S.B. 03-11 Medicaid - prescription drugs - use of generic equivalent - mail order - appropriation. Requires the medical services board ("board") to include in rules governing the reimbursement of medications under medicaid, the requirement that the generic equivalent of a brand-name drug be prescribed if the generic equivalent is a therapeutic equivalent to the brand-name drug. Allows an exception to this requirement if the patient has been stabilized on a medication and a transition to the generic equivalent of the brand-name drug would be unacceptably disruptive. Specifies that this requirement shall not apply to medications for the treatment of biologically based mental illness, the treatment of cancer, the treatment of epilepsy, or the treatment of HIV/AIDS. Specifies that a generic equivalent to a brand-name drug will not be required when reimbursement to the state for the use of a brand-name drug makes the drug less expensive than the cost of the generic equivalent. Authorizes the department of health care policy and financing ("department") to use savings in the medical services premiums appropriations to fund the administrative review of these exception requests.
Authorizes the department to ensure that if a federal medicare prescription drug benefit is passed, that any state medicaid recipient that is eligible for medicare participate in this new federal benefit.
Requires the board to adopt by rule a system to allow medical assistance recipients to receive maintenance medications through mail order, if the person suffers from a physical hardship that prohibits the person from obtaining prescriptions from a local pharmacy. Specifies that the board shall require, to the extent possible, the use of local pharmacies that are able to provide the same services as mail order.
Requires the department to develop and implement a drug utilization review process for the fee-for-service and primary care physician programs. Authorizes the department to use savings in the medical services premiums appropriations to fund the development and implementation of this process.
Makes various adjustments to the 2003 general appropriations act to reflect the administrative costs of implementing the provisions of this act and the savings to the medical assistance program. Specifies which appropriations clause takes effect conditioned upon Senate Bill 03-294 becoming law.
APPROVED by Governor May 22, 2003
EFFECTIVE May 22, 2003
NOTE: Senate Bill 03-294 was signed by the Governor June 5, 2003.
S.B. 03-13 Comprehensive primary and preventive care grant program - comprehensive primary care - definition. Specifies that comprehensive primary care includes providing or arranging for the provision of specified health care services on a year-round basis. Defines the phrase "arranging for the provision" for the purposes of further defining comprehensive primary care under the grant program. Specifies that the advisory council and the department of health care policy and financing shall consider rural areas when awarding grants under the comprehensive primary and preventive care grant program.
APPROVED by Governor April 7, 2003
EFFECTIVE August 6, 2003
NOTE: This act was passed without a safety clause. For further explanation concerning the
effective date, see page vi of this digest.
S.B. 03-22 Old age pension health and medical care programs - transfer - appropriation. Effective July 1, 2003, transfers the authority to administer the old age pension health and medical care program, the supplemental old age pension health and medical care program, and the corresponding funds from the department of human services to the department of health care policy and financing.
Transfers the fiscal year 2003-04 health and medical care fund appropriations from the department of human services to the department of health care policy and financing.
APPROVED by Governor June 5, 2003
EFFECTIVE June 5, 2003
S.B. 03-112 Medically indigent - health care program - department procedures and policies - provider contracts - modifications. Simplifies the current reporting requirements for the program for the medically indigent ("program") in the department of health care policy and financing ("department"). Eliminates numerous references to provisions required to be in each provider contract and requires the department to establish these provisions as overall procedures and policies for the program that would be applicable to each provider. Specifies that when adopting or modifying procedures under the program, the department is required to notify each provider under the program 30 days prior to implementation of a new procedure.
Consolidates line items pertaining to contract amounts under the program that are currently required to be in the general appropriations act. Repeals the requirement that providers receive monthly reimbursement checks. Eliminates a provider's ability to pay its reimbursement payments to providers in other regions of the state. Repeals obsolete statutory provisions related to the program.
APPROVED by Governor April 7, 2003
EFFECTIVE April 7, 2003
S.B. 03-173 FY 2002-03 budget reduction bill - medicaid - nursing facility payments - appropriation. For fiscal year 2002-03, repeals the requirement that the medical services board in the department of health care policy and financing adopt rules to determine and pay nursing facility providers a reasonable share of the amount by which the reasonable costs of the categories of administration, property, and room and board, exceed the actual costs in these categories. Repeals the definition of "reasonable share".
