Resolve, To Expand Eligibility for Presumptive Eligibility Determinations by Hospitals

Sec. 1. Department to amend rules regarding eligibility for presumptive eligibility determinations. Resolved: That the Department of Health and Human Services shall amend its rule Chapter 332: MaineCare Eligibility Manual, Part 18: Presumptive Eligibility Determined by Hospitals to:

1. Expand hospital presumptive eligibility to include eligibility for adults 19 to 64 years of age with income at or below 138% of the federal poverty level;

2. Expand hospital presumptive eligibility to include eligibility for individuals receiving acute care in a hospital who no longer require acute hospital care as certified by a physician but still require medical care that can be provided by a certified home health agency, long-term home health care program, hospice facility or residential health care facility. A qualified individual must reasonably appear to meet all of the criteria, financial and nonfinancial, pending the completion of the full eligibility determination;

3. Provide 20 days for hospitals to submit a copy of a completed MaineCare hospital presumptive eligibility card to the Department of Health and Human Services;

4. Require a qualified hospital to offer to assist individuals determined to be presumptively eligible with completing and submitting full MaineCare application forms; and

5. Require the Department of Health and Human Services to amend the performance standards for qualified hospitals to require that 85% of presumptive eligibility determinations made by hospitals will be found eligible for full MaineCare coverage. Hospitals that do not meet these standards may be subject to presumptive eligibility training facilitated by the Department of Health and Human Services or lose their qualified entity status.

SUMMARY

This resolve directs the Department of Health and Human Services to amend the department's rule Chapter 332: MaineCare Eligibility Manual, Part 18: Presumptive Eligibility Determined by Hospitals regarding expanding hospital presumptive eligibility, hospital presumptive eligibility cards, assisting individuals with MaineCare application forms and performance standards for qualified hospitals to require that 85% of presumptive eligibility determinations made will be found eligible for full MaineCare coverage.