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 it corrects the federal reference for this definition from 432.50(d)(1)(ii) to 432.2. Additionally, the bill mandates that the Department of Health and Human Services must consider information from the applicant’s primary care physician or nurse practitioner when assessing eligibility, and it allows the department to obtain necessary medical information for decision-making. Furthermore, the bill stipulates that no applicant undergoing annual redetermination can 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 ensure that clinical assessments are thorough and take into account comprehensive medical input. The fiscal impact of the bill is projected to exceed $2.5 million annually, with costs shared between general and federal funds. The Department of Health and Human Services has expressed concerns regarding the potential for delays in eligibility determinations and the risk of jeopardizing federal financial participation for Medicaid if the new requirements are not met efficiently.

Statutes affected:
Introduced: 151-E:3
As Amended by the Senate: 151-E:3