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.