AN ACT RELATIVE TO CHOICE OF LONG-TERM CARE.
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 118E of the General Laws, as appearing in the 2004 Official Edition, is hereby amended by striking out, in lines 14 to 18, inclusive, the words “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 the program” and inserting in place thereof the following words:- provided further, that long-term care services shall be available to otherwise eligible persons whose income and resources are insufficient to meet the costs of their medical care as determined by the financial eligibility requirements of the program. For the purposes of this section, the division shall establish clinical eligibility for a long-term care services. A person determined by the division to be clinically eligible for long-term care services shall be given the choice of care setting that is the least restrictive and most appropriate to meet his needs as determined by the division. The value of such long-term care services shall be determined based on the medically necessary long-term care needs of the individual.
SECTION 2. Said section 9 of said chapter 118E, as so appearing, is hereby further amended by adding the following paragraph:-
A person 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 community-based service options. A person seeking care in a long-term care facility on a private pay basis shall be offered pre-admission counseling. For the purposes of this section, pre-admission counseling shall be conducted by the executive office of health and human services or the executive office of elder affairs or their subcontractors. The executive office of elder affairs shall, in consultation with the office of acute and ambulatory care in the executive office of health and human services, study the advisability and feasibility of using certain Medicaid providers to provide pre-admission counseling. 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 the pre-admission counseling program.
SECTION 3. The division of medical assistance shall adopt regulations to implement section 1 and shall submit a research and demonstration waiver pursuant to section 1115(a) of the Social Security Act not later than October 1, 2006 to implement said section 1. The waiver shall establish an income eligibility up to 300 per cent of the federal benefit rate under the supplemental security income program and an asset test of not less than $10,000. The waiver shall be subject to the availability of federal financial participation for all enrollees and shall meet budget neutrality requirements established for such waivers.
Approved August 3, 2006.