NY State Senate Bill 2009-S4639

Archive: Last Bill Status - In Senate Committee Health Committee

Introduced
- In Committee Assembly
- In Committee Senate
- On Floor Calendar Assembly
- On Floor Calendar Senate
- Passed Assembly
- Passed Senate
Delivered to Governor
Signed By Governor

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	Assembly Actions - Lowercase Senate Actions - UPPERCASE
Apr 16, 2010	print number 4639a
Apr 16, 2010	amend and recommit to health
Jan 06, 2010	referred to health
May 13, 2009	committee discharged and committed to health
Apr 27, 2009	referred to social services

Bill Amendments

Original

A (Active)

2009-S4639 - Details

Current Committee:: Senate Health
Law Section:: Social Services Law
Laws Affected:: Amd §§364-i & 368-a, Soc Serv L
Versions Introduced in 2011-2012 Legislative Session:: S1606

2009-S4639 - Summary

Ensures that uninsured persons discharged from mental hospitals have continuous access to medications; expands the medical assistance presumptive eligibility program to include persons without insurance who are discharged from psychiatric inpatient care; requires the department of family assistance to submit a report on the impact of expanding the program to include persons discharged from psychiatric inpatient care.

2009-S4639 - Sponsor Memo

                                 BILL NUMBER:  S4639

 TITLE OF BILL :
An act to amend the social services law, in relation to the medical
assistance presumptive eligibility program


 PURPOSE OR GENERAL IDEA OF BILL :
The purpose of this bill is to ensure that uninsured persons
discharged from mental hospitals or released from prisons or jails
have continuous access to medical care for their mental illness.

 SUMMARY OF SPECIFIC PROVISIONS :
This bill would amend Section 364-i of the social services law to
expand the medical Assistance Presumptive Eligibility Program to
include persons without insurance who are discharged from psychiatric
inpatient care from a state hospital, a prison operated by the state,
county or city of New York. Under the bill, such individuals would be
presumed eligible for Medicaid coverage for care, services and
supplies to treat a mental illness for up to 90 days from the date of
discharge. The bill would require the Department of Health to submit a
report on the impact of expanding the program to include persons
discharged from psychiatric inpatient care. Current law limits
presumptive eligibility for medical assistance to uninsured
individuals who are transferred from general hospitals to a certified
home health agency or a long term home health care program, if the

individual meets eligibility criteria established by a local
department of social services.

 JUSTIFICATION :
The mentally ill who are released from State mental hospitals, prisons
or jails seldom have health care coverage at the time of discharge or
release. Without follow-up medical care, including medications they
have been taking within those facilities, they decompensate and act
out in the community, which causes them to be re-incarcerated or
re-hospitalized. If medications, clinic visits, and other follow-up
care that was part of their discharge plan were available to them
immediately upon release, they would have a much better chance to
remain stable and in our communities. Since these people are
prohibited from applying for Medicaid until their release, and there
is a time lapse between application and acceptance into the Medicaid
program, presumptive eligibility proves its effectiveness, as was
shown by a study done several years ago by the Office of Mental
Health.

 PRIOR LEGISLATIVE HISTORY :
A similar bill, which applied to medications only for those being
discharged from state hospitals, has been passed by the Assembly
previously A.6367 of 1997-98. The bill was extended to apply to those
who are released from prison or jail because there are many persons in
need of mental health services who are in our correctional system.
2001-02 - A.844a - Passed Assembly.  2003-04 - A.2493a - Passed
Assembly. 2005-06 - A6744a -In Social Services.

 FISCAL IMPLICATIONS TO STATE AND LOCAL GOVERNMENT :
Under existing law, there exists retroactive eligibility for Medicaid
for 3 months prior to application, thus this legislation will have
minimal fiscal impact. Any increased cost due to growth of utilization
or the assumption of the local share should be offset by the savings
that are anticipated due to the reduced rate of recidivism. In the
event that eligibility is denied, the Commissioner of Health is
authorized to recoup the costs from the individual.

 EFFECTIVE DATE :
Effective April 1, 2010.

