HCS SCS SB 842, 799 & 809 -- MO HEALTHNET PROGRAM

SPONSOR:  Schmitt (Stream)

COMMITTEE ACTION:  Voted "do pass" by the Special Committee on
General Laws by a vote of 14 to 0.

This substitute changes the laws regarding the procedures and
regulations of the MO HealthNet Program within the Department of
Social Services.  In its main provisions, the substitute:

(1)  Requires, subject to appropriations, the department to
establish a rate for the reimbursement of physicians and
optometrists for services rendered to patients under the program
which provides equal reimbursement for the same or similar
services;

(2)  Establishes criteria for the payment of MO HealthNet
subrogation claims by health benefit plans, third-party
administrators, administrative service organizations, and
pharmacy benefits managers.   A claim will be paid for up to
three years from the date services were provided or rendered but
will not be required to reimburse for items or services which are
not covered under MO HealthNet or for items or services not
covered by a plan subject to a subrogation claim.  A claim may
not be denied solely based on the date the claim is submitted,
the type or format of the claim form, failure to present proper
documentation at the point of sale, or failure to provide prior
authorization.  The amount of reimbursement is limited to the
amount properly billed at the point of sale; and

(3)  Specifies that the computerized records of the MO HealthNet
Division, certified by the department director or his or her
designee, will be prima facie evidence of proof of moneys
expended and due to the state.

FISCAL NOTE:  Estimated Cost on General Revenue Fund of
$1,066,936 in FY 2011, $1,327,695 in FY 2012, and $1,376,820 in
FY 2013.  Estimated Income on Other State Funds of Unknown but
Greater than $367,100 in FY 2011, FY 2012, and FY 2013.

PROPONENTS:  Supporters say that current law only allows a
three-month period for subrogation claims by MO HealthNet.  The
bill will allow a three-year period and result in up to $7
million in additional recovery for the state.  It often takes
time to discover and litigate subrogation claims.  The bill will
enable the state to be in compliance with federal cost recovery
mandates.

Testifying for the bill were Senator Schmitt; and MO HealthNet
Division, Department of Social Services.

OPPONENTS:  There was no opposition voiced to the committee.

Missouri House of Representatives
95th General Assembly, 2nd Regular Session
Last Updated September 14, 2010 at 3:15 pm