S T A T E   O F   N E W   Y O R K
________________________________________________________________________

                                  4361

                       2009-2010 Regular Sessions

                          I N  A S S E M B L Y

                            February 3, 2009
                               ___________

Introduced  by  M. of A. BRENNAN, DINOWITZ, GOTTFRIED, ORTIZ, J. RIVERA,
  PEOPLES, PHEFFER, CASTRO, CAHILL, JAFFEE, CHRISTENSEN  --  Multi-Spon-
  sored  by  --  M. of A. GALEF, GREENE, JACOBS, JOHN, LUPARDO, McENENY,
  MENG, SWEENEY -- read once and referred to  the  Committee  on  Social
  Services

AN  ACT  to  amend  the  social services law, in relation to the medical
  assistance presumptive eligibility program

  THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND  ASSEM-
BLY, DO ENACT AS FOLLOWS:

  Section  1.  Subdivisions  1,  2  and 3 of section 364-i of the social
services law, as amended by chapter 693 of the laws of 1996, are amended
to read as follows:
  1. (A) An individual, upon application for medical  assistance,  shall
be presumed eligible for such assistance for a period of sixty days from
the  date  of  transfer  from  a general hospital, as defined in section
twenty-eight hundred one of the public health law to  a  certified  home
health  agency  or  long  term  home  health care program, as defined in
section thirty-six hundred two of the public health law, or to a hospice
as defined in section four thousand two of the public health law, or  to
a  residential  health  care facility as defined in section twenty-eight
hundred one of the public health law, if the local department of  social
services  determines  that  the  applicant  meets  each of the following
criteria: [(a)] (I) the applicant is receiving acute care in such hospi-
tal; [(b)] (II)  a physician certifies that  such  applicant  no  longer
requires  acute hospital care, but still requires medical care which can
be provided by a certified home health agency,  long  term  home  health
care  program,  hospice or residential health care facility; [(c)] (III)
the applicant or his representative states that the applicant  does  not
have insurance coverage for the required medical care and that such care
cannot  be afforded; [(d)] (IV) it reasonably appears that the applicant
is otherwise eligible  to  receive  medical  assistance;  [(e)]  (V)  it