2009-S4639 - Bill Text download pdf

                            
                    S T A T E   O F   N E W   Y O R K
________________________________________________________________________

                                  4639

                       2009-2010 Regular Sessions

                            I N  S E N A T E

                             April 27, 2009
                               ___________

Introduced  by  Sen.  MONTGOMERY  -- read twice and ordered printed, and
  when printed to be committed to the Committee on Social Services

AN ACT to amend the social services law,  in  relation  to  the  medical
  assistance presumptive eligibility program

  THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
BLY, DO ENACT AS FOLLOWS:

  Section 1. Subdivisions 1, 2 and 3 of  section  364-i  of  the  social
services law, as amended by chapter 693 of the laws of 1996, are amended
to read as follows:
  1.  (A)  An individual, upon application for medical assistance, shall
be presumed eligible for such assistance for a period of sixty days from
the date of transfer from a general  hospital,  as  defined  in  section
twenty-eight  hundred  one  of the public health law to a certified home
health agency or long term home  health  care  program,  as  defined  in
section thirty-six hundred two of the public health law, or to a hospice
as  defined in section four thousand two of the public health law, or to
a residential health care facility as defined  in  section  twenty-eight
hundred  one of the public health law, if the local department of social
services determines that the  applicant  meets  each  of  the  following
criteria: [(a)] (I) the applicant is receiving acute care in such hospi-
tal;  [(b)]  (II)    a physician certifies that such applicant no longer
requires acute hospital care, but still requires medical care which  can
be  provided  by  a  certified home health agency, long term home health
care program, hospice or residential health care facility;  [(c)]  (III)
the  applicant  or his representative states that the applicant does not
have insurance coverage for the required medical care and that such care
cannot be afforded; [(d)] (IV) it reasonably appears that the  applicant
is  otherwise  eligible  to  receive  medical  assistance;  [(e)] (V) it
reasonably appears that the amount expended by the state and  the  local
social  services  district  for  medical  assistance in a certified home
health agency, long term home health care program, hospice  or  residen-

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD07140-02-9

S. 4639                             2

tial  health  care  facility, during the period of presumed eligibility,
would be less than the amount the state and the  local  social  services
district would expend for continued acute hospital care for such person;
and  [(f)] (VI) such other determinative criteria as the commissioner OF
HEALTH shall provide by rule or regulation. If a person has been  deter-
mined  to  be presumptively eligible for medical assistance, pursuant to
this subdivision, and is subsequently determined to  be  ineligible  for
such  assistance, the commissioner OF HEALTH, on behalf of the state and
the local social services district shall have the  authority  to  recoup
from  the  individual  the  sums expended for such assistance during the
period of presumed eligibility.
  (B) AN INDIVIDUAL, UPON APPLICATION FOR MEDICAL ASSISTANCE,  SHALL  BE
PRESUMED  ELIGIBLE  FOR  SUCH ASSISTANCE FOR CARE, SERVICES AND SUPPLIES
RELATED TO THE TREATMENT OF A MENTAL ILLNESS FOR A PERIOD OF NINETY DAYS
FROM THE DATE OF DISCHARGE FROM A HOSPITAL, AS DEFINED IN  SECTION  1.03
OF  THE  MENTAL HYGIENE LAW, A CORRECTIONAL FACILITY AS DEFINED IN PARA-
GRAPH (A) OF SUBDIVISION FOUR OF SECTION TWO OF THE CORRECTION LAW OR  A
LOCAL  CORRECTIONAL  FACILITY AS DEFINED IN PARAGRAPH (A) OF SUBDIVISION
SIXTEEN OF SECTION TWO OF THE CORRECTION LAW, IF THE LOCAL DEPARTMENT OF
SOCIAL SERVICES DETERMINES THAT THE APPLICANT MEETS EACH OF THE  FOLLOW-
ING  CRITERIA:  (I)  THE APPLICANT IS SEVERELY AND PERSISTENTLY MENTALLY
ILL; (II) A PHYSICIAN CERTIFIES THAT  SUCH  APPLICANT  REQUIRES  MEDICAL
CARE  TO TREAT SUCH MENTAL ILLNESS; (III) THE APPLICANT OR HIS REPRESEN-
TATIVE STATES THAT THE APPLICANT DOES NOT HAVE  INSURANCE  COVERAGE  FOR
THE REQUIRED MEDICAL CARE AND THAT SUCH CARE CANNOT BE AFFORDED; (IV) IT
REASONABLY  APPEARS  THAT THE APPLICANT IS OTHERWISE ELIGIBLE TO RECEIVE
MEDICAL ASSISTANCE; (V) IT REASONABLY APPEARS THAT THE  AMOUNT  EXPENDED
BY  THE STATE AND THE LOCAL SOCIAL SERVICES DISTRICT FOR MEDICAL ASSIST-
ANCE FOR TREATMENT OF A MENTAL ILLNESS DURING  THE  PERIOD  OF  PRESUMED
ELIGIBILITY,  WOULD  BE  LESS  THAN  THE  AMOUNT THE STATE AND THE LOCAL
SOCIAL SERVICES DISTRICT WOULD EXPEND  FOR  CONTINUED  OR  FUTURE  ACUTE
HOSPITAL  CARE FOR SUCH PERSON; AND (VI) SUCH OTHER DETERMINATIVE CRITE-
RIA AS THE COMMISSIONER OF HEALTH SHALL PROVIDE BY RULE  OR  REGULATION.
IF A PERSON HAS BEEN DETERMINED TO BE PRESUMPTIVELY ELIGIBLE FOR MEDICAL
ASSISTANCE, PURSUANT TO THIS SUBDIVISION, AND IS SUBSEQUENTLY DETERMINED
TO  BE  INELIGIBLE  FOR  SUCH ASSISTANCE, THE COMMISSIONER OF HEALTH, ON
BEHALF OF THE STATE AND THE LOCAL SOCIAL SERVICES  DISTRICT  SHALL  HAVE
THE  AUTHORITY  TO RECOUP FROM THE INDIVIDUAL THE SUMS EXPENDED FOR SUCH
ASSISTANCE DURING THE PERIOD OF PRESUMED ELIGIBILITY.
  2. (A) Payment for up to sixty days  of  care  for  services  provided
under  the  medical  assistance  program  shall be made for an applicant
presumed eligible for medical assistance pursuant to  PARAGRAPH  (A)  OF
subdivision  one  of  this  section provided, however, that such payment
shall not exceed sixty-five percent of the rate payable under this title
for services provided by a certified home health agency, long term  home
health care program, hospice or residential health care facility.
  (B)  PAYMENT FOR UP TO NINETY DAYS OF CARE FOR SERVICES PROVIDED UNDER
THE MEDICAL ASSISTANCE PROGRAM SHALL BE MADE FOR AN  APPLICANT  PRESUMED
ELIGIBLE  FOR MEDICAL ASSISTANCE FOR CARE, SERVICES AND SUPPLIES RELATED
TO THE TREATMENT OF A MENTAL ILLNESS PURSUANT TO PARAGRAPH (B) OF SUBDI-
VISION ONE OF THIS SECTION, PROVIDED HOWEVER, THAT  SUCH  PAYMENT  SHALL
NOT  EXCEED ONE HUNDRED PERCENT OF THE RATE PAYABLE UNDER THIS TITLE FOR
SUCH CARE, SERVICES AND SUPPLIES.
  (C) Notwithstanding any other provision of law, no  federal  financial
participation  shall  be claimed for services provided to a person while
presumed eligible for medical assistance under this program  until  such

