Summary
Permits hospitals to make presumptive eligibility determinations for all Medicaid-eligible populations beginning January 1, 2014,
Implementation Status
CMS provided preliminary details on the implementation of this provision in a proposed rule (and corresponding informational bulletin) released in January 2013.
On January 24, 2014, CMS issued guidance (announcement; tools) on implementing the ACA-authorized hospital PE required to be available in all states beginning this month under which Medicaid-participating hospitals provide temporary Medicaid coverage to qualifying individuals, including pregnant women, children, those formerly in foster care and, in states participating in Medicaid expansion, those in the newly eligible adult group.
Statutory Text
SEC. 2202. PERMITTING HOSPITALS TO MAKE PRESUMPTIVE ELIGIBILITY DETERMINATIONS FOR ALL MEDICAID ELIGIBLE POPULATIONS. (a) IN GENERAL.—Section 1902(a)(47) of the Social Security Act (42 U.S.C. 1396a(a)(47)) is amended— (1) by striking ‘‘at the option of the State, provide’’ and inserting ‘‘provide— ‘‘(A) at the option of the State,’’; (2) by inserting ‘‘and’’ after the semicolon; and (3) by adding at the end the following: ‘‘(B) that any hospital that is a participating provider under the State plan may elect to be a qualified entity for purposes of determining, on the basis of preliminary information, whether any individual is eligible for medical assistance under the State plan or under a waiver of the plan for purposes of providing the individual with medical assistance during a presumptive eligibility period, in the same manner, and subject to the same requirements, as apply to the State options with respect to populations described in section 1920, 1920A, or 1920B (but without regard to whether the State has elected to provide for a presumptive eligibility period under any such sections), subject to such guidance as the Secretary shall establish;’’. (b) CONFORMING AMENDMENT.—Section 1903(u)(1)(D)(v) of such Act (42 U.S.C. 1396b(u)(1)(D)v)) is amended— (1) by striking ‘‘or for’’ and inserting ‘‘for’’; and (2) by inserting before the period at the end the following: ‘‘, or for medical assistance provided to an individual during a presumptive eligibility period resulting from a determination of presumptive eligibility made by a hospital that elects under section 1902(a)(47)(B) to be a qualified entity for such purpose’’. (c) EFFECTIVE DATE.—The amendments made by this section take effect on January 1, 2014, and apply to services furnished on or after that date.