Print Friendly HOUSE BILL NO. 573 – Medical assistance/county/residency
HOUSE BILL NO. 573
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H0573.................................................by HEALTH AND WELFARE
MEDICAL ASSISTANCE - Amends existing law relating to medical indigency to
impose a state residency requirement of thirty days; to clarify
requirements for approval of a uniform application for county medical
assistance; and to require medical providers to reimburse a county when
payments are received from other resources.
02/15 House intro - 1st rdg - to printing
02/16 Rpt prt - to Health/Wel
02/23 Rpt out - rec d/p - to 2nd rdg
02/24 2nd rdg - to 3rd rdg
02/25 3rd rdg - PASSED - 56-0-14
AYES -- Barraclough, Barrett, Bell, Bieter, Black, Boe, Bruneel,
Cheirrett, Clark, Crow, Cuddy, Deal, Denney, Ellsworth, Field(13),
Field(20), Gagner, Geddes, Hadley, Hammond, Hansen(23), Henbest,
Hornbeck, Jaquet, Judd, Kempton, Kendell, Kunz, Lake, Linford,
Loertscher, Mader, Marley, McKague, Meyer, Montgomery, Mortensen,
Moss, Moyle, Pearce, Pomeroy, Reynolds, Ridinger, Ringo, Robison,
Sali, Schaefer, Sellman, Shepherd, Smylie, Stoicheff, Stone, Tilman,
Wheeler, Wood, Zimmermann
NAYS -- None
Absent and excused -- Alltus, Callister, Campbell, Chase, Gould,
Hansen(29), Jones, Kellogg, Pischner, Smith, Stevenson, Taylor,
Trail(Miller), Mr Speaker
Floor Sponsor - Reynolds
Title apvd - to Senate
02/28 Senate intro - 1st rdg - to Health/Wel
03/10 Rpt out - rec d/p - to 2nd rdg
03/13 2nd rdg - to 3rd rdg
03/29 3rd rdg - PASSED - 32-0-3
AYES--Boatright, Branch, Bunderson, Burtenshaw, Cameron, Crow,
Danielson, Darrington, Davis, Deide, Frasure, Geddes, Hawkins,
Ingram, Ipsen, Keough, King-Barrutia, Lee, McLaughlin, Noh, Parry,
Richardson, Riggs, Risch, Sandy, Schroeder, Sorensen, Stegner,
Thorne, Wheeler, Whitworth, Williams
Absent and excused--Andreason, Dunklin, Stennett
Floor Sponsor - King-Barrutia
Title apvd - to House
03/30 To enrol
03/31 Rpt enrol - Sp signed
04/03 Pres signed - to Governor
04/14 Governor signed
Session Law Chapter 317
|||| LEGISLATURE OF THE STATE OF IDAHO ||||
Fifty-fifth Legislature Second Regular Session - 2000
IN THE HOUSE OF REPRESENTATIVES
HOUSE BILL NO. 573
BY HEALTH AND WELFARE COMMITTEE
1 AN ACT
2 RELATING TO MEDICAL INDIGENCY; AMENDING SECTION 31-3502, IDAHO CODE, TO SPEC-
3 IFY THAT AN INDIVIDUAL MUST BE A RESIDENT OF THE STATE OF IDAHO FOR ELIGI-
4 BILITY AND TO MAKE A TECHNICAL CORRECTION; AMENDING SECTION 31-3504, IDAHO
5 CODE, TO CLARIFY REQUIREMENTS FOR A UNIFORM APPLICATION OF COUNTY MEDICAL
6 INDIGENT ASSISTANCE; AMENDING SECTION 31-3505, IDAHO CODE, TO GOVERN FIL-
7 ING REQUIREMENTS FOR AN APPLICATION FOR NECESSARY MEDICAL SERVICES AND TO
8 MAKE A TECHNICAL CORRECTION; AMENDING SECTION 31-3506, IDAHO CODE, TO
9 CLARIFY DETERMINATION OF THE OBLIGATED COUNTY WHEN STATE RESIDENCY
10 REQUIREMENTS HAVE BEEN MET; AND AMENDING SECTION 31-3509, IDAHO CODE, TO
11 SPECIFY TIME REQUIREMENTS GOVERNING REIMBURSEMENT BY MEDICAL PROVIDERS
12 WHEN A PAYMENT IS RECEIVED FROM OTHER RESOURCES.
13 Be It Enacted by the Legislature of the State of Idaho:
14 SECTION 1. That Section 31-3502, Idaho Code, be, and the same is hereby
15 amended to read as follows:
16 31-3502. DEFINITIONS. As used in this chapter, the terms defined in this
17 section shall have the following meaning, unless the context clearly indicates
18 another meaning:
19 (1) "Medically indigent" means any person who is in need of necessary
20 medical services and who, if an adult, together with his or her spouse, or
21 whose parents or guardian if a minor, does not have income and other resources
22 available to him from whatever source sufficient to pay for necessary medical
23 services. Nothing in this definition shall prevent the board of county commis-
24 sioners and administrator from requiring the applicant and obligated persons
25 to reimburse the county and the catastrophic health care costs program, where
26 appropriate, for all or a portion of their medical expenses, when investiga-
27 tion of their application pursuant to this chapter, determines their ability
28 to do so.
