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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
]]]] 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 June14 30, 1998July 1, 2005, it shall be the policy of the state of Idaho that there 15 be noa 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 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