HS HCS HB 618 -- ELDERLY HEALTH CARE (Harlan)

This substitute requires managed care organizations to provide
enrollees who reside in a licensed long term care facility or a
continuing care retirement community the option of receiving a
covered service in the facility serving as the enrollee's
primary residence.  The managed care organization must reimburse
the enrollee's facility for the covered services at a rate of
reimbursement that is not less than the organization's contract
rate for similar service providers or at a rate mutually
acceptable to the facility and the managed care organization.
Also, the health care providers delivering the services must
meet the licensing and training standards required by law and
the facility must be willing to provide the services to the
resident.

FISCAL NOTE:  No impact on state funds.

HCS HB 618 -- ELDERLY HEALTH CARE

SPONSOR:  Harlan

COMMITTEE ACTION:  Voted "do pass" by the Committee on Critical
Issues by a vote of 20 to 1.

This substitute requires managed care organizations to provide
enrollees who reside in a licensed long term care facility or a
continuing care retirement community the option of receiving a
covered service in the facility serving as the enrollee's
primary residence.  The managed care organization must reimburse
the enrollee's facility for the covered services at a rate of
reimbursement that is not less than the organization's contract
rate for similar service providers.  Also, the health care
providers delivering the services must meet the licensing and
training standards required by law.

FISCAL NOTE:  No impact on state funds.

PROPONENTS:  Supporters say that this bill would be helpful to
elderly Medicare recipients who are enrolled in a health
maintenance organization (HMO), live in a long term care
facility, are admitted to a hospital, and need services
following a hospital stay.  Often these residents are unable to
return home following a hospital stay because they need
rehabilitative services, and the home facility is not in the
HMO's network of providers.  Consequently, the residents are
unnecessarily disrupted by a move to a different facility before
they can return home when the home-facility is capable of
providing the services needed by the resident.  This bill allows
the resident to return to the facility where he or she lives if
the facility has licensed professionals to provide the services
and will accept the HMO's rate for providing the services.

Testifying for the bill were Representatives Harlan and Fraser;
Missouri Jewish Federation; Missouri Association of Homes for
the Aging; and American Association of Retired Persons.

OPPONENTS:  Those who oppose the bill say that HMOs should only
be required to pay for covered services rendered by providers
within the HMO's network.  This allows the HMO to control the
quality of care given for services the HMO covers.

Testifying against the bill were Blue Cross and Blue Shield of
Missouri; United Healthcare of the Midwest; Missouri Association
of Health Plans; and Kaiser Permanente.

Katharine Hickel Barondeau, Legislative Analyst

HB 618 -- Elderly Health Care Needs

Co-Sponsors:  Harlan, Fraser, May (108), Holand, Griesheimer,
Levin, Foley

This bill requires that primary care physicians for elderly
citizens who are enrolled in a health maintenance organization
and who are residents of licensed long term care facilities or
continuing care retirement communities, provide the elderly
resident with the option of receiving approved health services
in the long term care facility under certain conditions.  These
conditions include the ability of the facility to provide or
make arrangements to provide the needed services, and the
willingness of the facility to accept the negotiated contract
rate for health services.