SB 127 Modifies various public assistance provisions including MO HealthNet dental, home and community based referrals, Missouri adjusted gross income for MO HealthNet eligibility and extends Ticket-to-Work
Sponsor: Sater
LR Number: 0486S.04T Fiscal Note available
Committee: Veterans' Affairs and Health
Last Action: 7/8/2013 - Signed by Governor Journal Page: S2463-2464
Title: CCS HCS SB 127 Calendar Position:
Effective Date: August 28, 2013
House Handler: Lichtenegger

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Current Bill Summary


CCS/HCS/SB 127 - This act modifies provisions relating to public assistance benefits.

TICKET-TO-WORK PROGRAM

This act reauthorizes the Ticket-to-Work program until 2019. Currently the program is set to expire on August 28, 2013. (Section 208.146)

This provision is contained in SCS/HCS/HB 986 (2013).

ADVANCED PRACTICE REGISTERED NURSES

This act adds advanced practice registered nurses to the list of those who can prescribe drugs covered by MO HealthNet payments. Services of an advanced practice registered nurse are also added to the list of services qualified for MO HealthNet payments. (Section 208.152)

This provision is identical to provisions in SB 167 (2013) and HB 314 (2013).

MO HEALTHNET DENTAL DELIVERY SYSTEM

This act authorizes the MO HealthNet Division within the Department of Social Services, or a contractor of the division, to implement a statewide dental delivery system to ensure recipient participation and access to providers of dental services under MO HealthNet. (Section 208.240)

This provision is identical to HB 1078 (2012).

REFERRALS FOR HOME-AND COMMUNITY-BASED SERVICES

Under current law, upon the receipt of a referral for MO HealthNet-funded home-and community-based care containing a nurse assessment or a physician's order, the Department of Health and Senior Services is allowed to reimburse in-home providers for nurse assessments of participants in the in-home and home and community based programs and to contract for home-and community -based assessments through an independent third-party assessor.

Under this act, upon receipt of a properly completed referral for services or a physician's order, the department is required to process, review, and approve or deny the referral within 15 business days. For approved referrals, the department shall arrange for the provision of services by a home- and community-based provider and notify the referring entity or individual within 5 business days of receiving the referral if a different physical address is required to schedule the assessment. If a different physical address is needed, the 15 day limit included in the act is suspended until the information is received by the department.

The department shall also inform the applicant of:

- The full range of available MO HealthNet home- and community-based services;

- The choice of home- and community-based service providers in the applicant's area; and

- The option to choose more than one home- and community-based service provider to deliver or facilitate the services the applicant is qualified to receive.

This act also requires the department to:

- Prioritize the referrals received, giving the highest priority to referrals for high-risk individuals; and

- Notify the referring entity and the applicant within 10 business days of receiving the referral if it has not scheduled the assessment.

This act repeals the provision requiring the reassessments and care plan changes to be reviewed and approved by the independent third-party assessor.

If the department has not complied with the 15 day requirement for referral, a provider has the option of completing an assessment and care plan recommendation. At such time that the department approves or modifies the assessment and care plan, the care plan shall become effective; such approval or modification shall occur within 5 business days after receipt of the assessment and care plan from the provider. If such approval, modification, or denial by the department does not occur within 5 business days, the provider's care plan shall be approved and payment shall begin to the provider based on the assessment and care plan recommendation submitted by the provider.

At such time that the department approves or modifies the assessment and care plan, the latest approved care plan shall become effective. If the department assessment determines the client does not meet the level of care, the state shall not be responsible for the cost of services claimed prior to the department's written notification to the provider of such denial.

The department shall implement the provisions of this act unless the Centers for Medicare and Medicaid Services disapproves any necessary state plan amendments or waivers to implement such provisions. The act also prescribes the requirements for the department's auditing of the home-and community-based providers client plan of care and provider assessments.

The department shall also:

(1) Develop an automated electronic assessment care plan tool to be used by providers; and

(2) Make recommendations to the general assembly by January 1, 2014, for the implementation of the automated electronic assessment care plan tool.

No later than December 31, 2014, the department shall submit a report to the general assembly that reviews the implementation of the assessments and referrals under this act. (Section 208.895). This act removes the August 28, 2013 expiration date.

This provision is similar to a provision contained in HCS/SCS/SB 262 (2013) and SCS/HCS/HB 727 (2013).

NEW FEDERAL REQUIREMENTS FOR CURRENT MO HEALTHNET PARTICIPANTS

This act extends coverage for former foster youth up to age 26. (Section 208.151)

This act adds definitions for modified adjusted gross income (MAGI) methodologies and adds new federal requirements for all MO HealthNet applicants and participants to qualify for benefits regarding residency, citizenship or qualified alien status, and a Social Security number. (Section 208.990.1 and 5; 208.995.1)

Effective January 1, 2014, the Department of Social Services shall conduct an annual redetermination of all MO HealthNet participants' eligibility as provided under federal rule. (Section 208.990.2)

All applications for MO HealthNet shall be submitted in accordance with federal rule and applicants shall provide the required information and documentation necessary to make an eligibility determination necessary or for any purpose directly connected to the administration of the MO HealthNet program. (Section 208.990.4)

This act also outlines all of the current MO HealthNet participants whose eligibility shall be determined based on MAGI methodologies effective January 1, 2014, and how such participants shall receive all applicable benefits as under current law in Section 208.152. (Section 208.995.2 (1),(2) and (3))

MODIFIES THE EMPLOYMENT DISQUALIFICATION LIST FOR HOME CARE EMPLOYEES

This act provides that any employer or vendor of hospice, home health, long-term care, consumer-directed or in-home care services required to deny employment to an applicant or discharge an employee as a result of information obtained through a portion of the background screening and employment eligibility determination process required under the Family Care Safety Registry provisions shall not be liable in any action brought by the applicant or employee relating to discharge where the employer is required by law to terminate the employee, provisional or otherwise.

Such employer or vendor shall also not be charged for unemployment insurance benefits based on wages paid to the employee or based on an employer making payments in lieu of contributions for work prior to the date of discharge, if the employer terminated the employee because the employee:

(1) Has pled guilty to or nolo contendere or been found guilty in this state or any other state of a crime, which if committed in Missouri would be a class A or B felony violation of certain specified crimes such as offenses against the persons, sexual offenses and robbery or burglary offenses;

(2) Was placed on the employee disqualification list maintained by the Department of Health and Senior Services, after the date of hire;

(3) Was placed on the employee disqualification list maintained by the Department of Mental Health, after the date of hire;

(4) Is listed on any of the background check lists in the Family Care Safety Registry; or

(5) Has a disqualifying finding or was denied a good cause waiver under the employee disqualification list maintained by the Department of Health and Senior Services. (Section 660.315)

This provision is substantially similar to provisions contained in HCS/HB 781 (2013), HCS/HB 1900 (2012) and HCS/SCS/SB 854 (2012).

ADRIANE CROUSE