CSHB 162(HES): "An Act relating to mental health services and programs; relating to liability for payment for mental health evaluation and treatment services; and providing for an effective date."
00CS FOR HOUSE BILL NO. 162(HES) 01 "An Act relating to mental health services and programs; relating to liability for 02 payment for mental health evaluation and treatment services; and providing for 03 an effective date." 04 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF ALASKA: 05 * Section 1. AS 47.30.910 is repealed and reenacted to read: 06 Sec. 47.30.910. Liability for expense of placement in a facility. (a) A 07 patient, the patient's spouse, or the patient's parent if the patient is under 18 years of 08 age shall pay the charges for the care, transportation, and treatment of the patient when 09 the patient is hospitalized under AS 47.30.670 - 47.30.915 at a state-operated facility, 10 an evaluation facility, or a designated treatment facility providing services under 11 AS 47.30.670 - 47.30.915. The patient, the patient's spouse, or the patient's parent if 12 the patient is under 18 years of age shall make arrangements with a state-operated 13 facility, an evaluation facility, or a designated treatment facility for payment of 14 charges, including providing income information necessary to determine eligibility for
01 benefits under AS 47.31. Charges assessed for services provided under AS 47.30.670 - 02 47.30.915 when a patient is hospitalized at a state-operated facility may not exceed the 03 actual cost of care and treatment. The department may, when assessing charges for 04 services provided at a state-operated facility, consider the ability to pay of a patient, 05 a patient's spouse, or a patient's parent if the patient is under 18 years of age. In order 06 to impose liability for a patient's cost of care at a state-operated facility, the department 07 shall issue an order for payment within six months after the date on which the charge 08 was incurred. The order remains in effect unless modified by subsequent court order 09 or department order. The department may not impose liability for a patient's cost of 10 care at a state-operated facility if the patient would otherwise meet the eligibility 11 criteria, other than location of service, in AS 47.31.010. 12 (b) The department, the evaluation facility, or a designated treatment facility 13 shall make reasonable efforts to determine whether the patient, the patient's spouse, or 14 the patient's parent if the patient is under 18 years of age has a third-party payor or has 15 the available means to substantially contribute to the payment of charges, or whether 16 the patient is eligible for assistance under AS 47.31. 17 (c) If a patient is hospitalized at a state-operated facility and the patient, the 18 patient's spouse, or the patient's parent if the patient is under 18 years of age fails to 19 provide to the department information necessary to determine whether there is a third- 20 party payor or available means to substantially contribute to the payment of charges, or 21 whether the patient would, if not hospitalized at a state-operated facility, be eligible for 22 assistance under AS 47.31, the department may issue an administrative order imposing full 23 liability for the patient's actual cost of care on the patient, the patient's spouse, or the patient's 24 parent if the patient is under 18 years of age. The order remains in effect unless modified by 25 subsequent court order or department order. 26 (d) If a person who is hospitalized under AS 47.30.670 - 47.30.915 at an 27 evaluation facility or a designated treatment facility cannot pay or substantially 28 contribute to the payment of charges described under this section, the patient may 29 apply for assistance under AS 47.31. 30 (e) The department may charge or accept money or property from a person for 31 the care or treatment of a patient at a state-operated facility.
01 (f) Money paid by the patient or on the patient's behalf to the department 02 under this section shall be deposited in the general fund. 03 * Sec. 2. AS 47.30.915(4) is amended to read: 04 (4) "designated treatment facility" or "treatment facility" means a 05 hospital, clinic, institution, center, or other health care facility that has been designated 06 by the department for the treatment or rehabilitation of mentally ill persons under 07 AS 47.30.670 - 47.30.915 [AND FOR THE RECEIPT OF THESE PERSONS BY 08 COURT-ORDERED COMMITMENT,] but does not include correctional institutions; 09 * Sec. 3. AS 47 is amended by adding a new chapter to read: 10 Chapter 31. Mental Health Treatment Assistance Program. 11 Sec. 47.31.005. Applicability. This chapter applies only to those patients who 12 have received evaluation or treatment at an evaluation facility or a designated treatment 13 facility that is not a state-operated hospital. 14 Sec. 47.31.010. Eligibility for assistance. (a) The department shall provide 15 financial assistance under this chapter to a patient who 16 (1) does not have the available means to pay or substantially contribute 17 to the payment of charges assessed by a facility; 18 (2) has no other third party to pay for the evaluation or treatment 19 provided under AS 47.30; and 20 (3) meets the criteria in this chapter. 21 (b) To be eligible for assistance under this chapter, a patient must have 22 (1) been admitted for inpatient evaluation or treatment at an evaluation 23 facility or a designated treatment facility other than a state-operated hospital after 24 either 25 (A) an involuntary commitment under AS 47.30.700 - 26 47.30.915; or 27 (B) a voluntary admission chosen by the patient after a 28 determination by the patient's treating physician that the patient meets the 29 involuntary commitment criteria in AS 47.30.700 - 47.30.915 and that 30 involuntary commitment proceedings would be initiated if the patient did not 31 choose to be admitted voluntarily; and