S. 4639                             3

person  has been determined to be eligible for medical assistance by the
local social services district. During the period  of  presumed  medical
assistance  eligibility,  payment for services provided persons presumed
eligible  under this program shall be made from state funds.  [Upon] (I)
IN THE CASE OF COSTS INCURRED FOR A PERSON  PRESUMPTIVELY  ELIGIBLE  FOR
MEDICAL  ASSISTANCE  UNDER  PARAGRAPH  (A)  OF  SUBDIVISION  ONE OF THIS
SECTION, UPON the final determination of eligibility by the local social
services district, payment shall be made for the balance of the cost  of
such  care  and  services  provided to such applicant for such period of
eligibility and a retroactive adjustment shall be made by the department
OF HEALTH to appropriately reflect federal financial  participation  and
the  local share of costs for the services provided during the period of
presumptive eligibility. Such federal and local financial  participation
shall  be the same as that which would have occurred if a final determi-
nation of eligibility for medical assistance had been made prior to  the
provision  of  the  services  provided  during the period of presumptive
eligibility. In instances where an individual who is  presumed  eligible
for  medical assistance is subsequently determined to be ineligible, the
cost for services provided to such individual  shall  be  reimbursed  in
accordance with the provisions of section three hundred sixty-eight-a of
this  article. Provided, however, if upon audit the department OF HEALTH
determines that there are subsequent determinations of ineligibility for
medical assistance in at least fifteen percent of  the  cases  in  which
presumptive  eligibility  has  been  granted  in a local social services
district, payments for services provided to all persons presumed  eligi-
ble  and subsequently determined ineligible for medical assistance shall
be divided equally by the state and the district.
  (II) IN THE CASE OF COSTS INCURRED FOR A PERSON PRESUMPTIVELY ELIGIBLE
FOR MEDICAL ASSISTANCE UNDER PARAGRAPH (B) OF SUBDIVISION  ONE  OF  THIS
SECTION  UPON THE FINAL DETERMINATION OF ELIGIBILITY BY THE LOCAL SOCIAL
SERVICES DISTRICT, PAYMENT SHALL BE MADE FOR THE BALANCE OF THE COST  OF
SUCH  CARE  AND  SERVICES  PROVIDED TO SUCH APPLICANT FOR SUCH PERIOD OF
ELIGIBILITY AND A RETROACTIVE ADJUSTMENT SHALL BE MADE BY THE DEPARTMENT
OF HEALTH TO APPROPRIATELY REFLECT FEDERAL FINANCIAL  PARTICIPATION  AND
THE  LOCAL SHARE OF COSTS FOR THE SERVICES PROVIDED DURING THE PERIOD OF
PRESUMPTIVE ELIGIBILITY. SUCH FEDERAL FINANCIAL PARTICIPATION  SHALL  BE
THE  SAME  AS THAT WHICH WOULD HAVE OCCURRED IF A FINAL DETERMINATION OF
ELIGIBILITY FOR MEDICAL ASSISTANCE HAD BEEN MADE PRIOR TO THE  PROVISION
OF  THE  SERVICES PROVIDED DURING THE PERIOD OF PRESUMPTIVE ELIGIBILITY.
THERE SHALL BE NO LOCAL SHARE IN THE COSTS OF SUCH ASSISTANCE DURING THE
PRESUMPTIVE ELIGIBILITY PERIOD; PROVIDED HOWEVER THAT IF UPON AUDIT  THE
DEPARTMENT OF HEALTH DETERMINES THAT THERE ARE SUBSEQUENT DETERMINATIONS
OF  INELIGIBILITY  FOR MEDICAL ASSISTANCE IN AT LEAST FIFTEEN PERCENT OF
THE CASES IN WHICH PRESUMPTIVE ELIGIBILITY HAS BEEN GRANTED IN  A  LOCAL
SOCIAL  SERVICES DISTRICT, PAYMENTS FOR SERVICES PROVIDED TO ALL PERSONS
PRESUMED ELIGIBLE AND SUBSEQUENTLY  DETERMINED  INELIGIBLE  FOR  MEDICAL
ASSISTANCE  SHALL  BE  REIMBURSED  IN  ACCORDANCE WITH THE PROVISIONS OF
SECTION THREE HUNDRED SIXTY-EIGHT-A OF THIS ARTICLE.
  3. On or before March thirty-first,  [nineteen  hundred  ninety-seven]
TWO THOUSAND ELEVEN, the department OF HEALTH shall submit to the gover-
nor  and  legislature  an  evaluation  of  the  program,  including  the
program's effects on access, quality and cost of care, and any recommen-
dations for future modifications to improve the program.
  S 2. Subdivision 1 of section 368-a of  the  social  services  law  is
amended by adding a new paragraph (aa) to read as follows:

