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H0663aa...............................................by HEALTH AND WELFARE
MEDICAID - Adds to existing law relating to Medicaid to permit the
Department of Health and Welfare to establish personal health accounts for
Medicaid participants; to provide a purpose for the accounts; to provide
for funding of the accounts; to permit rulemaking by the department; to
provide for the use of the account funds; to provide payments from the
accounts; to require the department to establish enforceable cost sharing;
to provide for a purpose; to provide for rulemaking by the department; to
provide for practices that may invoke copayments; to define terms; and to
permit exceptions.
02/13 House intro - 1st rdg - to printing
02/14 Rpt prt - to Health/Wel
03/09 Rpt out - to Gen Ord
03/13 Rpt out amen - to engros
03/14 Rpt engros - 1st rdg - to 2nd rdg as amen
03/15 2nd rdg - to 3rd rdg as amen
03/16 3rd rdg as amen - PASSED - 53-13-4
AYES -- Anderson, Andrus, Barraclough, Bedke, Bell, Bilbao, Black,
Block, Boe, Bolz, Brackett, Bradford, Cannon, Chadderdon, Collins,
Deal, Denney, Edmunson, Ellsworth, Eskridge, Field(18), Field(23),
Garrett, Harwood, Henbest, Henderson, Jaquet, Martinez, Mathews,
Miller, Mitchell, Moyle, Nielsen, Nonini, Pasley-Stuart, Pence,
Raybould, Ring, Ringo, Rusche, Rydalch, Sayler, Schaefer,
Shepherd(2), Shirley, Skippen, Smith(30), Smith(24), Smylie,
Stevenson, Trail, Wills, Mr. Speaker
NAYS -- Barrett, Bayer, Clark, Hart, Kemp, Lake, LeFavour,
Loertscher, McGeachin, McKague, Roberts, Sali, Shepherd(8)
Absent and excused -- Bastian, Crow, Snodgrass, Wood
Floor Sponsor - Block
Title apvd - to Senate
03/17 Senate intro - 1st rdg - to Health/Wel
03/23 Rpt out - rec d/p - to 2nd rdg
03/24 2nd rdg - to 3rd rdg
03/28 3rd rdg - PASSED - 35-0-0
AYES -- Andreason, Brandt, Broadsword, Bunderson, Burkett(Clark),
Burtenshaw, Cameron, Coiner, Compton, Corder, Darrington, Davis,
Fulcher, Gannon, Geddes, Goedde, Hill, Jorgenson, Kelly, Keough,
Langhorst, Little, Lodge, Malepeai, Marley, McGee, McKenzie, Pearce,
Richardson, Schroeder, Stegner, Stennett, Sweet, Werk, Williams
NAYS -- None
Absent and excused -- None
Floor Sponsors - Compton & McGee
Title apvd - to House
03/29 To enrol
03/30 Rpt enrol - Sp signed
03/31 Pres signed - To Governor
03/31 Governor signed
Session Law Chapter 305
Effective: 07/01/06
]]]] LEGISLATURE OF THE STATE OF IDAHO ]]]]
Fifty-eighth Legislature Second Regular Session - 2006
IN THE HOUSE OF REPRESENTATIVES
HOUSE BILL NO. 663
BY HEALTH AND WELFARE COMMITTEE
1 AN ACT
2 RELATING TO MEDICAID; AMENDING CHAPTER 2, TITLE 56, IDAHO CODE, BY THE ADDI-
3 TION OF NEW SECTIONS 56-256 AND 56-257, IDAHO CODE, TO PERMIT THE DEPART-
4 MENT OF HEALTH AND WELFARE TO ESTABLISH PERSONAL HEALTH ACCOUNTS FOR MED-
5 ICAID PARTICIPANTS, TO PROVIDE A PURPOSE FOR THE ACCOUNTS, TO PROVIDE FOR
6 FUNDING OF THE ACCOUNTS, TO PERMIT RULEMAKING BY THE DEPARTMENT, TO PRO-
7 VIDE FOR USE OF THE ACCOUNT FUNDS, AND TO PROVIDE PAYMENTS FROM THE
8 ACCOUNTS, TO REQUIRE THE DEPARTMENT TO ESTABLISH ENFORCEABLE COST SHARING,
9 TO PROVIDE FOR A PURPOSE, TO PROVIDE FOR RULEMAKING BY THE DEPARTMENT, TO
10 PROVIDE FOR PRACTICES THAT MAY INVOKE COPAYMENTS, TO DEFINE TERMS AND TO
11 PERMIT EXCEPTIONS.
12 Be It Enacted by the Legislature of the State of Idaho:
13 SECTION 1. That Chapter 2, Title 56, Idaho Code, be, and the same is
14 hereby amended by the addition thereto of NEW SECTIONS, to be known and desig-
15 nated as Sections 56-256 and 56-257, Idaho Code, and to read as follows:
16 56-256. PERSONAL HEALTH ACCOUNTS. (1) The department of health and wel-
17 fare may establish a personal health account available to a medicaid partici-
18 pant in order to provide incentives to promote healthy behavior and responsi-
19 ble use of health care services.