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD07140-01-9
              

A. 4361                             2

reasonably  appears  that the amount expended by the state and the local
social services district for medical  assistance  in  a  certified  home
health  agency,  long term home health care program, hospice or residen-
tial  health  care  facility, during the period of presumed eligibility,
would be less than the amount the state and the  local  social  services
district would expend for continued acute hospital care for such person;
and  [(f)] (VI) such other determinative criteria as the commissioner OF
HEALTH shall provide by rule or regulation. If a person has been  deter-
mined  to  be presumptively eligible for medical assistance, pursuant to
this subdivision, and is subsequently determined to  be  ineligible  for
such  assistance, the commissioner OF HEALTH, on behalf of the state and
the local social services district shall have the  authority  to  recoup
from  the  individual  the  sums expended for such assistance during the
period of presumed eligibility.
  (B) AN INDIVIDUAL, UPON APPLICATION FOR MEDICAL ASSISTANCE,  SHALL  BE
PRESUMED  ELIGIBLE  FOR  SUCH ASSISTANCE FOR CARE, SERVICES AND SUPPLIES
RELATED TO THE TREATMENT OF A MENTAL ILLNESS FOR A PERIOD OF NINETY DAYS
FROM THE DATE OF DISCHARGE FROM A HOSPITAL, AS DEFINED IN  SECTION  1.03
OF  THE  MENTAL HYGIENE LAW, A CORRECTIONAL FACILITY AS DEFINED IN PARA-
GRAPH (A) OF SUBDIVISION FOUR OF SECTION TWO OF THE CORRECTION LAW OR  A
LOCAL  CORRECTIONAL  FACILITY AS DEFINED IN PARAGRAPH (A) OF SUBDIVISION
SIXTEEN OF SECTION TWO OF THE CORRECTION LAW, IF THE LOCAL DEPARTMENT OF
SOCIAL SERVICES DETERMINES THAT THE APPLICANT MEETS EACH OF THE  FOLLOW-
ING  CRITERIA:  (I)  THE APPLICANT IS SEVERELY AND PERSISTENTLY MENTALLY
ILL; (II) A PHYSICIAN CERTIFIES THAT  SUCH  APPLICANT  REQUIRES  MEDICAL
CARE  TO TREAT SUCH MENTAL ILLNESS; (III) THE APPLICANT OR HIS REPRESEN-
TATIVE STATES THAT THE APPLICANT DOES NOT HAVE  INSURANCE  COVERAGE  FOR
THE REQUIRED MEDICAL CARE AND THAT SUCH CARE CANNOT BE AFFORDED; (IV) IT
REASONABLY  APPEARS  THAT THE APPLICANT IS OTHERWISE ELIGIBLE TO RECEIVE
MEDICAL ASSISTANCE; (V) IT REASONABLY APPEARS THAT THE  AMOUNT  EXPENDED
BY  THE STATE AND THE LOCAL SOCIAL SERVICES DISTRICT FOR MEDICAL ASSIST-
ANCE FOR TREATMENT OF A MENTAL ILLNESS DURING  THE  PERIOD  OF  PRESUMED
ELIGIBILITY,  WOULD  BE  LESS  THAN  THE  AMOUNT THE STATE AND THE LOCAL
SOCIAL SERVICES DISTRICT WOULD EXPEND  FOR  CONTINUED  OR  FUTURE  ACUTE
HOSPITAL  CARE FOR SUCH PERSON; AND (VI) SUCH OTHER DETERMINATIVE CRITE-
RIA AS THE COMMISSIONER OF HEALTH SHALL PROVIDE BY RULE  OR  REGULATION.
IF A PERSON HAS BEEN DETERMINED TO BE PRESUMPTIVELY ELIGIBLE FOR MEDICAL
ASSISTANCE, PURSUANT TO THIS SUBDIVISION, AND IS SUBSEQUENTLY DETERMINED
TO  BE  INELIGIBLE  FOR  SUCH ASSISTANCE, THE COMMISSIONER OF HEALTH, ON
BEHALF OF THE STATE AND THE LOCAL SOCIAL SERVICES  DISTRICT  SHALL  HAVE
THE  AUTHORITY  TO RECOUP FROM THE INDIVIDUAL THE SUMS EXPENDED FOR SUCH
ASSISTANCE DURING THE PERIOD OF PRESUMED ELIGIBILITY.
  2. (A) Payment for up to sixty days  of  care  for  services  provided
under  the  medical  assistance  program  shall be made for an applicant
presumed eligible for medical assistance pursuant to  PARAGRAPH  (A)  OF
subdivision  one  of  this  section provided, however, that such payment
shall not exceed sixty-five percent of the rate payable under this title
for services provided by a certified home health agency, long term  home
health care program, hospice or residential health care facility.
  (B)  PAYMENT FOR UP TO NINETY DAYS OF CARE FOR SERVICES PROVIDED UNDER
THE MEDICAL ASSISTANCE PROGRAM SHALL BE MADE FOR AN  APPLICANT  PRESUMED
ELIGIBLE  FOR MEDICAL ASSISTANCE FOR CARE, SERVICES AND SUPPLIES RELATED
TO THE TREATMENT OF A MENTAL ILLNESS PURSUANT TO PARAGRAPH (B) OF SUBDI-
VISION ONE OF THIS SECTION, PROVIDED HOWEVER, THAT  SUCH  PAYMENT  SHALL
NOT  EXCEED ONE HUNDRED PERCENT OF THE RATE PAYABLE UNDER THIS TITLE FOR
SUCH CARE, SERVICES AND SUPPLIES.

