OLR Bill Analysis

SB 233

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

SUMMARY:

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.

EFFECTIVE DATE: July 1, 2012

COMPARISON OF EXISTING LAW AND THE BILL

Table 1 compares the differences between discretionary advances under existing law with automatic advances under the bill.

Table 1: Comparison of Existing Law and 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

BACKGROUND

Related Bill

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.

COMMITTEE ACTION

Human Services Committee

Joint Favorable

Yea

17

Nay

0

(03/13/2012)

Appropriations Committee

Joint Favorable Substitute

Yea

48

Nay

0

(04/13/2012)