20 (2) Each personal health account shall be funded by a base amount deter-
21 mined by department rule. Amounts may be added to the account when the partic-
22 ipant complies with recommended preventive care and demonstrates healthy
23 behaviors or conducts other activities as specified in department rule. Funds
24 in a personal health account are not the personal property of the participant,
25 but represent the value of benefits available for use by the participant while
26 eligible. If funds remain in a personal health account when a participant ter-
27 minates participation, such unexpended funds revert to the state.
28 (3) The uses of funds in personal health accounts may include, but not be
29 limited to, participant payments for preventive health products and services
30 and participant cost-sharing payments as specified in department rule.
31 (4) Copayments for services and delinquent premium payments may be auto-
32 matically deducted from personal health account funds by the department, sub-
33 ject to notice and opportunity for hearing.
34 56-257. COPAYMENTS. (1) The department of health and welfare shall estab-
35 lish enforceable cost sharing in order to increase the awareness and responsi-
36 bility of medicaid participants for the cost of their health care and to
37 encourage use of cost-effective care in the most appropriate setting.
38 Copayments established by department rule may include, but not be limited to,
39 the following:
40 (a) Inappropriate emergency room utilization. "Inappropriate emergency
41 room utilization" means the use of the emergency room for services that
42 are nonemergency and that can be delivered in a regular clinic setting. If
2
1 a hospital provider determines that it is reasonable that any prudent
2 layperson would have sought emergency treatment in the same circumstances,
3 a copayment will not be applied to such an individual even if the care
4 rendered is nonemergency;
5 (b) Inappropriate use of emergency medicaid funded medical transporta-
6 tion. "Inappropriate use of emergency medical transportation" means the
7 use of emergency medical transportation for conditions that do not meet
8 the criteria for emergency conditions specified in department rule;
9 (c) Missed appointments with health care providers. The department may
10 limit the types of providers for which copayments for missed appointments
11 are applicable. No such provider will be required by the department to
12 collect copayments as required in this section; and
13 (d) Nonpreferred prescription drugs. A nonpreferred drug is a drug for
14 which an alternative therapeutically interchangeable drug in the same
15 pharmacological class is available whose use provides advantages to the
16 medicaid program based on relative safety, effectiveness, clinical
17 outcomes and cost. Pharmacy providers may be required to collect
18 copayments at the point of service as part of the dispensing fee for the
19 prescribed medication.
20 (2) The director may exempt, subject to federal approval, any group of
21 medicaid participants from the cost-sharing provisions in this section.
]]]] LEGISLATURE OF THE STATE OF IDAHO ]]]]
Fifty-eighth Legislature Second Regular Session - 2006
Moved by Block
Seconded by Garrett
IN THE HOUSE OF REPRESENTATIVES
HOUSE AMENDMENT TO H.B. NO. 663
1 AMENDMENTS TO SECTION 1
2 On page 2 of the printed bill, in line 18, delete "as part of the dispens-
3 ing fee for the" and delete line 19 and insert: ". Pharmacy providers shall
4 not be required to dispense any prescribed medication unless a medicaid par-
5 ticipant provides for any applicable copayment under this paragraph.
6 Copayments shall not constitute a reduction of overall reimbursement to phar-
7 macists for the dispensing of prescribed medicine.".
]]]] LEGISLATURE OF THE STATE OF IDAHO ]]]]
