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H.B. 190

             1     

MEDICAID CHOICE CERTIFICATE

             2     
1999 GENERAL SESSION

             3     
STATE OF UTAH

             4     
Sponsor: Raymond W. Short

             5      AN ACT RELATING TO HEALTH; REQUIRING A MEDICAID APPLICANT FOR NURSING
             6      CARE TO OBTAIN A MEDICAID CHOICE CERTIFICATE AS PART OF THE
             7      PREADMISSION ASSESSMENT FOR THE PURPOSE OF INFORMING THE APPLICANT
             8      OF THE STATE'S MEDICAID CHOICE WAIVER AND THE AVAILABILITY OF HOME
             9      AND COMMUNITY-BASED SERVICES; REQUIRING A LONG-TERM PAMPHLET BE
             10      GIVEN TO A PERSON WHO INQUIRES ABOUT ADMISSION INTO A NURSING CARE
             11      FACILITY; ESTABLISHING DUTIES; MAKING CONFORMING AMENDMENTS; AND
             12      PROVIDING AN EFFECTIVE DATE.
             13      This act affects sections of Utah Code Annotated 1953 as follows:
             14      AMENDS:
             15          62A-3-104, as last amended by Chapter 254, Laws of Utah 1998
             16          62A-3-104.1, as last amended by Chapter 254, Laws of Utah 1998
             17      ENACTS:
             18          26-18-12, Utah Code Annotated 1953
             19      Be it enacted by the Legislature of the state of Utah:
             20          Section 1. Section 26-18-12 is enacted to read:
             21          26-18-12. Medicaid Choice Certificate.
             22          (1) As used in this section:
             23          (a) "Area agency" is as defined in Section 62A-3-101 .
             24          (b) "Division of Aging and Adult Services" means the Division of Aging and Adult
             25      Services within the Department of Human Services.
             26          (c) "Long-term care pamphlet" means a pamphlet prepared by the division and the Division
             27      of Aging and Adult Services that provides information about services available to aged and


             28      high-risk adults through the division, the Division of Aging and Adult Services, and area agencies.
             29          (d) "Medicaid choice certificate" means a certificate signed by an area agency on a form
             30      prepared by the division and the Division of Aging and Adult Services indicating that the Medicaid
             31      applicant, or person acting on the applicant's behalf:
             32          (i) was not interested in the applicant being evaluated or in receiving information in
             33      connection with the state's Medicaid choice waiver; or
             34          (ii) was interested and received:
             35          (A) an evaluation of the applicant from which the area agency determined the services, if
             36      any, that would be available to and appropriate for the applicant; and
             37          (B) information regarding the state's Medicaid choice waiver and the services available to
             38      the applicant through the Division of Aging and Adult Services, the area agency, and other
             39      agencies.
             40          (e) "Preadmission assessment" means the assessment the department requires a nursing
             41      care facility to conduct before seeking authorization to admit a Medicaid applicant.
             42          (f) "Resident" means a Medicaid recipient who resides in a nursing care facility.
             43          (2) (a) The Division of Aging and Adult Services shall distribute long-term care pamphlets
             44      to each nursing care facility in the state that accepts Medicaid applicants.
             45          (b) A nursing care facility that accepts Medicaid applicants shall:
             46          (i) give a long-term care pamphlet to each person who, for the purpose of inquiring into
             47      the admission process for himself or another, visits the facility or requests written materials from
             48      the facility; and
             49          (ii) contact the Division of Aging and Adult Services to request long-term care pamphlets
             50      when more are needed.
             51          (3) (a) The Medicaid choice certificate is a required component of the preadmission
             52      assessment and is subject to the same transmittal requirements.
             53          (b) (i) If a Medicaid applicant has a Medicaid choice certificate at the time of admission,
             54      the nursing home shall transmit the certificate to the department with the other information
             55      required as part of the preadmission assessment.
             56          (ii) If a Medicaid applicant does not have a Medicaid choice certificate when admission
             57      is sought, the nursing care facility shall:
             58          (A) communicate that fact to the local area agency within seven days of the applicant


