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LEGISLATURE
OF
THE
STATE
OF
IDAHO
Sixty-eighth
Legislature
Second
Regular
Session
-
2026
IN
THE
HOUSE
OF
REPRESENTATIVES
HOUSE
BILL
NO.
845
BY
HEALTH
AND
WELFARE
COMMITTEE
AN
ACT
1
RELATING
TO
MEDICAID;
AMENDING
CHAPTER
2,
TITLE
56,
IDAHO
CODE,
BY
THE
AD
-
2
DITION
OF
A
NEW
SECTION
56
-
276,
IDAHO
CODE,
TO
ESTABLISH
PROVISIONS
RE
-
3
GARDING
MEDICAID
PRESUMPTIVE
ELIGIBILITY
DETERMINATIONS
BY
QUALIFIED
4
HOSPITALS,
TO
PROVIDE
PERFORMANCE
STANDARDS,
AND
TO
PROVIDE
FOR
VIOLA
-
5
TIONS,
NOTICE,
AND
RIGHTS
OF
APPEAL;
AND
DECLARING
AN
EMERGENCY
AND
PRO
-
6
VIDING
AN
EFFECTIVE
DATE.
7
Be
It
Enacted
by
the
Legislature
of
the
State
of
Idaho:
8
SECTION
1.
That
Chapter
2,
Title
56,
Idaho
Code,
be,
and
the
same
is
9
hereby
amended
by
the
addition
thereto
of
a
NEW
SECTION
,
to
be
known
and
des
-
10
ignated
as
Section
56
-
276,
Idaho
Code,
and
to
read
as
follows:
1
1
56
-
276.
MEDICAID
PRESUMPTIVE
ELIGIBILITY
-
-
QUALIFIED
HOSPITAL
PER
-
12
FORMANCE
STANDARDS
-
-
VIOLATIONS.
(1)
The
director
shall
limit
presumptive
13
eligibility
determination
to
qualified
hospitals.
14
(2)
A
hospital
making
a
presumptive
eligibility
determination
shall:
15
(a)
Notify
the
department
of
each
presumptive
eligibility
determina
-
16
tion
no
later
than
five
(5)
business
days
after
the
date
of
the
determi
-
17
nation;
18
(b)
Assist
individuals
who
the
hospital
determines
are
presumptively
19
eligible
with
completing
and
submitting
a
full
medicaid
application;
20
(c)
Notify
the
applicant
in
writing,
on
all
relevant
forms,
with
plain
21
language
and
in
large
print,
that:
22
(i)
The
applicant's
presumptive
eligibility
will
end
on
the
last
23
day
of
the
following
month
if
the
applicant
does
not
file
a
full
24
medicaid
application
with
the
department
before
the
last
day
of
25
the
following
month;
and
26
(ii)
The
applicant's
presumptive
eligibility
will
continue
until
27
an
eligibility
determination
is
made
by
the
department
concerning
28
the
application
if
the
applicant
files
a
full
medicaid
application
29
with
the
department
before
the
last
day
of
the
following
month;
and
30
(d)
Comply
with
all
other
regulations
and
standards
required
pursuant
31
to
subsection
(3)
of
this
section.
32
(3)
The
department
shall:
33
(a)
Establish
performance
standards
for
hospitals
to
use
in
making
34
presumptive
eligibility
determinations
in
compliance
with
the
require
-
35
ments
of
subsection
(2)
of
this
section;
36
(b)
Establish
an
appeals
process
for
a
hospital
that
disputes
a
deter
-
37
mination
that
a
presumptive
eligibility
standard
was
violated;
and
38
(c)
Use
the
following
performance
standards
to
establish
and
ensure
ac
-
39
curate
presumptive
eligibility
determinations
by
a
qualified
hospital:
40
2
(i)
Determine
whether
each
presumptive
eligibility
determina
-
1
tion
received
from
the
hospital
complied
with
the
time
requirement
2
set
forth
in
subsection
(2)
of
this
section;
3
(ii)
Determine
whether
the
department
received
the
full
applica
-
4
tion
from
the
individual
determined
by
the
hospital
to
be
presump
-
5
tively
eligible
before
the
expiration
of
each
presumptive
eligi
-
6
bility
period;
and
7
(iii)
Determine
whether
each
applicant
who
was
determined
by
the
8
hospital
to
be
presumptively
eligible
was
determined
to
be
eligi
-
9
ble
for
medicaid
after
the
full
application
was
received.
10
(4)
Each
violation
by
a
hospital
of
any
of
the
performance
standards
set
1
1
forth
in
subsection
(3)
of
this
section
counts
as
one
(1)
violation
for
the
12
presumptive
eligibility
determination.
