SECOND REGULAR SESSION
94TH GENERAL ASSEMBLY
INTRODUCED BY REPRESENTATIVE PORTWOOD.
Read 1st time March 5, 2008 and copies ordered printed.
D. ADAM CRUMBLISS, Chief Clerk
AN ACT
To amend chapter 208, RSMo, by adding thereto two new sections relating to medical assistance.
Be it enacted by the General Assembly of the state of Missouri, as follows:
Section A. Chapter 208, RSMo, is amended by adding thereto two new sections, to be known as sections 208.510 and 208.512, to read as follows:
208.510. 1. Subject to appropriations and in accordance with authorization under federal law, including the federal Deficit Reduction Act, the medical assistance provided for in section 208.151 may be paid for a person who is employed and who:
(1) (a) Has a temporary disability but does not meet the definition of disabled under state or federal law, including but not limited to the Supplemental Security Income Program, Social Security Disability Insurance, the Ticket to Work Program, or any other state or federal program providing assistance for disabled persons; or
(b) Is the parent of a minor child; and
(2) Has earned income, as defined in subsection 2 of this section; and
(3) Meets the asset limits in subsection 3 of this section; and
(4) Has net income, as defined in subsection 3 of this section, that does not exceed the limit for permanent and totally disabled individuals to receive nonspenddown MO HealthNet under subdivision (24) of subsection 1 of section 208.151; and
(5) Has a gross income of two hundred fifty percent or less of the federal poverty level, excluding any earned income of the recipient worker between two hundred fifty and three hundred percent of the federal poverty level. For purposes of this subdivision, "gross income" includes all income of the person and the person's spouse that would be considered in determining MO HealthNet eligibility for permanent and totally disabled individuals under subdivision (24) of subsection 1 of section 208.151. Individuals with gross incomes in excess of one hundred percent of the federal poverty level shall pay a premium for participation in accordance with subsection 4 of this section.
2. For income to be considered earned income for purposes of this section, the department of social services shall document that Medicare and Social Security taxes are withheld from such income. Self-employed persons shall provide proof of payment of Medicare and Social Security taxes for income to be considered earned.
3. (1) For purposes of determining eligibility under this section, the available asset limit and the definition of available assets shall be the same as those used to determine MO HealthNet eligibility for permanent and totally disabled individuals under subdivision (24) of subsection 1 of section 208.151.
(2) To determine net income, the following shall be disregarded:
(a) All earned income of the worker;
(b) The first sixty-five dollars and one-half of the remaining earned income of a spouse's earned income;
(c) A fifty-dollar standard deduction;
(d) Health insurance premiums;
(e) A seventy-five dollar a month standard deduction for the worker's dental and optical insurance when the total dental and optical insurance premiums are less than seventy-five dollars;
(f) A six hundred dollar a month standard deduction for child care expenses;
(g) A one hundred fifty dollar a month standard deduction for transportation expenses;
(h) A two hundred fifty dollar a month standard deduction for housing expenses;
(i) A one hundred fifty dollar a month deduction for participation in self-improvement activities such as job skills improvement, retraining, and career counseling; and
(j) For a temporarily disabled worker, a two hundred fifty dollar a month standard deduction.
4. Any person whose gross income exceeds one hundred percent of the federal poverty level shall pay a premium for participation in the medical assistance provided in this section. Such premium shall be:
(1) For a person whose gross income is more than one hundred percent but less than one hundred fifty percent of the federal poverty level, four percent of income at one hundred percent of the federal poverty level;
(2) For a person whose gross income equals or exceeds one hundred fifty percent but is less than two hundred percent of the federal poverty level, four percent of income at one hundred fifty percent of the federal poverty level;
(3) For a person whose gross income equals or exceeds two hundred percent but less than two hundred fifty percent of the federal poverty level, five percent of income at two hundred percent of the federal poverty level;
(4) For a person whose gross income equals or exceeds two hundred fifty percent up to and including three hundred percent of the federal poverty level, six percent of income at two hundred fifty percent of the federal poverty level.
5. Recipients of services through this program shall report any change in income or household size within ten days of the occurrence of such change. An increase in premiums resulting from a reported change in income or household size shall be effective with the next premium invoice that is mailed to a person after due process requirements have been met. A decrease in premiums shall be effective the first day of the month immediately following the month in which the change is reported.
6. If an eligible person's employer offers employer-sponsored health insurance and the department of social services determines that it is more cost effective, such person shall participate in the employer-sponsored insurance. The department shall pay such person's portion of the premiums, co-payments, and any other costs associated with participation in the employer-sponsored health insurance.
7. The department shall seek the necessary waivers or state plan amendments to obtain the federal funding necessary to provide medical assistance to participants under this section.
8. The provisions of this section shall expire six years after August 28, 2008.
208.512. 1. As used in this section, "program" means the medical assistance program described in section 208.510.
2. Under the program, any physician who is a provider and meets the requirements of this section shall receive enhanced reimbursement for the specified services provided under the program. In order to qualify for the enhanced reimbursement, the physician provider shall:
(1) Become the health care home for the patient;
(2) Complete a patient history and consultation, including but not limited to a review of systems, a list of problems, and the initiation of coordination of care for the patient; and
(3) File a treatment plan for the patient. Such plan may be filed electronically.
3. If a physician provider meets the requirements of subsection 2 of this section, the physician provider shall be reimbursed at the following rates for all services provided under the program by the physician with the American Medical Association Current Procedural Terminology (CPT) codes 99201 to 99205 for new patients and CPT codes 99211 to 99215 for established patients:
(1) For new patients, one hundred twenty percent of the Medicare reimbursement rate for such services; and
(2) For established patients, one hundred ten percent of the Medicare reimbursement rate for such services.
4. (1) For purposes of this section, the MO HealthNet division, any third-party administrator, or any other entity that contracts with the division for health care services shall not change any diagnostic or current procedural terminology code submitted by the health care provider for health care services under the program without the express written permission of the health care provider and without the examination of the patient record.
(2) Every contract between the division or any agent of the division and a health care provider shall specifically set forth the codes, including code modifiers, for which the division shall provide compensation, remuneration, or reimbursement, and the amount of compensation, remuneration, or reimbursement for each such code under the program. The code and code modifier shall refer to the most recent American Medical Association code book and other recognized codes as adopted and used in the Medicare and Medicaid programs of the state and federal government.
5. The MO HealthNet division may promulgate rules for implementation of this section. Any rule or portion of a rule, as that term is defined in section 536.010, RSMo, that is created under the authority delegated in this section shall become effective only if it complies with and is subject to all of the provisions of chapter 536, RSMo, and, if applicable, section 536.028, RSMo. This section and chapter 536, RSMo, are nonseverable and if any of the powers vested with the general assembly pursuant to chapter 536, RSMo, to review, to delay the effective date, or to disapprove and annul a rule are subsequently held unconstitutional, then the grant of rulemaking authority and any rule proposed or adopted after August 28, 2008, shall be invalid and void.
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