Bill > S413

Introduced Session

This bill requires Medicaid fee-for-service (FFS) coverage of managed long term services and supports when the beneficiary is pending enrollment in a managed care organization (MCO). In doing so, the bill codifies existing Medicaid policy established in Medicaid Newsletter, Vol. 24, No. 14. This policy was prompted due to assisted living programs experiencing difficulties receiving reimbursement for established residents who had been determined financially and clinically eligible for Medicaid services, but who were awaiting enrollment in a MCO. Under this scenario, MCO enrollment may require up to 60 days. In response to this concern, the Division of Medical Assistance and Health Services (DMAHS) in the Department of Human Services implemented a new billing procedure intended to avoid a gap in service payment for Medicaid eligible beneficiaries residing in assisted living programs in which assisted living programs are authorized to request FFS payments during this gap period. Specifically, the bill requires the DMAHS to provide Medicaid coverage via the FFS delivery system for eligible services provided by an assisted living residence, a comprehensive personal care home, an assisted living program, or an adult family care provider to an individual who is determined eligible for the Medicaid Managed Long Term Services and Supports program, but who is pending enrollment in a MCO contracted by the division to provide health care services to Medicaid recipients. FFS coverage provided under the bill shall begin on the date on which the individual is determined clinically and financially eligible for services provided under the Medicaid Managed Long Term Services and Supports program, and shall end on the date on which the individual's enrollment in a Medicaid MCO becomes effective. The bill directs the Commissioner of Human Services to apply for such State plan amendments or waivers as may be necessary to implement the provisions of the bill and to secure federal financial participation for State Medicaid expenditures under the federal Medicaid program.

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Gordon Johnson (D)*, 

Referred to Senate Budget and Appropriations Committee (on 05/12/2022)

Official Document