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PAG LIN 1 1 Section 1. Section 249A.3, subsection 1, paragraph i, Code 1 2 1995, is amended to read as follows: 1 3 i. Is a pregnant woman who is determined to be 1 4 presumptively eligible by a health care provider qualified 1 5 under the federal Omnibus Budget Reconciliation Act of 1986, 1 6 Pub. L. No. 99-509, } 9407. The woman is eligible for 1 7 ambulatory prenatal care assistancefor a period of fourteen1 8daysuntil the last day of the month following the month of 1 9 the presumptive eligibility determination. If the department 1 10 receives the woman's medical assistance applicationwithin the1 11fourteen-day periodby the last day of the month following the 1 12 presumptive eligibility determination, the woman is eligible 1 13 for ambulatory prenatal care assistancefor forty-five days1 14from the date presumptive eligibility was determined oruntil 1 15 the department actually determines the woman's eligibility or 1 16 ineligibility for medical assistance, whichever occurs first. 1 17 The costs of services provided during the presumptive 1 18 eligibility period shall be paid by the medical assistance 1 19 program for those persons who are determined to be ineligible 1 20 through the regular eligibility determination process. 1 21 Sec. 2. Section 249A.5, subsection 2, Code 1995, is 1 22 amended by adding the following new paragraph: 1 23 NEW PARAGRAPH. f. If a debt is due under this subsection 1 24 from the estate of a recipient, the administrator of the 1 25 nursing facility, intermediate care facility for the mentally 1 26 retarded, or mental health institute in which the recipient 1 27 resided at the time of the recipient's death, and the personal 1 28 representative of the recipient, if applicable, shall report 1 29 the death to the department within ten days of the death of 1 30 the recipient. For the purposes of this paragraph, "personal 1 31 representative" means a person who filed a medical assistance 1 32 application on behalf of the recipient or who manages the 1 33 financial affairs of the recipient. 1 34 Sec. 3. Section 633.708, Code 1995, is amended to read as 1 35 follows: 2 1 633.708 DISPOSITION OF MEDICAL ASSISTANCE SPECIAL NEEDS 2 2 TRUSTS. 2 3 Regardless of the terms of a medical assistance special 2 4 needs trust, anyproperty received or held by the trustincome 2 5 received or asset added to the trust during a one-month period 2 6 shall be expended as provided for medical assistance income 2 7 trusts under section 633.709, on a monthly basis, during the 2 8 life of the beneficiary. Any increase in income or principal 2 9 retained in the trust from a previous month may be expended, 2 10 during the life of the beneficiary, only for reasonable and 2 11 necessary expenses of the trust, not to exceed ten dollars per 2 12 month without court approval, for special needs of the 2 13 beneficiary attributable to the beneficiary's disability and 2 14 approved by the district court, for medical care or services 2 15 that would otherwise be covered by medical assistance under 2 16 chapter 249A, or to reimburse the state for medical assistance 2 17 paid on behalf of the beneficiary. 2 18 EXPLANATION 2 19 This bill provides that a pregnant woman who is estab- 2 20 lishing eligibility under the presumptive eligibility 2 21 provisions is eligible for ambulatory prenatal care until the 2 22 last day of the month following the month of determination of 2 23 presumptive eligibility. If the department receives the 2 24 woman's application for medical assistance during the time in 2 25 which the woman is presumptively eligible, the woman is 2 26 eligible until the time that the department actually 2 27 determines the woman's ineligibility. The bill also provides 2 28 for the notification of the department of human services by 2 29 the administrator of a nursing facility, an intermediate care 2 30 facility for the mentally retarded, or a mental health 2 31 institute and by the personal representative of a person 2 32 within 10 days of the person's death if a debt is due from the 2 33 person's estate to the state for medical assistance provided. 2 34 The bill also amends the conditions for expenditure of income 2 35 and principal placed in medical assistance income trusts and 3 1 special needs trusts. 3 2 BACKGROUND STATEMENT 3 3 SUBMITTED BY THE AGENCY 3 4 This bill addresses three areas related to medical assis- 3 5 tance: presumptive eligibility for pregnant women, the report 3 6 of the death of medical assistance recipients to the 3 7 department, and the regulation of medical assistance income 3 8 and special needs trusts. 3 9 Section 1 of the bill amends the provision relating to 3 10 presumptive eligibility for medical assistance for pregnant 3 11 women in order to comply with changes in federal law. Federal 3 12 law currently provides that a woman who is presumptively 3 13 eligible is only eligible prior to the time the woman is 3 14 formally determined to be eligible or ineligible and for a 3 15 specified number of days while awaiting formal determination 3 16 of eligibility. 3 17 Section 2 of the bill requires the administrator of a 3 18 nursing facility, an intermediate care facility for the 3 19 mentally retarded, or a mental health institute facility, and 3 20 the personal representative of a medical assistance recipient, 3 21 to report the death of the recipient to the department of 3 22 human services to aid in estate recovery. By requiring 3 23 reporting of the death of a recipient, the bill also requires 3 24 that upon the death of the surviving spouse or the blind or 3 25 disabled child, the administrator or personal representative 3 26 of the spouse or child reports their death to the department. 3 27 Currently, the department is unable to track the amount in the 3 28 estate that could be used to repay the department for medical 3 29 assistance paid on behalf of the recipient. Implementing this 3 30 change could result in increased recovery of small estates not 3 31 subject to probate. The change will require additional staff 3 32 time and postage costs to forward reports to the contractor 3 33 who is handling the estate recovery program. 3 34 Section 3 provides changes in the regulation of special 3 35 needs trusts. Under the Omnibus Budget Reconciliation Act 4 1 (OBRA) of 1993, two types of trusts are allowed for persons 4 2 who are eligible for or may become eligible for medical 4 3 assistance: medical assistance income trusts and medical 4 4 assistance special needs trusts. Under the current law, some 4 5 beneficiaries meet the criteria of both types of trusts 4 6 because the medical assistance income trust is composed of 4 7 only the beneficiary's income and a special needs trust can be 4 8 used to meet the needs directly related to a beneficiary's 4 9 disability. The changes proposed in this bill would require 4 10 that if a trust meets both the definitions of a medical 4 11 assistance income trust and a special needs trust, expenditure 4 12 of any income or assets received by the trust within a one- 4 13 month period would initially be expended in accordance with 4 14 the requirements for a medical assistance income trust and 4 15 that any increase in income or principal retained in the trust 4 16 from a previous month may be expended in accordance with the 4 17 current requirements for a special needs trust, which includes 4 18 expenditure for the special needs of the beneficiary 4 19 attributable to the beneficiary's disability. These changes 4 20 may result in cost savings in trust income previously retained 4 21 in a trust and not considered when establishing eligibility 4 22 for medical assistance and client participation will be 4 23 considered for these purposes, thereby reducing the medical 4 24 assistance payment for the beneficiary's cost of care. 4 25 LSB 1292DP 76 4 26 pf/jw/5
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