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H0677aa....................................................by STATE AFFAIRS
MEDICALLY INDIGENT - Amends existing law to provide that necessary medical
services shall not include any medical service previously provided by the
state medical assistance program or regional mental health services which
are no longer reimbursed by the Department of Health and Welfare on and
after the effective date of this act.
02/25 House intro - 1st rdg - to printing
02/26 Rpt prt - to Health/Wel
02/27 Rpt out - to Gen Ord
02/28 Rpt out amen - to engros
03/01 Rpt engros - 1st rdg - to 2nd rdg as amen
03/04 2nd rdg - to 3rd rdg as amen
03/05 3rd rdg as amen - PASSED - 57-12-1
AYES -- Aikele, Barraclough, Barrett, Bedke, Bell, Black, Block,
Bolz, Bradford, Bruneel, Callister, Campbell, Clark, Collins, Crow,
Deal, Denney, Ellis, Ellsworth, Eskridge, Field(13), Field(20),
Gagner, Gould, Hadley, Hammond, Harwood, Higgins, Hornbeck, Jones,
Kellogg(Duncan), Kendell, Kunz, Lake, Langford, Loertscher, Mader,
McKague, Meyer, Mortensen, Moyle, Pearce, Pischner, Pomeroy,
Raybould, Ridinger, Roberts, Sali, Schaefer, Smith(23), Smylie,
Stevenson, Stone, Tilman, Wheeler, Young, Mr. Speaker
NAYS -- Bieter, Boe, Cuddy, Henbest, Jaquet, Martinez, Montgomery,
Robison, Sellman, Shepherd, Smith(33), Trail
Absent and excused -- Wood
Floor Sponsor - Loertscher
Title apvd - to Senate
03/06 Senate intro - 1st rdg - to Health/Wel
|||| LEGISLATURE OF THE STATE OF IDAHO ||||
Fifty-sixth Legislature Second Regular Session - 2002
IN THE HOUSE OF REPRESENTATIVES
HOUSE BILL NO. 677
BY STATE AFFAIRS COMMITTEE
1 AN ACT
2 RELATING TO THE MEDICALLY INDIGENT; AMENDING SECTION 31-3502, IDAHO CODE, TO
3 PROVIDE THAT NECESSARY MEDICAL SERVICES SHALL NOT INCLUDE ANY MEDICAL SER-
4 VICE PREVIOUSLY PROVIDED BY THE STATE MEDICAL ASSISTANCE PROGRAM OR THE
5 REGIONAL MENTAL HEALTH SERVICES ACT PRIOR TO THE EFFECTIVE DATE OF THIS
6 ACT AND ANY RULES PROMULGATED PURSUANT THERETO; AND DECLARING AN EMER-
7 GENCY.
8 Be It Enacted by the Legislature of the State of Idaho:
9 SECTION 1. That Section 31-3502, Idaho Code, be, and the same is hereby
10 amended to read as follows:
11 31-3502. DEFINITIONS. As used in this chapter, the terms defined in this
12 section shall have the following meaning, unless the context clearly indicates
13 another meaning:
14 (1) "Medically indigent" means any person who is in need of necessary
15 medical services and who, if an adult, together with his or her spouse, or
16 whose parents or guardian if a minor, does not have income and other resources
17 available to him from whatever source sufficient to pay for necessary medical
18 services. Nothing in this definition shall prevent the board of county commis-
19 sioners and administrator from requiring the applicant and obligated persons
20 to reimburse the county and the catastrophic health care costs program, where
21 appropriate, for all or a portion of their medical expenses, when investiga-
22 tion of their application pursuant to this chapter, determines their ability
23 to do so.
24 (2) "Hospital" means a facility licensed and regulated pursuant to sec-
25 tions 39-1301 through 39-1314, Idaho Code, excluding state institutions.
26 (3) "Dependent" means any person whom a taxpayer could claim as a depend-
27 ent under the income tax laws of the state of Idaho.
28 (4) "Applicant" means any person who is or may be requesting financial
29 assistance under this chapter.
30 (5) "Reimbursement rates" means the unadjusted medicaid rate of reim-
31 bursement for medical charges allowed pursuant to title XIX of the social
32 security act, as amended. For long-term care facilities, maximum
33 "reimbursement rates" means the unadjusted medicaid rate of reimbursement
34 allowed pursuant to the medical assistance program as determined by chapter 1,
35 title 56, Idaho Code, or the unadjusted medicare rate of reimbursement estab-
36 lished under title XVIII of the social security act, as amended, whichever is
37 greater.
38 (6) "Board" means the board of county commissioners.
39 (7) "Obligated persons" means those persons who are legally responsible
40 for an applicant.
41 (8) "County hospital" means any county approved institution or facility
42 for the care of sick persons.
