The bill mandates that the State Medicaid program provide coverage for assisted living services for individuals diagnosed with serious mental illnesses who do not require assistance with activities of daily living (ADLs) but struggle with instrumental activities of daily living (IADLs). It defines ADLs as basic self-care tasks, such as bathing and dressing, while IADLs encompass more complex tasks like managing medications and personal finances. To determine eligibility for these services, a licensed mental health professional will conduct a functional assessment that considers the individual's medical records, psychiatric history, and input from relevant parties, including treating physicians and family members.

Furthermore, the bill requires the Commissioner of Human Services to apply for any necessary State plan amendments or waivers to implement these provisions and secure federal financial participation for Medicaid expenditures. The Commissioner is also responsible for adopting rules and regulations within 180 days of the bill's enactment to facilitate its implementation. The provisions of the bill will take effect on the first day of the sixth month following its enactment, ensuring that payments for these services adhere to established rules, preventing providers from charging recipients additional fees for covered services.

Statutes affected:
Introduced: 30:4D-6