2006 Legislation
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HOUSE BILL NO. 776 – Medicaid Simplification Act

HOUSE BILL NO. 776

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Bill Status



H0776......................................................by STATE AFFAIRS
MEDICAID SIMPLIFICATION ACT - Adds to existing law relating to the Medicaid
Simplification Act to provide a short title; to state legislative intent;
to provide definitions; to provide powers and duties of the Director of the
Department of Health and Welfare; to provide for medical assistance
payments by the Department of Health and Welfare to or on behalf of
designated categories of eligible persons; to permit the Department of
Health and Welfare to make payment for medically necessary services
furnished by providers to designate categories of eligible participants;
and to specify the services for which payment may be made.
                                                                        
03/07    House intro - 1st rdg - to printing
03/08    Rpt prt - to Health/Wel
03/09    Rpt out - rec d/p - to 2nd rdg
03/10    2nd rdg - to 3rd rdg
03/14    3rd rdg - PASSED - 56-11-3
      AYES -- Anderson, Andrus, Barraclough, Bastian, Bedke, Bell, Bilbao,
      Block, Boe, Bolz, Bradford, Cannon, Chadderdon, Clark, Collins, Deal,
      Denney, Edmunson, Ellsworth, Eskridge, Field(18), Field(23), Garrett,
      Harwood, Henbest, Henderson, Jaquet, Kemp, Lake, Martinez, Mathews,
      Miller, Mitchell, Moyle, Nonini, Pasley-Stuart, Pence, Raybould,
      Ring, Ringo, Roberts, Rusche, Rydalch, Sayler, Schaefer, Shepherd(2),
      Shirley, Skippen, Smith(30), Smith(24), Smylie, Snodgrass, Stevenson,
      Trail, Wills, Mr. Speaker
      NAYS -- Barrett, Bayer, Hart, LeFavour, Loertscher, McGeachin,
      McKague, Nielsen, Sali, Shepherd(8), Wood
      Absent and excused -- Black, Brackett, Crow
    Floor Sponsor - Block
    Title apvd - to Senate
03/14    Senate intro - 1st rdg - to Health/Wel
03/21    Rpt out - rec d/p - to 2nd rdg
03/22    2nd rdg - to 3rd rdg
03/23    3rd rdg - PASSED - 33-0-2
      AYES -- Andreason, Broadsword, Bunderson, Burkett(Clark), Burtenshaw,
      Cameron, Coiner, Compton, Corder, Darrington, Davis, Fulcher, 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 -- Brandt, Gannon
    Floor Sponsors - Compton, Broadsword & Darrington
    Title apvd - to House
03/24    To enrol
03/27    Rpt enrol - Sp signed
03/28    Pres signed
03/29    To Governor
03/31    Governor signed
         Session Law Chapter 278
         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. 776
                                                                        
                                 BY STATE AFFAIRS COMMITTEE
                                                                        
  1                                        AN ACT
  2    RELATING TO MEDICAID; AMENDING CHAPTER 2, TITLE 56, IDAHO CODE, BY  THE  ADDI-
  3        TION  OF   NEW SECTIONS 56-250, 56-251, 56-252, 56-253, 56-254 AND 56-255,
  4        IDAHO CODE, TO PROVIDE A SHORT TITLE, TO STATE LEGISLATIVE INTENT, TO PRO-
  5        VIDE DEFINITIONS, TO PROVIDE POWERS AND DUTIES  OF  THE  DIRECTOR  OF  THE
  6        DEPARTMENT  OF  HEALTH AND WELFARE, TO PROVIDE FOR MEDICAL ASSISTANCE PAY-
  7        MENTS BY THE DEPARTMENT TO OR ON BEHALF OF DESIGNATED CATEGORIES OF ELIGI-
  8        BLE PERSONS, TO PERMIT THE DEPARTMENT TO MAKE PAYMENTS FOR MEDICALLY  NEC-
  9        ESSARY  SERVICES FURNISHED BY PROVIDERS TO DESIGNATED CATEGORIES OF ELIGI-
 10        BLE PARTICIPANTS AND TO SPECIFY THE SERVICES FOR  WHICH  PAYMENTS  MAY  BE
 11        MADE.
                                                                        
 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 56-250, 56-251, 56-252, 56-253,  56-254  and  56-255,  Idaho
 16    Code, and to read as follows:
                                                                        