01 (2) a gross monthly household income that does not exceed 185 percent 02 of the federal poverty guideline for this state for the calendar month in which service 03 was provided. 04 Sec. 47.31.015. Application for assistance. (a) To receive assistance under 05 this chapter, a patient or a patient's legal representative must apply in writing on a 06 form provided by the department. A patient must apply for assistance within 180 days 07 after the date of discharge from the facility. 08 (b) A patient is considered to have applied for assistance under (a) of this 09 section if the evaluation facility or designated treatment facility notifies the department 10 on a form provided by the department that there is good cause to believe that the 11 patient would be eligible for assistance under this chapter and 12 (1) the patient, the patient's spouse, or the patient's parent if the patient 13 is under 18 years of age failed within 150 days after the date of discharge from the 14 facility to make arrangements to pay the evaluation facility or designated treatment 15 facility; or 16 (2) the patient lacks the mental capacity to apply for benefits under this 17 chapter. 18 (c) A patient who applies or is considered to have applied for assistance under 19 this chapter, the patient's spouse, the patient's parent if the patient is under 18 years 20 of age, or a person in the patient's household shall release records and information to 21 the department necessary to verify eligibility for the assistance. 22 (d) If a patient, the patient's spouse, the patient's parent if the patient is under 23 18 years of age, or a person in the patient's household fails to provide records and 24 information to the department necessary to verify eligibility, the department may issue 25 an administrative order imposing full liability for the patient's cost of care and 26 treatment to the evaluation facility or designated treatment facility. 27 Sec. 47.31.020. Decision on eligibility. (a) Within 30 days after receiving 28 a complete application, the department shall give notice in writing of an eligibility 29 determination to the patient or the patient's legal representative. If the patient is found 30 ineligible, the notice must contain the reason for the denial and an explanation of the 31 patient's right to an administrative appeal of the denial.
01 (b) The department shall provide a copy of the notice of eligibility or 02 ineligibility to the facility at which the patient was treated. 03 Sec. 47.31.025. Eligible services; rates. The department shall identify the 04 type and level of services for which assistance is available under this chapter. An 05 evaluation facility or a designated treatment facility shall be reimbursed at a rate 06 established by the department that is equivalent to the Medicaid rate for that facility 07 at the time service was rendered as determined under AS 47.07.070. 08 Sec. 47.31.030. Payment. If the department determines that a patient is 09 eligible for assistance under this chapter, the department shall provide for payment of 10 assistance directly to the facility. By endorsing the check received from the 11 department or authorizing the endorsement by the facility's agent, the facility certifies 12 that the claim for which the check is payment is true and accurate unless written notice 13 of an error is sent to the department by the facility within 30 days after the date the 14 check is presented by the facility for payment. 15 Sec. 47.31.035. Appeals. (a) A patient or the patient's legal representative 16 may appeal a denial of assistance by sending written notice of objection to the 17 department within 30 days after the date of the notice of denial. The written notice 18 of objection must include an explanation of the reasons for the objection and may 19 include documentation supporting the objection. AS 44.62 (Administrative Procedure 20 Act) does not apply to the appeal. 21 (b) The commissioner or the commissioner's designee shall review the notice 22 of objection and issue a decision within 90 days after its receipt. The commissioner 23 or the commissioner's designee may request additional information on the appeal from 24 either the patient, the evaluation facility or designated treatment facility, or department 25 staff. A request for additional information suspends the time period for the appeal 26 until the department determines that the additional information has been received. If 27 more than 180 days have passed from the date of submission of a notice of appeal and 28 the additional information requested by the commissioner or the commissioner's 29 designee has not been received from a patient, the evaluation facility, the designated 30 treatment facility, or the department, the appeal shall be considered denied. 31 (c) The decision on the appeal under (b) of this section, including an appeal
01 denied for failure to submit additional information, is a final agency decision and may 02 be appealed to the superior court under the Alaska Rules of Appellate Procedure. 03 Sec. 47.31.900. Regulations. The department shall, after consultation with the 04 Alaska Mental Health Trust Authority, adopt regulations to interpret or implement this 05 chapter. 06 Sec. 47.31.990. Definitions. In this chapter, unless the context otherwise 07 requires, 08 (1) "commissioner" means the commissioner of health and social 09 services; 10 (2) "department" means the Department of Health and Social Services; 11 (3) "designated treatment facility" has the meaning given in 12 AS 47.30.915; 13 (4) "evaluation facility" means a health care facility that has been 14 designated by the department to perform the evaluations described in AS 47.30.670 - 15 47.30.915, including a facility licensed under AS 18.20.020 or operated by the federal 16 government; 17 (5) "gross monthly household income" means all earned or unearned 18 income from any source of a member of the patient's household; 19 (6) "household" means a patient and each person 20 (A) residing with the patient; and 21 (B) related to the patient by marriage or other legal relationship 22 giving rise to a duty of support and maintenance; 23 (7) "mental illness" has the meaning given in AS 47.30.915. 24 * Sec. 4. APPLICABILITY. This Act applies to expenses incurred for mental health 25 services received on or after the effective date of this Act. 26 * Sec. 5. This Act takes effect immediately under AS 01.10.070(c).