Senate Concurrent Resolution 598

A CONCURRENT RESOLUTION TO REQUEST THE DIVISION OF MEDICAID TO DEVELOP AND REPORT TO THE LEGISLATURE ON THE IMPLEMENTATION OF A REFERRAL PROCESS FOR LONG-TERM CARE ALTERNATIVES FOR MEDICAID BENEFICIARIES AND APPLICANTS; TO PROVIDE COMPONENTS TO BE CONSIDERED BY THE DIVISION; AND FOR RELATED PURPOSES.

NOW, THEREFORE, BE IT RESOLVED BY THE SENATE OF THE STATE OF MISSISSIPPI, THE HOUSE OF REPRESENTATIVES CONCURRING THEREIN, Thatthe Division of Medicaid is hereby encouraged to develop and pursue the feasibility of implementing an assessment process for long-term care services for recipients age sixty-five (65) and older and for adults with physical disabilities. The division is encouraged to address the following components:

(a) No Medicaid beneficiary shall be admitted to a Medicaid-certified nursing facility unless a licensed physician certifies that nursing facility care is appropriate for that person on a standardized form to be prepared and provided to nursing facilities by the Division of Medicaid.

(b) The Division of Medicaid shall determine, through an assessment of the applicant conducted within five (5) business days after receipt of the physician's certification, whether the applicant also could live appropriately and cost-effectively at home or in some other community-based setting if home- or community-based services were available to the applicant.

(c) The physician shall forward a copy of that certification to the Division of Medicaid within twenty-four (24) hours after it is signed by the physician.

(d) The division shall establish a triage system to evaluate the appropriate type of care for enrollees who may be at risk of institutionalization. Those determined to be in the highest tier of need shall be offered a traditional nursing facility or whatever expanded services were needed to keep them in their own homes. Those in the second tier who need fewer or less intensive services may receive nursing home or home-based care but would be served in the order of greatest need.

(e) Individuals entering the long-term care system are informed of their options prior to entering a nursing home.

(f) The assessment is provided in a timely manner so as not to delay discharges from hospitals and shall include provisions for emergency admissions to nursing homes.

(g) If the Division of Medicaid determines that a home- or other community-based setting is appropriate and cost-effective, the division shall:

(i) Advise the applicant or the applicant's legal representative that a home- or other community-based setting is appropriate;

(ii) Provide a proposed care plan and inform the applicant or the applicant's legal representative regarding the degree to which the services in the care plan are available in a home- or in other community-based setting rather than nursing facility care; and

(iii) Explain that such plan and services are available only if the applicant or the applicant's legal representative chooses a home- or community-based alternative to nursing facility care, and that the applicant is free to choose nursing facility care.

(h) The Division of Medicaid may provide the assessment services described in this section directly or through contract with case managers from the local Area Agencies on Aging or other appropriate contractors, and shall coordinate long-term care alternatives with the Department of Human Services and such local area agencies to avoid duplication with hospital discharge planning procedures.

(i) The assessment procedure shall be in compliance with applicable court orders.

BE IT FURTHER RESOLVED, That if the long-term care alternative assessment program is deemed feasible, that such a program be implemented and a report of findings and recommendations be prepared and provided to the Office of the Governor and the Chairmen of the House and Senate Public Health and Welfare Committees and the Chairman of the House Medicaid Committee so that it can evaluate the effectiveness of the program in reducing costs within the Medicaid program and in providing improved health and well-being of the affected patients.