 17        56-250.  SHORT  TITLE.  This  act  shall  be known and may be cited as the
 18    "Idaho Medicaid Simplification Act."
                                                                        
 19        56-251.  LEGISLATIVE INTENT. (1) The legislature finds  that  the  current
 20    federal  medicaid  law  and  regulations have not kept pace with modern health
 21    care management practices, create obstacles to quality care and impose  unnec-
 22    essary  costs on the delivery of effective and efficient health care. The leg-
 23    islature believes that the state of Idaho must strive to  balance  efforts  to
 24    contain  medicaid  costs,  improve  program quality and improve access to ser-
 25    vices. The legislature further believes that the state of Idaho could  achieve
 26    improved  health outcomes for medicaid participants by simplifying eligibility
 27    and developing health benefits for medicaid participants  according  to  their
 28    health needs, including appropriate preventive and wellness services.
 29        (2)  The  legislature supports development, at a minimum, of the following
 30    health-need categories:
 31        (a)  Low-Income Children and Working-Age Adults. The broad policy goal for
 32        the medicaid program for low-income children and working-age adults is  to
 33        achieve and maintain wellness by emphasizing prevention and by proactively
 34        managing health. Additional specific goals are:
 35             (i)   To emphasize preventive care and wellness;
 36             (ii)  To  increase  participant  ability to make good health choices;
 37             and
 38             (iii) To strengthen the employer-based health insurance system.
 39        (b)  Persons with Disabilities or Special Health Needs. The  broad  policy
 40        goal  for  the  medicaid  program for persons with disabilities or special
 41        health needs is to finance and deliver cost-effective individualized care.
 42        Additional specific goals are:
                                                                        
                                           2
                                                                        
  1             (i)   To emphasize preventive care and wellness;
  2             (ii)  To empower individuals with disabilities to  manage  their  own
  3             lives;
  4             (iii) To  provide  opportunities for employment for persons with dis-
  5             abilities; and
  6             (iv)  To provide and  to  promote  family-centered,  community-based,
  7             coordinated care for children with special health care needs.
  8        (c)  Elders. The broad policy goal for the medicaid program for elders is
  9        to  finance  and deliver cost-effective individualized care which is inte-
 10        grated, to the greatest extent possible,  with  medicare  coverage.  Addi-
 11        tional specific goals are:
 12             (i)   To emphasize preventive care and wellness;
 13             (ii)  To improve coordination between medicaid and medicare coverage;
 14             (iii) To increase nonpublic financing options for long-term care; and
 15             (iv)  To ensure participants' dignity and quality of life.
 16        (3)  To  the  extent practicable, the department shall achieve savings and
 17    efficiencies through use of modern care management practices, in areas such as
 18    network management, cost-sharing, benefit design and premium assistance.
 19        (4)  The department's duty to implement these changes in  accordance  with
 20    the intent of the legislature is contingent upon federal approval.
                                                                        
 21        56-252.  DEFINITIONS.  As  used  in  sections 56-250 through 56-255, Idaho
 22    Code:
 23        (1)  "Benefit design" means selection of services, providers  and  benefi-
 24    ciary cost-sharing to create the scope of coverage for participants.
 25        (2)  "Community  supports" means services that promote the ability of per-
 26    sons with disabilities to be self-sufficient and live independently  in  their
 27    own communities.
 28        (3)  "Cost-sharing"  means  participant  payment for a portion of medicaid
 29    service costs such as deductibles, coinsurance or copayment amounts.
 30        (4)  "Department" means the department of health and welfare.
 31        (5)  "Director" means the director of the department of  health  and  wel-
 32    fare.
 33        (6)  "Health risk assessment" means a process of assessing the health sta-
 34    tus and health needs of participants.
 35        (7)  "Medicaid" means Idaho's medical assistance program.
 36        (8)  "Medical  assistance"  means  payments for part or all of the cost of
 37    services funded by titles XIX or XXI of the federal  social  security  act  as
 38    amended, as may be designated by department rule.
 39        (9)  "Medical  home"  means  a primary care case manager designated by the
 40    participant or the department to coordinate the participant's care.
 41        (10) "Network management" means establishment and management of  contracts
 42    between the department and limited groups of providers or suppliers of medical
 43    and other services to participants.
 44        (11) "Participant"  means  a person eligible for and enrolled in the Idaho
 45    medical assistance program.
 46        (12) "Premium assistance" means use of medicaid funds to pay part  or  all
 47    of  the  costs of enrolling eligible individuals into private insurance cover-
 48    age.
 49        (13) "Primary care case manager" means a primary care physician  who  con-
 50    tracts with medicaid to coordinate the care of certain participants.
 51        (14) "Provider"  means  any individual, partnership, association, corpora-
 52    tion or  organization,  public  or  private,  which  provides  residential  or
 53    assisted  living  services,  certified  family home services, nursing facility
 54    services or services offered pursuant to medical assistance.
                                                                        
