House Committee Substitute

HCS/SS/SCS/SB 577 - This act establishes the Missouri Health Improvement Act of 2007, modifying various provisions relating to the state medical assistance program and changing the name of the program to MO HealthNet.

STATE LEGAL EXPENSE FUND

This act adds coverage for liability under the state legal expense fund to podiatrists, chiropractors, optometrists, pharmacists, certain mental health professionals, certain other health care providers who provide health care services at certain health departments or health centers, any social welfare board, the officers and members of such a board, and certain health care providers who are referred to provide specialty care without compensation for such a board.

The moneys in the fund shall also be available to pay claims or judgments against certain physicians and dentists providing specialty care without compensation to an individual referred to him or her by certain health departments or health centers. The payment for claims arising under this specific provision shall not exceed one million dollars in the aggregate for all claims arising out of the same act or acts alleged in a single cause, and shall not exceed one million dollars for any one claimant, and insurance policies purchased for such persons with moneys appropriated to the legal expense fund shall not exceed one million dollars. Additionally, liability or malpractice insurance for any physician or dentist shall not be considered available to pay any portion of a judgment or claim for which the legal expense fund is liable under this provision.

Also, any health care provider licensed under Chapter 330, 331, 332, 334, 335, 336, 337, or 338, RSMo, who is a defendant in a claim covered by the state legal expense fund shall have the right to consent to the settlement of the claim and shall not be forced to settle a particular claim. The above mentioned chapters include podiatrists, chiropractors, dentists, physicians and surgeons, therapists and athletic trainers, health care providers, nurses, optometrists, certain mental health professionals, social workers, pharmacists and pharmacies. (SECTION 105.711)

These provisions are substantially similar to SB 273 (2007).

INCOME TAX DEDUCTION FOR LONG-TERM CARE INSURANCE PREMIUMS

Beginning January 1, 2007, this bill authorizes 100% of the amount paid for nonreimbursed qualified long-term care insurance premiums to be deducted from a taxpayer's Missouri taxable income to the extent the amount is not already included in the taxpayer's itemized deductions. (SECTION 135.096)

MISSOURI HEALTHCARE ACCESS FUND

This act creates the Missouri Healthcare Access Fund to be used to expand healthcare services in state and federally designated areas with healthcare shortages. In addition, the state shall provide matching moneys from the general revenue fund equaling one-half of the amount deposited into the fund. The total annual amount available to the fund from state sources under such a match program shall be five hundred thousand dollars for fiscal year 2008, one million five hundred thousand dollars for fiscal year 2009, and one million dollars annually thereafter.

The Department of Health and Senior Services has the authority 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. The provisions of the bill will expire six years from the effective date. (SECTIONS 135.575, 191.1050, 191.1053, 191.1056)

These provisions are substantially similar to HB 878 (2007).

PRIMO PROGRAM

Adds psychiatrists and psychologists to the list of providers eligible for assistance through the Primary Care Resource Initiative for Missouri (PRIMO) program. (SECTION 191.411)

CERVICAL CANCER PREVENTION PUBLIC AWARENESS CAMPAIGN

This act 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. School districts are required to establish procedures to provide to the department of health and senior services the names and addresses of all parents, conservators, and guardians of female students entering the sixth grade. Each informational mailing sent to parents, conservators, and guardians shall 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. A student will be allowed to attend school if the parent, guardian, or conservator has opted not to have the student immunized against HPV. The HPV vaccination may be administered by any licensed physician or anyone under a physician's direction.(SECTION 167.182)

PRIMO PROGRAM

Adds psychiatrists and psychologists to the list of providers eligible for assistance through the Primary Care Resource Initiative for Missouri (PRIMO) program. (SECTION 191.411)

MO HEALTHNET (MEDICAID) FRAUD

A person commits a "knowing" violation of sections prohibiting Medicaid fraud if he or she has actual knowledge of the information, acts in deliberate ignorance of the truth or falsity of the information, or acts in reckless disregard of the truth or falsity of the information, but provides that the use of the terms "knowing" or "knowingly" shall be construed to include the term "intentionally." This act also expands the definition of "health care provider" to include any employee, representative, or subcontractor of the state.

