HB 1918 -- Public Assistance Programs

Sponsor:  Sater

This bill changes the laws regarding public assistance programs
administered by the state.  In its main provisions, the bill:

(1)  Requires health care practitioners who provide Missouri
Medicaid Program services to an individual who is eligible for
Medicaid, federal Medicare Part B, and Supplementary Medical
Insurance to receive full reimbursement for the services provided
except for hospital outpatient services;

(2)  Prohibits MO HealthNet payments made for eligible recipients
for personal care services from exceeding three and one-half
hours per day and 60 hours per month.  When the need for services
is demonstrated, the state can approve payment for up to an
additional 20 hours per month;

(3)  Authorizes the Department of Social Services, in order to
provide comprehensive health care, to require prepaid health
plans to limit reimbursements to health care providers who are
not contracted providers with the plan to up to 95% of the
medical assistance rates established by the MO HealthNet Division
within the department to enrolled providers to care for MO
HealthNet participants who are not enrolled in a prepaid health
plan;

(4)  Requires the division to establish the Psychotropic
Medication Review Subcommittee of the MO HealthNet Drug Prior
Authorization Committee to review psychotropic medications and
develop, access, use, and monitor requirements for all
medications approved by the United States Food and Drug
Administration that may be used to treat behavioral health
issues;

(5)  Requires, subject to appropriations, the department to
provide financial assistance for personal care services for
Medicaid-eligible recipients who have their unmet needs safely
met with no more than three and one-half hours per day and 60
hours per month.  When the need for services is demonstrated, the
state can approve payment for up to an additional 20 hours per
month;

(6)  Specifies that individuals receiving personal care
assistance are responsible for approving reimbursement requests
through a system that assures accuracy and compliance with
exceptions for consumers and vendors and for providing vendors
with all the information needed to determine the employer
identification number;

(7)  Specifies that personal care assistance vendors are
responsible for reviewing and certifying the accuracy of reports
of delivered services and for maintaining and utilizing a
telephone tracking system for the reporting and verification of
the delivery of services authorized by the Department of Health
and Senior Services for processing payroll and submitting claims
for reimbursement.  Vendors with more than 150 consumers must
have the system fully operational by July 1, 2011.  Vendors with
150 or fewer consumers must have the system fully operational by
July 1, 2012.  In order for a vendor to obtain an agreement with
the Department of Social Services, the vendor must demonstrate
the ability to implement the telephone tracking system;

(8)  Requires assessment reports prepared by a nurse assessing a
client and his or her plan of services to be submitted to the
department instead of the client's case manager.  Reimbursement
for the nurse's assessment visit must be preauthorized by the
department.  All in-home services clients must be informed that
the department can contract with a provider to receive complaint
calls;

(9)  Requires all in-home services provider agencies to have,
maintain, and utilize a telephone tracking system for the
reporting and verification of the delivery of services authorized
by the Department of Health and Senior Services for processing
payroll and submitting claims for reimbursement to the division.
Agencies with more than 150 consumers must have the system fully
operational by July 1, 2011.  Agencies with 150 or fewer
consumers must have the system fully operational by July 1, 2012.
In order for an agency to obtain an agreement with the Department
of Social Services, the agency must demonstrate the ability to
implement the telephone tracking system; and

(10)  Repeals provisions regarding the process for MO
HealthNet-funded home- and community-based referrals.

Missouri House of Representatives
95th General Assembly, 2nd Regular Session
Last Updated September 14, 2010 at 3:12 pm