                                           3
                                                                        
  1        (15) "Self-determination" means medicaid services that allow persons  with
  2    disabilities  to  exercise  choice  and control over the services and supports
  3    they receive.
  4        (16) "State plan" means the contract between the state and federal govern-
  5    ment under 42 U.S.C. section 1396a(a).
                                                                        
  6        56-253.  POWERS AND DUTIES OF THE DIRECTOR. (1)  The  director  is  hereby
  7    encouraged and empowered to obtain federal approval in order that Idaho design
  8    and implement changes to its medicaid program that advance the quality of ser-
  9    vices  to participants while allowing access to needed services and containing
 10    excessive costs. The design of Idaho's medicaid program shall incorporate  the
 11    concepts expressed in section 56-251, Idaho Code.
 12        (2)  The  director  may  create  health-need  categories  other than those
 13    stated in section 56-251(2)(a), Idaho Code, subject to  legislative  approval,
 14    and may develop a medicaid state plan for each category.
 15        (3)  Each  state  plan shall include explicit policy goals for the covered
 16    population identified in the plan,  as  well  as  specific  benefit  packages,
 17    delivery system components and performance measures in accordance with section
 18    67-1904, Idaho Code.
 19        (4)  The  director shall establish a mechanism to ensure placement of par-
 20    ticipants into the appropriate state plan. This mechanism shall  include,  but
 21    not be limited to, a health risk assessment. This assessment shall comply with
 22    federal requirements for early and periodic screening, diagnosis and treatment
 23    (EPSDT) services for children, in accordance with section 1905(a)(4)(B) of the
 24    social security act.
 25        (5)  The  director  may require, subject to federal approval, participants
 26    to designate a medical home. Applicants for medical assistance  shall  receive
 27    information  about primary care case management, and, if required to so desig-
 28    nate, shall select a primary care provider as part of the eligibility determi-
 29    nation process.
 30        (6)  The director may, subject to federal approval, enter  into  contracts
 31    for  medical and other services when such contracts are beneficial to partici-
 32    pant health outcomes as well as economically prudent for the medicaid program.
 33        (7)  The director may obtain agreements from  medicare,  school  districts
 34    and  other entities to provide medical care if it is practical and cost-effec-
 35    tive.
 36        (8)  The director is given authority to promulgate rules  consistent  with
 37    this act.
                                                                        
 38        56-254.  ELIGIBILITY  FOR  MEDICAL  ASSISTANCE.  The department shall make
 39    payments for medical assistance to, or on behalf  of,  the  following  persons
 40    eligible for medical assistance.
 41        (1)  The  state  plan  for  low-income  children  and  working-age  adults
 42    includes the following persons:
 43        (a)  Children  in families whose family income does not exceed one hundred
 44        eighty-five percent (185%) of the federal poverty guideline and  who  meet
 45        age-related  and other eligibility standards in accordance with department
 46        rule;
 47        (b)  Pregnant women of any age whose family income  does  not  exceed  one
 48        hundred  thirty-three  percent (133%) of the federal poverty guideline and
 49        who meet other eligibility standards in accordance with  department  rule,
 50        or who meet the presumptive eligibility guidelines in accordance with sec-
 51        tion 1920 of the social security act;
 52        (c)  Infants  born to medicaid-eligible pregnant women. Medicaid eligibil-
 53        ity must be offered throughout the first year  of  life  so  long  as  the
                                                                        
