SS/SB 1007 - This act modifies provisions relating to public assistance programs administered by the state.
INFORMATION REGARDING HOME AND COMMUNITY BASED SERVICES
Prior to admission of a MO HealthNet individual into a long-term care facility, the prospective resident or his or her next of kin, legally authorized representative, or designee shall be informed of the home and community based services available in this state and shall have on record that such home and community based services have been declined as an option. Section 198.016
EXEMPTION FOR MO HEALTHNET FROM PAYING MEDICARE PART B DEDUCTIBLE AMOUNTS FOR HOSPITAL SERVICES
Current law requires reimbursement for services provided to an individual who is eligible for MO HealthNet, Medicare Part B, and Supplementary Medical Insurance to include payment in full of deductible and coinsurance amounts as determined by federal Medicare Part B provisions. This act exempts MO HealthNet from paying for the Medicare Part B deductible and coinsurance amounts for hospital outpatient services. Section 208.010
MO HEALTHNET THIRD PARTY PAYERS
This act modifies provisions relating to the MO HealthNet Division's authority to collect from third party payers.
Under this act any third party administrator, administrative service organization, health benefit plan and pharmacy benefits manager shall process and pay all properly submitted MO HealthNet subrogation claims for a period of three years from the date services were provided or rendered, regardless of any other timely filing requirement. The entity shall not deny such claims on the basis of the type or format of the claim form, failure to present proper documentation of coverage at the point of sale, or failure to obtain prior authorization. The MO HealthNet Division shall also enforce its rights within six years of a timely submission of a claim.
Certified computerized MO HealthNet records shall be prima facie evidence of proof of moneys expended and the amount due the state.
These provisions are identical SCS/SBs 842, 799, & 809 (2010). Section 208.215
REPEAL OF PUBLIC HOSPITAL EXEMPTION FROM THE HOSPITAL REIMBURSEMENT ALLOWANCE
This act no longer allows public hospitals which are operated primarily for the care and treatment of mental disorders to be exempted from participating in the Hospital Reimbursement Allowance. Section 208.453
TELEPHONE TRACKING SYSTEM
This act requires both personal care assistance vendors and in-home services providers to use a telephone tracking system to review and certify the accuracy of reports of delivered services and to ensure more accurate billing by July 1, 2015. The requirements of the telephone tracking system are specified in the act. In order for vendors or provider agencies to obtain an agreement with the Department of Social Services, the vendor or agency must demonstrate the ability to implement the telephone tracking system.
Personal care assistance consumers shall be responsible for approving requests through the telephone tracking system and shall provide the vendor with necessary information to complete the required paperwork for establishing the employer identification number.
The Department of Health and Senior Services shall establish telephony pilot programs in collaboration with other appropriate agencies, including centers for independent living, in rural and urban areas and report to the governor and general assembly on the program. The report shall take into consideration the impact of a telephone tracking system on the quality of the services delivered to the consumer and the principles of self-directed care. Sections 208.909, 208.918, 660.023
INDEPENDENT THIRD PARTY IN-HOME AND COMMUNITY BASED ASSESSMENTS
This act repeals the language allowing for the Department of Health and Senior Services to reimburse in-home providers for nurse assessments of participants in the in-home and home and community based programs. New language is added allowing the department to contract for home and community based assessments through an independent third-party assessor.
The contracts shall include a requirement that within 15 days of receipt of a referral for service, the contractor shall have made an assessment of care need and developed a plan of care and the contractor shall notify the referring entity within 5 days of receipt of referral if additional information is needed to process the referral.
The contract shall also include the same requirements for such assessments as of January 1, 2010, related to timeliness of assessments and the beginning of service. Section 208.895
COMPLAINT CALLS FOR IN-HOME SERVICES CLIENTS
Current law provides that all in-home services clients shall be advised of their rights by the Department of Health and Senior Services, including the right to call the department to report dissatisfaction with the provider or services. This act provides that it can be by the department's designee. This act also provides that the department may contract for services relating to receiving such complaints. Section 660.300
This act is substantially similar to provision in HB 1918 (2010).