43 (9) "Administrator" means the board of the catastrophic health care cost
2
1 program, as provided in section 31-3517, Idaho Code.
2 (10) "Catastrophic health care costs" means all necessary medical expenses
3 for services which are incurred by a recipient for which the reimbursement
4 rate exceeds in aggregate the sum of ten thousand dollars ($10,000) in any
5 twelve (12) consecutive month period.
6 (11) "Recipient" means an individual determined eligible for necessary
7 medical services under this chapter.
8 (12) "Resident" means a person with a home, house, place of abode, place
9 of habitation, dwelling or place where he or she actually lived for a consecu-
10 tive period of thirty (30) days or more within the state of Idaho. A resident
11 does not include a person who comes into this state for temporary purposes,
12 including, but not limited to, education, vacation, or seasonal labor. Entry
13 into active military duty shall not change a person's residence for the pur-
14 poses of this chapter. Those physically present within the following facili-
15 ties and institutions shall be residents of the county where they were resi-
16 dents prior to entering the facility or institution:
17 (a) Correctional facilities;
18 (b) Nursing homes or residential or assisted living facilities;
19 (c) Other medical facility or institution.
20 (13) "Emergency service" means a service provided for a medical condition
21 in which sudden, serious and unexpected symptoms of illness or injury are suf-
22 ficiently severe to necessitate or call for immediate medical care.
23 (14) "Provider" means any person, firm, or corporation certified or
24 licensed by the state of Idaho or holding an equivalent license or certifica-
25 tion in another state, that provides necessary medical services as it appears
26 on an application for assistance pursuant to this chapter.
27 (15) "Third party applicant" means a person other than an obligated person
28 who completes, signs and files an application on behalf of a patient.
29 (16) "Clerk" means the clerk of the board or his or her designee.
30 (17) "Resources" means all property, whether tangible or intangible, real
31 or personal, liquid or nonliquid, including, but not limited to, all forms of
32 public assistance, crime victim's compensation, worker's compensation, vet-
33 erans benefits, medicaid, medicare and any other property from any source for
34 which an applicant and/or an obligated person may be eligible or in which he
35 or she may have an interest. Resources shall include the ability of an appli-
36 cant and obligated persons to pay for necessary medical services over a period
37 of up to three (3) years. For purposes of determining approval for medical
38 indigency only, resources shall not include the value of the homestead on the
39 applicant or obligated persons' residence, a burial plot, exemptions for per-
40 sonal property allowed in section 11-605(1) through (3), Idaho Code, and addi-
41 tional exemptions allowed by county resolution.
42 (18) A. "Necessary medical services" means a requested or provided medi-
43 cal service required in order to identify or treat a medically indigent
44 person's health condition, illness or injury and is:
45 (a) Consistent with the symptoms, diagnosis or treatment of the med-
46 ical indigent's condition, illness or injury;
47 (b) In accordance with generally accepted standards of medical or
48 surgical practice then prevailing in the community where the services
49 were provided;
50 (c) Furnished on an outpatient basis whenever it is safe, efficient
51 and reasonable to do so;
52 (d) Not provided primarily for the convenience of the medically
53 indigent person or the provider;
54 (e) The standard, most economical service or item that can safely,
55 reasonably and ethically be provided.
3
1 B. Necessary medical services shall not include the following:
2 (a) Bone marrow transplants;
3 (b) Organ transplants;
4 (c) Elective, cosmetic and/or experimental procedures;
5 (d) Services related to, or provided by, residential and/or shelter
6 care facilities;
7 (e) Normal, uncomplicated pregnancies, excluding caesarean section,
8 and childbirth well-baby care;
9 (f) Medicare copayments and deductibles; and
10 (g) Services provided by, or available to an applicant from state,
11 federal and local health programs; and
12 (h) Any medical service previously provided by the state medical
13 assistance program or the regional mental health services act prior
14 to the effective date of this act pursuant to chapter 2, title 56 or
15 chapter 31, title 39, Idaho Code, and any rules promulgated pursuant
16 thereto.
17 Provided however, each board may determine, by ordinance or resolution
18 duly adopted in its county, to include as necessary medical services addi-
19 tional services not covered in this section. Necessary medical services pro-
20 vided by this option shall not be paid by the catastrophic health care costs
21 program, and shall remain the liability of the respective county.
