Enrolled HB 426: Relating to cooperation of insurers with the Department of Health and Social Services; relating to subrogation, assignment, and lien rights and notices for medical assistance claims; relating to recovery of medical assistance overpayments; relating to asset transfers and income diversion by medical assistance applicants; relating to assets and Medicare enrollment as they affect medical assistance coverage; relating to home and community-based services; relating to medical assistance applications for persons under 21 years of age; requiring a report by the Department of Health and Social Services; and providing for an effective date.
00Enrolled HB 426 01 Relating to cooperation of insurers with the Department of Health and Social Services; 02 relating to subrogation, assignment, and lien rights and notices for medical assistance claims; 03 relating to recovery of medical assistance overpayments; relating to asset transfers and 04 income diversion by medical assistance applicants; relating to assets and Medicare enrollment 05 as they affect medical assistance coverage; relating to home and community-based services; 06 relating to medical assistance applications for persons under 21 years of age; requiring a 07 report by the Department of Health and Social Services; and providing for an effective date. 08 _______________ 09 * Section 1. AS 21.09 is amended by adding a new section to read: 10 Sec. 21.09.240. Cooperation with the Department of Health and Social 11 Services. An insurer, including a pharmacy benefits manager, with respect to medical
01 assistance programs under AS 47.07, shall cooperate with the Department of Health 02 and Social Services to 03 (1) provide, with respect to an individual who is eligible for or is 04 provided medical assistance under AS 47.07, on the request of the department, 05 information to determine during what period the individual or the individual's spouse 06 or dependents may be or may have been covered by the insurer and the nature of the 07 coverage that is or was provided by the insurer, including the name and address of the 08 insurer and the identifying number of the health care insurance plan; 09 (2) accept the department's right of recovery and the assignment to the 10 department of any right of an individual or other entity to payment from the party for 11 an item or service for which payment has been made under AS 47.07; 12 (3) respond to any inquiry by the department regarding a claim for 13 payment for any health care item or service that is submitted not later than three years 14 after the date of the provision of the health care item or service; and 15 (4) agree not to deny a claim submitted by the department solely on the 16 basis of the date of submission of the claim, the type or format of the claim form, or a 17 failure to present proper documentation at the point-of-sale that is the basis of the 18 claim if 19 (A) the claim is submitted by the department within the three- 20 year period beginning on the date on which the item or service was furnished; 21 and 22 (B) any action by the department to enforce its rights with 23 respect to the claim is commenced within six years after the department's 24 submission of the claim. 25 * Sec. 2. AS 47.05.070(b) is amended to read: 26 (b) When [IF] the department provides or pays for medical assistance for 27 injury or illness under this title, the department is subrogated to not more than the 28 part of an insurance payment or other recovery by the recipient that is for 29 medical expenses provided by the department [THE RIGHTS OF THE 30 RECIPIENT OF THAT MEDICAL ASSISTANCE FOR ANY CLAIM ARISING 31 FROM THE INJURY OR ILLNESS AND TO THE PROCEEDS OF AN
01 INSURANCE POLICY COVERING THE INJURY OR ILLNESS TO THE 02 EXTENT OF THE VALUE OF THE MEDICAL ASSISTANCE PROVIDED. A 03 RECIPIENT OF MEDICAL ASSISTANCE OR THE RECIPIENT'S ATTORNEY 04 MUST NOTIFY THE DEPARTMENT IN WRITING OF ANY ACTION OR 05 CLAIM AGAINST A THIRD-PARTY PAYOR IF MEDICAL ASSISTANCE WAS 06 PROVIDED BY THE DEPARTMENT TO TREAT AN INJURY OR ILLNESS FOR 07 WHICH THE THIRD PARTY MAY BE LIABLE]. Notwithstanding the assertion of 08 any action or claim by the recipient of medical assistance, the department may bring 09 an action in the superior court against an alleged third-party payor to recover an 10 amount subrogated to the department for medical assistance provided on behalf of a 11 recipient. 12 * Sec. 3. AS 47.05 is amended by adding new sections to read: 13 Sec. 47.05.071. Duty of a medical assistance recipient. (a) A medical 14 assistance recipient shall cooperate with and assist the department in identifying and 15 providing information concerning third parties who may be liable to pay for care and 16 services received by the recipient under the medical assistance program. 