OLR BILL ANALYSIS
AN ACT CONCERNING ADVANCE PAYMENTS TO NURSING FACILITIES FOR UNCOMPENSATED CARE.
SUMMARY:
By law, the Department of Social Services (DSS) commissioner may make advance Medicaid payments to skilled nursing facilities (licensed chronic and convalescent nursing homes or rest homes with nursing supervision) after consulting with the Office of Policy and Management secretary. The purpose of these payments is to reduce the impact of providing free (uncompensated) care to residents whose Medicaid eligibility determinations or initial payments are delayed.
This bill eliminates the commissioner's discretion and instead requires him to make advance payments to facilities on request when (1) at least one resident has waited more than 90 days for an eligibility determination or (2) the facility has not received payment within 30 days after approval of a resident's Medicaid application. The commissioner retains discretion to deny requests from other nursing homes.
Under the bill, he must (1) limit automatic advance payments at 90% of the estimated amount due and (2) within 30 days after receipt of the Medicaid payment, recover advances from facilities that automatically qualified for them by reducing future payments. Unlike discretionary payments, the commissioner is not required to accept receipts in repayment for automatic advances.
EFFECTIVE DATE: July 1, 2012
COMPARISON OF EXISTING LAW AND THE BILL
Table 1 compares the differences between discretionary advances under existing law with automatic advances under the bill.
Table 1: Comparison of Existing Law and the Bill
Features |
Existing Law |
Bill |
Approval Process |
Discretionary DSS must (a) consult the Office of Policy and Management secretary and (b) take prudent measures to assure that requesting facilities are not at risk for bankruptcy or insolvency |
Automatic if : (a) at least one resident's Medicaid application has been pending for more than 90 days or (b) the facility has not been paid within 30 days of an approved application |
Payment Amount |
100% of estimated costs |
90% of estimated costs |
Maximum Period Covered |
Most recent two months |
Not specified |
Repayment Deadline |
Within 90 days of receipt of advance |
Within 30 days of (a) Medicaid application approval and (b) facility's receipt of Medicaid payment |
Payment Protections |
DSS may execute security agreements to assure repayment |
None specified |
BACKGROUND
Related Bill
sHB 5283, reported favorably by the Human Services Committee, permits DSS to waive the law's advance payment limits and repayment deadlines for nursing homes under receivership.
COMMITTEE ACTION
Human Services Committee
Joint Favorable
Yea |
17 |
Nay |
0 |
(03/13/2012) |