HCS/SS/SCS/SB 1283 - This act establishes the Missouri Health Transformation Act of 2008. HEALTH CABINET AND HEALTH POLICY COUNCIL This act creates the Missouri Health Cabinet. The cabinet shall ensure that the public policy of the state relating to health is developed to promote interdepartmental collaboration and program implementation in order that services designed for health are planned, managed, and delivered in a holistic and integrated manner to improve the health of Missourians. The cabinet is created in the executive office of the Governor and shall meet for its first organizational session no later than October 1, 2008. Thereafter the cabinet shall meet at least six times each year, with two of the meetings in different regions of the state in order to solicit input from the public. The cabinet shall consist of six members, including the Governor, the director of the Departments of Health and Senior Services, mental health, insurance, financial institutions and professional registration and the commissioner of education. The president pro tem of the Senate, the Speaker of the House, the Chief Justice of the Supreme Court, the Attorney General, and the Commissioner of the Office of Administration, and the director of Agriculture, or their appointed designees shall serve as ex officio members of the cabinet. The Governor shall appoint a Health Policy Council to assist the cabinet in its tasks. Beginning August 28, 2008, the chairs of the MO HealthNet Oversight Committee and the Comprehensive Entry-Point System Subcommittee, shall be members on the Health Policy Council. The council shall replace the State Boards of Health and Senior Services, which are repealed under the act. The members of the council shall consist of representatives from the health care or health policy field. SECTIONS 26.850 TO 26.856 CAFETERIA PLAN FOR INSURANCE PREMIUMS This act allows the Commissioner of Administration to deduct cafeteria plan administrative fees and any amount necessary for the participation in the cafeteria plan from the employee's compensation warrant, unless the employee affirmatively elects not to participate in the plan. Vendors are allowed to solicit the selection of products currently allowed to be included in cafeteria plans, on site in state facilities. SECTION 33.103 This provision is similar to SCS/SB 1015 (2008) and HB 1535 (2008). STATE LEGAL EXPENSE FUND A physician's professional corporation or charitable organization is added to the list of health care providers for whom the State Legal Expense Fund is available for payment of certain claims filed against the provider. TAX CREDITS AND DEDUCTIONS This act increases the amount of tax credits available for taxpayers who modify their home to be accessible for seniors or disabled people who reside with such taxpayer. Under current law, up to one hundred thousand dollars in tax credits remaining unused under the rebuilding communities tax credit program are allocated for use by taxpayers who modify their homes for disabled persons residing with such taxpayers. This act increases the amount of available tax credits by allocating all unused tax credits under the rebuilding communities tax credit program for use by taxpayers who modify their homes for seniors or disabled persons residing with such taxpayers. The rebuilding communities tax credit program is capped at ten million dollars annually. Constructing additional rooms in the dwelling or a new structure on the property for the purpose of accommodating the senior or disabled person is added as a new eligible cost for which the tax credit may be claimed. SECTIONS 135.535 AND 135.562 This provision is substantially similar to SB 717 (2008). A self-employed, Missouri resident's individual health insurance premiums will be excluded from being deducted from adjusted gross income when computing his or her Missouri taxable income. A hospital or health care provider can submit a delinquent unpaid medical claim to the Department of Revenue rather than the Department of Health and Senior Services in order to offset the debtor's income tax refund. Sections 143.111 to 143.790 LOCAL COMMUNITY HEALTH COALITIONS Subject to appropriations, the Department of Social Services shall administer a grant in the amount of 350,000 dollars to a local government entity or local health department to be used for the establishment of a study to assess the feasibility of pilot projects in the greater St. Charles and Southeast bootheel areas of the state. Any grant awarded shall be matched in equal value by the grant recipient. The pilot projects shall have the involvement of the local community health coalition to establish new approaches to expand coverage for the uninsured population in the respective communities and to create healthier populations through a single comprehensive health care plan. The program shall be administered by the Department of Health and Senior Services and shall have a six-year sunset. SECTION 191.845 TRANSPARENCY OF HEALTH CARE SERVICES This act establishes guidelines for transparency in pricing and quality of health care services. Criteria are established for insurers to use in programs that publicly assess and compare