                                           4
                                                                        
  1        infant  remains  in  the  mother's  household and she remains eligible, or
  2        would be eligible if she were still pregnant;
  3        (d)  Adults in families with dependent children as  described  in  section
  4        1931  of the social security act, who meet the requirements in the state's
  5        assistance to families with dependent children (AFDC) plan  in  effect  on
  6        July 16, 1996;
  7        (e)  Families  who  are provided six (6) to twelve (12) months of medicaid
  8        coverage  following loss of eligibility under section 1931 of  the  social
  9        security act due to earnings, or four (4) months of medicaid coverage fol-
 10        lowing  loss  of eligibility under section 1931 of the social security act
 11        due to an increase in child or spousal support;
 12        (f)  Employees of small businesses who meet the definition  of   "eligible
 13        adult"  as  described  in section 56-238, Idaho Code, whose eligibility is
 14        limited to the medical assistance program  described  in  section  56-241,
 15        Idaho Code; and
 16        (g)  All  other  mandatory  groups  as  defined in title XIX of the social
 17        security act, if not listed separately in subsection (2) or  (3)  of  this
 18        section.
 19        (2)  The  state plan for persons with disabilities or special health needs
 20    includes the following persons:
 21        (a)  Persons under age sixty-five (65) years eligible in  accordance  with
 22        title  XVI of the social security act, as well as persons eligible for aid
 23        to the aged, blind and disabled (AABD) under titles I, X and  XIV  of  the
 24        social security act;
 25        (b)  Persons  under  age sixty-five (65) years who are in need of the ser-
 26        vices of a licensed nursing facility, a licensed intermediate care  facil-
 27        ity  for  the  developmentally disabled, a state mental hospital, or home-
 28        based and community-based care, whose income does not exceed three hundred
 29        percent (300%) of the social security income (SSI) standard and  who  meet
 30        the  asset  standards  and  other eligibility standards in accordance with
 31        federal law and regulation, Idaho law and department rule;
 32        (c)  Certain disabled children  described  in  42  CFR  435.225  who  meet
 33        resource  limits for aid to the aged, blind and disabled (AABD) and income
 34        limits for social security income (SSI) and other eligibility standards in
 35        accordance with department rules;
 36        (d)  Persons under age sixty-five (65) years who are eligible for services
 37        under both titles XVIII and XIX of the social security act;
 38        (e)  Children who are eligible under title IV-E of the social security act
 39        for subsidized board payments, foster  care  or  adoption  subsidies,  and
 40        children  for  whom the state has assumed temporary or permanent responsi-
 41        bility and who do not qualify for title IV-E assistance but are in  foster
 42        care,  shelter  or emergency shelter care, or subsidized adoption, and who
 43        meet eligibility standards in accordance with department rule;
 44        (f)  Eligible women under age sixty-five (65) years  with  incomes  at  or
 45        below  two hundred percent (200%) of the federal poverty level, for cancer
 46        treatment pursuant to the federal breast and  cervical  cancer  prevention
 47        and treatment act of 2000;
 48        (g)  Low-income  children and working-age adults under age sixty-five (65)
 49        years who qualify under subsection (1) of this section and who require the
 50        services for persons with disabilities or special health needs  listed  in
 51        subsection 56-255(3), Idaho Code; and
 52        (h)  Persons  over  age sixty-five (65) years who choose to enroll in this
 53        state plan.
 54        (3)  The state plan for elders includes the following persons:
 55        (a)  Persons aged sixty-five (65) years or older  eligible  in  accordance
                                                                        
                                           5
                                                                        
  1        with title XVI of the social security act, as well as persons eligible for
  2        aid  to  the  aged, blind and disabled (AABD) under titles I, X and XIV of
  3        the social security act;
  4        (b)  Persons aged sixty-five (65) years or older who are in  need  of  the
  5        services  of  a  licensed  nursing  facility, a licensed intermediate care
  6        facility for the developmentally disabled, a  state  mental  hospital,  or
  7        home-based  and  community-based  care, whose income does not exceed three
  8        hundred percent (300%) of the social security income  (SSI)  standard  and
  9        who  meet  the assets standards and other eligibility standards  in accor-
 10        dance with federal and state law and department rule;
 11        (c)  Persons aged sixty-five (65) years or older who are eligible for ser-
 12        vices under both titles XVIII and XIX of the social security act who  have
 13        enrolled in the medicare program; and
 14        (d)  Persons under age sixty-five (65) years who are eligible for services
 15        under  both  titles XVIII and XIX of the social security act and who elect
 16        to enroll in this state plan.
                                                                        
