HCS SS SCS SB 577 -- MO HEALTHNET PROGRAM

SPONSOR:  Shields (Schaaf)

COMMITTEE ACTION:  Voted "do pass" by the Special Committee on
Healthcare Facilities by a vote of 6 to 1.

This substitute 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 and dentists 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 allowed to be 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.

HEALTH PROFESSIONAL SHORTAGE AREAS

The Missouri Healthcare Access Fund is created to expand
healthcare services in state and federally designated areas with
healthcare 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 a tax credit.

CERVICAL CANCER PREVENTION PUBLIC AWARENESS CAMPAIGN

The substitute:

(1)  Establishes a public awareness campaign to educate parents,
health care providers, and women about the causes and risk
factors associated with cervical cancer, the human papilloma
virus (HPV), and the prevention of cervical cancer;

(2)  Requires school districts to establish procedures to provide
to the department the names and addresses of all parents,
conservators, and guardians of female students entering the sixth
grade;

(3)  Requires that each informational mailing sent to parents,
conservators, and guardians include a voluntary return form
indicating the student's immunization status or if the parent,
conservator, or guardian has chosen not to have the child
immunized;

(4)  Specifies that a student will be allowed to attend school if
the parent, guardian, or conservator has opted not to have the
student immunized against HPV; and

(5)  Allows the HPV vaccination to be administered by any
licensed physician or anyone under a physician's direction.

HEALTH ACCESS INCENTIVE FUND

The substitute adds psychiatrists and psychologists to the list
of providers who are allowed to receive enhanced payments in
designated shortage areas.

MO HEALTHNET FRAUD AND ABUSE

The substitute changes the laws regarding fraud and abuse in the
MO HealthNet Program.  The substitute:

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

(2)  Specifies that the terms "knowing" and "knowingly" mean
intentionally;

(3)  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 and upon conviction will be excluded from participating as
a provider;

(4)  Specifies that any person who is the original source of
information regarding a violation will be compensated unless he
or she participated in the fraud or abuse;

(5)  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;

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

(7)  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;

(8)  Creates a penalty for destroying or concealing records of
claims submitted or payments received and for filing false
reports or claims of alleged violations and receiving
compensation for failure to report violations;

(9)  Establishes an advisory working group, beginning
September 1, 2007, to determine the need for an Office of
Inspector General to oversee the state's medical assistance
programs; and

(10)  Creates a fund for the deposit of moneys recovered to be
used for increasing MO HealthNet provider reimbursements until
the average provider reimbursement equals the average federal
Medicare Program provider reimbursement.

MISAPPROPRIATION OF FUNDS

The substitute 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.

MEDICAL ASSISTANCE FOR EMPLOYED PERSONS WITH DISABILITIES

The Department of Social Services is required 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 substitute:

(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;

(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 $2,500 from the asset limits for
eligibility.

MISSOURI CONTINUING HEALTH IMPROVEMENT ACT

The substitute:

(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 eligibility for health insurance for a drug court
participant for 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)  Requires the department to study various aspects relating to
the MO HealthNet Program and its potential expansion;

(4)  Expands coverage to independent foster care adolescents
younger than 21 years of age;

(5)  Adds durable medical equipment, hospice care, dental
services, podiatry, optometry, orthopedic devices, physical
therapy services, and comprehensive day rehabilitation services
to the list of covered benefits when based on a medical
necessity;

(6)  Requires the division to establish a three-year plan to
increase the MO HealthNet provider reimbursement rate to the
federal Medicare Program rates;

(7)  Establishes the State Pay for Performance Program when MO
HealthNet provider reimbursement rates have reached at least 100%
of the federal Medicare Program payment for the same service and
the federal Pay for Performance Program is in operation;

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

(9)  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, that expense will be allowed as
a deduction to future required spenddown for up to three months;

(10)  Establishes the Professional Services Payment Committee to
monitor the performance program;

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

(12)  Establishes rules for personal care contracts;

(13)  Requires health benefit plans to pay all properly submitted
claims for a period of three years from the date of service;

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

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

(16)  Specifies how the per diem reimbursement rates will be
calculated for nursing home facility providers new in the MO
HealthNet Program;

(17)  Requires the department to submit a MO HealthNet
beneficiary report quarterly to the Governor and requires
applicants for MO HealthNet benefits to disclose their employer;

(18)  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;

(19)  Changes affordability requirements for children without
access to affordable health care and specifies that health
insurance plans that do not cover a child's pre-existing
condition are not considered affordable employer-sponsored health
care insurance;

(20)  Changes the eligibility requirements for the Uninsured
Women's Health Program;

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

(22)  Establishes the Long-Term Care Partnership Program that
provides incentives for individuals to purchase insurance for
their long-term care needs;

(23)  Specifies that providers receive sufficient reimbursement
for their services;

(24)  Specifies that an administrative services organization
(ASO) or a managed care organization (MCO) can be used to deliver
and manage health care to MO HealthNet participants.  ASOs
provide services to a defined population of non-risk bearing
participants using care management, participant education,
utilization management, and primary care case management.  MCOs
provide services on a risk-bearing, prepaid, capitated basis
using care management, utilization management, coverage, and
provider reimbursement;

(25)  Specifies that the state point-of-service plan will be
available everywhere in the state and will be used to provide
care to specific populations on a point-of-service basis;

