CCS HCS SS SCS SB 577 -- MO HEALTHNET PROGRAM

This bill changes the laws regarding the state medical assistance
program, known as the Missouri Medicaid Program, including
changing its name to the MO HealthNet Program.

STATE LEGAL EXPENSE FUND

Physicians, dentists, podiatrists, chiropractors, nurses,
optometrists, psychologists, professional counselors, social
workers, and pharmacists who provide specialty care without
compensation and who were referred by their city or county health
department, city health department operating under a city
charter, combined city-county health department, a nonprofit
community health center, or any social welfare board established
under Section 205.770, RSMo, are included in the list for whom
the State Legal Expense Fund is available.  The fund is not
available to a physician who performs an abortion procedure.

Any claim or judgment arising from these provisions is limited to
a maximum of $1 million based upon the same act or acts in a
single cause of action and $1 million for any one claimant.
Liability or malpractice insurance will not be considered
available to pay any portion of the judgment when the fund is
liable.

INCOME TAX DEDUCTION FOR LONG-TERM CARE INSURANCE

Beginning January 1, 2007, the bill authorizes an income tax
deduction for 100% of the nonreimbursed qualified long-term care
insurance premiums paid by the taxpayer to the extent the amount
is not already included in the taxpayer's itemized deductions.

HEALTHCARE ACCESS

The Missouri Healthcare Access Fund is created, subject to
appropriations, to expand health care services in state and
federally designated areas with health care shortages.  The
Department of Health and Senior Services is authorized to
designate eligible facilities in an area of defined need and is
required to re-evaluate eligible facilities every six years.
Beginning January 1, 2007, individuals making a donation in
excess of $100 to the fund will be eligible for an income tax
credit.

Psychiatrists and psychologists, as defined in Section 632.005,
and psychiatrists, psychologists, and other mental health
providers, professional counselors, and social workers licensed
under Chapter 337 are added to the list of providers who are
allowed to receive enhanced payments from the Health Access
Incentive Fund in designated shortage areas.

MO HEALTHNET FRAUD AND ABUSE

The bill:

(1)  Expands the definition of "health care provider" to include
any employee, representative, or subcontractor of the state;

(2)  Increases the penalty for making a false statement to a
class C felony for a first conviction and a class B felony for a
subsequent conviction.  A person who attempts to or willfully
prevents, obstructs, misleads, or delays the communication of
information relating to a violation will be guilty of a class D
felony;

(3)  Specifies that any person who is the original source of
information regarding a violation will receive 10% of any
recovery unless he or she participated in the fraud or abuse;

(4)  Prevents an employer from discriminating against an employee
for participating in a court action relating to a violation
unless the employee filed a frivolous claim, participated in the
violation, or is convicted of criminal conduct related to the
violation;

(5)  Requires the Office of the Attorney General and the
Department of Social Services to report information regarding
violations of the fraud statutes to the Governor and General
Assembly by January 1, 2008, and annually thereafter;

(6)  Requires the State Auditor to complete a financial audit of
the MO HealthNet fraud unit within the Office of the Attorney
General and the program integrity unit within the Department of
Social Services;

(7)  Creates the crime of knowingly destroying or concealing
records of claims submitted or payments received for the previous
five years.  Any person committing this crime will be guilty of a
class A misdemeanor;

(8)  Creates the crime of intentionally filing a false report or
claim of alleged violations.  Any person committing this crime
will be guilty of a class A misdemeanor for the first offense and
a class D felony for any subsequent offense;

(9)  Creates the crime of receiving compensation for failure to
report violations.  Any person committing this crime will be
guilty of a class D felony; and

(10)  Renames the Medicaid Fraud Reimbursement Fund to the MO
HealthNet Fraud Reimbursement Fund and allows the moneys to be
used for increasing MO HealthNet provider reimbursements until
the average provider reimbursement equals the average federal
Medicare Program provider reimbursement for comparable services.

CHRONIC KIDNEY DISEASE TASK FORCE

The Chronic Kidney Disease Task Force is established to educate
the public and health care professionals about early screening,
prevention, diagnosis, treatment, and complications of chronic
kidney disease.  The task force must submit a report of its
findings and recommendations to the General Assembly within one
year of the first task force meeting.

