Missouri Senate

Introduced

PERSONAL CARE ASSISTANCE PROGRAM - This act moves the personal care assistance program for disabled persons the Department of Elementary and Secondary Education to the Department of Health and Senior Services (Section 192.1000).

The department shall provide financial assistance to physically disabled persons for personal care assistance services through eligible vendors. The act prescribes requirements for eligibility and annual eligibility review (Sections 192.1003 and 192.1006). Upon determination of eligibility, the department shall develop a personal care assistance services plan (192.1006).

Consumers receiving personal care assistance shall be responsible for the supervision of the attendant while the vendor shall be responsible for the medicaid reimbursement process, including filing claims and mailing individual payment directly to the assistant (Section 192.1009).

The services are not authorized if the primary benefit of the services is to the household unit and such household may reasonably be expected to share or do for one another when they live in the same household. Neither shall the services be used to employ a personal care assistant who is listed on any of the background check lists, unless a good cause waiver is first obtained from the department (Section 192.1009).

In addition, this act delineates the duties of certain persons to report instances where such person reasonably believes a consumer has been neglected, abused, or where the consumer's property of funds have been misappropriated (Sections 192.1012 and 192.1015). It also details the duties of the department's case manager to investigate instances of abuse. It shall be a Class A misdemeanor if a person who is required to report abuse fails to do so. This act also provides for an employee disqualification list to be maintained by the department for attendants who commit fraudulent acts (Section 192.1015).

MEDICAID - This act provides that annual income eligibility and verification reviews are to be conducted for medicaid recipients (Section 208.147). The family support division shall annually send a re-verification from letter to the recipient requiring the recipient to respond within ten days and to provide income verification documents.

This act reduces income levels for eligibility and eliminates some optional services.

Further, this act provides the Department of Social Services may apply for federal medicaid waivers as necessary, provided that such costs to the state will not exceed one million additional dollars (Section 208.151). Such a request for a waiver will not become effective except by executive order.

In addition, the act provides that a health care provider may not refuse to provide a service if a recipient is unable to pay a required fee. However, upon approval from the Centers for Medicare and Medicaid Services, a provider may terminate future services to an individual with an unclaimed debt, so long as it is the provider's routine business practice to do so and the provider gives advance notice to the individual and reasonable opportunity for payment(Section 208.152).

This act also provides that for purposes of medicaid eligibility, investment in annuities shall be limited only to those annuities that are actuarially sound (Section 208.212). The department shall establish a seventy-two month look-back period to review any investment in an annuity by an applicant for medicaid benefits.

THE MISSOURI SENIOR RX PROGRAM - The Missouri Senior RX program may select one or more prescription drug plans as the preferred plan for purposes of the coordination of benefits between the program and the Medicare Part D drug benefit(Section 208.782). The department shall give initial enrollment priority to the medicaid dual eligible population, which are those individuals who are eligible for medicare and medicaid. The successive enrollment priority shall be medicare eligible participants with an annual household income at or below one hundred and fifty percent of the federal poverty guidelines(Section 208.784).

The program is a payor of last resort, and is meant to cover costs for participants who are not covered by the medicare part D program. Ineligible persons include those who are qualified for coverage of payments for prescriptions drugs under a public assistance program, other than from the Medicare Modernization Act benefits, and if the persons are not considered dual eligible. Also, persons who are qualified for full coverage under another plan of assistance or insurance are ineligible(Section 208.788).

This act also creates the Missouri Senior RX Program Advisory Commission, which shall be charged with advising the benefit design and operational policy of the program (Section208.792).

ADRIANE CROUSE