Modifies the fiscal year 2002-03 general appropriations act to reflect this change.
APPROVED by Governor March 5, 2003
EFFECTIVE March 5, 2003
S.B. 03-176 FY 2002-03 budget reduction bill - medicaid - eligibility - legal immigrants-appropriation. Repeals the eligibility of legal immigrants who qualify for medical assistance as an optional group. Authorizes the department of health care policy and financing to amend the state's medicaid plan to conform with these changes.
Makes adjustments to the fiscal year 2002-03 general appropriations act to reflect this change in medicaid eligibility.
APPROVED by Governor March 5, 2003
EFFECTIVE March 5, 2003
S.B. 03-187 FY 2002-03 budget reduction bill - medicaid - enrollment choices - appropriation. Repeals the provision requiring the department of health care policy and financing to consider a consumer's usual and historic sources of care, linguistic needs, special medical needs, and transportation needs when informing a medical assistance recipient of enrollment choices in the recipient's area.
Modifies the fiscal year 2002-03 general appropriations act to reflect this change.
APPROVED by Governor March 5, 2003
EFFECTIVE March 5, 2003
S.B. 03-259 FY 2003-04 budget reduction bill - medicaid - children's home- and community-based waiver programs - monthly premium fee - sliding fee scale - appropriation. Beginning July 1, 2003, requires the department of health care policy and financing ("department") to collect a monthly premium fee ("fee") to pay for a portion of the direct and indirect costs of the children's home- and community-based services and the children's extensive support waiver programs. Specifies that the fee shall be charged on a sliding fee scale basis to families of children who are enrolled in either the children's home- and community-based services waiver program or the children's extensive support waiver program. Specifies that the fee shall only be charged to a family with an income of greater than 300% of the federal poverty level and outlines parameters for which the sliding fee scale shall be based upon.
Requires the medical services board ("board") to establish the sliding fee scale for the fee by rule. Requires that the rules promulgated by the board also establish a process for a family to appeal the family's fee amount. Authorizes the department to collect any unpaid fees and specifies that the department may also collect unpaid fees by means of intercepting a family's state income tax refund or the garnishment of wages and other earnings, as currently authorized by law. Authorizes the department to recover from a family, who terminates or declines existing or readily available employer-based health insurance coverage for the sole purpose of avoiding multiple monthly premium payments, medical assistance payments made on behalf of an enrolled child for the applicable time period. Authorizes the department to make the determination of whether a family with an enrolled child deliberately declined or terminated existing or readily available employer-based health insurance coverage and to increase the family's fee by 10% in such case.
Makes various adjustments to the 2003 general appropriations act to reflect the moneys generated from the fees collected under this act.
APPROVED by Governor May 1, 2003
EFFECTIVE May 1, 2003
S.B. 03-266 FY 2003-04 budget reduction bill - medicaid - nursing facility providers - provider fee - quality of care grant program - state nursing facility service program - legal immigrants - appropriation. Beginning July 1, 2003, requires the department of health care policy and financing ("department") to collect a fee from nursing facility providers ("provider") and specifies that the fee shall be charged to a provider on a per patient per day basis. Specifies that the fee to be charged shall not exceed $6.50 per patient per day for each provider. Specifies that the fee shall not be charged to: A provider that is licensed by the department of public health and environment but does not accept state or federal assistance moneys for the services it provides to the facility's residents; a provider that does not receive payment for services pursuant to Title XIX of the social security act; or to a nursing facility that is owned by a governmental entity. Authorizes the department to seek the appropriate federal waiver for the imposition of a provider fee.
Establishes the nursing facility cash fund ("fund") for the deposit of the provider fees and specifies that the fund may be used for the nursing facility quality of care grant program and the state nursing facility service program, which are established in this act. Prohibits the department from collecting the provider fee for the purpose of funding the state nursing facility service program, unless the program is implemented.
