE LOCAL SOCIAL SERVICES OFFI-
   22  CIAL TO DO SO ON HIS OR HER BEHALF.
   23    S 9. Subdivision 3 of section 367-e of the  social  services  law,  as
   24  added by chapter 622 of the laws of 1988, is amended to read as follows:
   25    3.  The  commissioner  shall apply for any waivers, including home and
   26  community based services waivers pursuant to  section  nineteen  hundred
   27  fifteen-c  of  the social security act, necessary to implement AIDS home
   28  care programs. Notwithstanding any inconsistent  provision  of  law  but
   29  subject  to  expenditure  limitations of this section, the commissioner,
   30  subject to the approval of the state director of the budget, may author-
   31  ize the utilization of medical assistance  funds  to  pay  for  services
   32  provided  by  AIDS  home  care  programs  in  addition to those services
   33  included in the medical assistance program under section  three  hundred
   34  sixty-five-a  of  this  [chapter]    TITLE, so long as federal financial
   35  participation is available for such services.   Expenditures made  under
   36  this  subdivision  shall  be  deemed payments for medical assistance for
   37  needy persons and shall be subject to  reimbursement  by  the  state  in
   38  accordance with the provisions of section three hundred sixty-eight-a of
   39  this  [chapter]  TITLE.    ANY PERSON WHO IS ELIGIBLE FOR, OR REASONABLY
   40  APPEARS TO MEET THE CRITERIA OF ELIGIBILITY FOR, BENEFITS UNDER SUBCHAP-
   41  TER XVIII OF THE FEDERAL SOCIAL SECURITY ACT SHALL BE REQUIRED TO  APPLY
   42  FOR  AND  FULLY UTILIZE SUCH BENEFITS IN ACCORDANCE WITH THIS CHAPTER TO
   43  DEFRAY THE COSTS OF THE PROGRAM. IF SUCH PERSON APPLIES FOR  SUCH  BENE-
   44  FITS  UNDER SUBCHAPTER XVIII OF THE FEDERAL SOCIAL SECURITY ACT AND SUCH
   45  PERSON'S APPLICATION THEREFOR IS DENIED, SUCH PERSON  MUST  APPEAL  SUCH
   46  DENIAL  OR  PERMIT THE LOCAL SOCIAL SERVICES OFFICIAL TO DO SO ON HIS OR
   47  HER BEHALF.   IF SUCH PERSON RECEIVES  SUCH  BENEFITS  UNDER  SUBCHAPTER
   48  XVIII  OF  THE  FEDERAL SOCIAL SECURITY ACT AND SUCH PERSON'S CONTINUING
   49  RECEIPT THEREOF IS TERMINATED, SUCH PERSON MUST APPEAL SUCH  TERMINATION
   50  OR  PERMIT  THE  LOCAL  SOCIAL  SERVICES OFFICIAL TO DO SO ON HIS OR HER
   51  BEHALF.
   52    S 10. Subdivision 2 of section 367-f of the social  services  law,  as
   53  added by chapter 659 of the laws of 1997, is amended to read as follows:
   54    2.  Notwithstanding  any inconsistent provision of this chapter or any
   55  other law to the contrary, the partnership for long  term  care  program
   56  shall provide Medicaid extended coverage to a person receiving long term
       A. 6658--A                          6
    1  care  services if there is federal participation pursuant to such treat-
    2  ment and such person: (a) is or was covered by an  insurance  policy  or
    3  certificate providing coverage for long term care which meets the appli-
    4  cable  minimum  benefit standards of the superintendent of insurance and
    5  other requirements for approval of participation under the program; and,
    6  (b) has exhausted the coverage and benefits as required by the  program.
    7  ANY  SUCH PERSON WHO IS RECEIVING MEDICAL ASSISTANCE AND WHO IS ELIGIBLE
    8  FOR, OR REASONABLY APPEARS TO MEET  THE  CRITERIA  OF  ELIGIBILITY  FOR,
    9  BENEFITS UNDER SUBCHAPTER XVIII OF THE FEDERAL SOCIAL SECURITY ACT SHALL
   10  BE  REQUIRED  TO APPLY FOR AND FULLY UTILIZE SUCH BENEFITS IN ACCORDANCE
   11  WITH THIS CHAPTER TO DEFRAY THE COSTS OF THE  PROGRAM.  IF  SUCH  PERSON
   12  APPLIES  FOR  SUCH BENEFITS UNDER SUBCHAPTER XVIII OF THE FEDERAL SOCIAL
   13  SECURITY ACT AND SUCH PERSON'S  APPLICATION  THEREFOR  IS  DENIED,  SUCH
   14  PERSON MUST APPEAL SUCH DENIAL OR PERMIT THE LOCAL SOCIAL SERVICES OFFI-
   15  CIAL  TO  DO SO ON HIS OR HER BEHALF. IF SUCH PERSON RECEIVES SUCH BENE-
   16  FITS UNDER SUBCHAPTER XVIII OF THE FEDERAL SOCIAL SECURITY ACT AND  SUCH
   17  PERSON'S  CONTINUING  RECEIPT  THEREOF  IS  TERMINATED, SUCH PERSON MUST
   18  APPEAL SUCH TERMINATION OR PERMIT THE LOCAL SOCIAL SERVICES OFFICIAL  TO
   19  DO SO ON HIS OR HER BEHALF.
   20    S  11.  This  act  shall  take effect on the one hundred twentieth day
   21  after it shall have become a law;  provided  that  the  commissioner  of
   22  health is authorized to promulgate any and all rules and regulations and
   23  take any other measures necessary to implement this act on its effective
   24  date on or before such date.
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