CCS HCS SS SB 307 -- HEALTH CARE PROVIDER ASSESSMENTS

This bill establishes health care provider assessments for
certain health care providers.

AMBULANCE SERVICE REIMBURSEMENT ALLOWANCE TAX (Sections 190.800 -
190.839, RSMo, and Section 1)

The bill authorizes an ambulance service reimbursement allowance
tax for ground ambulance services.  Each ambulance service,
except state-owned and -operated ambulances, will be required to
pay a tax based on a formula established by the Department of
Social Services, not to exceed 6% per annum of its gross
receipts.  Each ambulance service must keep the necessary records
to determine the amount of its reimbursement allowance tax and
submit that information to the department by October 1 of each
year.

The department director is required to annually determine and
notify each ambulance service by October 1 of the amount of its
reimbursement allowance tax due.  If requested by the ambulance
service, the department is authorized to offset the federal
reimbursement allowance tax owed against any MO HealthNet Program
payment due to the ambulance service.

Each ambulance service reimbursement allowance tax determination
is final, unless the ambulance service files a protest with the
department director within 30 days of receipt of the written
notice specifying the grounds on which the protest is based.  If
a timely protest is filed, the department director must
reconsider the determination and grant a hearing within 45 days
if one is requested.  The department director's final decision,
which must be made within 45 days after the hearing, may be
appealed to the Administrative Hearing Commission.

The Ambulance Service Reimbursement Allowance Fund is created to
provide payment to ambulance services.  All investment earnings
of the fund must be credited to it.

The ambulance service reimbursement allowance tax period will be
from October 1 to September 30.  The department is required to
annually notify each ambulance service on September 30 of the
balance due.  If an ambulance service fails to pay its
reimbursement allowance tax within 30 days of the notice, the tax
will be considered delinquent and the department may proceed with
a lien against the ambulance service's property; deny, suspend,
or revoke its license; and cancel or refuse to issue, extend, or
reinstate its MO HealthNet participation agreement.

The provisions regarding the reimbursement allowance tax will
apply only so long as the revenues generated by the tax are
eligible for the federal government's share of Missouri's
expenditures under the MO HealthNet Program.  No rules
implementing these provisions may be filed with the Secretary of
State without first being provided 72 hours in advance to the
interested parties who have registered with the department
director.

Currently, ambulance reimbursement under the MO HealthNet Program
is made through a base fee, which includes the first five miles
of transport and mileage for the remainder of the transport.  The
bill requires reimbursement to be made based on mileage
calculations from the point of pick up to the destination.

HOSPITAL DISTRICT SALES TAXES (Section 205.202)

Hospital districts in certain counties, including Ripley County,
are authorized, upon voter approval, to abolish the hospital
district property tax and impose a retail sales tax of up to 1%
for funding the hospital district.  Moneys collected from the tax
will be deposited into the newly created Hospital District Sales
Tax Fund less 1% which is to be retained and deposited into the
General Revenue Fund by the Director of the Department of Revenue
for the cost of collection.

MENTAL HEALTH PROVIDER CERTIFICATION FEE (Section 633.402)

Beginning July 1, 2009, certain mental health providers will be
subject to a certification fee.  Providers that will be subject
to the fee include publicly and privately operated programs that
have been certified to meet the Department of Mental Health's
certification standards for providing residential habilitation,
individualized supported living, or day habilitation services to
developmentally disabled individuals.  The fee will be based on a
formula established by the department based on the reasonable
costs incurred by the department for its certification programs
of health benefit services providers and will not be in effect
until the department receives the necessary federal approvals to
assure that the collection of the fee will not adversely affect
the receipt of specified federal medical assistance under the
federal Social Security Act.  The fee will be determined on an
annual basis and prorated monthly by the department director and
paid to the Director of the Department of Revenue.  As an
alternative to paying the fee, the provider may request the
Director of the Department of Social Services to offset from the
amount of any payment to the provider the amount of the fee
payment owed for any month.  Every provider that is subject to
the fee must annually submit an acknowledgment of certification
for the purpose of paying its certification fee.

The Home and Community-based Developmental Disabilities Waiver
Reimbursement Allowance Fund is created into which fee payments
will be deposited.  All investment earnings of the fund must be
credited to it.

Upon receipt of notification from the Director of the Department
of Mental Health of a provider's delinquency in paying the
required fees, the Director of the Department of Social Services
must withhold the estimated fee amount from any state payment due
to the provider and remit it to the Director of the Department of
Revenue.  If a provider objects to the estimate or any other
decision of the Department of Mental Health under the provisions
of this section, a hearing may be requested.  A provider will be
offered 30 days to provide evidence of the correct amount due.
The Director of the Department of Mental Health is required to
issue a final decision within 45 days of the completed hearing.
An appeal regarding the assessment must be to the Cole County
circuit court or the circuit court in the county in which the
provider is located.

IN-HOME SERVICES GROSS RECEIPTS TAX (Sections 660.425 - 660.465)

The bill requires each MO HealthNet in-home services provider to
pay an in-home services gross receipts tax based on a formula
established by the Department of Social Services, not to exceed
6.5% of its gross receipts.  "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 a child out of
a hospital.  "In-home services provider" is defined as any
provider or vendor as specified under Section 208.900 of
compensated in-home services under Chapter 208 and under a
provider agreement or contracted with the departments of Social
Services or Health and Senior Services.

Each in-home services provider who is subject to the provisions
of the bill is required to keep the necessary records to
determine the total payments received for providing in-home
services and report the information to the Department of Social
Services.  The Department of Health and Senior Services must
provide the Department of Social Services with a list of all
in-home services providers and vendors covered under these
provisions.

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

The In-home Services Gross Receipts Tax Fund is created to
provide payment for in-home services.  All investment earnings of
the fund must be credited to it.

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; fail to renew his or her provider contract or provider
agreement; and cancel or refuse to issue, extend, or reinstate
his or her MO HealthNet provider agreement.

The provisions regarding the in-home services gross receipts tax
will be effective upon authorization by the federal Centers for
Medicare and Medicaid Services for a gross receipts tax for
in-home services or 60 days after a determination by the federal
centers that their authorization is not necessary.

The provisions of the bill regarding the in-home services gross
receipts tax will expire September 1, 2011, or sooner under
certain specified conditions.

The provisions regarding the ambulance service reimbursement
allowance tax and the mental health provider certification fee
will expire September 30, 2011.

The bill contains an emergency clause for the provisions
regarding the mental health provider certification fee.

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