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SB 301 - This act modifies provisions relating to public assistance. HEALTH CARE COST TRANSPARENCY (Section 191.870) Upon request from a patient, potential patient, or the person's parent or guardian, a health care provider shall provide an estimated cost, if known, for a health care service based on the patient or potential patient's health benefit plan coverage, Medicaid coverage, Medicare coverage, or uninsured status. If covered by a health benefit plan, Medicaid, or Medicare, the health care provider shall provide the contractual reimbursement rate for the service, if known, and, if applicable, the amount the patient or potential patient would pay as a result of a deductible, coinsurance, or co-payment. If a patient or potential patient is uninsured, the health care provider shall provide the estimated out-of-pocket cost and information regarding any payment plan or other financial assistance that may be available. The health care provider's response need not be in writing unless so requested by those authorized to receive such responses. Health care providers providing estimated costs under these provisions shall include with any price quote a specified statement. No provision in a contract entered into, amended, or renewed on or after August 28, 2015, between a health carrier and a health care provider shall be enforceable if the contractual provision prohibits, conditions, or in any way restricts any party to the contract from disclosing to an enrollee, patient, potential patient, or the person’s parent or legal guardian the contractual reimbursement rate for a health care service if the payment amount is less than the health care provider's usual charge for the health care service and if the 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. Any violation of these provisions shall result in a fine not to exceed $1,000 for each instance of violation. This provision is substantially similar to a provision in HB 1901 (2014). PRICE TRANSPARENCY (Section 191.875) On or after July 1, 2015, this act requires all health care providers and insurers to provide cost estimates prior to the provision of such services, if feasible, but in no event later than five business days after such request, except when the requested information is posted on the department's website. These provisions shall not apply to emergency health care services. Health care providers and health carriers shall include with any estimate a specified disclaimer stating that the estimated cost is an estimate and shall also make available the percentage or amount of any discounts for cash payment of any charges incurred by a posting on the provider's website or in person. Nothing in these provisions shall be construed as violating any provider contract provision with a health carrier that prohibits disclosure of the provider's fee schedule with a health carrier to third parties. If a hospital provides information to the Department for its public website, it need not also provide cost estimate to patients prior to provision of health care services upon request. The Department shall make the most current price information available to the public on its website. The information shall be provided in an easy-to-understand manner according to the following minimum requirements: information for each participating hospital shall be listed separately and hospitals shall be listed in groups by category and information for each hospital outpatient department shall be listed separately. Beginning with quarter ending June 30, 2016 and each quarter thereafter, each participating hospital shall provide to the Department the following information about the one hundred most frequently reported admissions by DRG (diagnosis related group) for inpatients: the amount to be charged to a patient for each DRG is charges are paid in full without third party assistance; the average negotiated settlement on the amount that will be charged to the patient; the amount of MO HealthNet reimbursement for each DRG; and the amount of Medicare reimbursement for each DRG. A hospital shall not be required to report this information where such information could reasonably lead to the identification of the person or persons admitted to the hospital in violation of the federal Health Insurance Portability and Accountability Act of 1996 (HIPAA) or other federal law. Beginning with quarter ending June 30, 2016 and each quarter thereafter, each participating hospital shall provide to the Department information about the fifty most common outpatient surgical procedures by CPT code (Current Procedure Terminology) and the fifty most common imaging procedures by CPT code as performed in hospital outpatient settings. A hospital shall not be required to report this information where such information could reasonably lead to the identification of the person or persons admitted to the hospital in violation of the federal Health Insurance Portability and Accountability Act of 1996 (HIPAA) or other federal law. This data as disclosed to the Department shall be the sole property of the submitting hospital. Any data or product derived from the submitting hospitals' data shall be the sole property of the state. The department shall not allow any proprietary information it receives or discloses under this section to be used for commercial purposes. This provision is similar to a provision in HCS/HB 1793 (2014) and similar to a provision in SB 847 (2014). REPORTING OF PRICES FOR MOST COMMON PROCEDURES (Sections 197.170 & 197.173) This act requires hospitals and ambulatory surgical centers to submit to the Department prices for one hundred and forty of the most common procedures, including one hundred of the most common procedures in hospital inpatient settings as well as twenty of the most common surgery and twenty of the most common imaging procedures conducted in both outpatient hospital and ambulatory surgical settings. The Department shall provide such information on its internet website in a manner that is easily understood by the public. Information for each hospital shall be listed