Health Care Policy And Financing - Digest of Bills

Digest of Bills - 2001

HEALTH CARE POLICY AND FINANCING
S.B. 01-52 Children's basic health plan - enrollment - administrative costs - contracts. Changes the cost-sharing assessed to enrollees in the children's basic health plan from a periodic premium to an annual enrollment fee. States that no enrollment fees shall be charged to families with incomes at or below 150% of the federal poverty level.

Mandates that the annual administrative costs for the children's basic health plan not exceed 10% of the total annual program costs.

Clarifies that the department shall make a capitation payment to managed care plans based upon a defined scope of services at an agreed-upon rate.

Permits, rather than requires, the department of health care policy and financing to contract with a private contractor for administration, but requires that any such contracts contain performance measures that are monitored by the state department. Permits the state department to use county departments of social services to perform administrative functions or to perform the functions within the state department. Requires the state department to allocate administrative functions based on the most cost-effective method.

APPROVED by Governor May 22, 2001
EFFECTIVE August 8, 2001
NOTE: This act was passed without a safety clause. For further explanation concerning the effective date, see the note from page vi of this digest.

S.B. 01-164 Dental loan repayment program - care for underserved populations - appropriations. Creates a state dental loan repayment program for dentists and dental hygienists who, as a condition of receiving assistance in paying dental education loans, agree to provide dental care to underserved populations. Specifies the eligibility requirements for participating in the loan repayment program. Authorizes the state board of health to promulgate rules for the program, including determining the amount of financial assistance available, establishing the criteria for loan repayment assistance, establishing the criteria for determining what constitutes a significant level of service to underserved populations in order to qualify for a loan, and establishing criteria for prioritizing the repayment of loans.

Directs that the program be developed and administered by the department of public health and environment. Creates a cash fund. Authorizes the department to accept private and public contributions, grants, and services and to apply for any available matching federal funds.

Reallocates $200,000 out of the moneys annually allocated to the children's basic health plan trust from the tobacco litigation settlement moneys for the purpose of funding the state dental loan repayment programs.

Appropriates $200,000 out of the tobacco litigation settlement moneys to the state dental loan repayment fund, and 0.4 FTE to the department of public health and environment. Appropriates $12,836 of such moneys to the department of law for the provision of legal services. Appropriates $436 and $96,115 out of the general fund to the department of health care policy and financing for implementation of the act. Makes the act contingent upon the passage of and savings realized from House Bill No. 01-1343. Makes other appropriations and adjustments to the long bill relating to the medicaid program and the children's basic health plan.

APPROVED by Governor June 4, 2001
EFFECTIVE June 4, 2001
NOTE: House Bill 01-1343 was signed by the Governor on May 22, 2001, and the fiscal estimate shows sufficient general fund savings.

H.B. 01-1040 Medicaid - false medicaid claims - penalties. Makes it unlawful for providers of medicaid services to intentionally or with reckless disregard make false medicaid claims or make false representations of material facts in connection with medicaid claims. Makes it unlawful to intentionally or with reckless disregard offer, solicit, or receive any kickback or bribe in connection with medicaid services, items, or purchases, leases, or orders. Authorizes the department of health care policy and financing to bring a civil action against providers who violate these provisions. For an intentional violation, requires the court to order full restitution of the medicaid amounts and a civil penalty of $5,000 per claim or twice the amount of medicaid wrongfully received. For a violation that was made with reckless disregard, requires the court to order full restitution of the medicaid amounts and a civil penalty not to exceed $1,000 per claim, but no more than $50,000, or twice the amount of medicaid wrongfully received. Authorizes a reduction of the civil penalty if the provider promptly cooperated with the investigation. Establishes a 6-year statute of limitations for such claims.

APPROVED by Governor April 12, 2001
EFFECTIVE July 1, 2001

H.B. 01-1161 Children's basic health plan - medicaid determinations - appropriation. Allows eligibility technicians for the department of health care policy and financing ("department") located at the private contractor for the children's basic health plan to make medicaid eligibility determinations for people applying for the children's basic health plan. Requires the department to evaluate the impact on the children's basic health plan of using state eligibility technicians to determine medicaid eligibility, whether the staff solved coordination problems between the children's basic health plan and the medicaid program, and whether there is a need to continue funding staff to perform this function. Requires the department to report to the House Health, Environment, Welfare, and Institutions committee and Senate Health, Environment, Children, and Families committee by October 1, 2003. Repeals the authority for the staff, effective July 1, 2004.

Appropriates $48,850 out of the children's basic health plan trust to fund 3.0 FTE to implement the act. Specifies that the department of health care policy and financing is expected to receive an additional $52,498 in federal funds for implementation of the act.

APPROVED by Governor June 4, 2001
EFFECTIVE July 1, 2001

H.B. 01-1171 Medical assistance - adverse coverage decisions of third parties - independent contractor. Clarifies that the assignment of rights by a person receiving medical assistance from the state includes the right to appeal an adverse coverage decision for which the medical assistance program would otherwise be responsible. Directs the state department of health care policy and financing ("department") or a person with whom the department contracts for such purpose to review and, if necessary, appeal such a decision.

Authorizes the department to enter into agreements with independent contractors to pursue recoveries from such third parties for a prudent and reasonable percentage of the amounts recovered on behalf of the department. Requires the contractors to maintain a record of the number of hours and the costs incurred and to submit to the department a statement when a matter is resolved.

