CCS HCS SCS SB 842, 799 & 809 -- CERTAIN STATE HEALTH CARE
PROGRAMS

This bill changes the laws regarding certain health care programs
administered by the departments of Social Services and Health and
Senior Services.

MO HEALTHNET PROGRAM (Sections 208.010, 208.895, and 660.300,
RSMo)

The MO HealthNet Program will be exempt from paying Medicare Part
B deductible and co-insurance amounts for outpatient hospital
services.

The Department of Health and Senior Services may contract with an
independent third-party assessor for initial home and community-
based assessments including a care plan.  The contract must
include a requirement that the contractor make a face-to-face
assessment of care needed and develop a plan of care within 15
days of the receipt of a referral for service.  The contractor
must notify the referring entity within five days of receipt of
the referral if additional information is needed to process the
referral.  The contract must also include the same requirements
for the assessments as of January 1, 2010, related to the
timeliness of assessments and the beginning of service.  The
contract must be bid under Chapter 34 and cannot be a risk-based
contract.  Reassessment visits conducted by a nurse must be
reviewed and approved by the independent third-party assessor.
These provisions will expire three years from the effective date.

Currently, all in-home services clients must be advised of their
rights by the department, including the right to report
dissatisfaction with a provider or services.  The bill specifies
that the department's designee can give the notification and that
the department may contract for services relating to receiving
complaints.

PHYSICIAN REIMBURSEMENT RATES (Section 208.198)

Subject to appropriations, the Department of Social Services must
establish a reimbursement rate for services rendered by
physicians and optometrists to MO HealthNet Program participants
which provides equal reimbursement for the same or similar
services.

PAYMENTS FROM THIRD-PARTY PAYERS TO THE MO HEALTHNET DIVISION
(Section 208.215)

The bill changes the laws regarding the authority of the MO
HealthNet Division within the Department of Social Services to
collect payments from third-party payers.  Health benefit plans,
third-party administrators, administrative service organizations,
and pharmacy benefits managers are required to process and pay
properly submitted medical assistance or MO HealthNet subrogation
claims using standard electronic transactions or paper claim
forms for a period of three years from the date services were
provided by an entity.  The entity cannot be required to
reimburse for items or services not covered under MO HealthNet;
cannot deny a claim based solely on the date of submission, 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; cannot be required to reimburse for
items or services previously submitted to the third-party payer
by the provider or the participant and the claim was properly
denied for procedural reasons; and cannot be required to
reimburse for items or services which are not covered under the
plan offered by the entity against which a claim for subrogation
has been filed.  An entity must reimburse for items or services
to the same extent that the entity would have been liable if it
had been properly billed at the point of sale and the amount due
is limited to what the entity would have paid if it had been
properly billed at the point of sale.  Health benefit plans,
third-party administrators, administrative service organizations,
and pharmacy benefits managers must also pay a subrogation claim
if the state enforces its right to a claim within six years of
the submission of the claim.

The computerized records of the division, if certified by the
division director or his designee, will be prima facie evidence
of proof of moneys expended and the amount of the debt due the
state.

HEALTH CARE PROVIDER TAX (Sections 208.453, 660.425 - 660.445,
and 660.455 - 660.465)

Currently, public hospitals which are operated primarily for the
care and treatment of mental disorders are exempt from the
payment of a federal hospital reimbursement allowance for the
privilege of engaging in the business of providing inpatient
health care in this state.  The bill removes this exemption.

Currently, MO HealthNet in-home services providers are exempt
from the in-home services tax assessed by the Department of
Social Services.  The bill removes this exemption and extends the
expiration date for the tax from September 1, 2011, to
September 1, 2012.

TELEPHONE TRACKING SYSTEM (Sections 208.909, 208.918, and
660.023)

By July 1, 2015, all personal care service vendors must have,
maintain, and use a telephone tracking system to report and
verify the delivery of consumer-directed care services as
authorized by the Department of Health and Senior Services or its
designee to process payroll and to submit claims for
reimbursement to the MO HealthNet Division.  The department, in
collaboration with other appropriate agencies including centers
for independent living, must establish telephone tracking system
pilot projects in an urban and a rural area.  The department must
submit a report by December 31, 2013, to the Governor and General
Assembly detailing the outcomes of these pilot projects.

In order to be a department-contracted vendor, the vendor must be
able to provide fiscal conduit services through a telephone
tracking system by July 1, 2015.

By July 1, 2015, all in-home services provider agencies must also
have, maintain, and use a telephone tracking system to report and
verify the delivery of home and community-based services as
authorized by the department or its designee to process payroll
and to submit claims for reimbursement to the MO HealthNet
Division.  The department, in collaboration with other
appropriate agencies including in-home services providers, must
establish telephone tracking system pilot projects in an urban
and a rural area.  The department must submit a report by
December 31, 2013, to the Governor and General Assembly detailing
the outcomes of these pilot projects.

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