General Assembly Substitute Bill No. 973
January Session, 2011 *_____SB00973AGEHS_031011____*
General Assembly
Substitute Bill No. 973
January Session, 2011
*_____SB00973AGEHS_031011____*
AN ACT CONCERNING THE DETERMINATION OF UNDUE HARDSHIP FOR PURPOSES OF MEDICAID ELIGIBILITY.
Be it enacted by the Senate and House of Representatives in General Assembly convened:
Section 1. (NEW) (Effective July 1, 2011) (a) Except as provided in subsection (c) of this section, the Commissioner of Social Services shall waive the imposition of a penalty period pursuant to subsection (a) of section 17b-261 of the general statutes or subsection (a) of section 17b-261a of the general statutes if such imposition would create an undue hardship.
(b) For purposes of this section, "undue hardship" exists when (1) the life or health of the applicant would be endangered by the deprivation of medical care, or the applicant would be deprived of food, clothing, shelter or other necessities of life, (2) the applicant is otherwise eligible for medical assistance under section 17b-261 of the general statutes but for the imposition of the penalty period, (3) if the applicant is receiving long-term care services at the time of the imposition of a penalty period, the provider of long-term care services has notified the applicant that such provider intends to discontinue providing long-term care services to the applicant because of nonpayment, (4) if the applicant is not receiving long-term care services at the time of the imposition of a penalty period, a provider of long-term care services has refused to provide long-term care services to the applicant due to lack of a payment source, and (5) no other person or organization is willing and able to provide long-term care services to the applicant.
(c) The commissioner shall not waive the imposition of a penalty period pursuant to subsections (a) and (b) of this section if (1) the applicant made a transfer or assignment of assets to deliberately impoverish such applicant in order to obtain or maintain eligibility for medical assistance, unless the applicant (A) suffers from dementia or other cognitive impairment and cannot explain the transfer or assignment of assets, (B) suffered from dementia or other cognitive impairment at the time the transfer or assignment of assets was made, or (C) was exploited into making the transfer or assignment of assets due to dementia or other cognitive impairment, or (2) the transfer or assignment of assets was made by the applicant's legal representative or the joint owner of the assets, provided such legal representative or joint owner did not exploit the applicant into making such transfer or assignment.
Sec. 2. (NEW) (Effective July 1, 2011) (a) As used in this section and section 1 of this act, "applicant" means an applicant for or recipient of medical assistant pursuant to section 17b-261 of the general statutes.
(b) If the Commissioner of Social Services, in determining an applicant's eligibility for medical assistance pursuant to section 17b-261 of the general statutes, intends to impose a penalty period as a result of a transfer or assignment of assets pursuant to section 17-261 of the general statutes or section 17b-261a of the general statutes, the commissioner shall provide a preliminary notice to the applicant. Such notice shall include a statement that the applicant may file a claim of undue hardship, as defined in section 1 of this act, or provide evidence to rebut the presumption resulting in the imposition of a penalty period pursuant to subsection (a) of section 17b-261a of the general statutes. The applicant shall file such claim or provide such evidence not later than fifteen days after the date on which the preliminary notice is postmarked. The commissioner shall grant one extension of time to file such claim or provide such evidence if requested by the applicant and shall grant additional extensions of time if reasonable. Failure to file a claim of undue hardship under this subsection shall not prohibit an applicant from making a claim of undue hardship at an administrative hearing.
(c) If the applicant files a claim of undue hardship pursuant to subsection (b) of this section or provides evidence to rebut the presumption resulting in the imposition of a penalty period pursuant to subsection (a) of section 17b-261a of the general statutes, the commissioner shall provide an interim decision notice to the applicant not later than ten days after receiving such claim or evidence. The interim decision notice shall inform the applicant whether or not (1) the commissioner has determined that undue hardship exists or the presumption has been rebutted, and (2) the penalty period for the transfer or assignment of assets indicated in the preliminary notice shall be waived or shall not be imposed.
(d) When the commissioner determines the eligibility of an applicant for medical assistance under section 17b-261 of the general statutes, the commissioner shall provide a final decision notice to the applicant. Such final decision notice shall include (1) a statement confirming any determination the commissioner made with regard to a transfer or assignment of assets pursuant to this section, and (2) a description of the applicant's appeal rights.
(e) If an applicant receives notice from a provider of long-term care services that the provider intends to discontinue providing or refuses to provide long-term care services to the applicant because of the imposition of a penalty period against the applicant pursuant to subsection (a) of section 17b-261 of the general statutes or subsection (a) of section 17b-261a of the general statutes, the applicant shall have no more than sixty days after receiving such notice to file a claim of undue hardship with the commissioner. Not later than ten days after receiving such claim, the commissioner shall provide a final decision notice to the applicant. Such final decision notice shall inform the applicant whether or not (1) the commissioner has determined that undue hardship exists, and (2) the penalty period shall be waived.
(f) (1) If an applicant is receiving long-term care services in a nursing home facility, as defined in section 19a-521 of the general statutes, and the nursing home facility demonstrates that the applicant is not competent, the commissioner shall grant an extension of time to claim undue hardship pursuant to subsection (b) of this section to allow a legal representative to be appointed to act on behalf of the applicant.
(2) The commissioner shall accept any claim filed pursuant to subsection (b) of this section by a nursing home facility, as defined in section 19a-521 of the general statutes, and allow the nursing home facility to represent the applicant with regard to such claim if the applicant or the legal representative of the applicant gives permission to the nursing home facility to file a claim pursuant to subsection (b) of this section.
This act shall take effect as follows and shall amend the following sections:
Section 1 July 1, 2011 New section
Sec. 2 July 1, 2011 New section
This act shall take effect as follows and shall amend the following sections:
Section 1
July 1, 2011
New section
Sec. 2
July 1, 2011
New section
AGE Joint Favorable Subst. C/R HS
AGE
Joint Favorable Subst. C/R
HS