4012-A - Hospice supplemental financial assistance program for persons with special needs.

§  4012-a.  Hospice  supplemental  financial  assistance  program  for  persons with special needs. 1. Notwithstanding any provision of  law  or  regulation  to  the  contrary,  an  additional  amount may be added to a  hospice's rate pursuant to the medical assistance  program,  subject  to  approval  by  the state director of the budget, for purposes of enabling  such hospice to provide care and services to persons with special needs,  after a determination that such care cannot be appropriately provided at  the rates of payment established pursuant to federal criteria.    2. "Persons with special needs" as used herein shall  include  persons  with   acquired  immune  deficiency  syndrome  and  other  illnesses  or  conditions, which require a more costly or intensive level of care  than  typically  provided,  and persons receiving care in a hospice residence.  Such other illnesses or conditions shall be specified in  regulation  by  the state hospital review and planning council.    3.  In  order  for  a hospice to obtain additional medicaid payment as  provided for in this section, the hospice shall submit cost  information  as  required  by the commissioner, in consultation with the commissioner  of social services, which justifies  additional  medicaid  expenditures,  including  a  demonstration  that  adequate care to persons with special  needs cannot  be  provided  within  the  rates  of  payment  established  pursuant  to  federal  criteria.  In  addition to demonstrating that the  hospice  is  certified  and  in  good  standing  with   all   applicable  regulations and requirements, the hospice shall also demonstrate that it  shall:    (a)  utilize  such  additional  payment to provide services to persons  with special needs;    (b) shall undertake reasonable efforts to maintain  financial  support  from public and community contributed funding sources;    (c)  shall  make  every  reasonable  effort  to  collect  payments for  services from third party  insurance  payers,  governmental  payers  and  self-paying patients; and    (d)  shall  establish  a  reasonable  relationship  between  costs and  charges, or establish charges at approximate costs.    4. The commissioner, in consultation with the commissioner  of  social  services, is authorized to submit for approval and adoption by the state  hospital  review  and  planning council such regulations as necessary to  effectuate the provisions of this section.    5. The commissioner shall establish a rate for persons receiving  care  in  a  hospice  residence,  and  may  by  regulation  specify additional  standards necessary to  ensure  that  the  provisions  of  this  section  promote  medical  assistance recipients access to hospice residence care  including;  (a)  that  such   recipients   are   otherwise   unable   to  appropriately  receive  hospice  care  in  their  own  home; and (b) the  provision  of  supplemental  financial  assistance  will   promote   the  efficient delivery of appropriate, quality, cost-effective services.