22 SECTION 2. An emergency existing therefor, which emergency is hereby
23 declared to exist, this act shall be in full force and effect on and after its
24 passage and approval.
|||| LEGISLATURE OF THE STATE OF IDAHO ||||
Fifty-sixth Legislature Second Regular Session - 2002
Moved by Loertscher
Seconded by Sali
IN THE HOUSE OF REPRESENTATIVES
HOUSE AMENDMENT TO H.B. NO. 677
1 AMENDMENT TO SECTION 1
2 On page 3 of the printed bill, delete lines 12 through 16 and insert:
3 "(h) Medical services previously provided under state medical assis-
4 tance programs pursuant to chapter 2, title 56, Idaho Code, or mental
5 health services pursuant to chapter 31, title 39, Idaho Code, or any
6 rules promulgated pursuant to either of those chapters, which ser-
7 vices are no longer reimbursed by the department of health and wel-
8 fare on or after the effective date of this paragraph.".
9 CORRECTION TO TITLE
10 On page 1, delete lines 4 through 6 and insert: "VICES PREVIOUSLY PROVIDED
11 UNDER STATE MEDICAL ASSISTANCE PROGRAMS PURSUANT TO CHAPTER 2, TITLE 56, IDAHO
12 CODE, OR MENTAL HEALTH SERVICES PURSUANT TO CHAPTER 31, TITLE 39, IDAHO CODE,
13 OR ANY RULES PROMULGATED PURSUANT TO THOSE TWO CHAPTERS, WHICH SERVICES ARE NO
14 LONGER REIMBURSED BY THE DEPARTMENT OF HEALTH AND WELFARE ON AND AFTER THE
15 EFFECTIVE DATE OF THIS ACT; AND DECLARING AN EMER-".
|||| LEGISLATURE OF THE STATE OF IDAHO ||||
Fifty-sixth Legislature Second Regular Session - 2002
IN THE HOUSE OF REPRESENTATIVES
HOUSE BILL NO. 677, As Amended
BY STATE AFFAIRS COMMITTEE
1 AN ACT
2 RELATING TO THE MEDICALLY INDIGENT; AMENDING SECTION 31-3502, IDAHO CODE, TO
3 PROVIDE THAT NECESSARY MEDICAL SERVICES SHALL NOT INCLUDE ANY MEDICAL SER-
4 VICES PREVIOUSLY PROVIDED UNDER STATE MEDICAL ASSISTANCE PROGRAMS PURSUANT
5 TO CHAPTER 2, TITLE 56, IDAHO CODE, OR MENTAL HEALTH SERVICES PURSUANT TO
6 CHAPTER 31, TITLE 39, IDAHO CODE, OR ANY RULES PROMULGATED PURSUANT TO
7 THOSE TWO CHAPTERS, WHICH SERVICES ARE NO LONGER REIMBURSED BY THE DEPART-
8 MENT OF HEALTH AND WELFARE ON AND AFTER THE EFFECTIVE DATE OF THIS ACT;
9 AND DECLARING AN EMERGENCY.
10 Be It Enacted by the Legislature of the State of Idaho:
11 SECTION 1. That Section 31-3502, Idaho Code, be, and the same is hereby
12 amended to read as follows:
13 31-3502. DEFINITIONS. As used in this chapter, the terms defined in this
14 section shall have the following meaning, unless the context clearly indicates
15 another meaning:
16 (1) "Medically indigent" means any person who is in need of necessary
17 medical services and who, if an adult, together with his or her spouse, or
18 whose parents or guardian if a minor, does not have income and other resources
19 available to him from whatever source sufficient to pay for necessary medical
20 services. Nothing in this definition shall prevent the board of county commis-
21 sioners and administrator from requiring the applicant and obligated persons
22 to reimburse the county and the catastrophic health care costs program, where
23 appropriate, for all or a portion of their medical expenses, when investiga-
24 tion of their application pursuant to this chapter, determines their ability
25 to do so.
26 (2) "Hospital" means a facility licensed and regulated pursuant to sec-
27 tions 39-1301 through 39-1314, Idaho Code, excluding state institutions.
28 (3) "Dependent" means any person whom a taxpayer could claim as a depend-
29 ent under the income tax laws of the state of Idaho.
30 (4) "Applicant" means any person who is or may be requesting financial
31 assistance under this chapter.
32 (5) "Reimbursement rates" means the unadjusted medicaid rate of reim-
33 bursement for medical charges allowed pursuant to title XIX of the social
34 security act, as amended. For long-term care facilities, maximum
35 "reimbursement rates" means the unadjusted medicaid rate of reimbursement
36 allowed pursuant to the medical assistance program as determined by chapter 1,
37 title 56, Idaho Code, or the unadjusted medicare rate of reimbursement estab-
38 lished under title XVIII of the social security act, as amended, whichever is
39 greater.
40 (6) "Board" means the board of county commissioners.
41 (7) "Obligated persons" means those persons who are legally responsible
42 for an applicant.
43 (8) "County hospital" means any county approved institution or facility
2
1 for the care of sick persons.
2 (9) "Administrator" means the board of the catastrophic health care cost
3 program, as provided in section 31-3517, Idaho Code.
