00                       CS FOR HOUSE BILL NO. 426(FIN)                                                                    
01 "An Act relating to cooperation of insurers with the Department of Health and Social                                    
02 Services; relating to subrogation, assignment, and lien rights and notices for medical                                  
03 assistance claims; relating to recovery of medical assistance overpayments; relating to                                 
04 asset transfers by medical assistance applicants; relating to medical assistance eligibility;                           
05 relating to home and community-based services; relating to medical assistance coverage                                  
06 for persons under 21 years of age; requiring a report by the Department of Health and                                   
07 Social Services; and providing for an effective date."                                                                  
08 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF ALASKA:                                                                
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, shall coordinate benefits                          
12       with medical assistance programs under AS 47.07, and shall cooperate with the                                     
13       Department of Health and Social Services by providing                                                             
01                 (1)  requested information on an insured who is receiving public                                        
02       assistance and on claims made by the department as long as the department agrees to                               
03       keep the information confidential;                                                                                
04                 (2)  prompt verification of an assignment to and right of recovery for                                  
05       the department; and                                                                                               
06                 (3)  a claim period of at least 36 months from the date of service for                                  
07       eligible claims made by the department.                                                                           
08    * Sec. 2. AS 47.05.070(b) is amended to read:                                                                      
09            (b)  If the department provides or pays for medical assistance for injury or                                 
10       illness under this title, the department is subrogated to the rights of the recipient of that                     
11       medical assistance for any claim arising from the injury or illness and to the proceeds                           
12       of an insurance policy covering the injury or illness to the extent of the value of the                           
13       medical assistance provided. [A RECIPIENT OF MEDICAL ASSISTANCE OR THE                                            
14       RECIPIENT'S ATTORNEY MUST NOTIFY THE DEPARTMENT IN WRITING                                                        
15       OF ANY ACTION OR CLAIM AGAINST A THIRD-PARTY PAYOR IF                                                             
16       MEDICAL ASSISTANCE WAS PROVIDED BY THE DEPARTMENT TO TREAT                                                        
17       AN INJURY OR ILLNESS FOR WHICH THE THIRD PARTY MAY BE LIABLE.]                                                    
18       Notwithstanding the assertion of any action or claim by the recipient of medical                                  
19       assistance, the department may bring an action in the superior court against an alleged                           
20       third-party payor to recover an amount subrogated to the department for medical                                   
21       assistance provided on behalf of a recipient.                                                                     
22    * Sec. 3. AS 47.05 is amended by adding new sections to read:                                                      
23            Sec. 47.05.071. Duty of a medical assistance recipient. (a) A medical                                      
24       assistance recipient shall cooperate with and assist the department in identifying and                            
25       providing information concerning third parties who may be liable to pay for care and                              
26       services received by the recipient under the medical assistance program.                                          
27            (b)  A medical assistance recipient may not compromise or resolve an action or                               
28       claim seeking payment for or related to an injury or illness for which care or services                           
29       were provided or received under the medical assistance program against an insurer,                                
30       entity, or other person without first providing notice to the attorney general's office of                        
31       the facts and circumstances giving rise to the action or claim and the asserted basis for                         
01       supporting the action or claim.                                                                                   
02            (c)  A medical assistance recipient may not receive payment from any source                                  
03       on account of or related to care or services for which medical assistance was received                            
04       unless the recipient has received written consent of the attorney general's office and                            
05       has paid the department reimbursement of the amount of medical assistance provided                                
06       or paid.                                                                                                          
07            (d)  As a condition of medical assistance eligibility, a person who applies for                              
08       medical assistance shall, at the time of application,                                                             
09                 (1)  assign to the department the applicant's rights of payment for care                                
10       and services from any third party;                                                                                
11                 (2)  cooperate with and assist the department in identifying and                                        
12       providing information concerning third parties who may be liable to pay for care and                              
13       services received by the recipient under the medical assistance program;                                          
14                 (3)  assign to the department the applicant's right to the applicant's                                  
15       permanent fund dividend and agree to sign a new assignment each year; the                                         
16       department shall use the assignment obtained under this paragraph to obtain                                       
17       reimbursement or enforce repayment when a recipient does not pay to the state                                     
18       reimbursement received from a third party for care or services provided or paid by the                            
19       medical assistance program or fails to satisfy a lien perfected under AS 47.05.075; and                           
20                 (4)  agree to make application for all other available third-party                                      
21       resources that may be used to provide or pay for the cost of care or services received                            
22       by the medical assistance recipient or that may be used to finance reimbursement to                               
23       the state for the cost of care or services received by the medical assistance recipient.                          
