Human Services - Mental Health - Digest of Bills

Digest of Bills - 2007

HUMAN SERVICES - MENTAL HEALTH

S.B. 07-4 Early intervention services - infants and toddlers with developmental delays - coordinated system of payment - coverage under medicaid, children's basic health plan, and private health insurance. Requires the department of human services (department) to develop and implement a coordinated system of payment for early intervention services for eligible children from birth up to their 3rd birthday who have developmental disabilities or developmental delays, using both public and private funds. In developing and implementing the system, specifies that the department is to:

● Establish an interagency cooperating agreement with the departments of education, health care policy and financing, and public health and environment regarding the responsibilities of each department;

● Develop the system for using public and private funds in cooperation with those specified departments, the division of insurance in the department of regulatory agencies (division), private health insurance carriers, and certified early intervention service brokers (certified brokers);

● Certify community-centered boards (CCBs) or other entities as certified brokers for early intervention services provided to eligible children; and

● Ensure an appropriate allocation of payment responsibilities among federal, state, local, and private sources.

Clarifies that any additional source of funds that may become available on or after July 1, 2007, for the payment of early intervention services as a result of the act is not to replace or reduce other funds currently available for such purpose. Preserves the right of CCBs or county governments to allocate local funds for the benefit of eligible children.

Requires the departments of education, health care policy and financing, and public health and environment to cooperate with the department in implementing the act and specifies particular duties of those departments. Requires the division to provide assistance to the department related to the requirements and implementation of the coverage of early intervention services and insurance laws and rules related to billing and claims handling.

Obligates certified brokers for each designated service area in the state to:

● Establish a registry of qualified early intervention service providers (qualified providers);

● Accept and process claims for reimbursement for early intervention services provided by a qualified provider;

● Negotiate for the payment of early intervention services provided to eligible children in the designated service area by qualified providers;

● Ensure payment to a qualified provider for early intervention services rendered by that provider;

● Use procedures and forms determined by the department to document the provision or purchase of early intervention services on behalf of eligible children and to submit invoices or insurance claims for the services to the appropriate federal, state, local, or private funding source based on available funds and applicable reimbursement rates.

Requires the department to establish a schedule of fees to be charged by certified brokers for providing certified broker services. Clarifies that use of a certified broker is voluntary and that qualified providers are not precluded from directly billing the appropriate entity for payment of services provided to an eligible child.

Compels the department to negotiate with private health insurance carriers regarding the method of payment of benefits for early intervention services for which coverage is required and allow carriers to pay benefits to certified brokers, qualified providers, or the department in trust for payment to a certified broker or qualified provider. Establishes a mechanism for the department to accept, hold in trust, and pay certified brokers and qualified providers from any such payments received from private health insurance carriers. Requires the department to provide a report to each such carrier regarding payments received and made on behalf of the carrier for covered benefits and to return any unexpended moneys to the carrier when a covered child is no longer eligible for early intervention services.

Requires the department to submit an annual report to the general assembly by November 1, 2008, and by each November 1 thereafter, regarding the various funding sources used for early intervention services, the number of eligible children served, and the average cost of early intervention services.

Requires the department of health care policy and financing to ensure integration of the medicaid system and the children's basic health plan into the coordinated system of payment for early intervention services and to make necessary modifications to medicaid and the children's basic health plan to achieve such integration. Establishes a process for the department and the department of health care policy and financing to determine which early intervention services are medically necessary for purposes of coverage under medicaid or the children's basic health plan. Excludes certain early intervention services from those services covered under medicaid and the children's basic health plan.

Requires health insurance policies and health care service or indemnity contracts issued or delivered on or after January 1, 2008, that provide dependent coverage to provide coverage for early intervention services delivered by a qualified provider to an eligible child. States that for purposes of such coverage, early intervention services that are specified in an eligible child's individualized family service plan are deemed medically necessary for that child. Specifies the duration and limitations on the amount of the required coverage and increases that amount annually based on the inflation rate.

Precludes the applicability of deductibles, copayments, and lifetime caps on the coverage unless the coverage is offered through a high deductible plan that would qualify for a health savings account under federal law. Unless otherwise agreed to by the carrier, allows a carrier to limit the reimbursement rate paid to a nonparticipating provider to the rate paid for comparable early intervention services provided by a participating provider.

Exempts the following from the limit on the annual amount of required coverage:

● Rehabilitation or therapeutic services necessitated by an acute medical condition; and

● Services provided to a child who is not participating in the federal program for early intervention services or that are not part of an individualized family service plan; except that such services are to be covered at the level required for congenital defects and birth abnormalities.

Excludes specified types of insurance, such as workers' compensation and short-term policies, from the mandatory coverage requirements. Requires the department, within 60 days after determining that a child is no longer eligible for coverage, to notify the carrier that it is no longer required to provide coverage of that child for early intervention services.

Limits the existing mandated coverage for congenital defects and birth abnormalities to a covered child from the child's 3rd birthday to the child's 6th birthday.

For the implementation of the act, appropriates:

● $31,423 and 1.0 FTE to the department of health care policy and financing, executive director's office;

● $4,000 to the department of health care policy and financing, indigent care program, for children's basic health plan administration;

● $59,734 to the department of health care policy and financing, indigent care program, for children's basic health plan premium costs;

● $53,920 to the department of human services, office of operations;

● $6,188 to the department of regulatory agencies, division of insurance; and

● $1,346,270 and 1.0 FTE to the department of public health and environment.

Makes the act, excluding the mandatory health insurance coverage of early intervention services provisions, effective July 1, 2007. Makes the mandatory health insurance coverage of early intervention services provisions effective January 1, 2008, and applicable to health insurance policies or contracts issued or delivered on or after said date.

APPROVED by Governor May 15, 2007
EFFECTIVE May 15, 2007

S.B. 07-230 Mental health agencies - residential treatment costs for categorically eligible children - appropriation. Authorizes mental health agencies ("agencies") to coordinate mental health care and services for children from assessment to discharge. Clarifies the items that agencies must report to the department of human services ("department"), including outcomes of treatment. Expands the rights of families by allowing for an appeal regarding the discharge of a child from a mental health program. Allows for the payment of room and board costs associated with residential treatment for categorically eligible children.

Appropriates $77,667 from the general fund to the department of human services for administration of mental health and alcohol and drug abuse services for the implementation of the act. Decreases the appropriation for residential treatment for youth by $77,667.

APPROVED by Governor May 30, 2007
EFFECTIVE May 30, 2007