Current law provides that any person committing such a violation shall be guilty of a Class D felony upon a first conviction, and shall be guilty of a Class C felony upon subsequent convictions; this act provides that such person shall be guilty of a Class C felony upon a first conviction, and shall be guilty of a Class B felony upon subsequent convictions. Also, any person who has been convicted of such violations shall be referred to the federal Office of Inspector General.

Any person who is the original source of the information used by the attorney general to bring a Medicaid fraud action shall receive 10 percent of any recovery by the Attorney General unless he or she participated in the fraud or abuse.

The act also contains "whistle-blower" protections, providing that a person who is discharged, demoted, suspended, threatened, harassed, or in any way discriminated against in terms of employment due to a lawful act taken by the person in furtherance of an action for Medicaid fraud shall be entitled to reinstatement with the same seniority status, not less than two times the amount of back pay, interest on the back pay. However, such protections shall not apply if the court finds that the employee brought a frivolous or clearly vexatious claim, planned, initiated, or participated in the conduct upon which the action is brought, or is convicted of criminal conduct arising from Medicaid fraud violations.

The Attorney General's office and the Department of Social Services shall make a detailed report to the General Assembly and the Governor regarding implementation and administration of the provisions of this act, as provided therein. Additionally, a financial audit of the medicaid fraud unit within the Attorney General's office and of the program integrity unit of the Department of Social Services shall be annually conducted by the State Auditor, to quantitatively determine the amount of money invested in such units and the amount of money actually recovered by them.

All Medicaid health care providers shall maintain adequate records regarding services provided, claims submitted, and payments requested, and shall maintain such records for at least five years after the date payment was received or for at least five years after the date on which the claim was submitted, if payment was not received. No person shall conceal or destroy such records before five years time, or he or she shall be guilty of a Class A misdemeanor.

Any person who intentionally files a false report or claim alleging a Medicaid fraud violation is guilty of a Class A misdemeanor and guilty of a Class D felony for any subsequent violations. In addition, it shall be a class D felony for any person to receive any compensation in exchange for knowingly failing to report any Medicaid fraud violations.

An advisory working group is created to study and determine whether an Office of Inspector General shall be established. Such office would be responsible for oversight, auditing, investigation, and performance review to provide increased accountability, integrity, and oversight of state medical assistance programs. The commission will consist of ten members, five from the House and five from the Senate. Additionally, the directors of the Departments of Social Services, Health and Senior Services, and Mental Health shall serve as ex-officio members of the advisory working group.

This act also allows for the deposit of moneys recovered in a Medicaid fraud action to be used to increase Medicaid provider reimbursement until amount equals the average Medicare provider reimbursement for comparable services. Such funds shall be deposited for this purpose so long as there are any funds remaining after the appropriation of funds to the Attorney General for cost of investigation and prosecution and which have been appropriated to the Department of Social Services for administering the state medical assistance program. (SECTIONS 191.900 TO 191.914)

These provisions are substantially similar to HB 353 (2007).

CHRONIC KIDNEY DISEASE TASK FORCE

This act creates the "Chronic Kidney Disease Task Force." The list of 17 members are specified in the act. The duties of the task force include developing a plan to educate the public and health care professionals about the advantages and methods of early screening, diagnosis, and treatment of chronic kidney disease. Also, the task force shall submit a report of its findings and recommendations to the General Assembly by August 30, 2008, at which time the task force shall expire. (SECTION 192.632)

This act is substantially similar to SB 677 and HB 1084 (2007).

ASSISTED LIVING FACILITIES

This act requires assisted living facilities to immediately implement and review, within 24 hours, any physician order and update a resident's care plan when the resident returns from a hospital or skilled nursing facility. The department of health and senior services shall adjust personal care units authorized upon effective date of the physicians orders to reflect the services required by such orders. (SECTION 198.069)

MISAPPROPRIATION OF FUNDS OF ELDERLY OR DISABLED FACILITY CARE RESIDENT

This act also modifies the offense of misappropriation of funds of elderly or disabled facility care resident. This act provides that evidence of misappropriating funds and failing to pay for the facility care of an elderly or disabled person may include, but shall not be limited to proof that the facility has sent, by certified mail with confirmation receipt requested, notification of failure to pay nursing home expenses incurred by a resident to the person who has assumed responsibility of managing the financial affairs of the resident.

