HB 741 -- Medical Assistance Benefit Payments

Co-Sponsors:  Bearden, Jetton, Wright, Reinhart, Portwood

This bill revises provisions pertaining to benefit payments under
the Medicaid Program and provisions pertaining to the Pharmacy
Tax.

MEDICAID BENEFITS

The bill requires the following to be subject to appropriations
and contingent upon available moneys:  (1)  benefit payments for
medical assistance not mandated by federal law; (2)  medical
assistance benefits available for federal matching dollars; and
(3)  state-funded Medicaid benefits.  Resources available must be
documented by appropriated moneys contained in an appropriations
bill signed by the Governor.  The resources available can be
subject to withholdings imposed by the Governor.  If the
Department of Social Services is bound by federally mandated
requirements, the department and its divisions will not be
required to file a notice of proposed rulemaking.

In addition, the bill:

(1)  Requires that Medicaid benefits be administered within
appropriations provided.  This provision does not require or
authorize a reduction in provider fees;

(2)  Allows the department to reduce expenditures in response to
withholdings by the Governor.  A reduction in provider fees is
exempt from this provision;

(3)  Allows the department to establish prior authorizations for
services based on emergency rules if services and payments are
reduced to comply with available state moneys;

(4)  Allows the department to not grant a hearing if a change to
a program is made resulting in a reduction of services and
payments in order to conform with available state moneys;

(5)  Removes payments for dental services under the Medicaid
Program and limits benefits to one pair of glasses following
cataract surgery;

(6)  Requires prescription and non-prescription drugs and
administering devices that are covered under the Medicaid Program
to be prescribed by a licensed health care professional and
subject to safety and effectiveness provisions of Sections 505 or
507 of the federal Food and Drug Cosmetic Act;

(7)  Authorizes the Division of Medical Services to require
Medicaid recipients to pay part of the charge or costs of all
covered services;

(8)  Requires the division to define by rule, reasonable costs,
quality, quantity, and charges for medical assistance on a basis
ensuring the greatest amount of medical care consistent with
moneys available;

(9)  Requires the department and its divisions to reduce payment
for covered benefits on a pro-rata basis during the final six
months of a fiscal year as based on the consensus budget
estimates and first quarter actual receipts;

(10)  Allows the department and its divisions to not grant a
hearing if a change is made in a program, subject to law.  The
change is conditioned on modifying services or payments based on
available moneys; and

(11)  Requires benefit payments for Medicaid to be made for
persons who would have been eligible for general relief benefits
as defined on June 30, 2003.

PHARMACY TAX

The bill makes the following changes to the Pharmacy Tax:

(1)  The effective date of the Pharmacy Tax is changed from July
1, 2002, to July 1, 2003;

(2)  The Department of Social Services can adjust the pharmacy
tax rate quarterly, on a prospective basis;

(3)  The tax will expire 90 days after stated conditions are met.
The director of the department is required to notify the Revisor
of Statutes of the expiration date if the conditions are met.  If
the conditions are not met, the tax will expire on June 30, 2005;
and

(4)  Certain statutes pertaining to the tax are repealed.

Missouri House of Representatives
Last Updated July 25, 2003 at 10:12 am