HF 706

as introduced - 86th Legislature (2009 - 2010) Posted on 02/09/2010 01:40am

A bill for an act
relating to human services; authorizing certain retroactive payments; authorizing
certain additional elderly waiver services; establishing time frames for
determining medical assistance eligibility; amending Minnesota Statutes 2008,
sections 256B.0645; 256B.0915, by adding a subdivision; 256B.19, by adding a
subdivision.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

Section 1.

Minnesota Statutes 2008, section 256B.0645, is amended to read:

256B.0645 PROVIDER PAYMENTS; RETROACTIVE CHANGES IN
ELIGIBILITY new text begin AND RETROACTIVE PAYMENTS new text end .

new text begin Subdivision 1. new text end

new text begin Retroactive changes in eligibility. new text end

Payment to a provider for
a health care service provided to a general assistance medical care recipient who is
later determined eligible for medical assistance or MinnesotaCare according to section
256L.03, subdivision 1a, for the period in which the health care service was provided, may
be adjusted due to the change in eligibility. This section does not apply to payments made
to health plans on a prepaid capitated basis.

new text begin Subd. 2. new text end

new text begin Retroactive payments. new text end

new text begin Payment to a provider for health care and related
services for a person who has applied for medical assistance waiver services or alternative
care services and who is later determined eligible for the waiver or alternative care
services, for the period in which the services were provided, shall be adjusted to cover all
services eligible under the program retroactively to the date of the recipient's eligibility.
new text end

Sec. 2.

Minnesota Statutes 2008, section 256B.0915, is amended by adding a
subdivision to read:

new text begin Subd. 3i. new text end

new text begin Additional elderly waiver services. new text end

new text begin Based on the determination of the
case manager, in consultation with the provider serving the elderly waiver client, if the
client needs additional services for 120 days or less in order to avoid a premature or
unnecessary nursing home placement, the case manager may authorize additional elderly
waiver services that exceed the client's monthly cost limit. For such clients, the total cost
of all elderly waiver services may not exceed the conversion cost limit for elderly waiver
applicants who reside in a nursing facility as defined in subdivision 3b.
new text end

Sec. 3.

Minnesota Statutes 2008, section 256B.19, is amended by adding a subdivision
to read:

new text begin Subd. 2d. new text end

new text begin Obligation of local agency to process medical assistance applications
within established time frames. new text end

new text begin (a) Except as provided in paragraph (b), when an
individual submits an application for medical assistance and the individual's eligibility is
based on disability or on being age 65 or older, the county must determine the applicant's
eligibility and mail a notice of its decision to the applicant no later than:
new text end

new text begin (1) 60 days from the date of the application for an individual whose eligibility is
based on disability; and
new text end

new text begin (2) 45 days from the date of the application for an individual whose eligibility is
based on being age 65 or older.
new text end

new text begin (b) The county must determine eligibility and mail a notice of its decision within the
time frames in paragraph (a), except in the following circumstances:
new text end

new text begin (1) the county cannot make a determination because, despite reasonable efforts by
the county to communicate what is required, the applicant or an examining physician
delays or fails to take a required action; or
new text end

new text begin (2) there is an administrative or other emergency beyond the county's control.
new text end

new text begin For the purposes of clause (2), a staffing shortage does not constitute an emergency
beyond the county's control. In either of these events, the county must document in the
applicant's case record the reason for delaying a determination of eligibility beyond the
established time frames.
new text end

new text begin (c) The county must not use the time frames in paragraph (a) as a waiting period
before determining eligibility or as a reason for denying eligibility because it has not
determined eligibility within the established time frames.
new text end

new text begin (d) Effective July 1, 2010, unless one of the exceptions listed under paragraph (b)
applies, if a county fails to comply with paragraph (a) and the applicant is ultimately
determined to be eligible for medical assistance, the county is responsible for the entire
cost of medical assistance services provided to the applicant by a nursing or other related
facility and not paid for by federal funds, from and including the first date of eligibility
through the date on which the county mails written notice of its decision on the application.
The applicable facilities shall bill and receive payment directly from the commissioner in
customary fashion, and the commissioner shall deduct any obligation incurred under this
paragraph from the amount due to the local agency under subdivision 1.
new text end

new text begin (e) This subdivision supersedes subdivision 1, clause (2), if both apply to an
applicant.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective the day following final enactment.
new text end