These provisions shall not be construed to limit the investigations or prosecutions of this crime or the crime of financial exploitation of an elderly or disabled person. (SECTION 198.097)

These provisions are substantially similar to SB 675 (2007).

TICKET TO WORK PROGRAM

This act establishes the Ticket to Work Program, which is authorized by the federal Ticket to Work and Work Incentives Improvement Act.

This act allows MO HealthNet eligibility for an employed person who meets the definition of disabled, satisfies asset limits, and who has an annual gross income of 250 percent or less of the federal poverty level.

The asset limit for the new program is the same as that for the Medical Assistance – Permanently and Totally Disabled (MA-PTD) program, currently $999.99 for a single person and $2,000 for a couple with the standard exemptions. The available asset limit does not include medical savings accounts or independent living accounts. The individual must have a gross income of 250 percent or less of the federal poverty level. Individuals with gross income in excess of one hundred percent of the federal poverty level shall pay a specified monthly premium for participation. For income to qualify as earned income for the purposes of this program, the individual must demonstrate that Social Security and Medicare taxes are paid on the earnings.

If an individual's employer offers health insurance that is more cost effective, the individual shall participate in the employer-sponsored insurance. The Department of Social Services, however, will be responsible for costs associated with the employer insurance. (SECTION 208.146)

These provisions are similar to SS/SCS/HCS/HB 1742 (2006) and SCS/HCS/HB 39 (2007).

MO HEALTHNET ELIGIBILITY AND SERVICES

Drug Court

Under this act, individuals who receive medical assistance due to the receipt of aid to families with dependent children, shall continue to be eligible for such assistance for sixty days despite having a child or children removed from their custody, if such person is a participant in a drug court program and upon federal approval by the Centers for Medicare and Medicaid Services. (SECTION 208.151.1(2))

Study for Expansion

By January 1, 2008, the Department of Social Studies shall study all significant aspects and report to the general assembly on projected costs and timelines for:

-expanding eligibility for the aged, blind, and disabled population to 100 percent of the federal poverty level;

-raising the resource limit for the aged, blind, and disabled recipients who qualify for waiver services; providing housing disregard for unsubsidized housing;

-expanding protection against spousal impoverishment to couples under age 63;

-expanding the elderly and disabled waiver to recipients under 63;

-allowing participants of the elderly and disabled waiver to spend down to the waiver income limit;

-expanding the Missouri RX plan to Missouri residents 65 years of age or older and retired;

-expanding eligibility for single adults without children; enacting the best practices from other states to reduce institutional bias that puts people in institutional acre setting, and disparity between income eligibility for skilled nursing versus home and community-based services;

-allowing nursing home residents who receive MO HealthNet benefits to retain not less than fifty dollars per month for discretionary spending. (SECTION 208.151.1.(22))

Extension of Services for former foster care children

This act extends MO HealthNet coverage for foster care children from the age of 18 to 21 without regard to income or assets. (SECTION 208.151.1 (26))

Long-Term Care Services

This act also provides that individuals with more than $500,000 in home equity will no longer qualify for long-term care services under MO HealthNet. (SECTION 208.152.1(4))

Benefits for personal care services, when delivered in a residential care facility or assisted living facility shall be authorized on a 4 tier level based on the services the resident requires and frequency of services. The rate paid to providers for each tier of service, subject to appropriations. (SECTION 208.152.1(14))

Services provided by in-home providers to participants who are qualified for the aged and disabled waiver and/or personal care, shall be authorized on a tier-level basis on the services required, frequency of delivery, and time needed to perform tasks. The rate paid for services shall be set subject to appropriations. (SECTION 208.152.1(16))

Pediatric or Family Nursing Practitioner

Under current law the services of certified pediatric or family nursing practitioners are covered under Medicaid, regardless of whether the nurse practitioner is supervised by or in association with a physician or other health care provider. This act provides that such services may only be covered if such pediatric or family nursing practitioners have a collaborative practice agreement. (SECTION 208.152.(17))

Optional Services

This act also allows for durable medical equipment and therapy services including physical, occupational, and speech therapy if medically necessary. An electronic web-based prior authorization system shall use best medical evidence and care and treatment. Hospice and comprehensive day services are also reinstated as covered services (SECTION 208.152.(19, (20), and (26))

