Government Relations

UM Legislative Update Newsletter

May 22, 2007

MO HealthNet bill passes on last day of session

The bill´s main provisions include:

• Coverage for liability under the state legal expense fund is added for a number of health professionals, including optometrists and pharmacists.
• An income tax deduction is added for long term care insurance premiums.
• The Missouri Health Care Access Fund is created to expand health care services in the state and in federally designated areas.
• Psychiatrists, psychologists, social workers, and professional counselors are added to the PRIMO loan assistance program.
• Medicaid fraud provisions are modified.
• The Chronic Kidney Disease Task Force is created.
• The Ticket to Work Program is established to allow MO HealthNet eligibility for certain disabled workers.
• Participants in drug court programs are given continued eligibility for 60 days, even if children have been removed from their custody.
• Former foster care children may receive extended eligibility up to the age of 21 without regard to income or assets.
• Individuals with more than $500,000 in home equity are no longer eligible for long term care services.
• Personal care services will be authorized on a 4-tier level based on services required and frequency of services.
• Pediatric or Family Nurse Practitioner services will only be covered if a collaborative practice agreement exists with a physician or other health care provider.
• Reinstates coverage of certain optional services, including durable medical equipment, hospice, dental, and optometry. The services are subject to appropriations and must be deemed medically necessary.
• By Jan. 1, 2008, the status of MO HealthNet provider reimbursement will be evaluated as compared to 100 percent of Medicare reimbursement rates and a plan must be presented to achieve parity with Medicare rates. The plan will be subject to appropriations.
• The requirement for a 2nd medical opinion before surgery is authorized and covered is repealed.
• Assisted living facilities are authorized as qualified MO HealthNet personal care providers.
• Income earned from employment at a sheltered workshop will not count as income when determining eligibility.
• Social security cost-of-living increases received at the beginning of each year will be disregarded as income until the federal poverty level for that year is established.
• A pay for performance committee is created to develop a P4P program. The 18-member committee will include nine physicians, consumer and patient advocates, and hospital and nursing home administrators.
• A pilot project for a premium offset program is created to make health insurance coverage available for the working poor. It is subject to appropriations and will occur in one urban region and one rural region of the state.
• Provisions are modified relating to collection from third-party payers and relating to counting annuities as income for long term care residents.
• Eligibility will not be affected if a personal care contract is received as valuable consideration in exchange for personal or real property, cash or securities.
• CHIP eligibility and the definition of "affordable employer-sponsored health insurance" are updated.
• Eligibility requirements are revised for the uninsured women´s health program to include women at least 18 years of age whose income is at or below 185 percent of poverty.
• The Department of Social Services must develop rules regarding the practice of Telehealth in the MO HealthNet program. Telehealth providers will be required to obtain patient consent before telehealth services are initiated.
• A long-term care partnership program is created to allow private insurance and MO HealthNet funds to be used to fund long term care.
• Three health improvement plans are established for participants: risk-bearing coordinated care plans, administrative service organizations, and coordinated fee-for-service plans. Enrollment will begin July 2008.
• Subject to appropriation, the Healthcare Technology Fund will promote technological advances to improve patient care and decrease administrative burdens.
• The June 30, 2008, expiration date for the current Medicaid program is repealed. The expiration date for the CHIP program is also repealed, but the program will be void when or if no federal funds are appropriated.

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