SP0494, LD 1424, item 1, An Act To Amend the Laws Governing MaineCare Eligibility Determination For Applicants To Nursing Homes

An Act To Amend the Laws Governing MaineCare Eligibility Determination For Applicants To Nursing Homes

Be it enacted by the People of the State of Maine as follows:

Sec. 1. 22 MRSA §3174-I, sub-§1-C is enacted to read:

1-C. Processing of initial applications for eligibility. Initial applications for eligibility under this section must be processed in accordance with this subsection.

A. The department shall provide timely and adequate notice to the applicant, the applicant's guardian or conservator and the facility in which the applicant resides or seeks to reside in any circumstance if the department is not able to make a decision on eligibility due to inconclusive or conflicting information or other deficiencies in the application. The notice must provide a period of not less than 20 business days for the recipient or recipients of the notice to respond. The facility in which the applicant resides or seeks to reside shall provide the department with written authorization from the applicant or the applicant's guardian or conservator to receive such information. The department shall notify the applicant, the applicant's guardian or conservator and the facility in which the applicant resides or seeks to reside of the application questions that remain unanswered, the additional information that is required and any issues that need to be resolved in order to determine eligibility. The department shall, in a timely fashion, provide to the applicant, the applicant's guardian or conservator and the facility in which the applicant resides or seeks to reside copies of all communications required under this paragraph.

B. The department shall provide to the applicant and the applicant's guardian or conservator a period of not less than 20 business days in which to respond to questions and to provide any necessary information, and the facility in which the applicant resides or seeks to reside may assist the applicant and the applicant's guardian or conservator in providing responses and information. The department, when appropriate, shall extend the time frame for receipt of responses and information.

C. After contacting the applicant or the applicant's guardian or conservator and the facility in which the applicant resides or seeks to reside and after a period of not less than 30 days has elapsed following the department's request for information under paragraph B, if the department cannot determine that eligibility exists, the department may deny assistance. If the necessary information and verifications are provided at a later date, the department shall use that information to update and supplement the previous application, and the applicant may not be required to submit a new application.

1-D. Notice of annual and other MaineCare reviews. The department shall provide advance notice of not less than 20 days of reviews for annual determinations and other periodic redeterminations of MaineCare eligibility to a recipient of MaineCare, the recipient's guardian or conservator and the facility in which the recipient resides or seeks to reside. The department shall work cooperatively with the recipient, the recipient's guardian or conservator and the facility in which the recipient resides or seeks to reside to timely secure any information and documentation needed to properly carry out a fair, timely and proper review, which must be completed within 30 business days of receiving any requested information. The department shall, in a timely fashion, provide to the recipient, the recipient's guardian or conservator and the facility in which the recipient resides or seeks to reside copies of all communications required under this subsection.

summary

This bill amends the laws governing MaineCare eligibility determinations for applicants to nursing homes. It directs the Department of Health and Human Services to provide timely and adequate notice to both the applicant and the facility in which the individual resides or seeks to reside if the department is unable to make a decision of eligibility due to inconclusive or conflicting information or other deficiencies in the application and requires the department to notify the applicant and the affected facility of the additional information required. It requires that the provision of copies of all communications be timely provided to the facility as well as the applicant, and that the applicant be provided a reasonable amount of time to respond and provide information. It directs the department to extend the time frame for responses in appropriate circumstances. If an application is denied and if necessary information is later provided, the additional information must be used to update and supplement the prior application, and the applicant need not submit a new application.

The bill also requires the department to provide timely advance notice of reviews for annual determinations and other periodic redeterminations of MaineCare eligibility to a MaineCare recipient and the facility in which the recipient resides or seeks to reside. The bill requires the department to provide to the recipient and the facility in which the recipient resides or seeks to reside copies of communications.

SP0494 LD 1424	Session - 128th Maine Legislature		LR 1169 Item 1
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