29 (2) "Hospital" means a facility licensed and regulated pursuant to sec-
30 tions 39-1301 through 39-1314, Idaho Code, excluding state institutions.
31 (3) "Dependent" means any person whom a taxpayer could claim as a depend-
32 ent under the income tax laws of the state of Idaho.
33 (4) "Applicant" means any person who is or may be requesting financial
34 assistance under this chapter.
35 (5) "Reimbursement rates" means the unadjusted medicaid rate of reim-
36 bursement for medical charges allowed pursuant to title XIX of the social
37 security act, as amended. For long-term care facilities, maximum
38 "reimbursement rates" means the unadjusted medicaid rate of reimbursement
39 allowed pursuant to the medical assistance program as determined by chapter 1,
40 title 56, Idaho Code, or the unadjusted medicare rate of reimbursement estab-
41 lished under title XVIII of the social security act, as amended, whichever is
43 (6) "Board" means the board of county commissioners.
1 (7) "Obligated persons" means those persons who are legally responsible
2 for an applicant.
3 (8) "County hospital" means any county approved institution or facility
4 for the care of sick persons.
5 (9) "Administrator" means the board of the catastrophic health care cost
6 program, as provided in section 31-3517, Idaho Code.
7 (10) "Catastrophic health care costs" means all necessary medical expenses
8 for services which are incurred by a recipient for which the reimbursement
9 rate exceeds in aggregate the sum of ten thousand dollars ($10,000) in any
10 twelve (12) consecutive month period.
11 (11) "Recipient" means an individual determined eligible for necessary
12 medical services under this chapter.
13 (12) "Resident" means a person with a home, house, place of abode, place
14 of habitation, dwelling or place where he or she actually lived for a consecu-
15 tive period of thirty (30) days or more within the state of Idaho. A resident
16 does not include a person who comes into this state for temporary purposes,
17 including, but not limited to, education, vacation, or seasonal labor. Entry
18 into active military duty shall not change a person's residence for the pur-
19 poses of this chapter. Those physically present within the following facili-
20 ties and institutions shall be residents of the county where they were resi-
21 dents prior to entering the facility or institution:
22 (a) Correctional facilities;
23 (b) Nursing homes or residential care facilities;
24 (c) Other medical facility or institution.
25 (13) "Emergency service" means a service provided for a medical condition
26 in which sudden, serious and unexpected symptoms of illness or injury are suf-
27 ficiently severe to necessitate or call for immediate medical care.
28 (14) "Provider" means any person, firm, or corporation certified or
29 licensed by the state of Idaho or holding an equivalent license or certifica-
30 tion in another state, that provides necessary medical services as it appears
31 on an application for assistance pursuant to this chapter.
32 (15) "Third party applicant" means a person other than an obligated person
33 who completes, signs and files an application on behalf of a patient.
34 (16) "Clerk" means the clerk of the board or his or her designee.
35 (17) "Resources" means all property, whether tangible or intangible, real
36 or personal, liquid or nonliquid, including, but not limited to, all forms of
37 public assistance, crime victim's compensation, worker's compensation, vet-
38 erans benefits, medicaid, medicare and any other property from any source for
39 which an applicant and/or an obligated person may be eligible or in which he
40 or she may have an interest. Resources shall include the ability of an appli-
41 cant and obligated persons to pay for necessary medical services over a period
42 of up to three (3) years. For purposes of determining approval for medical
43 indigency only, resources shall not include the value of the homestead on the
44 applicant or obligated persons' residence, a burial plot, exemptions for per-
45 sonal property allowed in section 11-605(1) through (3), Idaho Code, and addi-
46 tional exemptions allowed by county resolution.