S. 4639                             4

  (AA)  NOTWITHSTANDING ANY INCONSISTENT PROVISION OF LAW, REIMBURSEMENT
BY THE STATE FOR PAYMENTS MADE, WHETHER BY THE DEPARTMENT OF  HEALTH  ON
BEHALF  OF  A  LOCAL  SOCIAL SERVICES DISTRICT PURSUANT TO SECTION THREE
HUNDRED SIXTY-SEVEN-B OF THIS  TITLE  OR  BY  A  LOCAL  SOCIAL  SERVICES
DISTRICT  DIRECTLY,  FOR  MEDICAL  ASSISTANCE FURNISHED TO AN INDIVIDUAL
PRESUMED ELIGIBLE FOR MEDICAL ASSISTANCE UNDER PARAGRAPH (B) OF SUBDIVI-
SION ONE OF SECTION THREE HUNDRED SIXTY-FOUR-I OF THIS TITLE, DURING THE
PRESUMPTIVE ELIGIBILITY PERIOD,  SHALL  BE  MADE  FOR  THE  FULL  AMOUNT
EXPENDED FOR SUCH ASSISTANCE, AFTER FIRST DEDUCTING THEREFROM ANY FEDER-
AL FUNDS PROPERLY RECEIVED OR TO BE RECEIVED ON ACCOUNT OF SUCH EXPENDI-
TURE;  PROVIDED  THAT  IF UPON AUDIT THE DEPARTMENT OF HEALTH DETERMINES
THAT THERE ARE SUBSEQUENT DETERMINATIONS OF  INELIGIBILITY  FOR  MEDICAL
ASSISTANCE IN AT LEAST FIFTEEN PERCENT OF THE CASES IN WHICH PRESUMPTIVE
ELIGIBILITY  HAS  BEEN  GRANTED  IN  A  LOCAL  SOCIAL SERVICES DISTRICT,
PAYMENTS FOR SERVICES PROVIDED TO  ALL  PERSONS  PRESUMED  ELIGIBLE  AND
SUBSEQUENTLY DETERMINED INELIGIBLE FOR MEDICAL ASSISTANCE SHALL BE REIM-
BURSED IN ACCORDANCE WITH PARAGRAPH (D) OF THIS SUBDIVISION.
  S 3. This act shall take effect April 1, 2010.

