AN ACT CONCERNING ADVANCE PAYMENTS TO NURSING FACILITIES FOR UNCOMPENSATED CARE.

AN ACT CONCERNING ADVANCE PAYMENTS TO NURSING FACILITIES FOR UNCOMPENSATED CARE.

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.

The law requires the commissioner to take prudent measures to assure that advances are not given to nursing homes that are at risk of bankruptcy or insolvency. The commissioner may sign security agreements ensuring repayments.

The bill requires the advance payments to facilities when (1) at least one resident has waited more than one year for an eligibility determination or (2) the facility has not received payment within 30 days after approval of a resident's Medicaid application. Under the bill, the commissioner must (1) limit these payments to 50% of the estimated cost of caring for the resident and (2) begin, within 30 days of the nursing's home's receipt of the past-due Medicaid payment, to recoup the department's advances by reducing payments the facility would otherwise have received. Unlike discretionary payments, the commissioner is not required to accept receipts in repayment for automatic advances.

Table 1 compares the differences between discretionary advances under existing law with automatic advances under 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 one year or (b) the facility has not been paid within 30 days of an approved application
Payment Amount	100% of estimated costs	50% 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

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.