24            Sec. 47.05.072. Duty of attorney for medical assistance recipient. (a) Before                              
25       pursuing an action or claim on behalf of a medical assistance recipient for care or                               
26       services for an injury or illness for which medical assistance was received, an attorney                          
27       representing the medical assistance recipient shall notify the attorney general's office.                         
28            (b)  The notice to the attorney general's office required under (a) of this section                          
29       includes submission of the following:                                                                             
30                 (1)  identification of the medical assistance recipient's name, last                                    
31       known address, and telephone number, and the date of the injury or illness giving rise                            
01       to the action or claim;                                                                                           
02                 (2)  copies of the pleadings and other papers related to the action or                                  
03       claim;                                                                                                            
04                 (3)  the identification of each potentially liable third party, including                               
05       that party's name, last known address, and telephone number;                                                      
06                 (4)  the identification of any insurance policy potentially responsive to                               
07       the action or claim; and                                                                                          
08                 (5)  a description of the facts and circumstances supporting the action                                 
09       or claim.                                                                                                         
10            (c)  An attorney who represents a medical assistance recipient shall give the                                
11       attorney general's office 30 days' notice before any judgment, award, or settlement                               
12       may be satisfied in an action or claim by the medical assistance recipient to recover                             
13       damages for an injury or illness that has resulted in the department's providing or                               
14       paying for medical assistance.                                                                                    
15            (d)  An attorney representing a medical assistance recipient who has received                                
16       care or services for the injury or illness provided or paid for by the medical assistance                         
17       program shall maintain all proceeds paid in connection with the action or claim in a                              
18       trust account or deposit the proceeds into the registry of the court until any lien                               
19       perfected by the department under AS 47.05.075 is satisfied or, if a lien has not been                            
20       filed under AS 47.05.075, 60 days from the attorney's receipt of the proceeds.                                    
21            (e)  Notwithstanding AS 47.05.070(c), for pro rata reduction of the                                          
22       department's lien if an attorney fails to comply with this section,                                               
23                 (1)  the department is entitled to and shall collect the full lien amount                               
24       from the judgment, award, or settlement;                                                                          
25                 (2)  if the attorney has already received payment for the attorney's                                    
26       services through the pro rata reduction as provided in AS 47.05.070(c), the attorney is                           
27       civilly liable to the department for the amount of that payment.                                                  
28            (f)  If a medical assistance recipient is handling the action or claim on a pro se                           
29       basis, the provisions of this section apply as if the medical assistance recipient were an                        
30       attorney representing the medical assistance recipient.                                                           
31            Sec. 47.05.073. Judgment, award, or settlement of a medical assistance                                     
01       lien. (a) An action or claim brought by a medical assistance recipient or an attorney                           
02       who represents the medical assistance recipient against a third party or insurer may not                          
03       be compromised or discharged without the express written consent of the attorney                                  
04       general.                                                                                                          
05            (b)  A judgment, award, or settlement that requires or results in the                                        
06       compromise of a lien under AS 47.05.075 may not be entered into or granted by a                                   
07       court without the express written consent of the attorney general.                                                
08            (c)  A medical assistance recipient may not maintain any rights to payment as a                              
09       result of a judgment, award, or settlement of an action or claim for which another                                
10       person may be legally obligated to pay without first making full repayment to the                                 
11       department for costs of past medical assistance services provided to or paid for by the                           
12       medical assistance recipient that relate to that action or claim.                                                 
13            (d)  A medical assistance recipient may not place any payment as a result of a                               
14       judgment, award, or settlement of an action or claim for which another person was                                 
15       legally obligated to pay because of injury or illness into any trust for the purpose of                           
16       maintaining public assistance or medical assistance eligibility without first                                     
17                 (1)  making full repayment to the department for costs of past medical                                  
18       assistance services provided to the medical assistance recipient related to that action or                        
19       claim; and                                                                                                        
20                 (2)  obtaining the express written consent of the attorney general.                                     
21            (e)  The department's recovery under a subrogation right, assignment, or                                     
22       enforcement of a lien shall be applied to the entire payment made in satisfaction of                              
23       judgment, award, or settlement.                                                                                   
24            (f)  The doctrine of equitable subrogation, the equitable made whole doctrine,                               
25       or the common fund doctrine may not be applied to defeat, reduce, limit, or prorate                               
26       any recovery by the department based upon its subrogation rights, assignment, or lien,                            
27       or the medical assistance recipient's obligation of repayment.                                                    
28            (g)  The attorney general may only discharge or give written consent related to                              
29       a medical assistance lien under AS 47.05.075 if the discharge or consent complies                                 
30       with federal law.                                                                                                 
31            Sec. 47.05.074. Conflict with federal requirements. If any provision of this                               
01       chapter related to subrogation, assignment, or lien conflicts with federal law                                    
02       concerning the Medicaid program or receipt of federal money to finance the medical                                
03       assistance program, the provision does not apply to the extent of the conflict.                                   