2009-S4639A (ACTIVE) - Details

Current Committee:: Senate Health
Law Section:: Social Services Law
Laws Affected:: Amd §§364-i & 368-a, Soc Serv L
Versions Introduced in 2011-2012 Legislative Session:: S1606

2009-S4639A (ACTIVE) - Summary

2009-S4639A (ACTIVE) - Sponsor Memo

                                 BILL NUMBER:  S4639A

 TITLE OF BILL :
An act to amend the social services law, in relation to the medical
assistance presumptive eligibility program


 PURPOSE OR GENERAL IDEA OF BILL :
The purpose of this bill is to ensure that uninsured persons
discharged from mental hospitals or released from prisons or jails
have continuous access to medical care for their mental illness.

 SUMMARY OF SPECIFIC PROVISIONS :
This bill would amend Section 364-i of the social services law to
expand the medical Assistance Presumptive Eligibility Program to
include persons without insurance who are discharged from psychiatric
inpatient care from a state hospital, a prison operated by the state,
county or city of New York. Under the bill, such individuals would be
presumed eligible for Medicaid coverage for care, services and
supplies to treat a mental illness for up to 90 days from the date of
discharge. The bill would require the Department of Health to submit a
report on the impact of expanding the program to include persons
discharged from psychiatric inpatient care. Current law limits
presumptive eligibility for medical assistance to uninsured
individuals who are transferred from general hospitals to a certified
home health agency or a long term home health care program, if the

individual meets eligibility criteria established by a local
department of social services.

 JUSTIFICATION :
The mentally ill who are released from State mental hospitals, prisons
or jails seldom have health care coverage at the time of discharge or
release. Without follow-up medical care, including medications they
have been taking within those facilities, they decompensate and act
out in the community, which causes them to be re-incarcerated or
re-hospitalized. If medications, clinic visits, and other follow-up
care that was part of their discharge plan were available to them
immediately upon release, they would have a much better chance to
remain stable and in our communities. Since these people are
prohibited from applying for Medicaid until their release, and there
is a time lapse between application and acceptance into the Medicaid
program, presumptive eligibility proves its effectiveness, as was
shown by a study done several years ago by the Office of Mental
Health.

 PRIOR LEGISLATIVE HISTORY :
S.1806A: 2005-2006 Died in Committee
S.2276: 2003-2004 Died in Committee
S.2467: 2001-2002 Died in Committee

 FISCAL IMPLICATIONS TO STATE AND LOCAL GOVERNMENT :
Under existing law, there exists retroactive eligibility for Medicaid
for 3 months prior to application, thus this legislation will have
minimal fiscal impact. Any increased cost due to growth of utilization
or the assumption of the local share should be offset by the savings
that are anticipated due to the reduced rate of recidivism. In the
event that eligibility is denied, the Commissioner of Health is
authorized to recoup the costs from the individual.

 EFFECTIVE DATE :
Effective April 1, 2011.

2009-S4639A (ACTIVE) - Bill Text download pdf

                            
                    S T A T E   O F   N E W   Y O R K
________________________________________________________________________

                                 4639--A

                       2009-2010 Regular Sessions

                            I N  S E N A T E

                             April 27, 2009
                               ___________

Introduced  by  Sen.  MONTGOMERY  -- read twice and ordered printed, and
  when printed to be committed to the Committee on  Social  Services  --
  recommitted  to the Committee on Health in accordance with Senate Rule
  6, sec. 8 -- committee discharged, bill amended, ordered reprinted  as
  amended and recommitted to said committee

AN  ACT  to  amend  the  social services law, in relation to the medical
  assistance presumptive eligibility program

  THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND  ASSEM-
BLY, DO ENACT AS FOLLOWS:

  Section  1.  Subdivisions  1,  2  and 3 of section 364-i of the social
services law, as amended by chapter 693 of the laws of 1996, are amended
to read as follows:
  1. (A) An individual, upon application for medical  assistance,  shall
be presumed eligible for such assistance for a period of sixty days from
the  date  of  transfer  from  a general hospital, as defined in section
twenty-eight hundred one of the public health law to  a  certified  home
health  agency  or  long  term  home  health care program, as defined in
section thirty-six hundred two of the public health law, or to a hospice
as defined in section four thousand two of the public health law, or  to
a  residential  health  care facility as defined in section twenty-eight
hundred one of the public health law, if the local department of  social
services  determines  that  the  applicant  meets  each of the following
criteria: [(a)] (I) the applicant is receiving acute care in such hospi-
tal; [(b)] (II)  a physician certifies that  such  applicant  no  longer
requires  acute hospital care, but still requires medical care which can
be provided by a certified home health agency,  long  term  home  health
care  program,  hospice or residential health care facility; [(c)] (III)
the applicant or his representative states that the applicant  does  not
have insurance coverage for the required medical care and that such care
cannot  be afforded; [(d)] (IV) it reasonably appears that the applicant
is otherwise eligible  to  receive  medical  assistance;  [(e)]  (V)  it