A. 4361                             3

  (C) Notwithstanding any other provision of law, no  federal  financial
participation  shall  be claimed for services provided to a person while
presumed eligible for medical assistance under this program  until  such
person  has been determined to be eligible for medical assistance by the
local  social  services  district. During the period of presumed medical
assistance eligibility, payment for services provided  persons  presumed
eligible  under this program shall be made from state funds.  [Upon] (I)
IN THE CASE OF COSTS INCURRED FOR A PERSON  PRESUMPTIVELY  ELIGIBLE  FOR
MEDICAL  ASSISTANCE  UNDER  PARAGRAPH  (A)  OF  SUBDIVISION  ONE OF THIS
SECTION, UPON the final determination of eligibility by the local social
services district, payment shall be made for the balance of the cost  of
such  care  and  services  provided to such applicant for such period of
eligibility and a retroactive adjustment shall be made by the department
OF HEALTH to appropriately reflect federal financial  participation  and
the  local share of costs for the services provided during the period of
presumptive eligibility. Such federal and local financial  participation
shall  be the same as that which would have occurred if a final determi-
nation of eligibility for medical assistance had been made prior to  the
provision  of  the  services  provided  during the period of presumptive
eligibility. In instances where an individual who is  presumed  eligible
for  medical assistance is subsequently determined to be ineligible, the
cost for services provided to such individual  shall  be  reimbursed  in
accordance with the provisions of section three hundred sixty-eight-a of
this  article. Provided, however, if upon audit the department OF HEALTH
determines that there are subsequent determinations of ineligibility for
medical assistance in at least fifteen percent of  the  cases  in  which
presumptive  eligibility  has  been  granted  in a local social services
district, payments for services provided to all persons presumed  eligi-
ble  and subsequently determined ineligible for medical assistance shall
be divided equally by the state and the district.
  (II) IN THE CASE OF COSTS INCURRED FOR A PERSON PRESUMPTIVELY ELIGIBLE
FOR MEDICAL ASSISTANCE UNDER PARAGRAPH (B) OF SUBDIVISION  ONE  OF  THIS
SECTION  UPON THE FINAL DETERMINATION OF ELIGIBILITY BY THE LOCAL SOCIAL
SERVICES DISTRICT, PAYMENT SHALL BE MADE FOR THE BALANCE OF THE COST  OF
SUCH  CARE  AND  SERVICES  PROVIDED TO SUCH APPLICANT FOR SUCH PERIOD OF
ELIGIBILITY AND A RETROACTIVE ADJUSTMENT SHALL BE MADE BY THE DEPARTMENT
OF HEALTH TO APPROPRIATELY REFLECT FEDERAL FINANCIAL  PARTICIPATION  AND
THE  LOCAL SHARE OF COSTS FOR THE SERVICES PROVIDED DURING THE PERIOD OF
PRESUMPTIVE ELIGIBILITY. SUCH FEDERAL FINANCIAL PARTICIPATION  SHALL  BE
THE  SAME  AS THAT WHICH WOULD HAVE OCCURRED IF A FINAL DETERMINATION OF
ELIGIBILITY FOR MEDICAL ASSISTANCE HAD BEEN MADE PRIOR TO THE  PROVISION
OF  THE  SERVICES PROVIDED DURING THE PERIOD OF PRESUMPTIVE ELIGIBILITY.
THERE SHALL BE NO LOCAL SHARE IN THE COSTS OF SUCH ASSISTANCE DURING THE
PRESUMPTIVE ELIGIBILITY PERIOD; PROVIDED HOWEVER THAT IF UPON AUDIT  THE
DEPARTMENT OF HEALTH DETERMINES THAT THERE ARE SUBSEQUENT DETERMINATIONS
OF  INELIGIBILITY  FOR MEDICAL ASSISTANCE IN AT LEAST FIFTEEN PERCENT OF
THE CASES IN WHICH PRESUMPTIVE ELIGIBILITY HAS BEEN GRANTED IN  A  LOCAL
SOCIAL  SERVICES DISTRICT, PAYMENTS FOR SERVICES PROVIDED TO ALL PERSONS
PRESUMED ELIGIBLE AND SUBSEQUENTLY  DETERMINED  INELIGIBLE  FOR  MEDICAL
ASSISTANCE  SHALL  BE  REIMBURSED  IN  ACCORDANCE WITH THE PROVISIONS OF
SECTION THREE HUNDRED SIXTY-EIGHT-A OF THIS ARTICLE.
  3. On or before March thirty-first,  [nineteen  hundred  ninety-seven]
TWO THOUSAND ELEVEN, the department OF HEALTH shall submit to the gover-
nor  and  legislature  an  evaluation  of  the  program,  including  the
program's effects on access, quality and cost of care, and any recommen-
dations for future modifications to improve the program.