17 (b) As a condition of medical assistance eligibility, a person who applies for 18 medical assistance shall, at the time of application, 19 (1) assign to the department the applicant's rights of payment for care 20 and services from any third party to the extent the department has paid medical 21 assistance for care and services; 22 (2) cooperate with and assist the department in identifying and 23 providing information concerning third parties who may be liable to pay for care and 24 services received by the recipient under the medical assistance program; and 25 (3) agree to make application for all other available third-party 26 resources that may be used to provide or pay for the cost of care or services received 27 by the medical assistance recipient or that may be used to finance reimbursement to 28 the state for the cost of care or services received by the medical assistance recipient; a 29 medical assistance recipient is under no duty to file a civil or other action for the 30 purpose of reimbursing the state for the cost of care or services. 31 Sec. 47.05.072. Duty of attorney for medical assistance recipient. (a) An
01 attorney representing a medical assistance recipient shall notify the attorney general's 02 office. 03 (b) The notice to the attorney general's office required under (a) of this section 04 includes submission of the following: 05 (1) identification of the medical assistance recipient's name, last 06 known address, and telephone number, and the date of the injury or illness giving rise 07 to the action or claim; 08 (2) copies of the pleadings and other papers related to the action or 09 claim; 10 (3) the identification of each potentially liable third party, including 11 that party's name, last known address, and telephone number; 12 (4) the identification of any insurance policy potentially responsive to 13 the action or claim; and 14 (5) a description of the facts and circumstances supporting the action 15 or claim. 16 (c) An attorney who represents a medical assistance recipient shall give the 17 attorney general's office notice within 30 days of any judgment, award, or settlement 18 in an action or claim by the medical assistance recipient to recover damages for an 19 injury or illness that has resulted in the department's providing or paying for medical 20 assistance. 21 (d) If a medical assistance recipient is handling the action or claim on a pro se 22 basis, the provisions of this section apply as if the medical assistance recipient were an 23 attorney representing the medical assistance recipient. 24 Sec. 47.05.073. Judgment, award, or settlement of a medical assistance 25 lien. (a) A medical assistance recipient may not maintain any rights to payment for 26 medical costs as a result of a judgment, award, or settlement of an action or claim for 27 which another person may be legally obligated to pay without first making repayment 28 to the department for costs of past medical assistance services provided to or paid for 29 on behalf of the medical assistance recipient that relate to that action or claim. 30 (b) A medical assistance recipient may not place any payment as a result of a 31 judgment, award, or settlement of an action or claim for which another person was
01 legally obligated to pay because of injury or illness into any trust for the purpose of 02 maintaining public assistance or medical assistance eligibility without first making 03 repayment to the department for costs of past medical assistance services provided to 04 the medical assistance recipient related to that action or claim. 05 (c) The attorney general may only discharge a medical assistance lien under 06 AS 47.05.075 if the discharge complies with federal law. 07 (d) Notwithstanding (a) - (c) of this section, a third-party payor shall have no 08 further liability if it settles or compromises a dispute in good faith and without 09 knowledge that the individual is a recipient of medical assistance. 10 Sec. 47.05.074. Conflict with federal requirements. If any provision of this 11 chapter related to subrogation, assignment, or lien conflicts with federal law 12 concerning the Medicaid program or receipt of federal money to finance the medical 13 assistance program, the provision does not apply to the extent of the conflict. 14 * Sec. 4. AS 47.05.075(d) is amended to read: 15 (d) A perfected lien under this section has priority over all other liens except 16 tax liens and a lien perfected for attorney fees and costs [IMMEDIATELY AFTER 17 A LIEN PERFECTED BY A HOSPITAL, NURSE, OR PHYSICIAN UNDER 18 AS 34.35.450 - 34.35.480]. 