SS/SB 539 - This act modifies certain provisions dealing with various health care and social services programs, including Medicaid, the Missouri Senior RX, and personal care assistance programs. MEDICAID - This act requires an institutionalized spouse applying for Medicaid and who has a spouse living in the community to divert income to the community spouse to raise the community spouse's income to the level of the minimum monthly needs allowance. This diversion of income shall occur before the community spouse is allowed to retain assets (Section 208.010). This act also provides that annual income eligibility and verification reviews are to be conducted for medicaid recipients (Section 208.147). The Family Support Division shall annually send a re-verification form letter to the recipient requiring the recipient to respond within ten days and to provide income verification documents. This act reduces income levels for eligibility and eliminates some optional services, including the medical assistance for the working disabled (MAWD) and general relief medical assistance programs. Further, this act provides the Department of Social Services may apply for federal medicaid waivers as necessary, provided that such costs to the state will not exceed one million additional dollars (Section 208.151). Such a request for a waiver will not become effective except by executive order. Subject to federal law, the department must promulgate rules that require recipients of medical assistance to participate in cost-sharing activities for all covered services, except for those services covered by personal care, mental health, and health care for uninsured children programs. The cost-sharing provision will also not apply to other qualified children, pregnant women, or blind persons (Section 208.152). In addition, the act provides that a health care provider may not refuse to provide a service if a recipient is unable to pay a required fee. However, upon approval from the department, a provider may terminate future services to an individual with an unclaimed debt, so long as it is the provider's routine business practice to do so and the provider gives advance notice to the individual and reasonable opportunity for payment (Section 208.152). This act also provides that for purposes of medicaid eligibility, investment in annuities shall be limited only to those annuities that are actuarially sound (Section 208.212). The department shall establish a sixty month look-back period to review any investment in an annuity by an applicant for Medicaid benefits. This act also provides that the department shall have the right to enforce federal TEFRA liens on the property of permanently institutionalized individuals, which include those people who the department determines cannot reasonably be expected to be discharged and return home (Section 208.215). This act lowers the income level for parents of uninsured children in the CHIPS program that are required to pay a premium from two hundred and twenty-six percent of the federal poverty level to one hundred and fifty-one percent of the federal poverty level (Section 208.640). NURSING HOME FACILITIES - This act removes language specifying certain cost reports for future rebasing that were to be effective starting July 1 , 2005, and then successively on July 1, 2006, and July 1, 2007. THE MISSOURI RX PLAN - The Missouri RX plan may select one or more prescription drug plans as the preferred plan for purposes of the coordination of benefits between the program and the Medicare Part D drug benefit (Section 208.782). The department shall give initial enrollment priority to the Medicaid dual eligible population, which are those individuals who are eligible for Medicare and Medicaid. The successive enrollment priority shall be medicare eligible participants with an annual household income at or below one hundred and fifty percent of the federal poverty guidelines (Section 208.784). The program is a payor of last resort, and is meant to cover costs for participants who are not covered by the medicare part D program. Ineligible persons include those who are qualified for coverage of payments for prescriptions drugs under a public assistance program, other than from the Medicare Modernization Act benefits, and if the persons are not considered dual eligible. Also, persons who are qualified for full coverage under another plan of assistance or insurance are ineligible (Section 208.788). This act also creates the Missouri RX Plan Advisory Commission, which shall be charged with advising the benefit design and operational policy of the program (Section 208.792). Persons eligible for services under the current Missouri Senior RX program on December 13, 2005 shall be eligible for those services until January 1, 2006 (Section 208.786) The provisions of the current Missouri Senior Rx plan will expire following notice to the revisor of statutes by the Missouri Senior RX program advisory commission that the Medicare Modernization Act of 2003 has been fully implemented (Section 208.798). MEDICAID REFORM COMMISSION - This act establishes the "Medicaid Reform Commission" to study and review the current Medicaid program and make recommendations for reforms (Section 208.014). The commission will consist of ten members, five from the House and five from the Senate. Additionally, the directors of the Departments of Social Services, Health and Senior Services, and Mental Health shall serve as ex-officio members of the commission. The commission shall make recommendations to the General Assembly by January 1, 2006 on reforming, redesigning and restructuring a new innovative healthcare delivery state Medicaid system to replace the current state Medicaid system, which will sunset on June 30, 2008. ADOPTION SUBSIDY - The sections dealing with adoption subsidy rates now provide that the subsidy shall only be granted to children who reside in a household with an income that does not exceed two hundred percent of the federal poverty level or are eligible for Title IV-E adoption assistance (Section 453.073). PERSONAL CARE ASSISTANCE PROGRAM - This act moves the personal care assistance program for disabled persons from the Department of Elementary and Secondary Education to the Department of Health and Senior Services. (Section 660.661). The department shall provide financial assistance to physically disabled persons for personal care assistance services through eligible vendors. The act prescribes requirements for eligibility and annual eligibility review (Sections 660.664 and 660.667). Upon determination of eligibility, the department shall develop a personal care assistance services plan (Section 660.667). Consumers receiving personal care assistance shall be responsible for the supervision of the attendant while the vendor shall be responsible for the medicaid reimbursement process, including filing claims and mailing individual payment directly to the assistant (Section 660.670). The services are not authorized if the primary benefit of the services is to the household unit and such household may reasonably be expected to share or do for one another when they live in the same household. Neither shall the services be used to employ a personal care assistant who is listed on any of the background check lists, unless a good cause waiver is first obtained from the department (Section 660.670). The department of social services shall conduct hearings for the personal care assistance program (Section 660.681). In addition, this act delineates the duties of certain persons to report instances where such person reasonably believes a consumer has been neglected, abused, or where the consumer's property of funds have been misappropriated (Section 660.673 and 660.676). It also details the duties of the department's case manager to investigate instances of abuse. It shall be a Class A misdemeanor if a person who is required to report abuse fails to do so. This act also provides for an employee disqualification list to be maintained by the department for attendants who commit fraudulent acts (Section 660.676). ADRIANE CROUSE