the quality and cost efficiency of health care providers. A provider cannot decline to enter into a provider contract with an insurer solely because the insurer uses quality and cost efficiency of health care data programs. A person who sells or distributes health care quality and cost efficiency data in a comparative format to the public is required to identify the source used to confirm the validity of the data and its analysis as an objective indicator of health care quality. This provision does not apply to articles or research studies that are published in peer-reviewed academic journals that do not receive funding from or is affiliated with a health care insurer, or by state or local governments. The Department of Health and Senior Services is required to investigate complaints of alleged violations and is authorized to impose a penalty of up to $1,000. Alleged violations by health insurers will be investigated and enforced by the Department of Insurance, Financial Institutions, and Professional Registration. SECTIONS 191.1005 to 191.1010 These provisions are similar to certain provisions in HCS/HBs 2413, 2355 & 2398 (2008). INTERNET WEB-BASED PRIMARY CARE ACCESS PILOT PROJECT This act allows the General Assembly to appropriate 400,000 dollars from the Health Care Technology Fund to the Department of Social Services to award a grant to implement an Internet web-based primary care access pilot project designed as a collaboration between private and public sectors to connect, where appropriate, a patient with a primary care medical home, and schedule patients into available community-based appointments as an alternative to non-emergency use of the hospital emergency room as consistent with federal law and regulations. The criteria for the grant are specified in the act. SECTION 191.1200 TELEHEALTH This act expresses the state's recognition of the delivery of health care via telehealth as a safe, practical and necessary practice in the state. By January 1, 2009, the Department of Health and Senior Services shall promulgate quality control rules to be used in removing and improving the service of telehealth practitioners. Beginning July 1, 2009, all health carriers shall reimburse services provided through telehealth in the same manner they would reimburse a standard office visit or consultation by the provider or specialist. The Department of Social Services shall promulgate rules for the MO HealthNet program consistent with this provision. SECTIONS 191.1250 to 191.1271 COMMUNITY AND FAITH-BASED ORGANIZATIONS This act requires the Office of Minority Health to solicit proposals from such community programs and organizations to develop solutions regarding health and wellness. SECTION 192.083 MISSOURI FREE CLINICS FUND This act creates the "Missouri Free Clinics Fund" to be administered by the Department of Social Services for use by clinics in the Missouri free clinics association to increase their infrastructure and bolster their sustainability in order to serve a greater number of people in a more effective manner. For a one-time funding appropriation of 500,000 dollars from the General Assembly, the Department shall disburse funds to the association, to be equitably and evenly distributed to all free clinics in this state, in accordance with applicable guidelines, policies, and requirements established by the department. SECTION 192.990 TOBACCO USE PREVENTION, AND CESSATION FUND This act creates the tobacco use prevention and cessation fund. Beginning fiscal year 2009, payments received from the strategic contribution fund will be deposited into the newly created fund to be used to fund tobacco prevention and cessation programs. At least 25 percent of the moneys from the fund shall be used for youth smoking prevention programs modeled upon evidence-based programs proven to reduce youth smoking in one or more jurisdictions within the United States. SECTION 196.1200 This provision is substantially similar to SCS/SB 946 (2008). MISSOURI HEALTH FACILITIES REVIEW COMMITTEE This act increases the medical equipment exemption under the Certificate of Need Program from 1 million to 1.5 million dollars and specifies that the application fee cannot exceed 5,000 dollars for new equipment and 25,000 dollars for new health care facilities. Prior to the initial hearing of an application, any health care provider who is in opposition to the application is required to file a written statement in opposition. The act establishes requirements for all hearings held by the Missouri Health Facilities Review Committee. SECTION 197.305 TO 197.330 ADVERSE HEALTH EVENTS This act requires hospitals to report whenever they have a "serious reportable event in health care," as identified by the National Quality Forum. Such events include wrong-site surgery, retention of a foreign object in a patient after surgery, and death or serious disability associated with medication error. The initial report of the event shall be reported to the patient safety organization no later than the close of business on the next business day following discovery of the incident. The initial report shall include a description of immediate actions taken by the hospital to minimize