NY A05227

Expands the medical assistance presumptive eligibility program to include individuals discharged from psychiatric hospitals, correctional facilities, or local correctional facilities who are severely and persistently mentally ill and require treatment for mental illness for ninety days from discharge.

Requires applicants to meet six criteria for presumptive eligibility including physician certification of need for mental illness treatment, lack of insurance coverage, reasonable appearance of other eligibility requirements, and that treatment costs would be less than continued acute hospital care.

Sets payment rates for mental illness treatment services at one hundred percent of the applicable rate under medical assistance, compared to sixty-five percent for other presumptively eligible services, with no local social services district share during the presumptive eligibility period.

Provides that federal financial participation shall apply to mental illness treatment services during presumptive eligibility, and establishes a fifteen percent audit threshold after which costs for subsequently determined ineligible individuals shall be reimbursed according to existing provisions.

Requires the Department of Health to submit an evaluation of the program to the governor and legislature by March 31, 2016, addressing effects on access, quality, and cost of care, with an effective date of April 1, 2015.