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SPONSOR: |
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DATE TYPED: |
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HB |
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SHORT TITLE: |
Medicaid Reimbursement & Eligibility |
SB |
405 |
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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 |
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|
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$1,513.0 |
Recurring |
General
Fund |
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|
|
|
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(Parenthesis
( ) Indicate Expenditure Decreases)
REVENUE
|
Estimated Revenue |
Subsequent Years Impact |
Recurring or
Non-Rec |
Fund Affected |
|
|
FY03 |
FY04 |
|
|
|
|
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$4,486.0 |
|
Recurring |
Federal
Funds |
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|
|
|
|
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(Parenthesis ( ) Indicate Revenue Decreases)
Responses
Received From
Human
Services Department
SUMMARY
Synopsis
of Bill
SB
405 would add a new section to the Public Assistance Act entitled “Medicaid
Payment Rates for Physicians.” Under
this provision, for FY 2004, the Human Services Department shall provide
reimbursement for physicians participating in the Medicaid program in an amount
equal to one hundred twenty-five percent of the Medicare reimbursement
rate. On
SB
405 also would add to those eligible for Medicaid by including a member of a
benefit group if the benefit group’s income is below one hundred percent of the
federal poverty guidelines.
Significant
Issues
Children are
currently eligible for Medicaid in benefit groups with incomes up to 235%
FPL. Pregnant Women are eligible up to
185% FPL. Parents or other specified relatives
in budget groups with incomes up to 85% FPL are eligible to receive Medicaid
under the JUL Medicaid category. This
bill would provide Medicaid eligibility for those parents or specified
relatives who are not receiving cash assistance and whose benefit group’s
income is between eighty-five percent and one-hundred percent of the federal
poverty guidelines.
Currently, there are
approximately 577 budget groups with children receiving Medicaid, between 85%
FPL and 100% FPL, in which there are 647 adults.
The Medicaid program
has not historically increased physician rates on an annual basis. When the physician fees were increased in
fiscal year 2001 (FY 01), an appropriation was provided to the Department to
cover the increase. Currently, Medicaid
reimburses physicians at a higher rate than Medicare for most services.
SB 405 requires that the Department increase
physician rates each year after 2004 at not less than the percentage increase provided
by the Department in the previous fiscal year for managed care organizations in
the Medicaid managed care system.
Increases in the managed care contracts are negotiated whenever new contracts are being developed.
FISCAL IMPLICATIONS
The
total fiscal impact of SB 405 is $1,513.0 in general fund and $4,486.0 in
federal funds.
It
is estimated that 647 individuals will become eligible as a result of this
legislation. The cost of coverage for FY
2004 would be $2,181.0, with $550.0 in general fund and $1,631.0 in federal
funds.
A
sample of commonly used procedure codes indicate physician expenditures would
increase by approximately 11%. Based on
FY04 Medicaid projections for physician services, this would amount to $3,818.0
requiring a general fund match of $963.0.
SB
402 does not contain an appropriation to offset these additional expenditures.
ADMINISTRATIVE IMPLICATIONS
Changes would be required of ISD2 eligibility system, as well as the Medicaid Management Information System (MMIS). An additional appropriation would be necessary for these changes.
MW/sb:ls:prr