SS/SCS/SB 739 - This act modifies provisions relating to MO HealthNet.
ASSET LIMITS INCREASE FOR MEDICAID (Section 208.010)
This act modifies the amount of cash, securities or other total non-exempt assets an aged or disabled participant is allowed to retain in order to qualify for MO HealthNet benefits from less than $1,000 to $2,000 for a single person and from $2,000 to $4,000 for a married couple.
CHANGES TO WOMEN AND CHILDREN UNDER MO HEALTHNET (Section 208.151.2)
This act specifies that beginning July 1, 2015, the eligibility level for MO HealthNet benefits shall be modified under specified circumstances enumerated in the act for participants diagnosed with breast or cervical cancer, pregnant women, and infants under one year of age. The act specifies the lower or change in eligibility levels and conditions required for continued coverage under MO HealthNet such as if the person does not have access to employer-sponsored health insurance coverage, premium tax credits or subsidized insurance coverage through an exchange.
Such lowering of eligibility levels shall not occur unless and until:
(a) There are federal health insurance premium tax credits available to persons through the purchase of a health insurance plan in a health care exchange, whether federally facilitated, state-based, or operated on a partnership basis. The Director of the Department of Revenue must certify to the Director of the Department of Social Services that health insurance premium tax credits are available, and the Director of the Department of Social Services must notify the Revisor of Statutes; and
(b)The federal Department of Health and Human Services grants any necessary waivers and state plan amendments to implement these provisions, federal funding is received for the premium subsidies to be paid, and notice has been provided to the Revisor of Statutes.
NOTIFICATION TO SPENDDOWN PARTICIPANTS (Section 208.151.8)
Under this act the Department of Social Services shall notify any potential exchange-eligible participant who may be eligible for services due to spenddown that the participant may qualify for more cost-effective private insurance and federal premium tax credits available through the purchase of a health insurance plan in a health care exchange and the benefits that would be potentially covered under the insurance.
LICENSED PROFESSIONAL COUNSELORS (Section 208.152.12)
This act provides that Licensed professional counselors (LPCs) and provisional LPCs may provide MO HealthNet behavioral health services to adults age twenty-one and older in a federally qualified health center setting.
ASSESSMENTS FOR DRUG AND ALCOHOL TREATMENT AND JUVENILE COURT SERVICES (Section 208.186.)
Assessments for drug and alcohol treatment shall be made to MO HealthNet participants when drugs or alcohol were contributing factors to any crimes or to any child abuse and neglect allegations. Recommendations of the treatment provider may be used by the court in sentencing or rendering a disposition.
CHILDREN'S HEALTH INSURANCE PROGRAM (Section 208.631)
Beginning October 1, 2019, a child eligible for the current Children's Health Insurance Plan (CHIP) shall only remain eligible if, in addition to other requirements, his or her parents do not have access to health insurance coverage for the child through their employment or through a health insurance plan in a health care exchange because the parents are not eligible for a premium subsidy for the child or family through the exchange.
This change cannot go into effect unless and until federal health insurance premium tax credits are available for children and family coverage to purchase a health insurance plan from a health care exchange and the credits are available for six months prior to the discontinuation of CHIP benefits.
HEALTH CARE ACCESS IN LOW-INCOME PUBLIC SCHOOLS (Section 208.661)
The Department shall develop incentive programs, submit state plan amendments, and apply for necessary waivers to permit rural health clinics, federally-qualified health centers, certified mental health practices or other primary care practices to co-locate on the property of public elementary and secondary schools with 50% or more students who are eligible for free or reduced-price lunch. The act details the prohibitions on such clinics as well as the parental consent required.
SHOW-ME HEALTHY BABIES PROGRAM (Section 208.662)
This act establishes the Show-Me Healthy Babies Program within the Department of Social Services as a separate children's health insurance program for any low-income unborn child. For an unborn child to be eligible for enrollment in the program, the mother of the child must not be eligible for coverage under the Medicaid Program as administered by the state and must not have access to affordable employer-subsidized health care insurance or other affordable health care coverage that includes coverage for the unborn child. The unborn child must be in a family with income eligibility of no more than 300% of the federal poverty level or the equivalent modified adjusted gross income unless the income eligibility is set lower by the General Assembly through appropriations. The act delineates all of the parameters of the program.
TELEHEALTH (Section 208.670)
This act requires the Department of Social Services to promulgate rules regarding MO HealthNet telehealth to allow for out-of-state health care providers and hospitalists to use telehealth services to address access to care.
JOINT COMMITTEE ON MO HEALTHNET (Section 208.952)
This act amends the Joint Committee on MO HealthNet to have as its purpose of study the efficacy of the program as well as the resources needed to continue and improve the MO HealthNet program over time. The committee shall receive and obtain information from the departments of Social Services, Mental Health, Health and Senior Services and Elementary and Secondary Education as applicable, regarding the projected budget of the entire MO HealthNet program including projected MO HealthNet enrollment growth, categorized by population and geographic area.
The committee shall meet at least twice a year. The committee is authorized to hire an employee or enter into employment contracts. The compensation of such personnel and the expenses of the committee. The committee may also hire or contract for an executive director to conduct investigations to fulfill the duties of the committee.
CURRENT MANAGED CARE POPULATION EXTENDED STATEWIDE (208.998)
The Department of Social Services shall seek a state plan amendment to extend the current MO HealthNet managed care program statewide no earlier than January 1, 2015, and no later than July 1, 2015, for all eligibility groups currently enrolled in a managed care plan as of January 1, 2014. Such eligibility groups shall receive covered services through health plans offered by managed care entities which are authorized by the Department.