the risk of harm to patients and prevent reoccurrence. Within 45 days after the event occurred, the hospital shall submit to the patient safety organization a root cause analysis and a prevention plan. The patient safety organization shall publish an annual report to the public on reportable incidents. The report shall show the number and rate per patient encounter by region and by category of reportable incident and may identify reportable incidents by type of facility. A claim for payment filed by a hospital reporting a reportable incident under these provisions shall not be subject to the Unfair Claims Settlement Practices Act. SECTIONS 197.551 to 197.590 These provisions are substantially similar to SCS/SB 916 (2008). HOSPITAL PATIENT SAFETY This act allows any licensed hospital to establish a safe patient handling committee and program to develop procedures to safely handle patients. The Division of Workers' Compensation within the Department of Labor and Industrial Relations is required, by January 1, 2010, to develop rules to provide a reduced premium for hospitals that implement safe handling procedures. SECTIONS 197.625 AND 287.055 LOTTERY WINNINGS Currently, the Department of Revenue can enter into agreements with the Missouri Lottery Commission to satisfy outstanding state agency debts from a person's lottery winnings. The department will no longer be required to work with the Department of Health and Senior Services to enter into an agreement to pay a claim to a health care provider. SECTION 354.536 HEALTH MAINTENANCE ORGANIZATIONS This act requires proof that a dependent child is incapable of maintaining employment due to a mental or physical handicap to be submitted to the insured's HMO within 31 days after the child has attained the age when the child's coverage is to be terminated instead of the current time period of 31 days. SECTION 354.536 STANDARDIZED INSURANCE APPLICATIONS The director of the Department of Insurance, Financial Institutions, and Professional Registration must establish by rule uniform insurance application forms to be used by all insurers. SECTION 374.184 GROUP HEALTH INSURANCE POLICIES This act limits the exclusions and limitations for group health insurance policies to the prior six months before an individual becomes covered under the policy. Exclusions and limitations cannot apply to a loss or disability that occurred after the enrollment date or during the 18-month period thereafter for a late enrollee. The act requires proof that a dependent child is incapable of maintaining employment due to a mental or physical handicap and is dependent upon the policy holder for support and maintenance to be submitted to the health insurer within 31 days after the dependent child has attained the age when coverage is to be terminated in order to sustain coverage instead of the current time period of at least 31 days. SECTION 376.426 MISSOURI HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT This act adds the State Children's Health Insurance Program coverage is added to the list of creditable coverages for individuals. The definition of "waiting period" as it relates to the Missouri Health Insurance Portability and Accountability Act is revised to be a time period that must pass before coverage for an employee or dependent who is otherwise eligible to enroll in a group health plan becomes effective. Health issuers offering group coverage shall be required to provide a special enrollment period for a dependent being placed for adoption. SECTIONS 376.450 and 376.453 HIGH DEDUCTIBLE HEALTH PLANS Health carriers are allowed to include wellness and health promotion programs, disease management programs, health risk appraisal programs, and similar programs in high deductible health plans or policies if they are approved by the Department of Insurance, Financial Institutions, and Professional Registration. SECTION 376.685 INDIVIDUAL HEALTH INSURANCE POLICIES This act requires proof that a dependent child is incapable of maintaining employment due to a mental or physical handicap and is dependent upon the policy holder for support and maintenance to be submitted to the health insurer within 31 days after the dependent child has attained the age when coverage is to be determined in order to sustain coverage instead of the current time period of at least 31 days. SECTION 376.776 MISSOURI HEALTH INSURANCE POOL (HIGH RISK POOL) This act modifies the eligibility limits and premium obligations for the Missouri Health Insurance Pool. The lifetime benefit cap is increased to $2 million and the pre-existing condition waiting period is reduced from 12 months to six months for the Pool. The Pool is required, beginning July 1, 2008, to offer at least one plan that meets the criteria of the federal Centers for Medicare and Medicaid for uninsurable individuals eligible under the Insure Missouri Program. The insurer assessments are eliminated under the pool and the premium taxes currently collected from insurers offering health-related insurance products will be distributed to the pool beginning January 1, 2009. SECTIONS 148.380 AND 376.960 TO 376.991 These provisions shall become effective January 1, 2009. HEALTH