A. 4361                             4

  S 2. Subdivisions 1, 2 and 3 of section 364-i of the  social  services
law, as added by chapter 626 of the laws of 1987, are amended to read as
follows:
  1.  (A)  An individual, upon application for medical assistance, shall
be presumed eligible for such assistance for a period of sixty days from
the date of transfer from a general  hospital,  as  defined  in  section
twenty-eight  hundred  one  of the public health law to a certified home
health agency or long term home  health  care  program,  as  defined  in
section  thirty-six  hundred  two of the public health law, if the local
department of social services determines that the applicant  meets  each
of  the  following  criteria: [(a)] (I) the applicant is receiving acute
care in such hospital; [(b)] (II) a physician certifies that such appli-
cant no longer requires acute hospital care, but still requires  medical
care  which  can be provided by a certified home health agency or a long
term home health care program; [(c)] (III) the applicant or  his  repre-
sentative states that the applicant does not have insurance coverage for
the  required  medical care and that such care cannot be afforded; [(d)]
(IV) it reasonably appears that the applicant is otherwise  eligible  to
receive  medical  assistance;  [(e)]  (V) it reasonably appears that the
amount expended by the state and the local social services district  for
medical  assistance  in a certified home health agency or long term home
health care program, during the period of presumed eligibility, would be
less than the amount the state and the local  social  services  district
would  expend  for  continued  acute  hospital care for such person; and
[(f)] (VI) such other determinative  criteria  as  the  commissioner  OF
HEALTH  shall provide by rule or regulation. If a person has been deter-
mined to be presumptively eligible for medical assistance,  pursuant  to
this  subdivision,  and  is subsequently determined to be ineligible for
such assistance, the commissioner OF HEALTH, on behalf of the state  and
the  local  social  services district shall have the authority to recoup
from the individual the sums expended for  such  assistance  during  the
period of presumed eligibility.
  (B)  AN  INDIVIDUAL, UPON APPLICATION FOR MEDICAL ASSISTANCE, SHALL BE
PRESUMED ELIGIBLE FOR SUCH ASSISTANCE FOR CARE,  SERVICES  AND  SUPPLIES
RELATED TO THE TREATMENT OF A MENTAL ILLNESS FOR A PERIOD OF NINETY DAYS
FROM  THE  DATE OF DISCHARGE FROM A HOSPITAL, AS DEFINED IN SECTION 1.03
OF THE MENTAL HYGIENE LAW, A CORRECTIONAL FACILITY AS DEFINED  IN  PARA-
GRAPH  (A) OF SUBDIVISION FOUR OF SECTION TWO OF THE CORRECTION LAW OR A
LOCAL CORRECTIONAL FACILITY AS DEFINED IN PARAGRAPH (A)  OF  SUBDIVISION
SIXTEEN OF SECTION TWO OF THE CORRECTION LAW, IF THE LOCAL DEPARTMENT OF
SOCIAL  SERVICES DETERMINES THAT THE APPLICANT MEETS EACH OF THE FOLLOW-
ING CRITERIA: (I) THE APPLICANT IS SEVERELY  AND  PERSISTENTLY  MENTALLY
ILL;  (II)  A  PHYSICIAN  CERTIFIES THAT SUCH APPLICANT REQUIRES MEDICAL
CARE TO TREAT SUCH MENTAL ILLNESS; (III) THE APPLICANT OR HIS  REPRESEN-
TATIVE  STATES  THAT  THE APPLICANT DOES NOT HAVE INSURANCE COVERAGE FOR
THE REQUIRED MEDICAL CARE AND THAT SUCH CARE CANNOT BE AFFORDED; (IV) IT
REASONABLY APPEARS THAT THE APPLICANT IS OTHERWISE ELIGIBLE  TO  RECEIVE
MEDICAL  ASSISTANCE;  (V) IT REASONABLY APPEARS THAT THE AMOUNT EXPENDED
BY THE STATE AND THE LOCAL SOCIAL SERVICES DISTRICT FOR MEDICAL  ASSIST-
ANCE  FOR  TREATMENT  OF  A MENTAL ILLNESS DURING THE PERIOD OF PRESUMED
ELIGIBILITY, WOULD BE LESS THAN THE  AMOUNT  THE  STATE  AND  THE  LOCAL
SOCIAL  SERVICES  DISTRICT  WOULD  EXPEND  FOR CONTINUED OR FUTURE ACUTE
HOSPITAL CARE FOR SUCH PERSON; AND (VI) SUCH OTHER DETERMINATIVE  CRITE-
RIA  AS  THE COMMISSIONER OF HEALTH SHALL PROVIDE BY RULE OR REGULATION.
IF A PERSON HAS BEEN DETERMINED TO BE PRESUMPTIVELY ELIGIBLE FOR MEDICAL
ASSISTANCE, PURSUANT TO THIS SUBDIVISION, AND IS SUBSEQUENTLY DETERMINED

