HCS HB 1129 -- FEDERAL REIMBURSEMENT ALLOWANCE FOR IN-HOME
SERVICES

SPONSOR:  Icet

COMMITTEE ACTION:  Voted "do pass" by the Committee on Budget by
a vote of 24 to 0.

This substitute authorizes a federal reimbursement allowance for
in home services.  "In-home services" are defined as homemaker
services, personal care services, chore services, respite
services, consumer-directed services, and services provided in
the individual's home and under a plan of care created by a
physician which are necessary to keep children out of the
hospitals.  "In-home services provider" is defined as any
provider or vendor as specified under Section 208.900, RSMo, of
compensated in-home services under Chapter 208 and contracted
with the Department of Social Services.  Each in-home services
provider will be required to pay an in-home services
reimbursement allowance based on a formula established by the
Department of Social Services.

Each in-home services provider who is subject to the provisions
of the substitute is required to register with the Department of
Health and Senior Services and to keep records necessary to
determine the total payments received for providing in-home
services.  Each provider is required to report the total payments
received to the Department of Social Services.  The first $25,000
generated in gross income is disregarded for each provider.  The
Department of Health and Senior Services must provide the
Department of Social Services with a list of all registered
in-home services providers.

The Department of Social Services is required to determine and
notify each provider of the amount of tax due.  The tax may be
adjusted quarterly on a prospective basis or more frequently for
certain providers if the department identifies the need.  If
requested by the in-home services provider, the department may
offset the tax owed against any MO HealthNet Program payment due
the provider.

The In-Home Services Reimbursement Allowance Fund is created to
provide payment to in-home services providers.  All investment
earnings of the fund must be credited to the fund.

For an in-home services provider with a tax due of more than 90
days, the Department of Social Services is required to send
notification of the tax due.  If a provider fails to pay its tax
within 30 days of the notice, the tax is considered delinquent
and the department may proceed with a lien against the provider's
property; deny, suspend, or revoke his or her license; and cancel
or refuse to issue, extend, or reinstate his or her MO HealthNet
provider agreement.

The provisions of the substitute will be effective upon
authorization by the federal Centers for Medicare and Medicaid
Services for a federal reimbursement allowance for in-home
services.

The provisions of the substitute will expire September 1, 2011.

FISCAL NOTE:  Estimated Cost on General Revenue Fund of Unknown
but Greater than $24,725 in FY 2010, Unknown but Greater than
$30,547 in FY 2011, and Unknown but Greater than $31,463 in FY
2012.  No impact on Other State Funds in FY 2010, FY 2011, and FY
2012.

PROPONENTS:  Supporters say that the bill was modeled after the
federal reimbursement allowance for pharmacies.  The allowance is
limited to in-home providers who contract with the Department of
Social Services for services performed under Chapter 208, RSMo.
Small providers that earn $25,000 or less in gross income will be
exempt.  Currently, the allowance has not been approved by the
federal Centers for Medicare and Medicaid Services (CMS) and will
not be effective until authorized by CMS.  The allowance will
increase rates for providers and increase funds for the state
budget.

Testifying for the bill were Representative Stream; Integrity
Home Care; Jay Reichard, Pyramid Home Health Services; Missouri
Alliance for Home Care; Missouri Council for In-Home Services;
and Paraquad, Incorporated.

OPPONENTS:  Those who oppose the bill say that it is not under
the federal rule.  Using the term "federal" requires taxes to be
broadly based, and this one is pretty limited.  Federal
reimbursement allowances create some big winners and big losers.
In-home providers help with daily living instead of the care
provided by a doctor or nurse.

Testifying against the bill was Missouri Association of Homes for
the Aging.

Missouri House of Representatives
95th General Assembly, 1st Regular Session
Last Updated November 17, 2009 at 9:26 am