SCS/SB 28 - Under this act, the Department of Social Services shall apply for a global waiver for the MO HealthNet program designed to give the state greater flexibility to implement a patient-centered, sustainable, and cost-effective market-based health care system that emphasizes competitive and value-based purchasing. Such flexibility may include: (1) eligibility determinations that include work requirements for certain able-bodied adults; (2) initiatives to promote healthy outcomes and personal responsibility, including co-payments, premiums, and health savings accounts; (3) measures to improve the quality of and lower the cost of health care through the use of selective contracting and competitive bidding, preferred provider networks, and health outcome-based provider reimbursement; and (4) accountability and transparency measures. The waiver shall include provisions, to the fullest extent possible, that propose or accept funding mechanisms similar to a federally-capped block grant, which may include capped per capita allocations, capped allotments, or shared savings based on per-enrollee spending targets, adjusted for inflation, state gross domestic product, state population growth, state Medicaid population growth, natural disasters, man-made disasters, extensive economic downturns, and other economic and demographic factors, for the duration of the waiver. The Joint Committee on Public Assistance shall review the federal waiver application process. Prior to the submission of the waiver application to the federal government, the Department shall submit the application to the Joint Committee. The Joint Committee shall then hold a public hearing and received public testimony on the application and hear testimony from the Department, after which the Joint Committee shall either accept or reject the proposed waiver application and shall, if necessary, propose modifications to or recommendations for the application. If the waiver application is accepted by the federal government, the Department shall propose the necessary statutory changes to implement the waiver. Until such time as the proposed changes are enacted by the General Assembly, the existing laws relating to MO HealthNet shall remain in effect. The Joint Committee shall hold public meetings and receive public testimony on proposed statutory changes to determine if such changes satisfy the goals of this act and would result in substantial new opportunities for the MO HealthNet program on a cost-neutral basis. The Joint Committee is also authorized to meet at least twice a year to provide oversight on the global waiver; communicate as necessary with departments within the scope of the MO HealthNet program; recommend services for the MO HealthNet program; issue subpoenas, subpoenas duces tecum, and orders for production of documents, as necessary; and recommend to the General Assembly any amendments to the waiver or clarifying legislation that may be necessary. In the event that the global waiver is suspended or terminated or expires for any reason, the Department shall apply for an extension of the global waiver or any new waivers that, at a minimum, ensure the continuation of the waiver authorities in place prior to the acceptance of the global waiver. The Department shall ensure that any such actions are conducted in accordance with applicable federal statutes and regulations. The Department shall, to the fullest extent possible, ensure that the waiver authorities are reinstated prior to any suspension, termination, or expiration of the global waiver. In the event that the Medicaid program is changed or repealed to the extent that it becomes, or the federal government otherwise offers, a block grant to the states for the provision of health care to certain eligible persons, the provisions of this act shall expire. This act is similar to HB 290 (2017) and HB 402 (2017). SARAH HASKINS