47 (18) A. "Necessary medical services" means a requested or provided medi-
48 cal service required in order to identify or treat a medically indigent
49 person's health condition, illness or injury and is:
50 (a) Consistent with the symptoms, diagnosis or treatment of the med-
51 ical indigent's condition, illness or injury;
52 (b) In accordance with generally accepted standards of medical or
53 surgical practice then prevailing in the community where the services
54 were provided;
55 (c) Furnished on an outpatient basis whenever it is safe, efficient
1 and reasonable to do so;
2 (d) Not provided primarily for the convenience of the medically
3 indigent person or the provider;
4 (e) The standard, most economical service or item that can safely,
5 reasonably and ethically be provided.
6 B. Necessary medical services shall not include the following:
7 (a) Bone marrow transplants;
8 (b) Organ transplants;
9 (c) Elective, cosmetic and/or experimental procedures;
10 (d) Services related to, or provided by, residential and/or shelter
11 care facilities;
12 (e) Normal, uncomplicated pregnancies, excluding caesarean section,
13 and childbirth well-baby care;
14 (f) Medicare copayments and deductibles; and
15 (g) Services provided by, or available to an applicant from state,
16 federal and local health programs.
17 Provided however, each board may determine, by ordinance or resolution
18 duly adopted in its county, to include as necessary medical services addi-
19 tional services not covered in this section. Necessary medical services pro-
20 vided by this option shall not be paid by the catastrophic health care costs
21 program, and shall remain the liability of the respective county.
22 SECTION 2. That Section 31-3504, Idaho Code, be, and the same is hereby
23 amended to read as follows:
24 31-3504. APPLICATION FOR FINANCIAL ASSISTANCE. (1) An applicant request-
25 ing assistance under this chapter from the state or any county in this state
26 shall complete a written application on a uniform form agreed to by the Idaho
27 association of counties and the Idaho hospital association. prior to June 30,
28 1996. The truth of the matters contained in the application shall be sworn to
29 by the applicant. The application shall be signed by the applicant or on the
30 applicant's behalf and filed in the clerk's office.
31 (2) If a third party application is filed, the application shall be as
32 complete as practical and presented in the same form and manner as set forth
34 (3) Follow-up necessary medical services based on a treatment plan, for
35 the same condition, preapproved by the board, may be provided for a maximum of
36 six (6) months from the date of the original application without requiring an
37 additional application; however, a request for additional treatment not speci-
38 fied in the approved treatment plan shall be filed with the clerk ten (10)
39 days prior to receiving services. Beyond the six (6) months, requests for
40 additional treatment related to an original diagnosis in accordance with a
41 preapproved treatment plan shall be filed ten (10) days prior to receiving
42 services and an updated application may be requested by the board.
43 (4) Upon application for financial assistance pursuant to this chapter an
44 automatic lien shall attach to all real and personal property of the applicant
45 and on insurance benefits to which the applicant may become entitled. The lien
46 shall also attach to any additional resources to which it may legally attach
47 not covered above. The lien created by this section may be, in the discretion
48 of the board, perfected as to real property and fixtures by recording, in any
49 county recorder's office in this state in which the applicant and obligated
50 party own property a notice of application for medical indigency benefits on a
51 uniform form agreed to by the Idaho association of counties and the Idaho hos-
52 pital association, prior to June 30, 1996, which form shall be recorded as
53 provided herein within thirty (30) days from receipt of an application, and
1 such lien, if so recorded, shall have a priority date as of the date the nec-
2 essary medical services were provided. The lien created by this section may
3 also be, in the discretion of the board, perfected as to personal property by
4 filing with the secretary of state within thirty (30) days of receipt of an
5 application, a notice of application in substantially the same manner as a
6 filing under chapter 9, title 28, Idaho Code, except that such notice need not
7 be signed and no fee shall be required, and, if so filed, such lien shall have
8 the priority date as of the date the necessary medical services were provided.
9 An application for assistance pursuant to this chapter shall waive any confi-
10 dentiality granted by state law to the extent necessary to carry out the
11 intent of this section.
12 SECTION 3. That Section 31-3505, Idaho Code, be, and the same is hereby
13 amended to read as follows:
14 31-3505. TIME AND MANNER OF FILING APPLICATIONS AND REQUESTS. Applicants
15 Applications and requests for necessary medical services shall be filed with
16 the clerk according to the following time limits. Filing is complete upon
17 receipt by the clerk.
18 (1) An application for nonemergency necessary medical services shall be
19 filed ten (10) days prior to receiving services from the provider.