19 * Sec. 5. AS 47.05.080(a) is amended to read: 20 (a) Benefit overpayments collected by the department in administering 21 programs under AS 47.07 (medical assistance), AS 47.25.120 - 47.25.300 (general 22 relief), AS 47.25.430 - 47.25.615 (adult public assistance), AS 47.25.975 - 47.25.990 23 (food stamps), and 47.27 (Alaska temporary assistance program) shall be remitted to 24 the Department of Revenue under AS 37.10.050(a), except for overpayments 25 recovered under AS 47.07 that cover the value of services paid from federal 26 sources. 27 * Sec. 6. AS 47.07.020(f) is amended to read: 28 (f) A person may not be denied eligibility for medical assistance under this 29 chapter on the basis of a diversion of income or transfer of assets, whether by 30 assignment or after receipt of the income, into a Medicaid-qualifying trust or annuity 31 that, according to a determination made by the department,
01 (1) has provisions that require that the state will receive all of the trust 02 or annuity assets remaining at the death of the individual, subject to a maximum 03 amount that equals the total medical assistance paid on behalf of the individual; and 04 (2) otherwise meets the requirements of 42 U.S.C. 1396p(d)(4) for a 05 trust and 42 U.S.C. 1396p(c)(1)(F) and 42 U.S.C. 1396p(e)(1) for an annuity. 06 * Sec. 7. AS 47.07.020 is amended by adding new subsections to read: 07 (j) A person may not apply for medical assistance coverage on behalf of a 08 child under 18 years of age who is not emancipated unless the person is the parent or 09 legal guardian of the child or, if the parent or legal guardian can be contacted and 10 consents to the application, the person is 11 (1) an adult caretaker relative who lives with the child and who is 12 exercising care and control of the child; or 13 (2) an employee of the department who is applying on behalf of a child 14 who is in the custody of the department. 15 (k) A child who is unemancipated may apply for medical assistance coverage 16 on the child's own behalf if the parent or legal guardian of the child consents to the 17 application. The department may waive consent under this section if the child 18 expresses a reasonable fear of the child's parent or legal guardian or the department 19 has been unable to contact the parent or legal guardian after the department has made 20 reasonable efforts to do so. If a waiver of consent is granted, the department shall 21 document the reason for the waiver in the child's medical assistance record. 22 (l) Notwithstanding the eligibility provisions under (a) and (b) of this section, 23 a person may not receive medical assistance under this section unless the person first 24 enrolls in the Medicare program under 42 U.S.C. 1395 to the extent that the person is 25 eligible to receive benefits and services under the program. 26 (m) Except as provided in (g) of this section, the department shall impose a 27 penalty period of ineligibility for the transfer of an asset for less than fair market value 28 by an applicant or an applicant's spouse consistent with 42 U.S.C. 1396p(c)(1). 29 (n) Except as provided under 42 U.S.C. 1396p(f) and 42 U.S.C. 1396u-1, the 30 department shall include as an asset for eligibility purposes the value of an applicant's 31 home if the equity value in the home exceeds $500,000 at the time the application is
01 completed. Nothing in this subsection prohibits an applicant from reducing the equity 02 value in the applicant's home by selling the home or by taking out a loan that affects 03 the equity. 04 * Sec. 8. AS 47.07 is amended by adding a new section to read: 05 Sec. 47.07.045. Home and community-based services. (a) The department 06 may provide home and community-based services under a waiver in accordance with 07 42 U.S.C. 1396 - 1396p (Title XIX, Social Security Act), this chapter, and regulations 08 adopted under this chapter, if the department has received approval from the federal 09 government and the department has appropriations allocated for the purpose. To 10 supplement the standards in (b) of this section, the department shall establish in 11 regulation additional standards for eligibility and payment for the services. 12 (b) Before the department may terminate payment for services provided under 13 (a) of this section, 14 (1) the recipient must have had an annual assessment to determine 15 whether the recipient continues to meet the standards under (a) of this section; 16 (2) the annual assessment must have been reviewed by an independent 17 qualified health care professional under contract with the department; for purposes of 18 this paragraph, "independent qualified health care professional" means, 19 (A) for a waiver based on mental retardation or developmental 20 disability, a person who is qualified under 42 CFR 483.430 as a mental 21 retardation professional; 22 (B) for other allowable waivers, a registered nurse licensed 23 under AS 08.68 who is qualified to assess children with complex medical 24 conditions, older Alaskans, and adults with physical disabilities for medical 25 assistance waivers; and 26 (3) the annual assessment must find that the recipient's condition has 27 materially improved since the previous assessment; for purposes of this paragraph, 28 "materially improved" means that a recipient who has previously qualified for a 29 waiver for 30 (A) a child with complex medical conditions, no longer needs 31 technical assistance for a life-threatening condition, and is expected to be