Fifty-eighth Legislature Second Regular Session - 2006
IN THE HOUSE OF REPRESENTATIVES
HOUSE BILL NO. 663, As Amended
BY HEALTH AND WELFARE COMMITTEE
1 AN ACT
2 RELATING TO MEDICAID; AMENDING CHAPTER 2, TITLE 56, IDAHO CODE, BY THE ADDI-
3 TION OF NEW SECTIONS 56-256 AND 56-257, IDAHO CODE, TO PERMIT THE DEPART-
4 MENT OF HEALTH AND WELFARE TO ESTABLISH PERSONAL HEALTH ACCOUNTS FOR MED-
5 ICAID PARTICIPANTS, TO PROVIDE A PURPOSE FOR THE ACCOUNTS, TO PROVIDE FOR
6 FUNDING OF THE ACCOUNTS, TO PERMIT RULEMAKING BY THE DEPARTMENT, TO PRO-
7 VIDE FOR USE OF THE ACCOUNT FUNDS, AND TO PROVIDE PAYMENTS FROM THE
8 ACCOUNTS, TO REQUIRE THE DEPARTMENT TO ESTABLISH ENFORCEABLE COST SHARING,
9 TO PROVIDE FOR A PURPOSE, TO PROVIDE FOR RULEMAKING BY THE DEPARTMENT, TO
10 PROVIDE FOR PRACTICES THAT MAY INVOKE COPAYMENTS, TO DEFINE TERMS AND TO
11 PERMIT EXCEPTIONS.
12 Be It Enacted by the Legislature of the State of Idaho:
13 SECTION 1. That Chapter 2, Title 56, Idaho Code, be, and the same is
14 hereby amended by the addition thereto of NEW SECTIONS, to be known and desig-
15 nated as Sections 56-256 and 56-257, Idaho Code, and to read as follows:
16 56-256. PERSONAL HEALTH ACCOUNTS. (1) The department of health and wel-
17 fare may establish a personal health account available to a medicaid partici-
18 pant in order to provide incentives to promote healthy behavior and responsi-
19 ble use of health care services.
20 (2) Each personal health account shall be funded by a base amount deter-
21 mined by department rule. Amounts may be added to the account when the partic-
22 ipant complies with recommended preventive care and demonstrates healthy
23 behaviors or conducts other activities as specified in department rule. Funds
24 in a personal health account are not the personal property of the participant,
25 but represent the value of benefits available for use by the participant while
26 eligible. If funds remain in a personal health account when a participant ter-
27 minates participation, such unexpended funds revert to the state.
28 (3) The uses of funds in personal health accounts may include, but not be
29 limited to, participant payments for preventive health products and services
30 and participant cost-sharing payments as specified in department rule.
31 (4) Copayments for services and delinquent premium payments may be auto-
32 matically deducted from personal health account funds by the department, sub-
33 ject to notice and opportunity for hearing.
34 56-257. COPAYMENTS. (1) The department of health and welfare shall estab-
35 lish enforceable cost sharing in order to increase the awareness and responsi-
36 bility of medicaid participants for the cost of their health care and to
37 encourage use of cost-effective care in the most appropriate setting.
38 Copayments established by department rule may include, but not be limited to,
39 the following:
40 (a) Inappropriate emergency room utilization. "Inappropriate emergency
41 room utilization" means the use of the emergency room for services that
42 are nonemergency and that can be delivered in a regular clinic setting. If
2
1 a hospital provider determines that it is reasonable that any prudent
2 layperson would have sought emergency treatment in the same circumstances,
3 a copayment will not be applied to such an individual even if the care
4 rendered is nonemergency;
5 (b) Inappropriate use of emergency medicaid funded medical transporta-
6 tion. "Inappropriate use of emergency medical transportation" means the
7 use of emergency medical transportation for conditions that do not meet
8 the criteria for emergency conditions specified in department rule;
9 (c) Missed appointments with health care providers. The department may
10 limit the types of providers for which copayments for missed appointments
11 are applicable. No such provider will be required by the department to
12 collect copayments as required in this section; and
13 (d) Nonpreferred prescription drugs. A nonpreferred drug is a drug for
14 which an alternative therapeutically interchangeable drug in the same
15 pharmacological class is available whose use provides advantages to the
16 medicaid program based on relative safety, effectiveness, clinical
17 outcomes and cost. Pharmacy providers may be required to collect
18 copayments at the point of service. Pharmacy providers shall not be
19 required to dispense any prescribed medication unless a medicaid partici-
20 pant provides for any applicable copayment under this paragraph.
21 Copayments shall not constitute a reduction of overall reimbursement to
22 pharmacists for the dispensing of prescribed medicine.
23 (2) The director may exempt, subject to federal approval, any group of
24 medicaid participants from the cost-sharing provisions in this section.
STATEMENT OF PURPOSE
RS 16005
This proposal amends chapter 2, Title 56, Idaho code, by the
addition of new sections 56-256 and 56-257. This legislation will
permit the Department of Health and Welfare to establish Personal
Health Accounts for Medicaid participants. This will also
require the department to establish enforceable cost sharing that
will assist Medicaid participants to use the health system
efficiently.
FISCAL NOTE
This bill will result in a fiscal impact of $1,125,575 to the
state general fund in FY 2007.
Contact
Name: Representative Sharon Block
Senator Dick Compton
Phone: 332-1000
David Rogers, Department of Health and Welfare
364-1804
STATEMENT OF PURPOSE/FISCAL NOTE H 663