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD07140-03-0

S. 4639--A                          2

reasonably  appears  that the amount expended by the state and the local
social services district for medical  assistance  in  a  certified  home
health  agency,  long term home health care program, hospice or residen-
tial  health  care  facility, during the period of presumed eligibility,
would be less than the amount the state and the  local  social  services
district would expend for continued acute hospital care for such person;
and  [(f)] (VI) such other determinative criteria as the commissioner OF
HEALTH shall provide by rule or regulation. If a person has been  deter-
mined  to  be presumptively eligible for medical assistance, pursuant to
this subdivision, and is subsequently determined to  be  ineligible  for
such  assistance, the commissioner OF HEALTH, on behalf of the state and
the local social services district shall have the  authority  to  recoup
from  the  individual  the  sums expended for such assistance during the
period of presumed eligibility.
  (B) AN INDIVIDUAL, UPON APPLICATION FOR MEDICAL ASSISTANCE,  SHALL  BE
PRESUMED  ELIGIBLE  FOR  SUCH ASSISTANCE FOR CARE, SERVICES AND SUPPLIES
RELATED TO THE TREATMENT OF A MENTAL ILLNESS FOR A PERIOD OF NINETY DAYS
FROM THE DATE OF DISCHARGE FROM A HOSPITAL, AS DEFINED IN  SECTION  1.03
OF  THE  MENTAL HYGIENE LAW, A CORRECTIONAL FACILITY AS DEFINED IN PARA-
GRAPH (A) OF SUBDIVISION FOUR OF SECTION TWO OF THE CORRECTION LAW OR  A
LOCAL  CORRECTIONAL  FACILITY AS DEFINED IN PARAGRAPH (A) OF SUBDIVISION
SIXTEEN OF SECTION TWO OF THE CORRECTION LAW, IF THE LOCAL DEPARTMENT OF
SOCIAL SERVICES DETERMINES THAT THE APPLICANT MEETS EACH OF THE  FOLLOW-
ING  CRITERIA:  (I)  THE APPLICANT IS SEVERELY AND PERSISTENTLY MENTALLY
ILL; (II) A PHYSICIAN CERTIFIES THAT  SUCH  APPLICANT  REQUIRES  MEDICAL
CARE  TO TREAT SUCH MENTAL ILLNESS; (III) THE APPLICANT OR HIS REPRESEN-
TATIVE STATES THAT THE APPLICANT DOES NOT HAVE  INSURANCE  COVERAGE  FOR
THE REQUIRED MEDICAL CARE AND THAT SUCH CARE CANNOT BE AFFORDED; (IV) IT
REASONABLY  APPEARS  THAT THE APPLICANT IS OTHERWISE ELIGIBLE TO RECEIVE
MEDICAL ASSISTANCE; (V) IT REASONABLY APPEARS THAT THE  AMOUNT  EXPENDED
BY  THE STATE AND THE LOCAL SOCIAL SERVICES DISTRICT FOR MEDICAL ASSIST-
ANCE FOR TREATMENT OF A MENTAL ILLNESS DURING  THE  PERIOD  OF  PRESUMED
ELIGIBILITY,  WOULD  BE  LESS  THAN  THE  AMOUNT THE STATE AND THE LOCAL
SOCIAL SERVICES DISTRICT WOULD EXPEND  FOR  CONTINUED  OR  FUTURE  ACUTE
HOSPITAL  CARE FOR SUCH PERSON; AND (VI) SUCH OTHER DETERMINATIVE CRITE-
RIA AS THE COMMISSIONER OF HEALTH SHALL PROVIDE BY RULE  OR  REGULATION.
IF A PERSON HAS BEEN DETERMINED TO BE PRESUMPTIVELY ELIGIBLE FOR MEDICAL
ASSISTANCE, PURSUANT TO THIS SUBDIVISION, AND IS SUBSEQUENTLY DETERMINED
TO  BE  INELIGIBLE  FOR  SUCH ASSISTANCE, THE COMMISSIONER OF HEALTH, ON
BEHALF OF THE STATE AND THE LOCAL SOCIAL SERVICES  DISTRICT  SHALL  HAVE
THE  AUTHORITY  TO RECOUP FROM THE INDIVIDUAL THE SUMS EXPENDED FOR SUCH
ASSISTANCE DURING THE PERIOD OF PRESUMED ELIGIBILITY.
  2. (A) Payment for up to sixty days  of  care  for  services  provided
under  the  medical  assistance  program  shall be made for an applicant
presumed eligible for medical assistance pursuant to  PARAGRAPH  (A)  OF
subdivision  one  of  this  section provided, however, that such payment
shall not exceed sixty-five percent of the rate payable under this title
for services provided by a certified home health agency, long term  home
health care program, hospice or residential health care facility.
  (B)  PAYMENT FOR UP TO NINETY DAYS OF CARE FOR SERVICES PROVIDED UNDER
THE MEDICAL ASSISTANCE PROGRAM SHALL BE MADE FOR AN  APPLICANT  PRESUMED
ELIGIBLE  FOR MEDICAL ASSISTANCE FOR CARE, SERVICES AND SUPPLIES RELATED
TO THE TREATMENT OF A MENTAL ILLNESS PURSUANT TO PARAGRAPH (B) OF SUBDI-
VISION ONE OF THIS SECTION, PROVIDED HOWEVER, THAT  SUCH  PAYMENT  SHALL
NOT  EXCEED ONE HUNDRED PERCENT OF THE RATE PAYABLE UNDER THIS TITLE FOR
SUCH CARE, SERVICES AND SUPPLIES.

