2006 Legislation
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HOUSE BILL NO. 663 – Medicaid, personal hlth acct/copymt

HOUSE BILL NO. 663

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Bill Status



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

Bill Text


                                                                        
                                                                        
  ]]]]              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.

Amendment


                                                                        
                                                                        
  ]]]]              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.".

Engrossed Bill (Original Bill with Amendment(s) Incorporated)


                                                                        
                                                                        
  ]]]]              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 / Fiscal Impact



                       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