First Substitute S.B. 61

Senator Ed Mayne proposes the following substitute bill:

1 PORTABILITY OF MEDICAL ASSISTANCE
2 FUNDS
3 2007 GENERAL SESSION
4 STATE OF UTAH
5 Chief Sponsor: Ed Mayne
6 House Sponsor: Eric K. Hutchings
7
8 LONG TITLE
9 General Description:
10 This bill amends the Medical Assistance Act to require portability of funds, if
11 necessary, to allow an eligible aged person to receive home or community-based
12 services instead of being placed in, or remaining in, a nursing home.
13 Highlighted Provisions:
14 This bill:
15 . defines terms;
16 . requires the Department of Health to provide home or community-based services to
17 a Medicaid eligible aged person who is a resident of Utah and who qualifies to be
18 placed in, or remain in, a nursing home, if the person applies to receive the services
19 and the services can be provided at a cost to the state that is equal to, or less than,
20 the cost to the state of maintaining the person in a nursing home;
21 . provides for case management in determining the home or community-based
22 services necessary to care for an aged person outside of a nursing home;
23 . provides that the Department of Health may contract with the Department of Human
24 Services or other agencies to make the determinations or provide the services
25 described in this bill;

26 . provides for the portability of funds, that would have been used to place or maintain
27 a person in a nursing home, to fund the home or community-based services for that
28 person if the waiver funds designated for that purpose are inadequate.
29 Monies Appropriated in this Bill:
30 None
31 Other Special Clauses:
32 None
33 Utah Code Sections Affected:
34 ENACTS:
35 26-18-601, Utah Code Annotated 1953
36 26-18-602, Utah Code Annotated 1953
37 26-18-603, Utah Code Annotated 1953
38 26-18-604, Utah Code Annotated 1953
39
40 Be it enacted by the Legislature of the state of Utah:
41 Section 1. Section 26-18-601 is enacted to read:
42 Part 6. Portability of Medical Assistance Funds
43 26-18-601. Title.
44 This part is known as "Portability of Medical Assistance Funds."
45 Section 2. Section 26-18-602 is enacted to read:
46 26-18-602. Definitions.
47 As used in this part:
48 (1) "Aged" means a person 65 years of age or older.
49 (2) "Medical assistance" means financial assistance or other services paid for under the
50 state plan for Medicaid under Title XIX of the Social Security Act.
51 Section 3. Section 26-18-603 is enacted to read:
52 26-18-603. Requirement to provide home or community-based services --
53 Authority to contract.
54 (1) The department shall provide home or community-based services to an aged person
55 if:
56 (a) the aged person:

57 (i) is a resident of this state;
58 (ii) qualifies for medical assistance to fund the aged person's placement or maintenance
59 in a nursing home;
60 (iii) applies for home or community-based services in order to avoid being placed in, or
61 remaining in, a nursing home; and
62 (iv) may be safely and adequately cared for outside of a nursing home; and
63 (b) the cost to the state of providing the home or community-based services described
64 in this Subsection (1) is less than, or equal to, the cost to the state of providing care to the
65 person in a nursing home.
66 (2) If a person qualifies under Subsection (1) for, and chooses to receive, home or
67 community-based services, the department shall, on an ongoing basis:
68 (a) determine the extent of the resources already available to the person;
69 (b) determine the home and community-based services needed to safely and adequately
70 care for the person outside of a nursing home; and
71 (c) arrange for or provide the services described in Subsection (2)(b).
72 (3) The department may contract with the Department of Human Services or other
73 qualified agencies to make the determinations, or provide the services, described in this
74 section.
75 Section 4. Section 26-18-604 is enacted to read:
76 26-18-604. Funding for home or community-based services.
77 (1) Except as provided in Subsection (2), the costs of the home or community-based
78 services described in Section 26-18-603 shall be paid for with the applicable Medicaid
79 waiver funds designated for that purpose.
80 (2) If the funds described in Subsection (1) are not adequate to pay the costs of the
81 home and community-based services described in Section 26-18-603 :
82 (a) the costs shall be paid from the funds that would have been used to pay the costs of
83 maintaining the person in a nursing home; and
84 (b) if the services are provided by, or through a contract with, the Department of
85 Human Services or another agency, the department shall execute a revenue transfer to the
86 Department of Human Services or the other agency in order to comply with Subsection (2)(a).
87 (3) A revenue transfer described in Subsection (2)(b) is exempt from the requirements

88 of Title 63, Chapter 38, Budgetary Procedures Act.