HCS/SB 563 - This act modifies the Medicaid managed care reimbursement allowance by applying the it, beginning July 1, 2019, to all managed care organizations in Missouri, including those providing benefits to MO HealthNet managed care participants. The reimbursement allowance may be imposed on the basis of revenue or enrollment and may impose differential rates on Medicaid and commercial business. The Department of Social Services shall recognize the cost of the reimbursement allowance as a cost in calculating actuarially sound reimbursement rates.
Additionally, this act repeals existing provisions of law regarding hospital reimbursement allowance calculations and alternative reimbursements for outpatient services. Instead, each state fiscal year, the amount of federal reimbursement allowance levied under the Hospital Reimbursement Allowance Tax shall not exceed 41% of the total payments to hospitals from the Federal Reimbursement Allowance Fund and associated federal match, including payments made to hospitals from state-contracted managed care organizations that are attributable to the reimbursement fund and associated federal match. By October 1 of each subsequent state fiscal year, the Department shall report this calculation and the underlying data to the House budget committee and the Senate appropriations committee as specified in the act, including the amount of hospital payments made by the Department and the amount of hospital payments made by each managed care plan.
These provisions are similar to provisions in the truly agreed to and finally passed CCS/HCS/SS/SCS/SB 775 (2018).
Under current law, only Medicaid dual eligible individuals meeting certain income limitations are eligible to participate in the Missouri RX Plan. This act removes the Medicaid dual eligible requirement, while retaining the income limitations.
This provision is identical to HB 1276 (2018) and HB 2278 (2018).