             59      seeking admission; and
             60          (B) upon request, permit the local area agency to enter the nursing care facility to meet
             61      with the applicant, or person acting on behalf of the applicant, to satisfy the requirements of the
             62      Medicaid choice certificate.
             63          (c) For a Medicaid applicant who did not have a Medicaid choice certificate at the time
             64      of admission, a nursing care facility may proceed with the preadmission assessment upon:
             65          (i) the completion of the Medicaid choice certificate; or
             66          (ii) the failure of the area agency to complete the requirements of the Medicaid choice
             67      certificate within seven days of receiving notice under Subsection (3)(b)(ii)(A), which failure must
             68      be noted on the transmittal application.
             69          (d) After June 30, 1999, a new Medicaid choice certificate must be obtained whenever a
             70      person, who has discontinued his status as a Medicaid resident, reapplies for Medicaid payment
             71      for care at a nursing care facility.
             72          (4) A nursing care facility that:
             73          (a) complies with Subsection (3), including Subsection (3)(c)(ii), is eligible to receive
             74      Medicaid reimbursement for care provided to the applicant from the time of admission; and
             75          (b) fails to comply with Subsection (3) is only eligible to receive Medicaid reimbursement
             76      for care to the applicant that occurred after the nursing home facility transmitted a completed
             77      Medicaid choice certificate to the department on behalf of the applicant.
             78          (5) (a) Nothing in this section may be construed as requiring a Medicaid resident to obtain
             79      a Medicaid choice certificate to remain eligible for Medicaid if the resident:
             80          (i) was receiving care on June 30, 1999; or
             81          (ii) is transferred between health care facilities, as defined in Section 26-21-2 , and the
             82      transfer does not result in the resident needing to reapply for Medicaid.
             83          (b) Notwithstanding Subsection (5)(a), a person is subject to the requirements of
             84      Subsection (3) if that person:
             85          (i) applies for Medicaid payment for care at a nursing care facility after June 30, 1999; or
             86          (ii) discontinues his status as a Medicaid resident after June 30, 1999, and then reapplies
             87      for Medicaid payment for care at a nursing care facility.
             88          Section 2. Section 62A-3-104 is amended to read:
             89           62A-3-104. Authority of division.


             90          (1) The division is the sole state agency, as defined by the Older Americans Act of 1965,
             91      42 U.S.C. 3001 et seq., to serve as an effective and visible advocate for the aging and adult
             92      population of this state, to develop and administer a state plan under the policy direction of the
             93      board, and to take primary responsibility for state activities relating to provisions of the Older
             94      Americans Act of 1965, as amended.
             95          (2) (a) The division has authority to designate planning and service areas for the state, and
             96      to designate an area agency on aging within each planning and service area to design and
             97      implement a comprehensive and coordinated system of services and programs for the aged within
             98      appropriations from the Legislature.
             99          (b) Designation as an area agency on aging may be withdrawn:
             100          (i) upon request of the area agency on aging; or
             101          (ii) upon noncompliance with the provisions of the Older Americans Act of 1965, 42
             102      U.S.C. 3001 et seq., the federal regulations enacted under that act, the provisions of this chapter,
             103      or the rules, policies, or procedures established by the division.
             104          (3) (a) The division has the authority to designate planning and service areas for the state
             105      and to designate an area agency on high risk adults within each planning and service area in
             106      accordance with Subsection (3)(b) to design and implement a comprehensive and coordinated
             107      system of case management and programs for high risk adults within appropriations from the
             108      Legislature.
             109          (b) Before October 1, 1998, the division shall designate as the area agency on high risk
             110      adults in a planning and service area:
             111          (i) the area agency on aging that operates within the same geographic area if that agency
             112      has requested, before July 1, 1998, to expand its current contract with the division to include the
             113      responsibility of:
             114          (A) being the area agency on high risk adults; or
             115          (B) operating the area agency on high risk adults through joint cooperation with one or
             116      more existing area agencies on aging without reducing geographical coverage in any service area;
             117      or
             118          (ii) a public or private nonprofit agency or office if the area agency on aging that operates
             119      within the same geographic area has not made a request in accordance with Subsection (3)(b).
             120          (c) Area agencies on high risk adults shall be in operation before July 1, 1999. The


             121      division's efforts to establish area agencies on high risk adults shall start with counties with a
             122      population of more than 150,000 people.
             123          (d) Designation as an area agency on high risk adults may be withdrawn:
             124          (i) upon request by the area agency; or
             125          (ii) upon noncompliance with state or federal laws, or rules, policies, or procedures
             126      established by the division.
             127          (4) The division has authority to receive and distribute state and federal funds for the
             128      division's programs and services to the aging and adult populations of the state.
             129          (5) The division has authority to establish, either directly or by contract, programs of
             130      advocacy, monitoring, evaluation, technical assistance, and public education to enhance the quality
             131      of life for aging and adult citizens of the state.
             132          (6) In accordance with the rules of the division and Title 63, Chapter 56, Utah Procurement
             133      Code, the division may:
             134          (a) contract with the governing body of an area agency to provide a comprehensive
             135      program of services; and
             136          (b) contract with public and private entities for special services.
             137          (7) The division has authority to provide for collection, compilation, and dissemination
             138      of information, statistics, and reports relating to issues facing aging and adult citizens.
             139          (8) The division has authority to prepare and submit reports regarding the operation and
             140      administration of the division to the department, the Legislature, and the governor, as requested.
             141          (9) The division shall:
             142          (a) implement and enforce policies established by the board governing all aspects of the
             143      division's programs for aging and adult persons in the state;
             144          (b) monitor and evaluate programs provided by or under contract with the division, area
             145      agencies, and any entity that receives funds from an area agency to ensure compliance with all
             146      applicable state and federal statutes, policies, and procedures;
             147          (c) examine expenditures of public funds;
             148          (d) withhold funds from programs based on contract noncompliance;
             149          (e) review and approve plans of area agencies in order to ensure compliance with division
             150      policies and to ensure a statewide comprehensive program;
             151          (f) promote and establish cooperative relationships with state and federal agencies, social