A. 4361                             5

TO BE INELIGIBLE FOR SUCH ASSISTANCE, THE  COMMISSIONER  OF  HEALTH,  ON
BEHALF  OF  THE  STATE AND THE LOCAL SOCIAL SERVICES DISTRICT SHALL HAVE
THE AUTHORITY TO RECOUP FROM THE INDIVIDUAL THE SUMS EXPENDED  FOR  SUCH
ASSISTANCE DURING THE PERIOD OF PRESUMED ELIGIBILITY.
  2.  (A)  Payment  for  up  to sixty days of care for services provided
under the medical assistance program shall  be  made  for  an  applicant
presumed  eligible  for  medical assistance pursuant to PARAGRAPH (A) OF
subdivision one of this section provided,  however,  that  such  payment
shall not exceed sixty-five percent of the rate payable under this title
for  services  provided by a certified home health agency or a long term
home health care program.
  (B) PAYMENT FOR UP TO NINETY DAYS OF CARE FOR SERVICES PROVIDED  UNDER
THE  MEDICAL  ASSISTANCE PROGRAM SHALL BE MADE FOR AN APPLICANT PRESUMED
ELIGIBLE FOR MEDICAL ASSISTANCE FOR CARE, SERVICES AND SUPPLIES  RELATED
TO THE TREATMENT OF A MENTAL ILLNESS PURSUANT TO PARAGRAPH (B) OF SUBDI-
VISION  ONE  OF  THIS SECTION, PROVIDED HOWEVER, THAT SUCH PAYMENT SHALL
NOT EXCEED ONE HUNDRED PERCENT OF THE RATE PAYABLE UNDER THIS TITLE  FOR
SUCH CARE, SERVICES AND SUPPLIES.
  (C)  Notwithstanding  any other provision of law, no federal financial
participation shall be claimed for services provided to a  person  while
presumed  eligible  for medical assistance under this program until such
person has been determined to be eligible for medical assistance by  the
local  social  services  district. During the period of presumed medical
assistance eligibility, payment for services provided  persons  presumed
eligible  under this program shall be made from state funds.  [Upon] (I)
IN THE CASE OF COSTS INCURRED FOR A PERSON  PRESUMPTIVELY  ELIGIBLE  FOR
MEDICAL  ASSISTANCE  UNDER  PARAGRAPH  (A)  OF  SUBDIVISION  ONE OF THIS
SECTION, UPON the final determination of eligibility by the local social
services district, payment shall be made for the balance of the cost  of
such  care  and  services  provided to such applicant for such period of
eligibility and a retroactive adjustment shall be made by the department
OF HEALTH to appropriately reflect federal financial  participation  and
the  local share of costs for the services provided during the period of
presumptive eligibility. Such federal and local financial  participation
shall  be the same as that which would have occurred if a final determi-
nation of eligibility for medical assistance had been made prior to  the
provision  of  the  services  provided  during the period of presumptive
eligibility. In instances where an individual who is  presumed  eligible
for  medical assistance is subsequently determined to be ineligible, the
cost for services provided to such individual  shall  be  reimbursed  in
accordance with the provisions of section three hundred sixty-eight-a of
this  article. Provided, however, if upon audit the department OF HEALTH
determines that there are subsequent determinations of ineligibility for
medical assistance in at least fifteen percent of  the  cases  in  which
presumptive  eligibility  has  been  granted  in a local social services
district, payments for services provided to all persons presumed  eligi-
ble  and subsequently determined ineligible for medical assistance shall
be divided equally by the state and the district.
  (II) IN THE CASE OF COSTS INCURRED FOR A PERSON PRESUMPTIVELY ELIGIBLE
FOR MEDICAL ASSISTANCE UNDER PARAGRAPH (B) OF SUBDIVISION  ONE  OF  THIS
SECTION  UPON THE FINAL DETERMINATION OF ELIGIBILITY BY THE LOCAL SOCIAL
SERVICES DISTRICT, PAYMENT SHALL BE MADE FOR THE BALANCE OF THE COST  OF
SUCH  CARE  AND  SERVICES  PROVIDED TO SUCH APPLICANT FOR SUCH PERIOD OF
ELIGIBILITY AND A RETROACTIVE ADJUSTMENT SHALL BE MADE BY THE DEPARTMENT
OF HEALTH TO APPROPRIATELY REFLECT FEDERAL FINANCIAL  PARTICIPATION  AND
THE  LOCAL SHARE OF COSTS FOR THE SERVICES PROVIDED DURING THE PERIOD OF

