Editor’s note, the following information was provided in a release from the Legislative and Public Information Bureau.
Warwick, RI – Rep. Patricia A. Serpa (D-Dist 27, West Warwick, Coventry, Warwick) has submitted a bill requiring appeals of nursing home discharges to be scheduled within 30 days of filing.
“Patients have a right to appeal a nursing home discharge, even if the reason for the discharge is non-payment of a bill,” said Serpa. “That wouldn’t be a problem if appeals were scheduled promptly. But they are rarely scheduled promptly, and once they are, patients can get the hearing postponed again and again. Facilities have been forced to provide uncompensated care for up to a year because of the misuse of the appeals process.”
The bill (2015 H-5712) would also limit the patient to one postponement. The postponed hearing would have to be scheduled within 40 days of the filing of the appeal.
In addition to closing loopholes that allow misuse of the appeals process, the legislation would eliminate misuse of the Medicaid application process. As it stands now, nursing facilities are compelled to provide care without payment while Medicaid applications are pending. Sometimes patients — or more likely family members — drag out the application process for weeks or months by failing to respond to questions or submit necessary paperwork, according to Serpa
“Even when it’s perfectly clear that a patient won’t qualify for Medicaid, sometimes an application will be filed in order to take advantage of the period of free care that’s mandated by law,” Serpa said. “More often, patients or their families will just drag their feet in submitting the necessary documents because they know the facilities have no choice but to provide uncompensated care while the application languishes.”
Even though Medicaid pays bills retroactively to the date the application was filed, the delay still causes unwarranted strain. If the application is denied, then the bill is usually uncollectible.
The proposed legislation would permit a nursing facility to inquire whether an application is complete. If it isn’t, the facility would be able to give written notice to the patients and family that the patient will be discharged in 30 days for non-payment unless the application is completed within that time.
The final loophole the bill closes is one that has come about because of Medicaid policy. To protect against applicants transferring their money to a family member in order to be eligible, Medicaid has instituted a five-year financial “look back” for applicants. If the applicant has transferred assets to someone else — typically a family member — in the last five years, then Medicaid will impose a period of ineligibility.
“While this policy protects Medicaid from financial abuses, nursing facilities are still compelled to provide care while the application is pending,” said Serpa. “Even if all documentation has been submitted, the process can take months. If the application is denied due to improper asset transfer, facilities are usually unable to collect payment for the care that was given.”
The bill would permit nursing facilities to recover the costs of such care from the recipient of the transferred assets. Recovery would be limited to the amount of the assets that were transferred. The bill would also allow facilities to collect patient co-pays from anyone who has control over the patient’s income.
The bill is co-sponsored by Representatives K. Joseph Shekarchi (D-Dist. 23, Warwick) and Charlene Lima (D-Dist. 14, Cranston, Providence). It has been referred to the House Finance Committee.
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