separately and hospitals shall be listed in groups by category as determined by the Department through the promulgation of rules. Information for each hospital outpatient department and each ambulatory surgical center shall also be listed separately. The information regarding hospital inpatient procedures shall be submitted beginning with the quarter ending June 30, 2016, and quarterly thereafter. The information regarding outpatient surgical and imaging procedures shall be submitted beginning with the quarter ending September 30, 2016, and quarterly thereafter. This data as disclosed to the Department shall be the sole property of the submitting hospital. Any data or product derived from the submitting hospitals' data shall be the sole property of the state. The department shall not allow any proprietary information it receives or discloses under this section to be used for commercial purposes. A hospital shall not be required to report this information where such information could reasonably lead to the identification of the person or persons admitted to the hospital in violation of the federal Health Insurance Portability and Accountability Act of 1996 (HIPAA) or other federal law. These provisions are substantially similar to HB 617 (2015) and similar to HCS/HB 617 (2015), SB 46 (2015), SB 684 (2014) and to provisions contained in SB 847 (2014) and HCS/HB 1793 (2014). CERTIFICATE OF NEED (Sections 197.305 to 197.330) This act amends the certificate of need (CON) law as follows: (1) Limits the radius area for "affected persons" to a five mile radius of proposed new development as well as when consideration shall be given to the facilities located within the five mile radius when determining if a CON shall be issued; (2) Provides that a certificate of need shall not be required for a proposed project which creates ten or more new full-time jobs; (3) Raises the expenditure minimum for falling under CON review for capital expenditures to one million dollars and for major medical equipment to two million dollars; (4) Requires all testimony and other evidence taken during the hearings to be under oath and subject to penalty of perjury; (5) Changes the procedures and evidentiary standard at the certificate of need hearing; (6) Prohibits all ex parte communications between members of the committee and any interested party or witness regarding the subject matter of the hearing at any time prior to, during, or after the hearing and (7) Modifies the membership and requirements for Missouri Health Facilities Review Committee for the Certificate of Need Program. These provisions are identical to provisions contained in SB 847 (2014); HCS/HB 1793 (2014); SB 10 (2011 Special); SB 640 (2012) and substantially similar to HB 2355 (2008). ASSET LIMITS INCREASE FOR PUBLIC ASSISTANCE (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 public assistance benefits from less than $1,000 to $2,000 for a single person and from $2,000 to $4,000 for a married couple. This provision is identical to HB 466 (2015) and provisions contained in SCS/SB 582 (2014) and SS/SCS/SB 739 (2014) and similar to SB 322 (2015), SCS/SB 322 (2015), and HCS/SCS/SB 322 (2015) and provisions in SCS/HCS/HB 796 (2015). SNAP REQUIREMENTS (Section 208.023) This act requires the Department of Social Services to imprint a photograph of a recipient on all EBT cards distributed for Supplemental Nutrition Assistance Program (SNAP) benefits. The card shall expire and be subject to renewal every three years. (Section 208.203(1)) Under this act, certain SNAP applicants are required to sign an affidavit stating that such individuals will follow certain requirements such as registering to work, providing sufficient information of job status and availability, accepting suitable jobs if offered, continuing employment if hired, and to not voluntarily reduce employment hours and failure to comply with requirements may result in loss of SNAP benefits (Section 208.023(2)) SNAP recipients are required to participate in any one or a combination of certain activities such as a condition of eligibility: secondary education, job search and readiness, community service, job training or employment. (Section 208.023(3)). SNAP recipients shall report any time their monthly gross income is over the maximum allowed for household size and shall also complete recertification once every 12 months. (Section 208.023(4) and (5)). This provision is similar to HB 441 (2015). EBT USE BY TANF RECIPIENTS IN CERTAIN ESTABLISHMENTS (Section 208.031) This act provides that electronic benefit transfer transactions (EBTs) made by otherwise eligible TANF applicants or recipients who have made cash withdrawals in casinos, gambling casinos, or gaming establishments shall be declared ineligible for TANF benefits for three years. The applicant or recipient may request an administrative hearing to be conducted by the Department. Other household members shall, if otherwise eligible, continue to receive TANF benefits as protective or vendor payments to a third-party payee for the benefit of the household. Any person who makes a good-faith report of a suspected violation of this section shall not be held civilly or criminally liable for reporting. BENEFITS APPEALS (section 208.080) This act modifies the benefits appeals process to require notification of right to an appeal to be give to the recipient prior to adverse action when a case has been closed or modified and no appeal was requested prior to closure or modification. MO HEALTHNET WAIVERS AND NOTIFICATIONS (Section 208.151) The Department of Social Services shall also notify potential exchange-eligible participants who may be eligible due to spenddowns that the participant may qualify for more cost-effective private insurance and tax credits through the purchase of a health insurance plan in a health care exchange. This provision is substantially similar to a provision in SB 230 (2015). PUBLIC ASSISTANCE FRAUD (Section 208.249) Subject to federal approval, this act specifies that any person who knowingly commits fraud in obtaining or attempting to obtain public assistance benefits shall permanently lose eligibility for the benefits. The requirements for an investigation are specified. CHILDREN'S HEALTH INSURANCE PROGRAM and UNINSURED WOMEN'S HEALTH PROGRAM (Sections 208.655 to 659) This act makes technical corrections to the statutory language of the CHIP program. The Uninsured Women's health program is repealed beginning July 1, 2016, with such change not going 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. 