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SPONSOR: |
Madalena |
DATE TYPED: |
|
HB |
384/aHAFC |
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|
SHORT TITLE: |
Medicaid Reform Committee Recommendations |
SB |
|
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|
|
ANALYST: |
Weber |
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APPROPRIATION
|
Appropriation
Contained |
Estimated
Additional Impact |
Recurring or
Non-Rec |
Fund Affected |
||
|
FY03 |
FY04 |
FY03 |
FY04 |
|
|
|
|
|
|
($11,300.0-$27,800.0) |
Recurring |
General
Fund |
(Parenthesis
( ) Indicate Expenditure Decreases)
Duplicates SB 338
REVENUE
|
Estimated Revenue |
Subsequent Years Impact |
Recurring or
Non-Rec |
Fund Affected |
|
|
FY03 |
FY04 |
|
|
|
|
|
($33,900.0-$83,500.0) |
|
Recurring |
Federal
Funds |
(Parenthesis ( ) Indicate Revenue Decreases)
Responses Received From
Human Services Department
Health Policy Commission
SUMMARY
Synopsis of HAFC Amendment
The House
Appropriations and Finance Committee made a variety of language changes and
minor clarifications that do not change the intent or potential impact House
bill 384.
Synopsis of Original Bill
House Bill 384 adds a
section to the Public Assistance Act to incorporate recommendations of the
Medicaid Reform Committee, which had been established pursuant to Laws 2002,
Chapter 96. The recommendations become statutory requirements and relate to
state and federal pharmacy programs, drug buying cooperatives, community health
promoters, disease management programs, consumer-directed services, Medicaid
fraud detection, Medicaid co-payments and premiums, and collaboration with
other agencies on Medicaid-covered services.
The bill contains an emergency clause.
Significant Issues
House Bill 384
requires the following based on recommendations from the Medicaid Reform
Committee. The range of savings noted
was developed by the Medicaid Reform Committee with the Legislative Council
Service and appears in the Committee final report.
1.
Develop
a Uniform Preferred Medicaid Drug List to be used by all Medicaid programs and
services.
2.
Work
with other State agencies to integrate the Uniform Preferred Drug List.
3. Identify
entities eligible to participate in the 340bB Federal Drug Pricing Program and assist them to enroll in the 340B
program.
4. Work
toward developing a prescription drug purchasing cooperative through the combination
buying power of the Medicaid Program, the Health Care Purchasing Act participating
health care agencies, the Department of Health, the Department of Corrections,
other states, and other public and private purchasers.
5. Develop
a program to expand the use of community health promoters to assist Medicaid
beneficiaries in understanding the requirements of the Program.
6. Oversee
Managed Care Organizations (MCOs) to ensure that they collaborate with primary
care and safety net providers to coordinate disease management programs and
adopt uniform key health status indicators for Medicaid recipients.
7. Ensure
that case management services assist Medicaid beneficiaries in accessing needed
medical, social and other services and require MCOs to provide or strengthen
case management services by closer coordination with primary and safety net
providers.
8. Design
a pilot disease management program for the fee-for-service population.
9. Continue
the Personal Care Option with increased consumer awareness of consumer-directed
services and consumer-delegated services choices.
10. Expand
the program of all-inclusive care for the elderly to an urban area with a population
less than 4,000.
11. Coordinate and consolidate the State’s long term care services, to include health and social services, in conjunction with the Department of Health (DOH), Children, Youth and Families (CYFD), and the State Agency on Agency (AoA) for assessment, information and referral development for recipients of all ages. Cost of $250,000.
12. Develop a Medicaid fraud and abuse detection recovery plan with the cooperation and collaboration of the Attorney General, the MCOs, Medicaid providers, consumer groups, and HSD. Range of General Fund Savings $2.5 million -$5 million.
13. Identify
other State-funded health care programs and services that may be Medicaid reimbursable,
ensuring that the services meet federal requirements.
14. Work
with Indian health or tribally operated facilities to ensure that Indian health
service and tribally operated facilities are used, when possible, for services
that are eligible for 100% Federal matching funds.
15. Develop
a payment methodology that provides maximum allowable Medicaid reimbursement
for eligible federally qualified health centers (FQHC) or FQHC
look-alikes.
16. Ensure
that primary care clinics are reimbursed for Medicaid-related outreach and enrollment.
17. Assess
a premium on selected Medicaid recipients.
18. Assess
co-payments comparable to commercial insurance for emergency room visits, not
resulting in hospital admission, for MCO enrolled or fee for service Medicaid
recipients.
19. Assess
tiered co-payments on selected higher-cost prescription drugs when there is a generic
or lower-cost equivalent drugs available.
20. Assess
co-payments on prescription drugs not on the Uniform Preferred Drug List.
21. Resolve
any conflicts or duplications in patient-cost sharing requirements by ensuring
that premiums do not harm access to health care, and ensure that premiums and
co-payments are in compliance with federal requirements.
22. Provide
one eye exam and one pair of corrective contact lenses annually or one pair of
frame lenses in a two-year period under the vision benefits for adults.
23. Review
prescription drug policies to ensure that pharmacists have the flexibility and
ability to use available, lower costing generic drugs.
24. Review
nursing home eligibility criteria to ensure that consideration of income,
trusts, and other assets are the maximum permissible under federal law.
FISCAL IMPLICATIONS
Based on the range of
general fund savings associated with the above changes, the total will range
from $11.3 million to $27.8 million.
With the $33.9 million to $83.5 million reduction in federal match, the
final program decrease will be $45.2 million to $111.3 million. No funds are included for the additional
administrative and contractual costs needed to accomplish these changes.
ADMINISTRATIVE
IMPLICATIONS
Changes of this magnitude and complexity will require considerable
administrative effort on the part of Medical Assistance Division. An appropriation for this program expansion
is not included.
MW/sb