APPROVED by Governor March 23, 2001
EFFECTIVE March 23, 2001

H.B. 01-1271 Medicaid - buy-in program for people with disabilities - appropriations. Directs the department of health care policy and financing ("department") to submit an amendment to the state medical assistance plan and to request any waivers necessary to expand eligibility under medicaid to implement a medicaid buy-in program for individuals with disabilities who would otherwise be eligible for supplemental security income (SSI) except for their income and for individuals with disabilities whose medical condition improves. States the intent of the general assembly that the program be budget-neutral. Specifies the eligibility requirements for the medicaid buy-in program. States that a person who is eligible for the medicaid buy-in program may also be a home and community-based services waiver recipient.

Requires the department to apply for a federal medicaid infrastructure grant to develop and implement the act. States that the department shall not implement the medicaid buy-in program if the department does not receive a medicaid infrastructure grant.

Authorizes the medical services board to promulgate rules specifying the amount of the premium based on a sliding fee schedule to buy into medicaid. Directs that such rules be based on an actuarial study of the disabled population in the state. Directs that the actuarial study be funded by the medicaid infrastructure grant or other private gifts, grants, and donations. Creates a cash fund for such donations and for premiums. Requires the department to submit a report to the joint budget committee on the actuarial study and the fiscal analysis of the premiums.

Authorizes the medical services board to promulgate rules to implement the medicaid buy-in program.

Appropriates $80,000 out of the medicaid cash fund to the department of health care policy and financing for implementation of the act. Specifies that the department of health care policy and financing is expected to receive an additional $129,400 in federal funds for implementation of the act. Appropriates $24,000 to the department of human services for implementation of the act.

APPROVED by Governor June 5, 2001
EFFECTIVE August 8, 2001
NOTE: This act was passed without a safety clause. For further explanation concerning the effective date, see the note from page vi of this digest.

H.B. 01-1282 Medicaid - reimbursement of dental hygienists for services - appropriations. Allows dental hygienists who are providing services without supervision by a dentist to bill directly and be reimbursed by the department of health care policy and financing for providing preventive dental hygiene services to children under the medicaid program. Requires the dental hygienist to attempt to identify a medicaid-participating dentist for the child.

Appropriates $6,846 and $139,271 to the department of health care policy and financing to implement the act. Makes the act contingent upon the passage of and savings realized from House Bill No. 01-1343. Specifies that the department of health care policy and financing is expected to receive an additional $139,271 in federal funds for the implementation of this act.

APPROVED by Governor June 4, 2001
EFFECTIVE August 8, 2001
NOTE: (1) This act was passed without a safety clause. For further explanation concerning the effective date, see page vi of this digest.
(2) House Bill 01-1343 was signed by the Governor on May 22, 2001, and the fiscal estimate shows sufficient general fund savings.

H.B. 01-1331 Children's basic health plan - elimination of policy board - transfer of rule-making authority to medical services board - additional members on medical services board - studies - appropriation. Clarifies and restates the goals of the children's basic health plan program.

Eliminates the children's basic health plan policy board and the advisory board. Gives complete administrative authority for the children's basic health plan to the department of health care policy and financing ("department"). Transfers the rule-making function handled by the policy board to the medical services board.

Adds 2 members to the medical services board, to be appointed by the governor, one of whom is a private sector member with experience with the delivery of health care and one of whom has experience or expertise in caring for medically underserved children.

Directs the department to conduct a study on consolidation of state health care programs for children. Requires the department to submit such study with recommendations to the joint budget committee and to the health, environment, welfare, and institutions committee of the house of representatives and the health, environment, children and families committee of the senate.

Authorizes the department to conduct pilot projects to test different models where appropriate and as approved by the joint budget committee. Directs the department to use performance-based contracting based on quality assurance measures.

Requires any private contractor that provides services under the children's basic health plan to provide quarterly reports to the medical services board relating to the functions performed by the contractor. Requires the contractor to submit any data requested by the medical services board relating to the plan and the functions provided by that contractor.

Reduces the appropriation to the department of health care policy and financing, indigent care program, children's basic health plan administration, in the general appropriation act.

APPROVED by Governor June 4, 2001
EFFECTIVE August 8, 2001
NOTE: This act was passed without a safety clause. For further explanation concerning the effective date, see the note from page vi of this digest.

H.B. 01-1343 Medical assistance - managed care - adjustment in long bill appropriation. Allows a medicaid client to disenroll from a managed care organization without good cause within the first 90 days of enrollment. Increases the length of time before a medicaid recipient can change to a different managed care organization from 6 to 12 months.

Repeals an optional program that allowed a guaranteed minimum enrollment period of 6 months in managed care programs for recipients who become ineligible for medicaid.

Decreases the appropriation in the long bill for FY 2001-2002 for the department of health care policy and financing by $300,000.

H.B. 01-1401 Comprehensive primary and preventative care grant program - modification of definitions - qualified provider - uninsured or medically indigent patient. For purposes of the comprehensive primary and preventive care grant program, modifies the definition of "qualified provider" to include an entity that:

Provides comprehensive primary care services free of charge;
Serves a population or area that lacks adequate health care services for low-income, uninsured persons; and
Completes initial screening for eligibility for the state medical assistance program, children's basic health plan, and any other relevant government health care program.

Modifies the definition of "uninsured or medically indigent patient" to include a patient whose yearly family income is below 200% of the federal poverty level rather than 185% of the federal poverty level.

APPROVED by Governor June 5, 2001
EFFECTIVE June 5, 2001