2005 Legislation
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HOUSE BILL NO. 321 – Medical assistance, pharmacy copay

HOUSE BILL NO. 321

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Bill Status



H0321.....................................................by WAYS AND MEANS
MEDICAL ASSISTANCE - Adds to and amends existing law to provide that
certain medical assistance recipients, their spouses or parents pay
copayments for prescription and over-the-counter drugs; to provide services
for which no copayments shall be charged; to provide the maximum amount of
a copayment; to provide for the inability to make a required copayment; to
provide for waivers; to provide for rules; and to revise the medicaid
pharmacy reimbursement rates.
                                                                        
03/11    House intro - 1st rdg - to printing
03/14    Rpt prt - to Health/Wel

Bill Text


                                                                        
                                                                        
  ]]]]              LEGISLATURE OF THE STATE OF IDAHO             ]]]]
 Fifty-eighth Legislature                   First Regular Session - 2005
                                                                        
                                                                        
                              IN THE HOUSE OF REPRESENTATIVES
                                                                        
                                     HOUSE BILL NO. 321
                                                                        
                                BY WAYS AND MEANS COMMITTEE
                                                                        
  1                                        AN ACT
  2    RELATING TO STATE MEDICAL ASSISTANCE; AMENDING  CHAPTER  2,  TITLE  56,  IDAHO
  3        CODE,  BY  THE  ADDITION  OF A NEW SECTION 56-209q, IDAHO CODE, TO PROVIDE
  4        THAT CERTAIN MEDICAL ASSISTANCE RECIPIENTS, THEIR SPOUSES, OR PARENTS  PAY
  5        COPAYMENTS  FOR  PRESCRIPTION  AND OVER-THE-COUNTER DRUGS, TO PROVIDE SER-
  6        VICES FOR WHICH NO COPAYMENTS SHALL BE CHARGED,  TO  PROVIDE  THE  MAXIMUM
  7        AMOUNT  OF  A  COPAYMENT,  TO  PROVIDE  FOR THE INABILITY TO MAKE REQUIRED
  8        COPAYMENT, TO PROVIDE FOR WAIVERS AND TO PROVIDE FOR RULES;  AND  AMENDING
  9        SECTION 56-209g, IDAHO CODE, TO REVISE THE MEDICAID PHARMACY REIMBURSEMENT
 10        LEVELS.
                                                                        
 11    Be It Enacted by the Legislature of the State of Idaho:
                                                                        
 12        SECTION  1.  That  Chapter  2,  Title  56, Idaho Code, be, and the same is
 13    hereby amended by the addition thereto of a NEW SECTION, to be known and  des-
 14    ignated as Section 56-209q, Idaho Code, and to read as follows:
                                                                        
 15        56-209q.  MEDICAL   ASSISTANCE   RECIPIENTS   TO   PAY  ALLOWABLE  NOMINAL
 16    COPAYMENTS. (1) The department of health and welfare shall  institute  nominal
 17    copayments or similar charges as provided in subsection (3) of this section to
 18    be paid by medical assistance recipients, their spouses, or parents, under the
 19    provisions of section 1916 of title XIX of the federal social security act, 42
 20    U.S.C. section 1396o.
 21        (2)  Copayments  or similar charges shall not be imposed for the following
 22    services:
 23        (a)  All services provided to children under eighteen (18) years of age;
 24        (b)  All services furnished to pregnant women, if the services  relate  to
 25        the  pregnancy  or to any other medical condition which may complicate the
 26        pregnancy;
 27        (c)  Emergency services  including  hospital,  clinic,  office,  or  other
 28        facility  services  which  are  necessary  to prevent the death or serious
 29        impairment of the individual;
 30        (d)  Services furnished to institutionalized individuals if the individual
 31        is required, as a condition of receiving services, to spend all but a min-
 32        imal amount of income for personal needs;
 33        (e)  Services furnished for an individual who is receiving hospice care as
 34        defined under section 1905 of title XIX of  the  federal  social  security
 35        act, 42 U.S.C section 1396d(o); and
 36        (f)  Other  services  excluded from cost sharing by federal law or regula-
 37        tion.
 38        (3)  A standard nominal copayment  per  service,  not  to  exceed  amounts
 39    allowable  under section 1916 of title XIX of the federal social security act,
 40    42 U.S.C. section 1396o, shall be collected by the provider  and  charged  for
 41    prescription  and over-the-counter drugs.  Any copayment for a prescription or
 42    over-the-counter drug shall not exceed one dollar ($1.00).
 43        (4)  No provider participating in the  medical  assistance  program  shall
                                                                        
                                           2
                                                                        
  1    deny services to any eligible recipient due to the inability of a recipient to
  2    make  the  required  copayment.  This provision shall not excuse the recipient
  3    from liability for payment of the charge.
  4        (5)  This section shall not limit copayments by  eligible  populations  if
  5    pilot programs or waivers are permitted by the federal government.
  6        (6)  The director of the department of health and welfare shall promulgate
  7    rules to implement the provisions of this section.
                                                                        
  8        SECTION  2.  That  Section 56-209g, Idaho Code, be, and the same is hereby
  9    amended to read as follows:
                                                                        
 10        56-209g.  PHARMACY REIMBURSEMENT. Medicaid pharmacy  reimbursement  levels
 11    are  a combination of the cost of the drug and a dispensing fee which includes
 12    such pharmaceutical care services as counseling, obtaining a patient  history,
 13    documentation,  and  dispensing.  From and after January 1, 1995, through June
 14    30, 1998 July 1, 2005, it shall be the policy of the state of Idaho that there
 15    be no a one dollar ($1.00) reduction of all dispensing fees. The  director  of
 16    the  department  of health and welfare shall set pharmacy reimbursement levels
 17    through state rule promulgation for medicaid under title  XIX  of  the  social
 18    security  act  except  as necessary to comply with federal regulations, 42 CFR
 19    447.331 through 447.334, as implemented in the state of Idaho. Effective  July
 20    1,  1998,  pharmacy  reimbursement levels, except for dispensing fees,  may be
 21    adjusted in accordance with rules promulgated by the director through  negoti-
 22    ated rulemaking with interested parties including representatives of the phar-
 23    macy profession.

Statement of Purpose / Fiscal Impact



                       STATEMENT OF PURPOSE

                            RS 15085C2

This legislation would provide that certain medical assistance
recipients, their spouses or parents pay copayments for certain
medical procedures.  In addition, this legislation would provide
for exceptions, for the maximum amount of copayment, the
inability to make required payment, and revision of the Medicaid
pharmacy reimbursement level.


                           FISCAL NOTE

At a minimum, the saving to the general fund is estimated to be
$525,000.  The Department of Health and Welfare reports there
were 2.6 million prescriptions filled during calendar year 2004. 
A conservative estimate is that of that total 1.75 million are
subject to a dispensing fee.  The savings generated by requiring
a co-payment are shared with the federal government.

1.75 million x $1.00=$1,750,000 x 30%= $525,000 savings to general fund 




Contact
Name:  Representative Block
       Representative Garrett
       Representative McGeachin
       Representative Henbest
Phone: 332-1120



STATEMENT OF PURPOSE/FISCAL NOTE                      H 321