Requires the department to establish a nursing facility quality of care grant program ("grant program") for the purpose of maintaining the continuity and quality of care for medicaid nursing facility patients. Requires the department to distribute grants under the grant program to providers on the basis of medicaid patient days and no more than 14 days after the receipt of the provider fee charged. Specifies that the authorization for the provider fee and the grant program are contingent on one another.
Contingent on the implementation of Senate Bill 03-176, establishes the state nursing facility service program ("program") for specified legal immigrants who lost eligibility for medical assistance due to the repeal of legal immigrants as an optional medicaid group. Defines who is eligible to receive services under the program. Authorizes the department to pay a provider for services given on the implementation date of Senate Bill 03-176, and each day thereafter to an eligible person until that person is discharged from nursing facility care. Specifies the services to be provided under the program and the rate to be paid by the department for those services. Sunsets the program, effective July 1, 2008.
Makes various adjustments to the 2003 general appropriations act to reflect the implementation of the nursing facility provider fee, the quality of care grant program, and the state nursing facility service program.
APPROVED by Governor May 1, 2003
EFFECTIVE May 1, 2003
NOTE: Senate Bill 03-176 was signed by the Governor March 5, 2003.
S.B. 03-279 FY 2003-04 budget reduction bill - medical assistance - limitation of services. To stay within approved appropriations, authorizes the medical services board ("board") to limit services under the medical assistance program by rule so long as the services provided are sufficient in amount, duration, and scope to reasonably achieve their purpose as required by federal law or regulation. If services are limited by rule, directs the board to provide a summary report to the health, environment, welfare and institutions committees.
APPROVED by Governor May 1, 2003
EFFECTIVE July 1, 2003
S.B. 03-288 FY 2003-04 budget reduction bill - medical assistance - private-duty nursing services - limitation. If Senate Bill 03-107 does not become law, from July 1, 2003, to June 30, 2006, limits the provision of private-duty nursing services under the medical assistance program to no more than 112 hours per week.
APPROVED by Governor May 1, 2003
EFFECTIVE July 1, 2003
NOTE: Senate Bill 03-107 became law without the Governor's signature April 29, 2003.
S.B. 03-291 FY 2003-04 budget reduction bill - children's basic health plan - suspend prenatal program - state-only prenatal program. Suspends enrollment of pregnant women in the prenatal program of the children's basic health plan ("plan") on the effective date of the act and during fiscal year 2003-04. Provides that a pregnant woman who was determined to be eligible prior to the effective date of the act, or who was already enrolled in the plan prior to the effective date of the act shall continue to be eligible for prenatal care and postpartum care under the plan until November 1, 2003. Creates a state-only prenatal program to continue to provide prenatal care and postpartum care for such women on or after November 1, 2003, and until the last woman eligible for the state-only prenatal program has received care. Authorizes the medical services board to adopt rules necessary to implement the state-only prenatal program.
Authorizes the general assembly to set enrollment caps on the number of pregnant women who may enroll in the prenatal program under the plan.
Requires the department to report quarterly to the joint budget committee on any enrollment caps that have been instituted for the plan and on the number of children that are on waiting lists to receive services under the plan.
Adjusts the 2003 general appropriation act to decrease the children's basic health plan trust by $5,822,908, to decrease the children's basic health plan, administration, by $368,899, to decrease the children's basic health plan, premium costs, by $16,085,746, and to decrease the children's basic health plan, dental benefit costs, by $227,289. Adjusts the 2003 general appropriation act to increase the children's basic health plan trust by $300,000, to increase the children's basic health plan, premium costs by $761,503, and to increase the children's basic health plan costs, dental benefit costs, by $95,134, and provides that such appropriations shall be derived from savings generated by the passage of Senate Bill 03-101. Appropriates $484,000 to the children's basic health plan trust, $1,228,503 to the children's basic health plan, premium costs, and $153,475 to the children's basic health plan, dental benefits costs and provides that such appropriations shall be derived from savings generated by the passage of Senate Bill 03-107.