04    * Sec. 4. AS 47.05.075(d) is amended to read:                                                                      
05            (d)  A perfected lien under this section has priority over all other liens except                        
06       tax liens and a lien perfected for attorney fees and costs [IMMEDIATELY AFTER                                 
07       A LIEN PERFECTED BY A HOSPITAL, NURSE, OR PHYSICIAN UNDER                                                         
08       AS 34.35.450 - 34.35.480].                                                                                        
09    * Sec. 5. AS 47.05.080(a) is amended to read:                                                                      
10            (a)  Benefit overpayments collected by the department in administering                                       
11       programs under AS 47.07 (medical assistance), AS 47.25.120 - 47.25.300 (general                               
12       relief), AS 47.25.430 - 47.25.615 (adult public assistance), AS 47.25.975 - 47.25.990                             
13       (food stamps), and 47.27 (Alaska temporary assistance program) shall be remitted to                               
14       the Department of Revenue under AS 37.10.050(a), except for overpayments                                      
15       recovered under AS 47.07 that cover the value of services paid from federal                                   
16       sources.                                                                                                      
17    * Sec. 6. AS 47.07.020(f) is amended to read:                                                                      
18            (f)  A person may not be denied eligibility for medical assistance under this                                
19       chapter on the basis of a diversion of income or transfer of assets, whether by                               
20       assignment or after receipt of the income, into a Medicaid-qualifying trust or annuity                        
21       that, according to a determination made by the department,                                                        
22                 (1)  has provisions that require that the state will receive all of the trust                           
23       or annuity assets remaining at the death of the individual, subject to a maximum                              
24       amount that equals the total medical assistance paid on behalf of the individual; and                             
25                 (2)  otherwise meets the requirements of 42 U.S.C. 1396p(d)(4) for a                                
26       trust and 42 U.S.C. 1396p(c)(1)(F) and 42 U.S.C.1396p(e)(1) for an annuity.                                 
27    * Sec. 7. AS 47.07.020 is amended by adding new subsections to read:                                               
28            (j)  A person may not apply for medical assistance coverage on behalf of a                                   
29       child under 18 years of age who is not emancipated unless the person is the parent or                             
30       legal guardian of the child or, if the parent or legal guardian can be contacted and                              
31       consents to the application and the person is                                                                     
01                 (1)  an adult caretaker relative who lives with the child and who is                                    
02       exercising care and control of the child; or                                                                      
03                 (2)  an employee of the department who is applying on behalf of a child                                 
04       who is in the custody of the department.                                                                          
05            (k)  A child who is unemancipated may apply for medical assistance coverage                                  
06       on the child's own behalf if the parent or legal guardian of the child consents to the                            
07       application. The department may waive consent under this section if the child                                     
08       expresses a reasonable fear of the child's parent or legal guardian or the department                             
09       has been unable to contact the parent or legal guardian after the department has made                             
10       reasonable efforts to do so. If a waiver of consent is granted, the department shall                              
11       document the reason for the waiver in the child's medical assistance record.                                      
12            (l)  Notwithstanding the eligibility provisions under (a) and (b) of this section,                           
13       a person may not receive medical assistance under this section unless the person first                            
14       enrolls in the Medicare program under 42 U.S.C. 1395 to the extent that the person is                             
15       eligible to receive benefits and services under the program.                                                      
16            (m)  Except as provided in (g) of this section, the department shall impose a                                
17       penalty period of ineligibility for the transfer of an asset for less than fair market value                      
18       by an applicant or an applicant's spouse consistent with 42 U.S.C. 1396p(c)(1).                                   
19            (n)  Except as provided under 42 U.S.C. 1396p(f) and 42 U.S.C. 1396u-1, the                                  
20       department shall include as an asset for eligibility purposes the value of an applicant's                         
21       home if the equity value in the home exceeds $500,000 at the time the application is                              
22       completed. Nothing in this subsection prohibits an applicant from reducing the equity                             
23       value in the applicant's home by selling the home or by taking out a loan that affects                            
24       the equity.                                                                                                       
25    * Sec. 8. AS 47.07 is amended by adding a new section to read:                                                     
26            Sec. 47.07.045. Home and community-based services. (a) The department                                      
27       may provide home and community-based services under a waiver in accordance with                                   
28       42 U.S.C. 1396 - 1396p (Title XIX, Social Security Act), this chapter, and regulations                            
29       adopted under this chapter, if the department has received approval from the federal                              
30       government and the department has appropriations allocated for the purpose. To                                    
31       supplement the standards in (b) of this section, the department shall establish in                                
01       regulation additional standards for eligibility and payment for the services.                                     