20 (2) An application for emergency necessary medical services shall be made
21 any time within thirty-one (3 01) days following beginning with the first day
22 of the provision of necessary medical services from the provider or in the
23 case of hospitalization, thirty-one (3 01) days from beginning with the date of
25 (3) Requests for additional treatment related to an original diagnosis in
26 accordance with a preapproved treatment plan shall be filed ten (10) days
27 prior to receiving services.
28 (4) (a) A delayed application for necessary medical services may be filed
29 up to one hundred eighty (180) days after beginning with the first day of
30 the provision of necessary medical services on condition that the provider
31 and/or applicant demonstrates that an application or claim for social
32 security, third party insurance, medicaid, medicare, crime victims compen-
33 sation, and/or worker's compensation was timely filed within ninety (90)
34 days following beginning with the first day of the provision of necessary
35 medical services from the provider or, in the case of hospitalization,
36 ninety (90) days from beginning with the date of admission.
37 (b) In the event that a county determines that a different county is the
38 obligated county, an application may be filed within thirty (30) days in
39 the other county within thirty (30) days of the date of the initial county
41 SECTION 4. That Section 31-3506, Idaho Code, be, and the same is hereby
42 amended to read as follows:
43 31-3506. OBLIGATED COUNTY. The county obligated for payment shall be
44 determined as follows:
45 (1) The obligated county for payment of pharmaceuticals for
46 noninstitutionalized individuals shall be the county where the applicant cur-
47 rently resides.
48 (2) The obligated county for payment of necessary medical services for
49 medical indigent individuals shall be as follows:
50 (a) The last county in which the applicant or head of household has main-
51 tained a residence for six (6) consecutive months or longer within the
1 past five (5) years preceding application shall be obligated. If the
2 applicant or head of household maintains another residence in a different
3 county or state for purposes of employment, the county where the family
4 residence is maintained shall be deemed the applicant's or head of
5 household's place of residence.
6 (b) If an individual has not resided in any county for a period of six
7 (6) months within the five (5) years preceding incurrence of medical costs
8 for which counties have a responsibility in whole or in part, then the
9 county where the applicant maintained a residence for at least thirty (30)
10 days immediately preceding such incurrence shall be the obligated county.
11 (c) Active military duty, or being admitted as a patient in a hospital,
12 nursing home, other medical facility or institution, shall not change the
13 obligated county. The county obligated shall remain the same county that
14 would have been obligated prior to institutionalization as above
16 (d) For full-time students at public institutions of higher learning, the
17 obligated county shall be the county of residence of the applicant unless
18 an obligated person, for whom the applicant is claimed as a dependent,
19 resides in another county or state.
20 (e) If an individual has not resided in any county for a consecutive
21 period of thirty (30) days but has resided in the state of Idaho for a
22 consecutive period of thirty (30) days then the county where the individ-
23 ual last resided prior to receiving medical services shall be the obli-
24 gated county.
25 SECTION 5. That Section 31-3509, Idaho Code, be, and the same is hereby
26 amended to read as follows:
27 31-3509. COLLECTIONS BY PROVIDERS. Providers making claims for necessary
28 medical services of medically indigent persons shall make all reasonable
29 efforts to determine liability for the account so incurred from any available
30 insurance or other sources available for payment of such expenses prior to
31 submitting the bill to the county for payment. In the event that a provider
32 has been notified that an individual qualifies for approval of benefits, such
33 provider(s) shall submit a bill to third party insurance, medicaid, medicare,
34 crime victims compensation and/or worker's compensation for payment within
35 thirty (30) days of such notice. In the event any payments are thereafter
36 received for charges which have been paid by a county and/or the administrator
37 pursuant to the provisions of this chapter, said sums up to the amount actu-
38 ally paid by the county and/or the administrator shall be paid over to such
39 county and/or administrator within sixty (60) days of receiving such payment
40 from other resources.
STATEMENT OF PURPOSE
The purpose of this bill is to provide some technical changes in the medical
indigency statutes to clarify the following:
1. That a person must be a resident of the state of Idaho for 30 days, not a
particular county to qualify for benefits.
2. That the Idaho Association of Counties and Idaho Hospital Association must
approve a uniform application for county medical assistance.
3. That the process for filing an application for county medical indigent
assistance begins with the first day of the provision of necessary medical services.
4. That medical providers submit a bill to another resource within 30 days of
being notified and then reimburse such county within 60 days of receiving a
payment from such other resource.
There is no fiscal impact on the state general fund. There is no impact on any
political subdivision or medical provider in this state.
CONTACT: Marcia Wingfield, Shoshone County Clerk 752-1264
Tony Poinelli, Idaho Association of Counties 345-9126
STATEMENT OF PURPOSE/FISCAL IMPACT H 573