This act also reinstates dental, podiatry, optometry, orthopedic, physical, speech, and occupational therapy services. Such services shall be subject to "precertification." Precertification shall be based on best practices and consistent with accepted standards of care and treatment guidelines and peer-reviewed medical literatures.(SECTION 208.152.(19)and (20))

Reimbursement Rates for MO HealthNet Providers

By January 1, 2008, the MO HealthNet division shall report the status of MO HealthNet provider reimbursement rates as compared to one hundred percent of the Medicare reimbursement rate. The division shall also by that date provide to the general assembly a three-year plan to achieve parity with Medicare reimbursement rates. Benefit payments made by the division under the act shall be made on the basis of medical necessity, which shall be based on the same standard as "precertification." (SECTION 208.152.(27))

Co-pays

Beginning January 1, 2009, the division may require any participant receiving services to pay an additional payment, for all covered services except for those personal care services, mental health services, and CHIP services. (SECTION 208.152.2)

Second Medical Opinion for Surgery-Repealed

Under current law, benefit payments for medical assistance for surgery shall be made only when a second medical opinion by a licensed physician as to the need for the surgery is obtained. This act repeals such provision. (SECTION 208.152.3)

Assisted Living Facilities as MO HealthNet Providers

This act adds assisted living facilities as well as residential care facilities to the list of qualified MO HealthNet personal care providers. (SECTION 208.152.9)

Sheltered Workshop Income

This act also provides that as to the permanent and totally disabled population, any income derived through certified extended employment at a sheltered workshop shall not be considered as income for determining Medicaid eligibility. (SECTION 208.152.10)

PAY-FOR-PERFORMANCE

This act requires establishes a state pay-for-performance payment 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 is in operation. Guidelines for the program shall be developed in consultation with a professional services payment committee. Any employer of a provider whose work generates any payment under the program shall pass the P4P payment on to the provider, without any corresponding decrease in compensation to which the provider would otherwise be entitled. (SECTION 208.153.2)

The committee is established within the division, to guide, develop, and provide advice about the program guidelines. The committee shall be composed of 18 members, geographically balanced, including 10 physicians, one consumer advocate, and one patient advocate. The other members shall be persons actively engaged in hospital administration and nursing home administration. The Division shall maintain the program to ensure quality, foster relationships between the patient and the provider, uses clinically relevant and evidence-based measures which are statistically valid. (SECTION 208.197)

THIRD PARTY LIABILITY AND ESTATE RECOVERY

This act modifies provisions relating to the MO HealthNet Division's authority to collect from third party payers. This act provides that in order for annuities not to be counted as income for purposes of MO Healthnet eligibility in a long-term care facility, the annuities must be in the name of spouse residing in long-term care facility. Also, third party payers are required to honor MO HealthNet subrogation claims for up to three years from the date of service. This act also provides for the ability of the MO HealthNet Division to obtain eligibility data from third party insurance carriers, health plans, pharmacy benefits managers, and third party administrators at least twice a year in a usable format. Also, this act provides for the recovery of medical assistance program payments made on behalf of the decedent from a decedent's estate. (SECTIONS 208.212 TO 208.217 AND 473.398)

PERSONAL CARE SERVICES CONTRACTS

Under this act, if a personal care contract is received as fair and valuable consideration in exchange for personal property, real property, cash or securities, such exchange shall not render an institutionalized individual ineligible for Medicaid based on an improper transfer of assets. A personal care contract is fair and valuable consideration when:

-There is a written agreement between the individual providing services and the individual receiving care which specifies the type, frequency, and duration of the services to be provided that was signed and dated on or before the date the services began;

- The services do not duplicate those which another party is being paid to provide;

-The individual receiving the services has a documented need for the personal care services provided;

- The services are essential to avoid institutionalization of the individual receiving benefit of the services;

- Compensation for the services must be made at the time services are performed or within two months of the provision of the services; and

- The fair market value of the services provided prior to the month of institutionalization is equal to the fair market value of the assets exchanged for the services. (SECTION 208.213)