 17        56-255.  MEDICAL ASSISTANCE PROGRAM -- SERVICES TO BE  PROVIDED.  (1)  The
 18    department may make payments for the following services furnished by providers
 19    to  participants  who  are determined to be eligible on the dates on which the
 20    services were provided. Any service under this  section  shall  be  reimbursed
 21    only  when  medically necessary and in accordance with federal law and regula-
 22    tion, Idaho law and department rule. Notwithstanding any  other  provision  of
 23    this  chapter,  medical assistance includes the following benefits specific to
 24    the eligibility categories established in  section  56-254(1),  (2)  and  (3),
 25    Idaho Code, as well as a list of benefits to which all Idaho medicaid partici-
 26    pants are entitled, defined in subsection (5) of this section.
 27        (2)  Specific  health benefits and limitations for low-income children and
 28    working-age adults include:
 29        (a)  All services described in subsection (5) of this section;
 30        (b)  Early and periodic screening, diagnosis and  treatment  services  for
 31        individuals  under  age twenty-one (21) years, and treatment of conditions
 32        found; and
 33        (c)  Cost-sharing required of participants. Participants in the low-income
 34        children and working-age adult group are subject to the following  premium
 35        payments, as stated in department rules:
 36             (i)  Participants  with family incomes equal to or less than one hun-
 37             dred thirty-three percent (133%) of the federal poverty guideline are
 38             not required to pay premiums; and
 39             (ii) Participants with family incomes above one hundred  thirty-three
 40             percent  (133%)  of the federal poverty guideline will be required to
 41             pay premiums in accordance with department rule.
 42        (3)  Specific health benefits for persons  with  disabilities  or  special
 43    health needs include:
 44        (a)  All services described in subsection (5) of this section;
 45        (b)  Early  and  periodic  screening, diagnosis and treatment services for
 46        individuals under age twenty-one (21) years, and treatment  of  conditions
 47        found;
 48        (c)  Case  management  services  as  defined in accordance with subsection
 49        1905(a)(19) or section 1915(g) of the social security act; and
 50        (d)  Mental health services, including:
 51             (i)   Inpatient psychiatric facility services whether in a  hospital,
 52             or for persons under age twenty-two (22) years in a freestanding psy-
 53             chiatric  facility,  as  permitted by federal law, in excess of those
 54             limits in department rules on inpatient psychiatric facility services
                                                                        
                                           6
                                                                        
  1             provided under subsection (5) of this section;
  2             (ii)  Outpatient mental health services in excess of those limits  in
  3             department  rules on outpatient mental health services provided under
  4             subsection (5) of this section;  and
  5             (iii) Psychosocial rehabilitation for reduction of mental  disability
  6             for children under the age of eighteen (18) years with a serious emo-
  7             tional  disturbance  (SED) and for severely and persistently mentally
  8             ill adults, aged eighteen (18) years or older, with severe  and  per-
  9             sistent mental illness;
 10        (e)  Long-term care services, including:
 11             (i)   Nursing  facility  services, other than services in an institu-
 12             tion for mental diseases, subject to participant cost-sharing;
 13             (ii)  Home-based and community-based  services,  subject  to  federal
 14             approval,  provided to individuals who require nursing facility level
 15             of care who, without home-based and community-based  services,  would
 16             require  institutionalization.  These services will include community
 17             supports, including an  option  for  self-determination,  which  will
 18             enable  individuals to have greater freedom to manage their own care;
 19             and
 20             (iii) Personal care services in a participant's home,  prescribed  in
 21             accordance  with a plan of treatment and provided by a qualified per-
 22             son under supervision of a registered nurse;
 23        (f)  Services for persons with developmental disabilities, including:
 24             (i)   Intermediate care facility services, other than  such  services
 25             in  an  institution  for  mental  diseases, for persons determined in
 26             accordance with section 1902(a)(31) of the social security act to  be
 27             in  need  of  such care, including such services in a public institu-
 28             tion, or distinct part thereof, for the mentally retarded or  persons
 29             with related conditions;
 30             (ii)  Home-based  and  community-based  services,  subject to federal
 31             approval, provided to individuals who require  an  intermediate  care
 32             facility  for the mentally retarded (ICF/MR) level of care who, with-
 33             out home-based and community-based services, would  require  institu-
 34             tionalization.   These  services  will  include  community  supports,
 35             including an option for self-determination, which will  enable  indi-
 36             viduals to have greater freedom to manage their own care; and
 37             (iii) Developmental  services. The department shall pay for rehabili-
 38             tative services, including medical or remedial services provided by a
 39             facility that has entered into a provider agreement with the  depart-
 40             ment  and  is certified as a developmental disabilities agency by the
 41             department;
 42        (g)  Home health services, including:
 43             (i)   Intermittent or part-time nursing services provided by  a  home
 44             health  agency  or  by  a registered nurse when no home health agency
 45             exists in the area;
 46             (ii)  Home health aide services provided by a home health agency; and
 47             (iii) Physical therapy, occupational therapy or speech pathology  and
 48             audiology  services provided by a home health agency or medical reha-
 49             bilitation facility;
 50        (h)  Hospice care in accordance with section 1905(o) of the  social  secu-
 51        rity act;
 52        (i)  Specialized medical equipment and supplies; and
 53        (j)  Medicare cost-sharing, including:
 54             (i)   Medicare  cost-sharing  for  qualified  medicare  beneficiaries
 55             described in section 1905(p) of the social security act;
                                                                        
