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S. 2273 (as reported favorably by Elder Affairs, Health Care Finance, and engrossed in the Senate
AN ACT REGARDING CHOICE OF LONG TERM CARE SETTING
Be it enacted by the Senate and House of Representatives in General Court
assembled, and by the authority of the same, as follows:
SECTION 1.
Section 9 of chapter one hundred and eighteen E is hereby amended by striking,
in the second paragraph, the following sentence: "provided, further, that said
benefits shall be available to otherwise eligible persons seeking admission to
and residents of long-term care facilities whose income and resources are
insufficient to meet the cost of their medical care as determined by the
financial eligibility requirements of said program." And replacing it with the
following new sentences: "provided, further, that said benefits shall be
available to otherwise eligible persons seeking long term care whose income and
resources are insufficient to meet the cost of their
medical care as determined by the financial eligibility requirements of said
program. For the purposes of this chapter, the division shall establish clinical
eligibility for a long term care benefit, so-called. Any person determined by
the division as clinically eligible for said long term care benefit shall be
given the choice of care setting that is the least restrictive and most
appropriate to meet his or her needs. The dollars that are provided for said
long term care benefit shall follow such individual as his or her setting of
care changes, but for each such individual, the division of health care finance
and policy shall establish a rate that reflects the individual’s clinical
case-mix acuity and his care and benefit needs in the most appropriate setting.
SECTION 2. The division shall promulgate regulations to implement the provisions
of section 1, and shall submit a section 1115(a) research and demonstration
waiver no later than July 1, 2006 to implement the provisions of section 1. Said
waiver shall establish an income eligibility up to 300 percent of the federal
benefit rate under the supplemental security income program, and an asset test
of not less than $10,000. Said waiver shall maximize the federal financial
participation for all enrollees, and meet budget neutrality requirements
established for such waivers.
SECTION 3. Section 9 of Chapter one hundred and eighteen E is hereby further
amended by adding at the end thereof the following new language: "All persons
seeking admission to a long term care facility paid for by MassHealth shall
receive pre-admission counseling for long term care services, which shall
include an assessment of their community-based service options. All persons
seeking care in a long term care facility on a private pay basis shall be
offered said pre-admission counseling on a voluntary basis. For the purpose of
this section, all said pre-admission counseling shall be conducted by the
executive office of elder affairs, or its subcontractors. The division shall
report to the general court on an annual basis the number of individuals who
received pre-admission counseling under this section, and the number of
diversions to the community generated by this pre-admission counseling program,
so-called."