CSSSSB 5(HES): "An Act implementing an option available under federal law to extend Medicaid eligibility to certain persons who are eligible to be institutionalized but who are not in institutions; relating to Medicaid waivers; reordering the priorities assigned to groups of persons served under the Medicaid program; and providing for an effective date."
00CS FOR SPONSOR SUBSTITUTE FOR SENATE BILL NO. 5(HES) 01 "An Act implementing an option available under federal law to extend Medicaid 02 eligibility to certain persons who are eligible to be institutionalized but who are 03 not in institutions; relating to Medicaid waivers; reordering the priorities assigned 04 to groups of persons served under the Medicaid program; and providing for an 05 effective date." 06 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF ALASKA: 07 * Section 1. AS 47.07.020(b) is amended to read: 08 (b) In addition to the persons specified in (a) of this section, the following 09 optional groups of persons for whom the state may claim federal financial participation 10 are eligible for medical assistance: 11 (1) persons eligible for but not receiving assistance under any plan of 12 the state approved under 42 U.S.C. 601 - 615 (Title IV-A, Social Security Act, Aid to 13 Families with Dependent Children) or 42 U.S.C. 1381 - 1383c (Title XVI, Social 14 Security Act, Supplemental Security Income);
01 (2) persons in a general hospital, skilled nursing facility or intermediate 02 care facility, who, if they left the facility, would be eligible for assistance under one 03 of the federal programs specified in (1) of this subsection; 04 (3) persons under age 21 who are under supervision of the department, 05 for whom maintenance is being paid in whole or in part from public funds, and who 06 are in foster homes or private child-care institutions; 07 (4) aged, blind, or disabled persons, who, because they do not meet 08 income and resources requirements, do not receive supplemental security income under 09 42 U.S.C. 1381 - 1383c (Title XVI, Social Security Act), and who do not receive a 10 mandatory state supplement, but who are eligible, or would be eligible if they were not 11 in a skilled nursing facility or intermediate care facility to receive an optional state 12 supplementary payment; 13 (5) persons under age 21 who are in an institution designated as an 14 intermediate care facility for the mentally retarded and who are financially eligible as 15 determined by the standards of the federal aid to families with dependent children 16 program; 17 (6) persons in a medical or intermediate care facility whose income 18 while in the facility does not exceed 300 percent of the supplemental security income 19 benefit rate under 42 U.S.C. 1381 - 1383c (Title XVI, Social Security Act) but who 20 would not be eligible for an optional state supplementary payment if they left the 21 hospital or other facility; 22 (7) persons under age 21 who are receiving active treatment in a 23 psychiatric hospital and who are financially eligible as determined by the standards of 24 42 U.S.C. 601 - 615 (Title IV-A, Social Security Act, Aid to Families with Dependent 25 Children); 26 (8) persons under age 21 and not covered under (a) of this section, who 27 would be eligible for benefits under the federal aid to families with dependent children 28 program, except that they have the care and support of both their natural and adoptive 29 parents; 30 (9) pregnant women not covered under (a) of this section and who meet 31 the income and resource requirements of the federal aid to families with dependent
01 children program; 02 (10) persons who can be considered under 42 U.S.C. 1396a(e)(3) 03 (Title XIX, Social Security Act, Medical Assistance) to be individuals with respect 04 to whom a supplemental security income is being paid under 42 U.S.C. 1381 - 05 1383c (Title XVI, Social Security Act) because they meet all of the following 06 criteria: 07 (A) they are 18 years of age or younger and qualify as 08 disabled individuals under 42 U.S.C. 1382c(a) (Title XVI, Social Security 09 Act); 10 (B) the department has determined that 11 (i) they require a level of care provided in a hospital, 12 nursing facility, or intermediate care facility for the mentally 13 retarded; 14 (ii) it is appropriate to provide their care outside of 15 an institution; and 16 (iii) the estimated amount that would be spent for 17 medical assistance for their individual care outside an institution is 18 not greater than the estimated amount that would otherwise be 19 expended individually for medical assistance within an appropriate 20 institution; 21 (C) if they were in a medical institution, they would be 22 eligible for medical assistance under other provisions of this chapter; and 23 (D) home and community-based services under a waiver 24 approved by the federal government are either not available to them under 25 this chapter or would be inappropriate for them [REPEALED]. 