This bill amends the eligibility criteria for Medicaid nursing facility services and home and community-based care by updating the definition of activities of daily living to include mobility. It clarifies that the determination of clinical eligibility is the responsibility of "skilled professional medical personnel" and requires that the applicant's primary care physician or nurse practitioner provide a determination of the need for long-term care. Additionally, the bill mandates that substantial weight be given to clinical information from other healthcare providers, including specialty care physicians and therapists, in the eligibility decision-making process. The previous reference to "skilled professional medical personnel" in federal regulations has been updated from 432.50(d)(1)(ii) to 432.2. Furthermore, the bill stipulates that no applicant undergoing annual redetermination shall be denied eligibility without the agreement of their primary care physician or nurse practitioner that they no longer meet the required level of care. This change aims to streamline the eligibility process while ensuring that medical professionals are involved in the decision-making. The Department of Health and Human Services anticipates that these changes could lead to increased costs exceeding $2.5 million annually, funded through a combination of general and federal funds. However, there are concerns regarding the potential for delays in processing applications and the risk of jeopardizing federal financial participation for Medicaid if eligibility determinations are not made within the required timeframe.

Statutes affected:
Introduced: 151-E:3
As Amended by the Senate (2nd): 151-E:3
As Amended by the Senate: 151-E:3