States the assumptions for the 2003 general appropriation act for the average annual medical costs per child on the plan, the average monthly caseload, average dental costs, member months of prenatal care, and the number of births.
Appropriates $43,700 to the department of health care policy and financing for the purpose of funding the state-only prenatal program and provides that such appropriations shall be derived from savings generated from the passage of Senate Bill 03-101.
APPROVED by Governor May 1, 2003
EFFECTIVE May 1, 2003
NOTE: Senate Bill 03-107 became law without the Governor's signature April 29, 2003.
Senate Bill 03-101 was vetoed by the Governor May 22, 2003.
S.B. 03-294 FY 2003-04 budget reduction bill - prescription drugs - prior authorization - rules. Allows the department of health care policy and financing (the department) to implement utilization mechanisms that include, but are not limited to, prior authorization. Requires the department to develop a process by which interested parties will be notified and may provide comment to the department before the class is prior authorized. Requires the department to report to the health, environment, welfare, and institutions committees for the house of representatives and the senate no later than December 1, 2003, and each December 1 thereafter, on the time frames for implementing utilization mechanisms and expected savings associated with each utilization mechanism.
Adjusts the FY 2003-04 general appropriation act to account for the implementation of the act.
APPROVED by Governor June 5, 2003
EFFECTIVE June 5, 2003
H.B. 03-1028 Pilot program - teen pregnancy and dropout prevention - continuation. Continues the existence of the statewide pilot program for teen pregnancy and dropout prevention ("pilot program") serving teenagers who are medicaid recipients for 3 more years.
Continues the requirement for the state department of health care policy and financing to provide a report to the general assembly demonstrating the effectiveness of the pilot program, and states that the next report shall be provided to the general assembly no later than September 1, 2005.
APPROVED by Governor March 25, 2003
EFFECTIVE March 25, 2003
H.B. 03-1107 Medicaid - consumer-directed attendant support program - extension. Repeals the 150-person limit on the number of persons who can participate in the consumer-directed attendant support program ("program") under medicaid. Specifies that the program allows persons to participate in the program to the extent authorized by the federal waiver.
Makes modifications to the current reporting requirements under the program. Extends the scheduled July 1, 2003, repeal date of the program to July 1, 2009.
APPROVED by Governor March 20, 2003
EFFECTIVE March 20, 2003
H.B. 03-1292 Intermediate care facilities for the mentally retarded - service fee - appropriations. Beginning in fiscal year 2003-04, and for each fiscal year thereafter, authorizes the department of human services to charge both privately owned intermediate care facilities for the mentally retarded and state-operated intermediate care facilities for the mentally retarded a service fee. Establishes that the service fee shall be charged for the purposes of maintaining the quality and continuity of services provided by intermediate care facilities for the mentally retarded. Specifies that the service fee shall not exceed 5% of the costs incurred by the intermediate care facility for the fiscal year in which the fee is charged. Requires the department of human services to transfer the moneys collected to the state treasurer, for credit to the service fee fund. Specifies that the moneys in the service fee fund shall be subject to annual appropriation by the general assembly to the department of health care policy and financing in order for the moneys to be applied toward the state match for the federal financial participation for payment to intermediate care facilities for the mentally retarded. Requires the state board of human services to adopt rules consistent with federal law to implement the act.
Adjusts various appropriations made to the department of human services and the department of health care policy and financing in the annual general appropriation act for the fiscal year beginning July 1, 2003, to facilitate the state match for the federal financial participation and the reimbursement of intermediate care facilities for the mentally retarded.
APPROVED by Governor May 22, 2003
EFFECTIVE July 1, 2003
H.B. 03-1359 Medicaid - in-home support services - discontinuation of services. Requires the in-home support services rules of the medical services board to establish that an in-home support service agency ("agency") can involuntarily discontinue a client from services only in the following circumstances: When equivalent care in the community has been secured for the client or after the client has exhibited documented prohibited behavior involving attendants and dispute resolution has failed. Specifies that the department of health care policy and financing shall determine whether an agency has made adequate attempts at resolution.
APPROVED by Governor May 22, 2003
EFFECTIVE May 22, 2003
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