26 * Sec. 2. AS 47.07.030 is amended by adding a new subsection to read: 27 (c) Notwithstanding (b) of this section, the department may offer a service for 28 which the department has received a waiver from the federal government if the 29 department was authorized, directed, or requested to apply for the waiver by law or by 30 a concurrent or joint resolution of the legislature. The department shall annually 31 submit to the legislature its recommendations about where a service offered under this
01 subsection should be placed on the priority list in AS 47.07.035. 02 * Sec. 3. AS 47.07.035 is amended to read: 03 Sec. 47.07.035. PRIORITY OF MEDICAL ASSISTANCE. If the department 04 finds that the cost of medical assistance for all persons eligible under this chapter will 05 exceed the amount allocated in the state budget for that assistance for the fiscal year, 06 the department shall eliminate coverage for optional medical services and optionally 07 eligible groups of individuals in the following order: 08 (1) clinical social workers' services; 09 (2) psychologists' services; 10 (3) chiropractic services; 11 (4) advanced nurse practitioner services; 12 (5) adult dental services; 13 (6) emergency hospital services; 14 (7) treatment of speech, hearing, and language disorders; 15 (8) optometrists' services and eyeglasses; 16 (9) occupational therapy; 17 (10) mammography screening; 18 (11) prosthetic devices; 19 (12) medical supplies and equipment; 20 (13) targeted case management services; 21 (14) rehabilitative services for substance abusers and emotionally 22 disturbed or chronically mentally ill adults; 23 (15) clinic services; 24 (16) physical therapy; 25 (17) personal care services in a recipient's home; 26 (18) prescribed drugs; 27 (19) long-term care noninstitutional services; 28 (20) inpatient psychiatric facility services; 29 (21) intermediate care facility services for the mentally retarded; 30 (22) intermediate care facility services; 31 (23) individuals described in AS 47.07.020(b)(10);
01 (24) individuals under age 21 who are not eligible for benefits under 02 the federal aid to families with dependent children program because they are not 03 deprived of one or more of their natural or adoptive parents; 04 (25) [(24)] skilled nursing facility services for persons under age 21; 05 (26) [(25)] aged, blind, and disabled individuals who, because they do 06 not meet the income requirements, do not receive supplemental security income under 07 Title XVI of the Social Security Act, but who are eligible, or would be eligible if they 08 were not in a skilled nursing facility or intermediate care facility, to receive an 09 optional state supplementary payment; 10 (27) [(26)] individuals in a hospital, skilled nursing facility, or 11 intermediate care facility whose income while in the facility does not exceed 300 12 percent of the supplemental security income benefit rate under Title XVI of the Social 13 Security Act, but who, because of income, are not eligible for the optional state 14 supplementary payment; 15 (28) [(27)] individuals under age 21 under supervision of the 16 department, for whom maintenance is being paid in whole or in part from public 17 money and who are in foster homes or private child-care institutions. 18 * Sec. 4. (a) Sections 1 and 3 of this Act take effect on the 180th day after the effective 19 date of Medicaid plan amendments approved by the federal government under which the state 20 would implement a waiver for home and community-based services under 42 U.S.C. 1396n 21 for persons who are Medicaid eligible and who would otherwise require a level of care 22 provided in a hospital, nursing facility, or intermediate care facility for the mentally retarded 23 in the absence of home and community-based services. 24 (b) The Department of Health and Social Services shall notify the revisor of statutes 25 as to the effective date of the plan amendments referred to in (a) of this section. 26 * Sec. 5. Section 2 of this Act takes effect immediately under AS 01.10.070(c).