4 (10) "Catastrophic health care costs" means all necessary medical expenses
5 for services which are incurred by a recipient for which the reimbursement
6 rate exceeds in aggregate the sum of ten thousand dollars ($10,000) in any
7 twelve (12) consecutive month period.
8 (11) "Recipient" means an individual determined eligible for necessary
9 medical services under this chapter.
10 (12) "Resident" means a person with a home, house, place of abode, place
11 of habitation, dwelling or place where he or she actually lived for a consecu-
12 tive period of thirty (30) days or more within the state of Idaho. A resident
13 does not include a person who comes into this state for temporary purposes,
14 including, but not limited to, education, vacation, or seasonal labor. Entry
15 into active military duty shall not change a person's residence for the pur-
16 poses of this chapter. Those physically present within the following facili-
17 ties and institutions shall be residents of the county where they were resi-
18 dents prior to entering the facility or institution:
19 (a) Correctional facilities;
20 (b) Nursing homes or residential or assisted living facilities;
21 (c) Other medical facility or institution.
22 (13) "Emergency service" means a service provided for a medical condition
23 in which sudden, serious and unexpected symptoms of illness or injury are suf-
24 ficiently severe to necessitate or call for immediate medical care.
25 (14) "Provider" means any person, firm, or corporation certified or
26 licensed by the state of Idaho or holding an equivalent license or certifica-
27 tion in another state, that provides necessary medical services as it appears
28 on an application for assistance pursuant to this chapter.
29 (15) "Third party applicant" means a person other than an obligated person
30 who completes, signs and files an application on behalf of a patient.
31 (16) "Clerk" means the clerk of the board or his or her designee.
32 (17) "Resources" means all property, whether tangible or intangible, real
33 or personal, liquid or nonliquid, including, but not limited to, all forms of
34 public assistance, crime victim's compensation, worker's compensation, vet-
35 erans benefits, medicaid, medicare and any other property from any source for
36 which an applicant and/or an obligated person may be eligible or in which he
37 or she may have an interest. Resources shall include the ability of an appli-
38 cant and obligated persons to pay for necessary medical services over a period
39 of up to three (3) years. For purposes of determining approval for medical
40 indigency only, resources shall not include the value of the homestead on the
41 applicant or obligated persons' residence, a burial plot, exemptions for per-
42 sonal property allowed in section 11-605(1) through (3), Idaho Code, and addi-
43 tional exemptions allowed by county resolution.
44 (18) A. "Necessary medical services" means a requested or provided medi-
45 cal service required in order to identify or treat a medically indigent
46 person's health condition, illness or injury and is:
47 (a) Consistent with the symptoms, diagnosis or treatment of the med-
48 ical indigent's condition, illness or injury;
49 (b) In accordance with generally accepted standards of medical or
50 surgical practice then prevailing in the community where the services
51 were provided;
52 (c) Furnished on an outpatient basis whenever it is safe, efficient
53 and reasonable to do so;
54 (d) Not provided primarily for the convenience of the medically
55 indigent person or the provider;
3
1 (e) The standard, most economical service or item that can safely,
2 reasonably and ethically be provided.
3 B. Necessary medical services shall not include the following:
4 (a) Bone marrow transplants;
5 (b) Organ transplants;
6 (c) Elective, cosmetic and/or experimental procedures;
7 (d) Services related to, or provided by, residential and/or shelter
8 care facilities;
9 (e) Normal, uncomplicated pregnancies, excluding caesarean section,
10 and childbirth well-baby care;
11 (f) Medicare copayments and deductibles; and
12 (g) Services provided by, or available to an applicant from state,
13 federal and local health programs; and
14 (h) Medical services previously provided under state medical assis-
15 tance programs pursuant to chapter 2, title 56, Idaho Code, or mental
16 health services pursuant to chapter 31, title 39, Idaho Code, or any
17 rules promulgated pursuant to either of those chapters, which ser-
18 vices are no longer reimbursed by the department of health and wel-
19 fare on or after the effective date of this paragraph.
20 Provided however, each board may determine, by ordinance or resolution
21 duly adopted in its county, to include as necessary medical services addi-
22 tional services not covered in this section. Necessary medical services pro-
23 vided by this option shall not be paid by the catastrophic health care costs
24 program, and shall remain the liability of the respective county.
25 SECTION 2. An emergency existing therefor, which emergency is hereby
26 declared to exist, this act shall be in full force and effect on and after its
27 passage and approval.
STATEMENT OF PURPOSE
RS l2l37Cl
This legislation clarifies that should reductions in Medicaid occur
that Counties would not have an unfunded mandate to provide those
services.
FISCAL IMPACT
No fiscal impact.
Contact
Name: Rep. Tom Loertscher
Phone: (208) 332-1000
STATEMENT OF PURPOSE/FISCAL NOTE H 677