The health plans must resemble commercially available health plans while complying with federal Medicaid Program requirements as authorized by federal law or through a federal waiver. The plans must include cost sharing for out-patient services to the maximum extent allowed by federal law and may include other co-payments and provide incentives that encourage and reward the prudent use of the health benefit provided. In addition, the plans must encourage access to care through provider rates that include pay-for-performance and are comparable to commercial rates.
The managed care health plans shall also require all MO HealthNet managed care plans to provide coverage for ambulatory patient services; emergency services; hospitalization; maternity and newborn care; mental health and substance abuse treatment, including behavioral health treatment; habilitative services and devices; laboratory services; preventive and wellness care, and chronic disease management; pediatric services, including oral and vision care; case management; and preventive services and any other services required by federal law.
The health plans shall also provide a high-deductible health plan option. Such high deductible health plan must include coverage for benefits as specified by Department rule after meeting a $1,000 deductible; an account, funded by the Department, of at least $1,000 per adult to pay the medical costs for the initial deductible; preventive care, as defined by Department rule, that is not subject to the deductible and does not require a payment of money from the account.
The managed care health plans shall also offer all participants with chronic conditions, as specified by the Department, an option to be included in an incentive program for MO HealthNet participants who obtain specified primary care and preventive services and who participate or refrain from specified activities to improve the participant's overall health.
A MO HealthNet participant is eligible to participate in only one of either the high deductible health plan or the incentive program for chronic conditions.
MANAGED CARE DATA AND NETWORK ADEQUACY REQUIREMENTS (208.1500)
This act requires managed care organizations to provide to the Department of Social Services, and the Department to publicly report, certain information regarding medical loss ratios, total payments to the managed care organization in any form, provider compensation rates, service utilization information, data regarding complaints, grievances and appeals, quality measurements and consumer satisfaction.
CERTAIN CURRENT FEE-FOR-SERVICE POPULATION MOVED TO COORDINATED CARE ORGANIZATIONS (208.1503 AND 208.950)
Beginning July 1, 2018, participants in the MO HealthNet fee-for-service program as of January 1, 2014, shall begin enrollment in regionally-based or statewide coordinated care organizations except for those participants transitioning to the MO HealthNet managed care program, those residing in skilled nursing facilities, and those with developmental disabilities receiving state plan services or home- and community-based services through a waiver administered by the Department of Mental Health. A "Coordinated care organization" or "CCO" shall mean an organization of health care providers, including health care homses, that agrees to be accountable for the quality, cost, and overall care of a defined group of MO HealthNet participants. The regional CCOs shall be reimbursed through a global payment methodology developed by the department. Participants under a CCO shall be placed in a health care home.
The Department shall also advance the development of systems of care for medically complex children who are recipients of MO HealthNet benefits by accepting cost-effective regional proposals from and contracting with appropriate pediatric care networks, pediatric centers for excellence, and medical homes for children to provide MO HealthNet benefits when the Department determines it is cost effective to do so. Such entities shall be treated as coordinated care organizations.
The act requires the Departments of Social Services, Health and Senior Services and Mental Health and the Division of Budget and Planning to jointly conduct a study on the feasibility, practical implications and risks of integrating all of the aged, blind and disabled population, including Medicare and Medicaid dual eligibles, skilled nursing facility, health home, home-and community-based waiver and Department of Mental Health waiver populations into the coordinated care organization model established under this act.
HEALTH CARE HOMES (208.997)
By July 1, 2018, the MO HealthNet Division shall implement the Health Care Homes Program as a provider-directed care coordination program for MO HealthNet participants who shall be transitioned from the fee-for-service program to a coordinated care organization. The program must provide payment to primary care clinics for care coordination for individuals deemed medically frail. Clinics must meet certain specified criteria, including the capacity to develop care plans; a dedicated care coordinator; an adequate number of clients, evaluation mechanisms, and quality improvement processes to qualify for reimbursement; and the capability to maintain and use a disease registry.
URGENT CARE CLINICS (208.999)
Subject to appropriations, the Department of Social Services shall develop incentive programs to encourage the construction and operation of urgent care clinics that operate outside normal business hours and are located in or adjoined to emergency room facilities that receive a high proportion of patients who are
participating in MO HealthNet to the extent that the incentives are eligible for federal matching funds.
PRIVATE INSURANCE PREMIUM SUBSIDY (208.1506)
Beginning July 1, 2015, any MO HealthNet participant who elects to receive medical coverage through a private health insurance plan instead of through the MO HealthNet program shall be eligible for a private insurance premium subsidy to assist the participant in paying the costs of such private insurance if it is determined to be cost effective by the Department. The subsidy shall be provided on a sliding scale based on income, with a graduated reduction in subsidy over a period of time not to exceed two years.
PRICE TRANSPARENCY (SECTION 376.2020)
Under this act, no contract provision between a health carrier and a health care provider shall be enforceable if such provision prohibits, conditions, or in any way restricts any party to such contract from disclosing to an enrollee, patient, potential patient, or such person's parent or legal guardian, the contractual payment amount for a health care service if such payment amount is less than the health care provider's usual charge for the health care service, and if such contractual provision prevents the determination of the potential out-of-pocket cost for the health care service by the enrollee, patient, potential patient, parent or legal guardian.
This provision is identical to SB 847 (2013) and SB 307 (2013).
PUBLIC ASSISTANCE RECOVERY (473.398)
This act allows for the Department of Social Services to use computerized records as prima facie evidence for the recovery of public assistance funds from a participant's estate.
This act also repeals the MO HealthNet Oversight Committee in 208.955.
This act contains substantially similar provisions to SB 582 (2014), SB 518 (2014) and HCS/HB 700 (2013).