ASSISTED LIVING FACILITIES

Assisted living facilities are required to immediately implement
any physician order and, within 24 hours, review and update a
resident's care plan when the resident returns from a hospital or
skilled nursing facility.

MISAPPROPRIATION OF FUNDS

The bill specifies that a person assuming the responsibility of
managing the financial affairs of an elderly person is guilty of
misappropriation of funds for failure to pay for the care of an
elderly or disabled person.

TICKET TO WORK HEALTH ASSURANCE PROGRAM

The bill establishes the Ticket to Work Health Assurance Program
which requires the Department of Social Services to determine the
eligibility of an employed disabled person requesting medical
assistance whose family gross income is less than 250% of the
federal poverty level.  The bill:

(1)  Requires that an individual meet the definition of a
disabled person under the federal Supplemental Security Income
Program or of an employed individual with a medically improved
disability under the federal Ticket to Work and Work Incentives
Improvement Act of 1999 to qualify for assistance;

(2)  Requires an individual whose net income does not exceed the
limit for permanent and total disability to receive non-spenddown
MO HealthNet benefits;

(3)  Requires any participant whose gross income exceeds 100% of
the federal poverty level to pay a premium for participation in
the program;

(4)  Requires an individual to participate in an
employer-sponsored health insurance plan if the department
determines that it is more cost effective;

(5)  Exempts any income earned through certified extended
employment at a sheltered workshop for the purpose of determining
eligibility; and

(6)  Exempts medical savings accounts and independent living
accounts not exceeding $5,000 from the asset limits for
eligibility.

MISSOURI CONTINUING HEALTH IMPROVEMENT ACT

The bill:

(1)  Establishes the Missouri Continuing Health Improvement Act
and changes the name of the Division of Medical Services within
the Department of Social Services to the MO HealthNet Division;

(2)  Extends the eligibility for health insurance for a drug
court participant to 60 days from the time his or her dependent
child is removed from his or her custody, subject to the approval
of the federal Centers for Medicare and Medicaid Services;

(3)  Expands coverage to include independent foster care
adolescents younger than 21 years of age without regard to income
or assets;

(4)  Adds hospice services to the list of covered services and
adds durable medical equipment, dental services, and optometry to
the list of covered benefits when it is based on a medical
necessity;

(5)  Requires the division to establish by July 1, 2008, a four-
year plan to increase the MO HealthNet provider reimbursement
rates to the federal Medicare Program rates;

(6)  Requires the division to develop pay-for-performance program
guidelines;

(7)  Specifies that any Social Security cost-of-living increase
will be disregarded as income until the federal poverty level for
the year is implemented;

(8)  Specifies that if a MO HealthNet recipient prepays his or
her spenddown in cash to the division and subsequently pays a
valid out-of-pocket medical bill, the expense will be allowed as
a deduction to future required spenddown for up to three months;

(9)  Establishes the Professional Services Payment Committee to
monitor the pay-for-performance program;

(10)  Establishes, subject to appropriation and approval by the
MO HealthNet Oversight Committee, a premium offset program pilot
project in one urban and one rural area of the state.  Qualified
individuals must be uninsured for one year and must have an
income of less than or equal to 185% of the federal poverty
level.  No employer will be allowed to participate in the pilot
project for more than five years;

(11)  Allows certain income from annuity investments to be
excluded when determining MO HealthNet eligibility;

(12)  Establishes rules for personal care contracts which will
not cause an institutionalized individual to be ineligible for
federal Medicare Program benefits based on an improper transfer
of assets;

(13)  Specifies the department's rights to third-party benefits;

(14)  Requires compliance with the federal Health Insurance
Portability and Accountability Act;

(15)  Establishes the Public Assistance Beneficiary Employer
Disclosure Act which requires the department to submit the
Missouri Health Care Responsibility Report quarterly to the
Governor and requires applicants for MO HealthNet benefits to
disclose their employer;

(16)  Requires the departments of Social Services, Mental Health,
and Health and Senior Services to collaborate in addressing
common problems of the elderly;