02            (b)  Before the department may terminate payment for services provided under                                 
03       (a) of this section,                                                                                              
04                 (1)  the recipient must have had an annual assessment to determine                                      
05       whether the recipient continues to meet the standards under (a) of this section;                                  
06                 (2)  the annual assessment must have been reviewed by an independent                                    
07       qualified health care professional under contract with the department; for purposes of                            
08       this paragraph, "independent qualified health care professional" means,                                           
09                      (A)  for a waiver based on mental retardation or developmental                                     
10            disability, a person who is qualified under 42 CFR 483.430 as a mental                                       
11            retardation professional;                                                                                    
12                      (B)  for other allowable waivers, a registered nurse licensed                                      
13            under AS 08.68 who is qualified to assess children with complex medical                                      
14            conditions, older Alaskans, and adults with physical disabilities for medical                                
15            assistance waivers; and                                                                                      
16                 (3)  the annual assessment must find that the recipient's condition has                                 
17       materially improved since the previous assessment; for purposes of this paragraph,                                
18       "materially improved" means that a recipient who has previously qualified for a                                   
19       waiver for                                                                                                        
20                      (A)  a child with complex medical conditions, no longer needs                                      
21            technical assistance for a life-threatening condition, and is expected to be                                 
22            placed in a skilled nursing facility for less than 30 days each year;                                        
23                      (B)  mental retardation or developmental disability, no longer                                     
24            needs the level of care provided by an intermediate care facility for the                                    
25            mentally retarded either because the qualifying diagnosis has changed or the                                 
26            recipient is able to demonstrate the ability to function in a home setting without                           
27            the need for waiver services; or                                                                             
28                      (C)  an older Alaskan or adult with a physical disability, no                                      
29            longer has a functional limitation or cognitive impairment that would result in                              
30            the need for nursing home placement, and is able to demonstrate the ability to                               
31            function in a home setting without the need for waiver services.                                             
01    * Sec. 9. AS 47.05.070(e) is repealed.                                                                             
02    * Sec. 10. The uncodified law of the State of Alaska is amended by adding a new section to                         
03 read:                                                                                                                   
04       APPLICABILITY. Sections 2 - 4 of this Act apply to a cause of action related to a                                 
05 subrogation, assignment, or lien by the Department of Health and Social Services that accrues                           
06 on or after the effective date of this Act.                                                                             
07    * Sec. 11. The uncodified law of the State of Alaska is amended by adding a new section to                         
08 read:                                                                                                                   
09       REPORT. The Department of Health and Social Services shall prepare a report and                                   
10 deliver the report to the legislature not later than the first day of the First Regular Session of                      
11 the Twenty-Fifth Alaska State Legislature. The report must include recommendations for                                  
12 statutory, regulatory, and systematic changes that will                                                                 
13            (1)  assist the department in reducing medical assistance expenditures for                                   
14 services received in residential psychiatric treatment centers and substance abuse treatment                            
15 facilities;                                                                                                             
16            (2)  enhance and clarify parental financial responsibility for children receiving                            
17 residential psychiatric treatment center and substance abuse treatment facilities services; and                         
18            (3)  maximize all third-party resources available to pay for the cost of                                     
19 residential psychiatric treatment center and substance abuse treatment facilities services                              
20 before a provider seeks reimbursement under AS 47.07.                                                                   
21    * Sec. 12. The uncodified law of the State of Alaska is amended by adding a new section to                         
22 read:                                                                                                                   
23       TRANSITION: REGULATIONS FOR HOME AND COMMUNITY-BASED                                                              
24 SERVICES. To the extent that regulations on home and community-based services that are in                               
25 effect on the effective date of sec. 8 of this Act are not inconsistent with the language and                           
26 purposes of sec. 8 of this Act, those regulations remain in effect as valid regulations                                 
27 implementing sec. 8 of this Act.                                                                                        
28    * Sec. 13. The uncodified law of the State of Alaska is amended by adding a new section to                         
29 read:                                                                                                                   
30       STATE PLAN. (a) The Department of Health and Social Services shall immediately                                    
31 apply for federal approval of a revised state plan to implement the changes to the medical                              
01 assistance program made under secs. 1 - 7 and 9 of this Act.                                                            
02       (b)  The commissioner of health and social services shall notify the revisor of statutes                          
03 of the date of the federal approval of the revised state plan submitted under (a) of this section.                      
04    * Sec. 14. Sections 8 and 12 of this Act take effect immediately under AS 01.10.070(c).                            
05    * Sec. 15. Except as provided in sec. 14 of this Act, this Act takes effect July 1, 2006, or on                    
06 the date of notification under sec. 13 of this Act of federal approval of a revised state plan for                      
07 medical assistance coverage incorporating the changes made by secs. 1 - 7 and 9 of this Act,                            
08 whichever is later.