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 hospitals to use telehealth services to address access to care. REVISED JOINT COMMITTEE ON MO HEALTHNET AND REPEAL OF MO HEALTHNET OVERSIGHT COMMITTEE (Sections 208.950; 208.952; 208.960; 208.975; 208.985) 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 meet at least twice a year. The committee may also hire or contract for an executive director to conduct investigations to fulfill the duties of the committee. This act also repeals the MO HealthNet Oversight Committee and references made to it. This provision is substantially similar to SB 38 (2015) and SB 197 (2015) and substantially similar to SB 9 (2015), SB 58 (2015), SCS/SB 38 (2015), SCS/SB 197 (2015), SB 230 (2015), and provisions in HCS/SCS/SB 197 (2015). CHIROPRACTIC SERVICES IN MO HEALTHNET (Section 208.960) This act adds chiropractic services as a covered service under MO HealthNet. MO HEALTHNET ELIGIBILITY (Section 208.991) The Department of Social Services shall implement an automated process to ensure applicants applying for benefits are eligible. The program will periodically review current beneficiaries to ensure that they remain eligible. This requirement will only become effective if necessary funding is appropriated. The Department shall provide premium subsidy and other cost supports for individuals eligible for MO HealthNet benefits to enroll in employer-sponsored health plans or other private health plans based on cost-effective principles determined by the Department. All individuals who meet the definition of medically frail shall receive all benefits that they are entitled to under Section 208.152, current MO HealthNet services and Sections 208.900 to 208.930, consumer-directed personal care services. The Department in conjunction with the Departments of Mental and Health and Senior Services, shall establish a screening process for determining whether an individual is medically frail and shall enroll all such individuals deemed so in the health care home program or other care coordination program. Such individuals may opt out of a health home program. These new provisions will sunset on January 1, 2020, unless reauthorized by the general assembly. These provisions are similar to provisions in HB 153 (2015), HB 474 (2015), HB 809 (2015), HB 825 (2015), HB 988 (2015), HB 989 (2015), HB 1351 (2015), SB 125 (2015). HEALTH CARE HOMES PROGRAM (Section 208.997) The MO HealthNet Division shall implement the Health Care Homes Program as a provider-directed care coordination program for MO HealthNet participants who are not enrolled in a prepaid MO HealthNet benefits option and who are receiving services on a fee-for-service basis. The program shall provide payment to primary care clinics, community mental health centers, and other appropriate providers for care coordination for individuals deemed medically frail. Clinics shall 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. The act specifies the other parameters of the program. This provision is substantially similar to SB 230 (2015). MO HEALTHNET MANAGED CARE (Sections 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, 2016, and no later than July 1, 2016, for all eligible groups currently enrolled in a managed care plan as of January 1, 2015. The Department may accept regional proposals as an additional option for beneficiaries. The proposals may be submitted by accountable care organizations or other organizations and entities. The Department shall advance the development of systems of care for medically complex children who are MO HealthNet benefit recipients 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. The entities shall be treated as accountable care organizations. 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; prescription drugs; rehabilitative and habilitative services and devices; laboratory services; preventive and wellness care, and chronic disease management; and any other services required by federal law. No MO HealthNet plan or program shall provide coverage for an abortion unless a physician certifies in writing to MO HealthNet that, in the physician's professional judgment, the life of the mother would be endangered if the fetus were carried to term. The Department shall seek all necessary waivers and state plan amendments from the federal Department of Health and Human Services that are necessary to implement the provisions of the act. No provisions of the act may be implemented unless the waivers and state plan amendments are approved. No MO HealthNet managed care organization shall refuse to contract with any willing licensed Missouri medical doctor, doctor of osteopathy, psychiatrist or psychologist who is located within the geographic coverage area of a MO HealthNet managed care program and is who is willing to be paid at rates equal to one hundred percent of MO HealthNet's fee schedule, unless prohibited by law. In the MO HealthNet managed care program, all provisional licensed clinical social workers, licensed clinical social workers, provisional licensed professional counselors, and licensed professional counselors may provide behavioral health services to all participants in any setting, so long as they are geographically located in the area of a MO HealthNet managed care program and are willing to be paid at rates equal to one hundred percent of MO HealthNet's fee schedule, unless prohibited by law. This provision is similar to SB 230 (2015). MANAGED CARE DATA AND NETWORK ADEQUACY REQUIREMENTS (208.999) 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. This act specifies all of the data and reporting requirements for the managed care organizations. SARAH HASKINS
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