HS/SS#2/SB 695 - This act modifies various provisions relating to medical services and eligibility.

Current law provides that Medicaid eligibility for the elderly and disabled be raised to 90% of the federal poverty level by July 1, 2003, and 100% of the federal poverty level by July 1, 2004. The act stipulates that the mandatory increase of Medicaid eligibility for the elderly and disabled shall be subject to appropriation (Section 208.151).

Section 208.152 includes and clarifies prescription drug coverage. Nonprescription drugs will be covered if they are approved by the Division of Medical Services and prescribed by a health care professional. The drugs must be FDA-approved for safety and effectiveness.

Section 208.152 also provides that optional Medicaid services shall be subject to appropriation.

Payments made for nonemergency medical transportation services shall be a credit against any payments that the state owes for the services (Section 208.152).

Section 208.154 stipulates that payments for public and medical assistance benefits may only be provided if money is appropriated for the benefits.

Section 208.162 allows the continuation of medical assistance for the General Relief population despite the elimination of cash assistance.

Section 208.565 modifies the rebate amount for prescription drugs in the Missouri Senior Rx Program. For all transactions that occur prior to July 1, 2003, the rebate amount shall be fifteen percent of the average manufacturers' price. For all transactions that occur on or after July 1, 2003, the rebate amount shall be fifteen percent for brand name prescription drugs and eleven percent for generic prescription drugs. This section contains an emergency clause (This provision is contained in SCS/SB 307).

Parents of uninsured children with available incomes between 101% and 225% of the federal poverty level are responsible for co-payments in amounts established by rule by the Department of Social Services. Current law requires a $5 co-payment (Section 208.640).

Section 208.643 requires the Department to establish procedures for:

-requiring verification of available income for participants on an annual basis;

-requiring participants to sign a release allowing the Department to contact the participant's employer regarding any employer-subsidized health insurance; and

-making participants ineligible for coverage if the participant fails to provide 3 co-payments for services or prescriptions within a period of one year.

The Department of Social Services may adjust the pharmacy provider tax rate quarterly on a prospective basis. The Department may adjust the rate more frequently for individual providers if there is a substantial and statistically significant change in their pharmacy sales. The pharmacy provider tax imposed pursuant to Sections 338.500 to 338.550 shall be effective by July 1, 2003.

The pharmacy provider tax shall expire 90 days after:

- The aggregate dispensing fee paid to pharmacists per prescription is less than dispensing fees reimbursement amount for the 2003 fiscal year; or

- The formula is changed which results in lower reimbursement in the aggregate than provided in fiscal year 2003; or

- June 30, 2005.
LORIE TOWE

HA #1 - BEGINNING JULY 1, 2003, NEW POLICIES SHALL ONLY BE IMPLEMENTED BY RULES OR REGULATIONS AND THE DEPARTMENT MAY NEGOTIATE SUPPLEMENTAL REBATES WITH INDIVIDUAL MANUFACTURERS. VENDORS OF NONEMERGENCY MEDICALLY NECESSARY TRANSPORTATION SERVICES ARE NOT REQUIRED TO PROVIDE THE SERVICES IF THE RECIPIENT DOES NOT PAY THE CO-PAYMENT AT THE TIME OF TRANSPORTATION. A NEW SUBSECTION 4 FOR 208.640 DETAILS THE POTENTIAL OUTCOMES FOR A PROVIDER IF A MANDATORY CO-PAYMENT IS NOT PAID