(26)  Requires the automatic enrollment in the state plan of
individuals not enrolled in managed care plans.  As new plans are
established, individuals will be given 30 days to select a new
health improvement plan.  If the individual does not select a
plan, the MO HealthNet Division will place the individual in an
appropriate plan;

(27)  Specifies that the division will use tools such as health
risk assessment and risk prediction to identify high-risk
individuals for more intense care coordination and management
plans.  High-risk state point-of-service participants can be
enrolled in the Chronic Care Improvement Plan designed for
specific populations of high-risk participants;

(28)  Allows the division to implement pilot projects to
determine the best way to achieve good health outcomes and cost
savings in health care delivery;

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

(30)  Requires the division to establish a sliding scale schedule
of co-payments for hospital emergency room visits;

(31)  Requires all health improvement plans to help participants
remain in the least restrictive level of care possible, use call
centers and nursing help lines, report participant and provider
satisfaction information annually, and ensure that subcontracted
vendors pay no less than the MO HealthNet service plan fee
schedule;

(32)  Requires all participants to have a primary care physician;

(33)  Establishes the MO HealthNet Oversight Committee which will
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;

(34)  Establishes a subcommittee within the oversight committee
to advise the department on the development of a comprehensive
entry-point system;

(35)  Establishes the Joint Committee on MO HealthNet to study
the resources needed to continue improvements to the program;

(36)  Establishes requirements for the MO HealthNet for Children
and Families including, but not limited to, the use of existing
MCOs and health improvement plans, placement in newly developed
health plans, use of wellness coaches, and use of case management
strategies;

(37)  Establishes requirements for the MO HealthNet for the Aged,
Blind, and Disabled including, but not limited to, the use of the
least restrictive environment possible, use of existing health
improvement plans, placement in newly developed health plans, use
of individual support team coaches, and use of case management
strategies;

(38)  Requires the Department of Health and Senior Services to
establish a universal informational and assessment system to
provide information to participants through natural points of
entry;

(39)  Creates the Health Care Technology Fund to promote
technological advances in health care delivery;

(40)  Establishes the Missouri Health Profession Shortage
Commission to develop recommendations regarding the health
professionals workforce in the state;

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

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

(43)  Creates the MORx Pharmacy Rebate Fund; and

(44)  Requires the Department of Social Services to study and
develop an acuity-based reimbursement system for the payment of
nursing home services.

The provisions of the substitute regarding the tax credit for
donations to the Missouri Healthcare Access Fund will expire six
years from the effective date.  The provisions regarding medical
assistance for employed persons with a disability will expire
three years from the effective date.

The provision of the substitute regarding the eligibility of
certain foster care participants in the MO HealthNet Program
contains an emergency clause.

FISCAL NOTE:  Estimated Cost on General Revenue Fund of Unknown
Greater than $61,346,642 to Unknown Greater than $62,596,642 in
FY 2008, Unknown Greater than $40,997,327 to Unknown Greater than
$22,995,474 in FY 2009, and Unknown Greater than $10,671,151 to
Unknown Greater than $15,738,776 in FY 2010.  Estimated Cost on
Other State Funds of $36,922 to $41,922 in FY 2008, $49,679 in
FY 2009, and $51,169 in FY 2010.

PROPONENTS:  Supporters say that the bill restores coverage to
some participant groups; adds important services such as durable
medical equipment and hospice services; does not force the aged,
blind, and disabled populations into managed care; represents a
good start for Medicaid reform; and expands eligibility for
children.  The comprehensive entry point is good for
participants.

Testifying for the bill were Representative Schaaf; Senator
Shields; Doug Bouldin, Troy Family Practice; Citizens for
Missouri's Children; Partnership for Children; Missouri Alliance
of Area Agencies on Aging; and Missouri Association of Homes for
the Aging.

OPPONENTS:  Those who oppose the bill say that the bill is vague
and without details.  The entry-point concept should be defined
and in-home and consumer-driven service should remain in the
control of the state.  The bill falls short of reform, changes
the doctor-patient relationship, cuts aren't restored, and
doesn't serve participant needs.

Testifying against the bill were Missouri Budget Project;
Missouri Association for Social Welfare; Missouri Catholic
Conference; Catholic Charities Archdiocese of St. Louis; Epilepsy
Foundation of the St. Louis Region; Craig Henning, Disability
Resource Association of Jefferson County, Incorporated; Bob Pund;
DeAnna Noriega; Sidney Watson; Southwest Center for Independent
Living; Ozark Independent Living; Dr. Katie Plax; Patricia
Barnett, Metropolitan Congregations United; Rev. Dr. James T.
Morris, Missouri Conference Christian Methodist Episcopal Church;
Rev. Ronald L. Bobo, Sr., St. Louis Clergy Coalition; Dee Wilson,
St. Louis and Missouri NAACP; Paraquad, Incorporated; and Mary
Hussmann, Grass Roots Organizing.

OTHERS:  Others testifying on the bill say that too much is left
for chance and new bureaucracies are added.  It does not restore
cuts made in 2005.  There are concerns about the premium offset
program and the health care advocate.

Testifying on the bill were Timothy Hogan; and AARP.

Missouri House of Representatives
94th General Assembly, 1st Regular Session
Last Updated July 25, 2007 at 11:22 am