A. 4361                             6

PRESUMPTIVE ELIGIBILITY. SUCH FEDERAL FINANCIAL PARTICIPATION  SHALL  BE
THE  SAME  AS THAT WHICH WOULD HAVE OCCURRED IF A FINAL DETERMINATION OF
ELIGIBILITY FOR MEDICAL ASSISTANCE HAD BEEN MADE PRIOR TO THE  PROVISION
OF  THE  SERVICES PROVIDED DURING THE PERIOD OF PRESUMPTIVE ELIGIBILITY.
THERE SHALL BE NO LOCAL SHARE IN THE COSTS OF SUCH ASSISTANCE DURING THE
PRESUMPTIVE ELIGIBILITY PERIOD; PROVIDED HOWEVER THAT IF UPON AUDIT  THE
DEPARTMENT OF HEALTH DETERMINES THAT THERE ARE SUBSEQUENT DETERMINATIONS
OF  INELIGIBILITY  FOR MEDICAL ASSISTANCE IN AT LEAST FIFTEEN PERCENT OF
THE CASES IN WHICH PRESUMPTIVE ELIGIBILITY HAS BEEN GRANTED IN  A  LOCAL
SOCIAL  SERVICES DISTRICT, PAYMENTS FOR SERVICES PROVIDED TO ALL PERSONS
PRESUMED ELIGIBLE AND SUBSEQUENTLY  DETERMINED  INELIGIBLE  FOR  MEDICAL
ASSISTANCE  SHALL  BE  REIMBURSED  IN  ACCORDANCE WITH THE PROVISIONS OF
SECTION THREE HUNDRED SIXTY-EIGHT-A OF THIS ARTICLE.
  3. On or before March thirty-first, [nineteen hundred eighty-nine] TWO
THOUSAND TEN, the department OF HEALTH shall submit to the governor  and
the  legislature  an  initial  evaluation  of  the impact of the medical
assistance presumptive eligibility  program,  including  recommendations
regarding  possible  modifications  and on or before March thirty-first,
nineteen hundred ninety, the department shall submit to the governor and
legislature a second evaluation of the program, including further recom-
mendations for future modifications.
  S 3. Subdivision 1 of section 368-a of  the  social  services  law  is
amended by adding a new paragraph (z) to read as follows:
  (Z)  NOTWITHSTANDING  ANY INCONSISTENT PROVISION OF LAW, REIMBURSEMENT
BY THE STATE FOR PAYMENTS MADE, WHETHER BY THE DEPARTMENT OF  HEALTH  ON
BEHALF  OF  A  LOCAL  SOCIAL SERVICES DISTRICT PURSUANT TO SECTION THREE
HUNDRED SIXTY-SEVEN-B OF THIS  TITLE  OR  BY  A  LOCAL  SOCIAL  SERVICES
DISTRICT  DIRECTLY,  FOR  MEDICAL  ASSISTANCE FURNISHED TO AN INDIVIDUAL
PRESUMED ELIGIBLE FOR MEDICAL ASSISTANCE UNDER PARAGRAPH (B) OF SUBDIVI-
SION ONE OF SECTION THREE HUNDRED SIXTY-FOUR-I OF THIS TITLE, DURING THE
PRESUMPTIVE ELIGIBILITY PERIOD,  SHALL  BE  MADE  FOR  THE  FULL  AMOUNT
EXPENDED FOR SUCH ASSISTANCE, AFTER FIRST DEDUCTING THEREFROM ANY FEDER-
AL FUNDS PROPERLY RECEIVED OR TO BE RECEIVED ON ACCOUNT OF SUCH EXPENDI-
TURE;  PROVIDED  THAT  IF UPON AUDIT THE DEPARTMENT OF HEALTH DETERMINES
THAT THERE ARE SUBSEQUENT DETERMINATIONS OF  INELIGIBILITY  FOR  MEDICAL
ASSISTANCE IN AT LEAST FIFTEEN PERCENT OF THE CASES IN WHICH PRESUMPTIVE
ELIGIBILITY  HAS  BEEN  GRANTED  IN  A  LOCAL  SOCIAL SERVICES DISTRICT,
PAYMENTS FOR SERVICES PROVIDED TO  ALL  PERSONS  PRESUMED  ELIGIBLE  AND
SUBSEQUENTLY DETERMINED INELIGIBLE FOR MEDICAL ASSISTANCE SHALL BE REIM-
BURSED IN ACCORDANCE WITH PARAGRAPH (D) OF THIS SUBDIVISION.
  S  4.  This  act  shall  take  effect April 1, 2010; provided that the
amendments to subdivisions 1, 2 and 3 of section  364-i  of  the  social
services  law  made  by  section one of this act shall be subject to the
expiration and reversion of such section pursuant to section 2 of  chap-
ter  693  of  the  laws  of  1996,  as  amended, when upon such date the
provisions of section two of this act shall take effect.