REIMBURSEMENT ARRANGEMENT ONLY PLANS Under this act, the director of Insurance, Financial Institutions and Professional Registration is authorized to allow health reimbursement arrangement only plans that encourage employer financial support of health insurance or health related expenses recognized under the rules of the Internal Revenue Service to be approved for sale in connection with or packaged with individual health insurance policies otherwise approved by the director. SECTION 376.1600 STUDY OF BARRIERS TO THE HEALTH INSURANCE MARKETPLACE The director shall study and recommend to the General Assembly changes to remove any unnecessary application and marketing barriers that limit the entry of new health insurance products into the Missouri market. The director shall examine state statutory and regulatory requirements along with market conditions which create barriers for the entry of new health insurance products and health insurance companies. The director shall also examine proposals adopted in other states that streamline the regulatory environment to make it easier for health insurance companies to market new and existing products. The director shall submit a report of his or her findings and recommendations to each member of the General Assembly no later than January 1, 2009. SECTION 376.1618. SMALL EMPLOYER HEALTH INSURANCE AVAILABILITY ACT The definition of "dependent' is revised as it relates to insurance coverage to be a person that is a spouse. An unmarried child who resides in Missouri and is younger than 25 years of age and is not covered by an group or individual health benefit plan or entitled to federal Social Security assistance benefits, or an unmarried disabled person who is dependent upon his or her parent. A small employer can make a defined contribution to his or her employees with individual health insurance plans by establishing a cafeteria plan according to the laws regulating the Missouri Health Insurance Portability and Accountability Act. A small employer insurance carrier must reasonably compensate an agent or broker for the sale of any small employer health benefit plan, and a small employer carrier must maintain and issue all health benefit plans it actively markets to small employers in the state. Currently, a small employer insurance carrier will not be in violation of any unfair trade practice if the small employer charges a lesser premium or deductible for employees who do not use tobacco products. This act revises the definition of "unfair trade practice" by using the provisions that apply to all insurance carriers in Missouri instead of only health and accident insurance companies. INSURE MISSOURI This act also establishes the Insure Missouri program to be administered by the Department of Social Services to provide health care coverage through the private insurance market to low-income working citizens of this state. The department shall be required to apply to the United States Department of Health and Human Services for a waiver and/or a state plan amendment to implement the program. The maximum enrollment of program participants is dependent on the moneys appropriated by the General Assembly, and eligibility for the program can be phased in incrementally based on appropriations. A health care account is established for each eligible individual into which payments for his or her participation can be made by the individual, an employer, the state, or any philanthropic or charitable contributor. A participant will be terminated from participation in the plan if his or her required payment is not made within 90 days after the required date. Approved participants are eligible for a 12-month period but must file a renewal application to remain in the program. SECTION 1 TO 8 These provisions contain an emergency clause. MO HEALTH NET Under current law, fee-for-service eligible policies for prescribing psychotropic medications are prohibited from including any new limits to initial drug access requirements. The act applies these provisions to any additional geographic area or participant population covered and designated to receive MO HealthNet benefits through a health improvement plan other than a fee-for-service plan. SECTION 9 The Professional Services Payment Committee shall be required to review and make recommendations to the MO HealthNet Division regarding standards and policies for denying payment to a health care provider for treatment costs associated with preventable errors. SECTION 10 This act requires third party payers to honor MO HealthNet subrogation claims for up three years from the date of service and grants the MO HealthNet Division authority to collect from third party payers through subrogation of claims. SECTION 11 In implementing provisions related to coverage of the uninsured and payments to providers for providing care to the uninsured under Insure Missouri and the MO HealthNet program, the MO HealthNet Division shall take into consideration the special needs of Missouri's Tier I Safety Net providers so that they are not disproportionately impacted by regulations promulgated by the Division as it implements the provisions of such programs. SECTION 12 ADRIANE CROUSE