S. 4639--A                          3

  (C) Notwithstanding any other provision of law, no  federal  financial
participation  shall  be claimed for services provided to a person while
presumed eligible for medical assistance under this program  until  such
person  has been determined to be eligible for medical assistance by the
local  social  services  district. During the period of presumed medical
assistance eligibility, payment for services provided  persons  presumed
eligible  under this program shall be made from state funds.  [Upon] (I)
IN THE CASE OF COSTS INCURRED FOR A PERSON  PRESUMPTIVELY  ELIGIBLE  FOR
MEDICAL  ASSISTANCE  UNDER  PARAGRAPH  (A)  OF  SUBDIVISION  ONE OF THIS
SECTION, UPON the final determination of eligibility by the local social
services district, payment shall be made for the balance of the cost  of
such  care  and  services  provided to such applicant for such period of
eligibility and a retroactive adjustment shall be made by the department
OF HEALTH to appropriately reflect federal financial  participation  and
the  local share of costs for the services provided during the period of
presumptive eligibility. Such federal and local financial  participation
shall  be the same as that which would have occurred if a final determi-
nation of eligibility for medical assistance had been made prior to  the
provision  of  the  services  provided  during the period of presumptive
eligibility. In instances where an individual who is  presumed  eligible
for  medical assistance is subsequently determined to be ineligible, the
cost for services provided to such individual  shall  be  reimbursed  in
accordance with the provisions of section three hundred sixty-eight-a of
this  article. Provided, however, if upon audit the department OF HEALTH
determines that there are subsequent determinations of ineligibility for
medical assistance in at least fifteen percent of  the  cases  in  which
presumptive  eligibility  has  been  granted  in a local social services
district, payments for services provided to all persons presumed  eligi-
ble  and subsequently determined ineligible for medical assistance shall
be divided equally by the state and the district.
  (II) IN THE CASE OF COSTS INCURRED FOR A PERSON PRESUMPTIVELY ELIGIBLE
FOR MEDICAL ASSISTANCE UNDER PARAGRAPH (B) OF SUBDIVISION  ONE  OF  THIS
SECTION  UPON THE FINAL DETERMINATION OF ELIGIBILITY BY THE LOCAL SOCIAL
SERVICES DISTRICT, PAYMENT SHALL BE MADE FOR THE BALANCE OF THE COST  OF
SUCH  CARE  AND  SERVICES  PROVIDED TO SUCH APPLICANT FOR SUCH PERIOD OF
ELIGIBILITY AND A RETROACTIVE ADJUSTMENT SHALL BE MADE BY THE DEPARTMENT
OF HEALTH TO APPROPRIATELY REFLECT FEDERAL FINANCIAL  PARTICIPATION  AND
THE  LOCAL SHARE OF COSTS FOR THE SERVICES PROVIDED DURING THE PERIOD OF
PRESUMPTIVE ELIGIBILITY. SUCH FEDERAL FINANCIAL PARTICIPATION  SHALL  BE
THE  SAME  AS THAT WHICH WOULD HAVE OCCURRED IF A FINAL DETERMINATION OF
ELIGIBILITY FOR MEDICAL ASSISTANCE HAD BEEN MADE PRIOR TO THE  PROVISION
OF  THE  SERVICES PROVIDED DURING THE PERIOD OF PRESUMPTIVE ELIGIBILITY.
THERE SHALL BE NO LOCAL SHARE IN THE COSTS OF SUCH ASSISTANCE DURING THE
PRESUMPTIVE ELIGIBILITY PERIOD; PROVIDED HOWEVER THAT IF UPON AUDIT  THE
DEPARTMENT OF HEALTH DETERMINES THAT THERE ARE SUBSEQUENT DETERMINATIONS
OF  INELIGIBILITY  FOR MEDICAL ASSISTANCE IN AT LEAST FIFTEEN PERCENT OF
THE CASES IN WHICH PRESUMPTIVE ELIGIBILITY HAS BEEN GRANTED IN  A  LOCAL
SOCIAL  SERVICES DISTRICT, PAYMENTS FOR SERVICES PROVIDED TO ALL PERSONS
PRESUMED ELIGIBLE AND SUBSEQUENTLY  DETERMINED  INELIGIBLE  FOR  MEDICAL
ASSISTANCE  SHALL  BE  REIMBURSED  IN  ACCORDANCE WITH THE PROVISIONS OF
SECTION THREE HUNDRED SIXTY-EIGHT-A OF THIS ARTICLE.
  3. On or before March thirty-first,  [nineteen  hundred  ninety-seven]
TWO  THOUSAND  TWELEVE,  the  department  OF  HEALTH shall submit to the
governor and legislature an evaluation of  the  program,  including  the
program's effects on access, quality and cost of care, and any recommen-
dations for future modifications to improve the program.