MO HEALTNET PER DIEM REIMBURSEMENT RATE FOR NURSING HOMES

This act provides that for any facility new to the MO HealthNet program that did not have a MO HealthNEt cost report for the year ending in 2001, its MO HealthNet per diem reimbursement rate shall be calculated from its fiscal year cost report which covers the second 12 month fiscal year following the facility's initial date of MO HealthNet certification using the class ceilings prescribed under current law. Such prospective rate shall be retroactive to the beginning of the first day of the facility's second full 12 month fiscal year. (SECTION 208.225)

MO HEALTHNET BENEFICIARY EMPLOYER REPORTS

Requires the Department of Social Services to submit a Mo HealthNet beneficiary quarterly report to the governor and requires applicants for Mo HealthNet benefits to disclose their employer. (SECTION 208.230)

HEALTH INSURANCE FOR UNINSURED CHILDREN PROGRAM

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. (SECTION 208.631)

Under current law, children who qualify for the health insurance for uninsured children program (MC+ for Kids) must lack access to affordable employer-sponsored health insurance. This act modifies the definition of "affordable employer-sponsored health insurance" as follows:

-for families with gross income above 150 percent to 185 percent of the federal poverty level, the health insurance should require a monthly premium of 3 percent of 150 percent of the federal poverty level for a family of three;

-for families with gross income above 185 percent to 225 percent of the federal poverty level, the health insurance should require a monthly premium of 4 percent of 185 percent of the federal poverty level for a family of three;

-for families with gross income above 225 percent and below 350 percent of the federal poverty level, the health insurance should require a monthly premium of 5 percent of 225 percent of the federal poverty level for a family of three.

In addition, health insurance plans that do not cover an eligible child's pre-existing condition shall not be considered "affordable employer-sponsored health care insurance." (SECTION 208.640)

UNINSURED WOMEN'S HEALTH PROGRAM

This act requires revision of eligibility requirements for the uninsured women's health program to include women who are at least 18 years old and with a net family income of at or below 185 percent of the federal poverty level. Such women shall not have assets in excess of 250,000 dollars, nor shall they have access to employer-sponsored health insurance. There is an emergency clause for the provisions relating to foster care eligibility. (SECTION 208.659)

This provision is substantially similar to SB 653 (2007).

LONG-TERM CARE PARTNERSHIP PROGRAM

This act establishes the Missouri Long-Term Care Partnership Program and provides that the Department of Social Services shall, in conjunction with the Department of Insurance, Financial Institutions and Professional Registration, coordinate the program so that private insurance and MO Health Net funds shall be used to finance long-term care.

Under such a program, an individual may purchase a qualified long-term care partnership approved policy in accordance with the requirements of the Federal Deficit Reduction Act of 2005 to provide a mechanism for individuals to qualify for coverage of the cost of the individual's long-term care needs under Mo HealthNet without first being required to substantially exhaust his or her resources. Individuals seeking to qualify for MO HealthNet are permitted to retain assets equal to the dollar amount of qualified long-term care partnership insurance benefits received beyond the level of assets otherwise permitted to be retained under Mo HealthNet.

The Department of Insurance, Financial Institutions and Professional Registration may certify qualified state long-term care insurance partnership policies that meet the applicable provisions of the National Association of Insurance Commissioners (NAIC) Long-Term Care Insurance Model Act and Regulation as specified in the Federal Deficit Reduction Act of 2005. In addition, the department shall develop requirements regarding training for those who sell qualified long-term care partnership policies.

The issuers of qualified long-term care partnership policies in this state shall provide regular reports to both the Secretary of the federal Department of Health and Human Services and to the Departments of Social Services and Insurance, Financial and Professional Regulation.

The Departments of Social Services and Insurance, Financial and Professional Regulation shall promulgate rules to implement the provisions of this act.

This act repeals Sections 660.546 to 660.557, RSMo, relating to a similar long-term care partnership program but that was never approved by federal law. SECTIONS 208.690 TO 208.698

The provisions of these sections are substantially similar to SCS/SB 15 (2007).