(17)  Changes the eligibility requirement for the State
Children's Health Insurance Program and specifies that the
program will remain in effect only if the federal government
appropriates funds;

(18)  Changes affordability requirements for uninsured children
without access to affordable health care.  Health insurance plans
that do not cover a child's pre-existing condition are not
considered affordable employer-sponsored health care insurance.
A child is also considered uninsured under these provisions when
the child exceeds the annual coverage limits for all health care
services;

(19)  Changes the eligibility requirements for the Uninsured
Women's Health Program to include a woman at least 18 years of
age with a net family income at or below 185% of the federal
poverty level who has assets of less than $250,000 and no access
to employer-sponsored health insurance;

(20)  Allows the use of telehealth services in the MO HealthNet
Program;

(21)  Establishes the Missouri Long-term Care Partnership Program
Act which provides incentives for individuals to purchase
insurance for their long-term care needs;

(22)  Extends the expiration date for consumer-directed personal
care services from June 30, 2008, to June 30, 2019;

(23)  Requires the Department of Social Services to establish
health improvement plans for all participants with the advice and
approval of the MO HealthNet Oversight Committee.  The health
improvement plans will include, but are not limited to,
risk-bearing coordinated care plans, administrative services
organizations, and coordinated fee-for-service plans;

(24)  Requires the development of and enrollment into the health
improvement plans to begin July 1, 2008, and be completed by
July 1, 2011;

(25)  Requires that contracts for risk-bearing coordinated care
plans and administrative services organization plans have a
financial penalty if quality targets are not met;

(26)  Specifies that every program participant will be enrolled
in a health improvement plan and be provided a health care home;

(27)  Specifies that no aged, blind, or disabled program
participant will be required to enroll in a risk-bearing
coordination plan;

(28)  Requires the department to commission an independent survey
to evaluate health and wellness outcomes of program participants
and report the results of the survey within six months to the
Governor, General Assembly, and the MO HealthNet Oversight
Committee;

(29)  Requires the department to use a public process for the
design, development, and implementation of health improvement
plans;

(30)  Requires all health improvement plans to complete a health
risk assessment and develop a plan of care for enrolled
participants by July 1, 2008;

(31)  Requires that there be a competitive bid process for any
necessary contracts related to the purchase of products or
services required to administer the program;

(32)  Establishes the Joint Committee on MO HealthNet to study
the resources needed to continue and improve the program;

(33)  Establishes the MO HealthNet Oversight Committee to advise
the department and study various aspects of the program
including, but not limited to, satisfaction reports, pilot
project results, and health risk assessment results.  The
committee must report its findings to the Governor and General
Assembly, at least annually, beginning January 1, 2009;

(34)  Establishes a subcommittee within the oversight committee
to advise the department on the development of a comprehensive
entry-point system.  The subcommittee is required to report its
findings to the Governor and General Assembly by October 1, 2008;

(35)  Creates the Health Care Technology Fund to be administered
by the Department of Social Services to promote technological
advances in health care delivery.  The MO HealthNet Oversight
Committee must report to the Governor and General Assembly
regarding the expenditures of moneys appropriated to the fund by
January 1, 2008;

(36)  Requires the Legislative Budget Office to conduct a
five-year rolling MO HealthNet budget forecast;

(37)  Specifies that fee-for-service-policies which prescribe
psychotropic medications will not include any new limits to the
initial access requirements;

(38)  Specifies that there will not be a single, statewide
contract for any health improvement plan; and

(39)  Abolishes the Medicaid Reform Commission.

The provisions regarding the tax credit for donations to the
Missouri Healthcare Access Fund and medical assistance for
employed persons with a disability will expire six years from the
effective date.  The provisions regarding the MO HealthNet
Oversight Committee's report on the expenditures of the Health
Care Technology Fund will expire April 15, 2008.  The provisions
regarding the Chronic Kidney Disease Task Force will expire
August 30, 2008.  The provisions regarding the premium offset
program pilot project will expire June 30, 2011.

The provisions regarding the eligibility of certain foster care
participants in the MO HealthNet Program contain an emergency
clause.

Missouri House of Representatives
Last Updated July 25, 2007 at 11:24 am