S. 4639--A                          4

  S  2.  Subdivision  1  of  section 368-a of the social services law is
amended by adding a new paragraph (aa) to read as follows:
  (AA)  NOTWITHSTANDING ANY INCONSISTENT PROVISION OF LAW, REIMBURSEMENT
BY THE STATE FOR PAYMENTS MADE, WHETHER BY THE DEPARTMENT OF  HEALTH  ON
BEHALF  OF  A  LOCAL  SOCIAL SERVICES DISTRICT PURSUANT TO SECTION THREE
HUNDRED SIXTY-SEVEN-B OF THIS  TITLE  OR  BY  A  LOCAL  SOCIAL  SERVICES
DISTRICT  DIRECTLY,  FOR  MEDICAL  ASSISTANCE FURNISHED TO AN INDIVIDUAL
PRESUMED ELIGIBLE FOR MEDICAL ASSISTANCE UNDER PARAGRAPH (B) OF SUBDIVI-
SION ONE OF SECTION THREE HUNDRED SIXTY-FOUR-I OF THIS TITLE, DURING THE
PRESUMPTIVE ELIGIBILITY PERIOD,  SHALL  BE  MADE  FOR  THE  FULL  AMOUNT
EXPENDED FOR SUCH ASSISTANCE, AFTER FIRST DEDUCTING THEREFROM ANY FEDER-
AL FUNDS PROPERLY RECEIVED OR TO BE RECEIVED ON ACCOUNT OF SUCH EXPENDI-
TURE;  PROVIDED  THAT  IF UPON AUDIT THE DEPARTMENT OF HEALTH DETERMINES
THAT THERE ARE SUBSEQUENT DETERMINATIONS OF  INELIGIBILITY  FOR  MEDICAL
ASSISTANCE IN AT LEAST FIFTEEN PERCENT OF THE CASES IN WHICH PRESUMPTIVE
ELIGIBILITY  HAS  BEEN  GRANTED  IN  A  LOCAL  SOCIAL SERVICES DISTRICT,
PAYMENTS FOR SERVICES PROVIDED TO  ALL  PERSONS  PRESUMED  ELIGIBLE  AND
SUBSEQUENTLY DETERMINED INELIGIBLE FOR MEDICAL ASSISTANCE SHALL BE REIM-
BURSED IN ACCORDANCE WITH PARAGRAPH (D) OF THIS SUBDIVISION.
  S 3. This act shall take effect April 1, 2011.

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Senate Bill S4639

Sponsored By

Archive: Last Bill Status - In Senate Committee Health Committee

Bill Amendments

2009-S4639 - Details

2009-S4639 - Summary

2009-S4639 - Sponsor Memo

2009-S4639 - Bill Text download pdf

2009-S4639A (ACTIVE) - Details

2009-S4639A (ACTIVE) - Summary

2009-S4639A (ACTIVE) - Sponsor Memo

2009-S4639A (ACTIVE) - Bill Text download pdf

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Senate Bill S4639

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Sponsored By

Velmanette Montgomery

Archive: Last Bill Status - In Senate Committee Health Committee

Bill Amendments

2009-S4639 - Details

2009-S4639 - Summary

2009-S4639 - Sponsor Memo

2009-S4639 - Bill Text download pdf

2009-S4639A (ACTIVE) - Details

2009-S4639A (ACTIVE) - Summary

2009-S4639A (ACTIVE) - Sponsor Memo

2009-S4639A (ACTIVE) - Bill Text download pdf

Comments