TELEHEALTH

This act provides that the Department of Social Services shall promulgate rules governing the practice of telehealth in the MO HealthNet program. Telehealth providers shall be required to obtain patient consent before telehealth services are initiated and to ensure confidentiality of medical information. (SECTION 208.670)

COMMUNITY-BASED ORGANIZATIONS IN THE FAMILY DEVELOPMENT ACCOUNT PROGRAM

The act revises the definition of "community-based organizations" to include any nonprofit corporations formed under Chapter 355 for which the department can approve to implement the Family Development Account Program. (SECTION 208.750)

HEALTH IMPROVEMENT PLANS

This act 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. This act also 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. This act also requires the automatic enrollment in the state plan of individuals not enrolled in managed care plans. As new plans are established, participants will be given 30 days to select a new health improvement plan. If the participant does not select a plan, the MO HealthNet Division will place the participant in an appropriate plan.

This act also specifies that the division will use tools such as health risk assessment and risk prediction to identify high-risk participants 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. In addition, the division is allowed to implement pilot projects to determine the best way to achieve good health outcomes and cost savings in health care delivery. The department is also required to use a public process for the design, development, and implementation of health improvement plans. The division shall establish a sliding scale schedule of co-payments for hospital emergency room visits.

All health improvement plans are required 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. Participants are also required to have a primary care physician.

This act 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. This committee shall also develop recommendations relating to the expenditure of funds appropriated to the healthcare technology fund. A subcommittee is established within the oversight committee to advise the department on the development of a comprehensive entry-point system for long-term care. The Joint Committee on MO HealthNet is also established to study the resources needed to continue improvements to the program.

This act also 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. Also, the MO HealthNet for Aged, Blind, and Disabled is established and requirements are prescribed for the program, 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. In addition, the Department of Health and Senior Services is required to establish a universal informational and assessment system to provide information to participants through natural points of entry. (SECTIONS 208.950 to 208.968, 208.978)

HEALTH CARE TECHNOLOGY FUND

This act establishes the Healthcare Technology Fund, which shall be administered by the Department of Social Services.

Upon appropriation, moneys in the fund shall be used to promote technological advances to improve patient care, decrease administrative burdens, and increase patient and health care provider satisfaction. Any programs or improvements on technology shall include encouragement and implementation of technologies intended to improve the safety, quality and costs of health care services in the state.

The department shall promulgate rules setting forth the procedures and methods for implementing the provisions the section and establish criteria for the disbursement of funds to include preference for not-for-profit health care entities where the majority of the patients and clients served are either MO HealthNet participants or are from the medically underserved population. This act also prohibits an employer from requiring an employee to have a personal identification microchip implanted as a condition of employment. A violation of this provision is a Class A misdemeanor. (SECTION 208.975)

The provisions of this section are similar to SB 274 (2007)

MISSOURI HEALTH PROFESSION SHORTAGE COMMISSION

This act establishes the Missouri Health Profession Shortage Commission to develop recommendations regarding the health professionals workforce in the state. (SECTION 620.510)

COMMITTEES AND STUDIES

The Legislative Budget Office to conduct a five-year rolling MO HealthNet budget forecast. (SECTION 1)

The Department of Social Services to study and develop an acuity-based reimbursement system for the payment of nursing home services. The department shall include representatives of the nursing home profession in the discussion and development of this study. (SECTION 4)

PRESCRIPTION DRUGS

This act specifies that the fee for service policies that prescribe psychotropic medications will not include any new limits to the initial access requirements. (SECTION 2)

The "Pharmacy Rebate Fund" and the "MoRx Pharmacy Rebate Fund". Any revenues received by the state, either directly or indirectly, from pharmaceutical manufacturer rebates as required by federal law or state supplemental rebates as defined in state plan amendments shall be deposited in the pharmacy rebate fund and shall be used only in the Medicaid pharmacy program. Any state rebates obtained in conjunction with the MORx program shall be deposited in the MoRx pharmacy program. (SECTION 3)

SUNSET PROVISION

This act repeals the provision establishing the Medicaid Reform Commission and the June 30, 2008, expiration date for the current Medicaid system. This act also repeals the expiration date for the Health Care for Uninsured Children program and provides that the program shall be void and of no affect if there are no funds appropriated by Congress to be provided to Missouri. Extends the sunset date for the consumer-directed personal care assistance services program for non-Medicaid eligible clients from June 30,2008 to June 30, 2009. SECTIONS 208.014, 208.631, AND 208.930.

ADRIANE CROUSE


Return to Main Bill Page