CCS/HCS/SCS/SBs 842, 799 & 809 – This act modifies provisions relating to public assistance programs administered by the state. EXEMPTION FOR MO HEALTHNET FROM PAYING MEDICARE PART B DEDUCTIBLE AMOUNTS FOR HOSPITAL SERVICES Current law requires reimbursement for services provided to an individual who is eligible for MO HealthNet, Medicare Part B, and Supplementary Medical Insurance to include payment in full of deductible and coinsurance amounts as determined by federal Medicare Part B provisions. This act exempts MO HealthNet from paying for the Medicare Part B deductible and coinsurance amounts for hospital outpatient services. SECTION 208.010 This provision is identical to provisions in CCS/HCS/SS/SCS/SB 1007 (2010) and is substantially similar to provisions in HB 1918 (2010). REIMBURSEMENT Subject to appropriations, the Department of Social Services shall establish an equal reimbursement rate for the same or similar services rendered by physicians and optometrists to MO HealthNet patients. SECTION 208.198 This provision is identical to provisions in CCS/HCS/SS/SCS/SB 1007 (2010) and CCS/CCS/HCS/SS/SCS/SB 754 (2010). THIRD PARTY PAYERS/SUBROGATION Under this act any third party payer, such as third party administrators, administrative service organizations, health benefit plans and pharmacy benefits managers, shall process and pay all properly submitted MO HealthNet subrogation claims using standard electronic transactions or paper claims forms for a period of three years from the date services were provided or rendered. However, such third party payers shall not: (1) Be required to reimburse for items or services which are not covered under MO HealthNet; (2) Deny a claim submitted by the state solely on the basis of the date of submission of the claim, the type or format of the claim form, failure to present proper documentation of coverage at the point of sale, or failure to obtain prior authorization; (3) Be required to reimburse for items or services for which a claim was previously submitted to the third party payer by the health care provider or the participant and the claim was properly denied by the third party payer for procedural reasons, except for timely filing, type or format failure to present proper documentation of coverage at the point of sale, or failure to obtain prior authorization; (4) Be required to reimburse for items or services which are not covered under or were not covered under the plan offered by the entity against which a claim form for subrogation has been filed. Such third party payers shall reimburse for items or services to the extent that the entity would have been liable as if it had been properly billed at the point of sale, and the amount due is limited to what the entity would have paid as if it has been properly billed at the point of sale. The MO HealthNet Division shall also enforce its rights within six years of a timely submission of a claim. Certified computerized MO HealthNet records shall be prima facie evidence of proof of moneys expended and the amount due the state. SECTION 208.215 This provision is identical to provisions in CCS/HCS/SS/SCS/SB 1007 (2010), CCS/SCS/HB 2226 (2010), CCS/SCS/HB 1868 (2010) and substantially similar to SB 799 (2010), SB 809 (2010) and SB 552 (2009). This provision is also contained in the truly agreed to version of SB 583 (2010). REPEAL OF PUBLIC HOSPITAL EXEMPTION FROM THE HOSPITAL REIMBURSEMENT ALLOWANCE This act no longer allows public hospitals which are operated primarily for the care and treatment of mental disorders to be exempted from participating in the Hospital Reimbursement Allowance. SECTION 208.453 This provision is identical to provisions in CCS/HCS/SS/SCS/SB 1007 (2010). INDEPENDENT THIRD PARTY IN-HOME AND COMMUNITY BASED ASSESSMENTS This act allows, rather than requires, the Department of Health and Senior Services to reimburse in-home providers for nurse assessments of participants in the in-home and home and community based programs. New language is added allowing the department to contract for home and community based assessments through an independent third-party assessor. The contracts shall include a requirement that within 15 days of receipt of a referral for service, the contractor shall have made a face to face assessment of care need and developed a plan of care and the contractor shall notify the referring entity within 5 days of receipt of referral if additional information is needed to process the referral. The contract shall also include the same requirements for such assessments as of January 1, 2010, related to timeliness of assessments and the beginning of service. The two nurse visits that are currently allowed under section 660.300, shall continue to be performed by home and community-based providers for, including but not limited to, reassessments and level of care recommendations. These reassessments and care plan changes shall be reviewed and approved by the independent third party assessor. In the event of dispute over the level of care required, the third party assessor shall conduct a face-to-face review with the client in question. This provision has a three-year expiration date. SECTION 208.895 This provision is identical to provisions in CCS/HCS/SS/SCS/SB 1007 (2010) and similar to provisions in HB 1918 (2010). TELEPHONE TRACKING SYSTEM This act requires both personal care assistance vendors and in-home services providers to use a telephone tracking system to review and certify the accuracy of reports of delivered services and to ensure more accurate billing by July 1, 2015. The requirements of the telephone tracking system are specified in the act. In order for vendors or provider agencies to obtain an agreement with the Department of Social Services, the vendor or agency must demonstrate the ability to implement the telephone tracking system. Personal care assistance consumers shall be responsible for approving requests through the telephone tracking system and shall provide the vendor with necessary information to complete the required paperwork for establishing the employer identification number. DHSS in collaboration with centers for independent living must establish a telephony pilot project in an urban and a rural area. This act requires the telephony report provided to the Governor to include a minority report detailing elements not agreed upon by centers for independent living and the executive branch. Entities interested in participating in the telephony pilot project will not be required to pay the full cost of the project and can contract with a vendor of their choice. SECTIONS 208.909, 208.918, 660.023 This provision is identical to provisions in CCS/HCS/SS/SCS/SB 1007 (2010) and similar to provisions in HB 1918 (2010). COMPLAINT CALLS FOR IN-HOME SERVICES CLIENTS Current law provides that all in-home services clients shall be advised of their rights by the Department of Health and Senior Services, including the right to call the department to report dissatisfaction with the provider or services. This act provides that it can be by the department's designee. This act also provides that the department may contract for services relating to receiving such complaints. SECTION 660.300 This provision is identical to provisions in CCS/HCS/SS/SCS/SB 1007 (2010) and substantially similar to provision in HB 1918 (2010). IN-HOME PROVIDER TAX This act removes references to Chapter 208 (the Mo HealthNet chapter) from the sections relating to the in-home provider tax. It also extends the expiration date for the provider tax from 2011 to 2012. SECTION 660.425 to 660.465 This provision is substantially similar to provisions in CCS/HCS/SS/SCS/SB 1007 (2010). ADRIANE CROUSE