             152      and health agencies, education and research organizations, and other related groups in order to
             153      further programs for aging and adult persons, and prevent duplication of services;
             154          (g) advocate for the aging and adult populations; and
             155          (h) promote and conduct research on the problems and needs of aging and adult persons,
             156      and submit recommendations for changes in policies, programs, and funding to the governor and
             157      the Legislature.
             158          (10) As provided for in Section 26-18-12 , the division shall:
             159          (a) prepare the Medicaid choice certificate and long-term pamphlet in conjunction with
             160      the Division of Health Care Financing within the Department of Health; and
             161          (b) distribute long-term pamphlets to nursing care facilities that accept Medicaid
             162      applicants.
             163          Section 3. Section 62A-3-104.1 is amended to read:
             164           62A-3-104.1. Powers and duties of area agencies.
             165          (1) An area agency that provides services to the aged, high risk adults, or both shall within
             166      its respective jurisdiction:
             167          (a) advocate by monitoring, evaluating, and providing input on all policies, programs,
             168      hearings, and levies that affect those persons;
             169          (b) design and implement a comprehensive and coordinated system of services within a
             170      designated planning and service area;
             171          (c) conduct periodic reviews and evaluations of needs and services;
             172          (d) prepare and submit to the division plans for funding and service delivery for services
             173      within the designated planning and service area;
             174          (e) establish, either directly or by contract, programs licensed under Chapter 2 of this title;
             175          (f) appoint an area director, prescribe his duties, and provide adequate and qualified staff
             176      to carry out the area plan described in Subsection (1)(d);
             177          (g) establish rules not contrary to policies of the board and rules of the division, regulating
             178      local services and facilities;
             179          (h) operate other services and programs funded by sources other than those administered
             180      by the division;
             181          (i) establish mechanisms to provide direct citizen input, including an area agency advisory
             182      council with a majority of members who are eligible for services from the area agency;


             183          (j) establish fee schedules; [and]
             184          (k) satisfy the requirements of the Medicaid choice certificate, as set forth in Section
             185      26-18-12 , within seven days of receiving notification of a Medicaid applicant from a nursing care
             186      facility; and
             187          [(k)] (l) comply with the requirements and procedures of Title 11, Chapter 13, Interlocal
             188      Cooperation Act, and with the requirements and procedures of Title 51, Chapter 2.
             189          (2) Before disbursing any public funds, an area agency shall require that all entities
             190      receiving any public funds agree in writing that:
             191          (a) the division may examine the entity's program and financial records; and
             192          (b) the auditor of the local area agency may examine and audit the entity's program and
             193      financial records, if requested by the local area agency.
             194          (3) Local area agencies may receive property, grants, gifts, supplies, materials, including
             195      any benefit derived therefrom, and contributions for the purpose of providing services pursuant to
             196      this part. If those gifts are conditioned upon their use for a specified service or program, they shall
             197      be so used.
             198          (4) (a) Area agencies shall award all public funds in compliance with the requirements of
             199      Title 63, Chapter 56, Utah Procurement Code, or with a county procurement ordinance that
             200      requires similar procurement procedures.
             201          (b) If all initial bids on a project are rejected, the area agency shall publish a new invitation
             202      to bid. If no satisfactory bid is received by the area agency when the bids received from the second
             203      invitation are opened, the area agency may execute a contract without requiring competitive
             204      bidding.
             205          (c) An area agency need not comply with the procurement provisions of this section when
             206      it disburses public funds to other governmental entities. For purposes of this Subsection (4)(c),
             207      "governmental entity" means any political subdivision or institution of higher education of the
             208      state.
             209          (d) Contracts awarded by an area agency shall be for a fixed amount and limited period.
             210      Contracts may be modified due to changes in available funding for the same contract purpose
             211      without competition.
             212          (5) Local area agencies shall comply with all applicable state and federal statutes, policies,
             213      audit requirements, and any directives resulting from those audits.


             214          Section 4. Effective date.
             215          This act takes effect on July 1, 1999.




Legislative Review Note
    as of 12-3-98 7:45 AM


A limited legal review of this legislation raises no obvious constitutional or statutory concerns.

Office of Legislative Research and General Counsel


Committee Note

The Health and Human Services Interim Committee recommended this bill.


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