Each
subsequent
violation
of
a
per
-
13
formance
standard
is
an
additional
violation
for
purposes
of
this
section.
14
(5)
For
the
first
violation
of
a
presumptive
eligibility
standard
un
-
15
der
this
section
that
a
hospital
receives
in
a
calendar
year,
the
depart
-
16
ment
shall
notify
the
hospital
of
the
violation
in
writing
no
later
than
five
17
(5)
days
after
the
determination
of
a
violation
is
made.
The
notice
must
in
-
18
clude:
19
(a)
A
description
of
the
standard
that
was
not
met
and
an
explanation
of
20
why
the
hospital
did
not
meet
the
standard;
21
(b)
Notice
that
a
second
violation
by
the
hospital
of
a
presumptive
el
-
22
igibility
standard
will
result
in
a
requirement
that
the
hospital's
ap
-
23
plicable
staff
participate
in
mandatory
training
on
hospital
presump
-
24
tive
eligibility
rules
and
standards
that
is
performed
by
the
depart
-
25
ment;
and
26
(c)
A
description
of
the
appeal
procedures
available
to
the
hospital
27
to
dispute
the
finding
of
a
violation
of
presumptive
eligibility
stan
-
28
dards.
29
(6)
If
the
department
determines
that
a
hospital
has
failed
to
meet
any
30
of
the
presumptive
eligibility
standards
under
this
section
in
any
presump
-
31
tive
eligibility
determination
by
the
hospital
for
a
second
time
within
a
32
twelve
(12)
month
period
of
a
first
violation,
the
department
shall
notify
33
the
hospital
of
the
violation
in
writing
no
later
than
five
(5)
days
after
34
the
determination
that
a
second
violation
has
occurred.
The
notice
must
in
-
35
clude:
36
(a)
A
description
of
the
standard
that
was
not
met
and
an
explanation
of
37
why
the
hospital
did
not
meet
the
standard;
38
(b)
Notice
that
the
hospital's
applicable
staff
must
participate
in
39
mandatory
training
on
hospital
presumptive
eligibility
rules
and
stan
-
40
dards
that
is
performed
by
the
department,
and
information
concerning
41
the
date,
time,
and
location
of
the
training;
42
(c)
A
description
of
the
appeal
procedures
available
to
the
hospital
43
to
dispute
the
finding
of
a
violation
of
presumptive
eligibility
stan
-
44
dards;
and
45
(d)
Notice
that
a
third
violation
by
the
hospital
of
a
presumptive
eli
-
46
gibility
standard
within
a
twelve
(12)
month
period
from
the
second
vi
-
47
olation
will
result
in
the
hospital
no
longer
being
qualified
to
make
48
presumptive
eligibility
determinations.
49
3
(7)
If
the
department
determines
that
a
hospital
has
failed
to
meet
any
1
of
the
presumptive
eligibility
standards
under
this
section
in
any
presump
-
2
tive
eligibility
determination
by
the
hospital
for
a
third
time
within
a
3
twelve
(12)
month
period
of
the
second
violation
by
the
hospital,
the
depart
-
4
ment
shall
notify
the
hospital
of
the
violation
in
writing
no
later
than
five
5
(5)
days
from
a
determination
that
a
presumptive
eligibility
standard
was
6
violated
by
the
hospital
for
the
third
time.
The
notice
shall
include:
7
(a)
A
description
of
the
standard
that
was
not
met
and
an
explanation
of
8
why
the
hospital
did
not
meet
the
standard;
9
(b)
A
description
of
the
appeal
procedures
available
to
the
hospital
10
to
dispute
the
finding
of
a
violation
of
presumptive
eligibility
stan
-
1
1
dards;
and
12
(c)
Notice
that,
effective
immediately
upon
receipt
of
the
notice,
the
13
hospital
is
no
longer
qualified
to
make
presumptive
eligibility
deter
-
14
minations
for
the
medicaid
program.
15
(8)
If
a
hospital
appeals
a
finding
of
a
violation
of
presumptive
eli
-
16
gibility
standards
set
forth
in
subsection
(3)
of
this
section,
the
hospital
17
must
provide
clear
and
convincing
evidence
during
the
appeals
process
that
18
the
standard
was
met
by
the
hospital.
19
SECTION
2.
An
emergency
existing
therefor,
which
emergency
is
hereby
20
declared
to
exist,
this
act
shall
be
in
full
force
and
effect
on
and
after
21
July
1,
2026.
22