SS SB 539 -- HEALTH CARE AND SOCIAL SERVICES PROGRAMS

This bill changes the laws regarding health care and social
services programs, including the Missouri Medicaid Program, the
Missouri Rx Plan, and personal care assistance programs.

MISSOURI MEDICAID PROGRAM

The bill reduces income levels for eligibility for medical
assistance and eliminates some optional services, including
medical assistance for the working disabled and general relief
medical assistance, and lowers from 226% to 151% of the federal
poverty level the income of parents of uninsured children in the
MC+ for Kids Program who are required to pay a premium.  The
Family Support Division within the Department of Social Services
is required to conduct annual income eligibility and verification
reviews of all recipients of medical assistance and send a
re-verification form letter annually requiring the recipient to
respond and provide income verification documents within 10 days.
The bill changes the division of assets procedure for the
purposes of determining eligibility for the Missouri Medicaid
Program when one spouse enters a nursing home and the other
spouse remains in the community.  Currently, resources that are
allocated to the institutionalized spouse may be diverted to the
community spouse to provide an income stream for the community
spouse.  The bill requires an institutionalized spouse to divert
income to the community spouse to raise the community spouse's
income to the level of the minimum monthly needs allowance.  The
diversion of income must occur before the community spouse is
allowed to retain assets in excess of the community spouse's
protected amount described in federal law.

For purposes of determining Medicaid eligibility, investment in
annuities is limited to those that are actuarially sound, provide
equal payments for the duration of the device, and provide the
state secondary or contingent beneficiary status.  The department
must establish a 60-month look-back period to review any
investment in an annuity by an applicant for Medicaid benefits.
The department is allowed to enforce federal Tax Equity and
Fiscal Responsibility Act (TEFRA) liens on the property of
permanently institutionalized individuals, which include those
persons the department determines cannot reasonably be expected
to be discharged and returned to their home.

Subject to federal law, the department is required to promulgate
rules that require recipients of medical assistance to
participate in cost-sharing activities for all covered services,
except for personal care, mental health, and health care for
uninsured children programs.  The cost-sharing provision will
also not apply to other qualified children, pregnant women, or
blind persons.  A health care provider may not refuse to provide
a service if a recipient is unable to pay a required fee.
However, upon approval from the department, a provider may
terminate future services to an individual with an unpaid debt,
as long as it is the provider's routine business practice and the
provider gives advance notice and a reasonable opportunity to
make payment to the individual.  The department is allowed to
apply for federal Medicaid waivers as necessary if the cost to
the state as a result of the waiver does not exceed an additional
$1 million.  The request for a waiver will not become effective
except by an executive order of the Governor.

MISSOURI RX PLAN

The bill allows the Missouri Rx Plan to select one or more
prescription drug plans as the preferred plan for purposes of the
coordination of benefits between the Missouri Rx Plan and the
Medicare part D drug benefit.  The Department of Health and
Senior Services must give initial enrollment priority to
individuals who are dually eligible for both Medicare and
Medicaid.  The next enrollment priority will be Medicare eligible
participants with an annual household income at or below 150% of
the federal poverty level.

The plan is the payor of last resort and is meant to cover the
costs of participants that are not covered by Medicare part D.
Persons ineligible for coverage under the Missouri Rx Plan
include individuals qualified for coverage for prescription drugs
under a public assistance program other than the Medicare
Modernization Act, persons who are not considered
dually-eligible, and persons qualified for full coverage under
another plan of assistance or insurance.

Persons eligible for services under the current Missouri Senior
Rx Program on December 13, 2005, will continue to be eligible for
those services until January 1, 2006.  The provisions of the
current Missouri Senior Rx Program will expire following notice
to the Revisor of Statutes by the Missouri Rx Plan Advisory
Commission that the Medicare Modernization Act of 2003 has been
fully implemented.

PERSONAL CARE ASSISTANCE PROGRAM

The bill transfers the Personal Care Assistance Program for
Disabled Persons from the Department of Elementary and Secondary
Education to the Department of Health and Senior Services which
will provide financial assistance to physically disabled persons
for personal care assistance services through eligible vendors.
The requirements for eligibility and annual eligibility review
are specified; and upon determination of eligibility, the
department must develop a personal care assistance services plan
for each disabled person.

Disabled persons receiving personal care assistance are
responsible for the supervision of the attendant, while the
vendor is responsible for the Medicaid reimbursement process,
including filing claims and mailing individual payments directly
to the assistant.

The services are not authorized if the primary beneficiary of the
services is the household unit and the household may reasonably
be expected to share responsibilities or assist one another when
they live in the same household.  A personal care assistant who
is listed on any of the Family Care Safety Registry's background
checklists cannot be employed unless a good cause waiver is first
obtained from the department.

Applicants for personal care assistance services and consumers
receiving those services are entitled to a hearing with the
Department of Social Services if eligibility for personal care
assistance services is denied, if the type or amount of services
is set at a level less than the consumer believes is necessary,
if disputes arise after preparation of the personal care
assistance services plan concerning the provision of services, or
if services are discontinued.

The bill specifies the duties of certain persons to report
instances where the person reasonably believes that a disabled
person has been neglected, abused, or his or her property or
funds have been misappropriated.  The duties of the department's
case manager to investigate instances of abuse are also
specified.  A mandated reporter who fails to report abuse will be
guilty of a class A misdemeanor.  An employee disqualification
list will be maintained by the Department of Health and Senior
Services for attendants who commit fraudulent acts.

MISCELLANEOUS PROVISIONS

The bill removes provisions specifying recalculation of future
nursing facility reimbursement rates that were to be effective
starting July 1, 2005, and then successively on July 1, 2006, and
July 1, 2007.

The Medicaid Reform Commission is established, consisting of 10
members, five from the House of Representatives and five from the
Senate, to study and review the current Missouri Medicaid Program
and make recommendations for reforms.  The directors of the
departments of Social Services, Health and Senior Services, and
Mental Health will serve as ex-officio members.  The commission
must make recommendations to the General Assembly by January 1,
2006, on reforming, redesigning, and restructuring a new
innovative healthcare delivery Medicaid system to replace the
current system which will sunset on June 30, 2008.

The bill specifies that the adoption subsidy may only be granted
to children who reside in a household with an income that does
not exceed 200% of the federal poverty level or who are eligible
for Title IV-E adoption assistance.

Missouri House of Representatives
93rd General Assembly, 1st Regular Session
Last Updated August 25, 2005 at 1:21 pm