§ 364-i. Medical assistance presumptive eligibility program. 1. An\nindividual, upon application for medical assistance, shall be presumed\neligible for such assistance for a period of sixty days from the date of\ntransfer from a general hospital, as defined in section twenty-eight\nhundred one of the public health law to a certified home health agency\nor long term home health care program, as defined in section thirty-six\nhundred two of the public health law, or to a hospice as defined in\nsection four thousand two of the public health law, or to a residential\nhealth care facility as defined in section twenty-eight hundred one of\nthe public health law, if the local department of social services\ndetermines that the applicant meets each of the following criteria: (a)\nthe applicant is receiving acute care in such hospital; (b) a physician\ncertifies that such applicant no longer requires acute hospital care,\nbut still requires medical care which can be provided by a certified\nhome health agency, long term home health care program, hospice or\nresidential health care facility; (c) the applicant or his\nrepresentative states that the applicant does not have insurance\ncoverage for the required medical care and that such care cannot be\nafforded; (d) it reasonably appears that the applicant is otherwise\neligible to receive medical assistance; (e) it reasonably appears that\nthe amount expended by the state and the local social services district\nfor medical assistance in a certified home health agency, long term home\nhealth care program, hospice or residential health care facility, during\nthe period of presumed eligibility, would be less than the amount the\nstate and the local social services district would expend for continued\nacute hospital care for such person; and (f) such other determinative\ncriteria as the commissioner shall provide by rule or regulation. If a\nperson has been determined to be presumptively eligible for medical\nassistance, pursuant to this subdivision, and is subsequently determined\nto be ineligible for such assistance, the commissioner, on behalf of the\nstate and the local social services district shall have the authority to\nrecoup from the individual the sums expended for such assistance during\nthe period of presumed eligibility.\n 2. Payment for up to sixty days of care for services provided under\nthe medical assistance program shall be made for an applicant presumed\neligible for medical assistance pursuant to subdivision one of this\nsection provided, however, that such payment shall not exceed sixty-five\npercent of the rate payable under this title for services provided by a\ncertified home health agency, long term home health care program,\nhospice or residential health care facility. Notwithstanding any other\nprovision of law, no federal financial participation shall be claimed\nfor services provided to a person while presumed eligible for medical\nassistance under this program until such person has been determined to\nbe eligible for medical assistance by the local social services\ndistrict. During the period of presumed medical assistance eligibility,\npayment for services provided persons presumed eligible under this\nprogram shall be made from state funds. Upon the final determination of\neligibility by the local social services district, payment shall be made\nfor the balance of the cost of such care and services provided to such\napplicant for such period of eligibility and a retroactive adjustment\nshall be made by the department to appropriately reflect federal\nfinancial participation and the local share of costs for the services\nprovided during the period of presumptive eligibility. Such federal and\nlocal financial participation shall be the same as that which would have\noccurred if a final determination of eligibility for medical assistance\nhad been made prior to the provision of the services provided during the\nperiod of presumptive eligibility. In instances whe
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