01 placed in a skilled nursing facility for less than 30 days each year; 02 (B) mental retardation or developmental disability, no longer 03 needs the level of care provided by an intermediate care facility for the 04 mentally retarded either because the qualifying diagnosis has changed or the 05 recipient is able to demonstrate the ability to function in a home setting without 06 the need for waiver services; or 07 (C) an older Alaskan or adult with a physical disability, no 08 longer has a functional limitation or cognitive impairment that would result in 09 the need for nursing home placement, and is able to demonstrate the ability to 10 function in a home setting without the need for waiver services. 11 * Sec. 9. AS 47.05.070(e) is repealed. 12 * Sec. 10. The uncodified law of the State of Alaska is amended by adding a new section to 13 read: 14 APPLICABILITY. Sections 2 - 4 of this Act apply to a cause of action related to a 15 subrogation, assignment, or lien by the Department of Health and Social Services that accrues 16 on or after the effective date of secs. 2 - 4 of this Act. 17 * Sec. 11. The uncodified law of the State of Alaska is amended by adding a new section to 18 read: 19 REPORT. The Department of Health and Social Services shall prepare a report and 20 deliver the report to the legislature not later than the first day of the First Regular Session of 21 the Twenty-Fifth Alaska State Legislature. The report must include recommendations for 22 statutory, regulatory, and systematic changes that will 23 (1) assist the department in reducing medical assistance expenditures for 24 services received in mental health treatment facilities located in the state and outside the state, 25 including community mental health facilities, residential psychiatric treatment centers, and 26 substance abuse treatment facilities; 27 (2) enhance and clarify parental financial responsibility for children receiving 28 services provided by mental health treatment facilities located in the state and outside the 29 state, including community mental health facilities, residential psychiatric treatment centers, 30 and substance abuse treatment facilities; and 31 (3) maximize all third-party resources available to pay for the cost of services
01 provided by mental health treatment facilities located in the state and outside the state, 02 including community mental health facilities, residential psychiatric treatment centers, and 03 substance abuse treatment facilities, before a provider seeks reimbursement under AS 47.07. 04 * Sec. 12. The uncodified law of the State of Alaska is amended by adding a new section to 05 read: 06 TRANSITION: REGULATIONS FOR HOME AND COMMUNITY-BASED 07 SERVICES. To the extent that regulations on home and community-based services that are in 08 effect on the effective date of sec. 8 of this Act are not inconsistent with the language and 09 purposes of sec. 8 of this Act, those regulations remain in effect as valid regulations 10 implementing sec. 8 of this Act. 11 * Sec. 13. The uncodified law of the State of Alaska is amended by adding a new section to 12 read: 13 STATE PLAN. (a) The Department of Health and Social Services shall immediately 14 apply for federal approval of a revised state plan to implement the changes to the medical 15 assistance program made under secs. 1 - 7 and 9 of this Act. 16 (b) The commissioner of health and social services shall notify the revisor of statutes 17 of the date of the federal approval of the revised state plan submitted under (a) of this section. 18 * Sec. 14. Sections 8, 12, and 13 of this Act take effect immediately under AS 01.10.070(c). 19 * Sec. 15. Section 1 of this Act takes effect July 1, 2007. 20 * Sec. 16. Except as provided in secs. 14 and 15 of this Act, this Act takes effect July 1, 21 2006, or on the date of notification under sec. 13 of this Act of federal approval of a revised 22 state plan for medical assistance coverage incorporating the changes made by secs. 1 - 7 and 9 23 of this Act, whichever is later.