                                           7
                                                                        
  1             (ii)  Medicare  part  A  premiums  for qualified disabled and working
  2             individuals described in section  1902(a)(10)(E)(ii)  of  the  social
  3             security act;
  4             (iii) Medicare part B premiums for specified low-income medicare ben-
  5             eficiaries  described  in  section  1902(a)(10)(E)(iii) of the social
  6             security act; and
  7             (iv)  Medicare part B premiums for qualifying  individuals  described
  8             in  section  1902(a)(10)(E)(iv)  and  subject  to section 1933 of the
  9             social security act.
 10        (4)  Specific health benefits for elders include:
 11        (a)  All services described in subsection (5) of this section, other  than
 12        if provided under the federal medicare program;
 13        (b)  All  services described in subsection (3) of this section, other than
 14        if provided under the federal medicare program; and
 15        (c)  Other services that supplement medicare coverage.
 16        (5)  Benefits for all medicaid participants, unless  specifically  limited
 17    in subsection (2), (3) or (4) of this section include the following:
 18        (a)  Health  care  coverage including, but not limited to, basic inpatient
 19        and outpatient medical services, and including:
 20             (i)    Physicians' services, whether furnished  in  the  office,  the
 21             patient's home, a hospital, a nursing facility or elsewhere;
 22             (ii)   Services  provided by a physician or other licensed practitio-
 23             ner to prevent disease, disability and  other  health  conditions  or
 24             their progressions, to prolong life, or to promote physical or mental
 25             health; and
 26             (iii)  Hospital care, including:
 27                  1.  Inpatient  hospital  services other than those services pro-
 28                  vided in an institution for mental diseases;
 29                  2.  Outpatient hospital services; and
 30                  3.  Emergency hospital services;
 31             (iv)   Laboratory and x-ray services;
 32             (v)    Prescribed drugs;
 33             (vi)   Family planning  services  and  supplies  for  individuals  of
 34             child-bearing age;
 35             (vii)  Certified pediatric or family nurse practitioners' services;
 36             (viii) Emergency medical transportation;
 37             (ix)   Mental health services, including:
 38                  1.  Outpatient  mental  health  services  that  are appropriate,
 39                  within limits stated in department rules; and
 40                  2.  Inpatient psychiatric facility services within limits stated
 41                  in department rules;
 42             (x)    Medical supplies, equipment, and appliances suitable  for  use
 43             in the home; and
 44             (xi)   Physical therapy and related services;
 45        (b)  Primary care case management;
 46        (c)  Dental  services,  and  medical  and surgical services furnished by a
 47        dentist in accordance with section 1905(a)(5)(B) of  the  social  security
 48        act;
 49        (d)  Medical  care  and  any  other type of remedial care recognized under
 50        Idaho law, furnished by licensed practitioners within the scope  of  their
 51        practice as defined by Idaho law, including:
 52             (i)   Podiatrists' services;
 53             (ii)  Optometrists' services;
 54             (iii) Chiropractors' services; and
 55             (iv)  Other  practitioners'  services,  in accordance with department
                                                                        
                                           8
                                                                        
  1             rules;
  2        (e)  Services for individuals with speech, hearing and language disorders,
  3        provided by or under the supervision of a speech pathologist  or  audiolo-
  4        gist;
  5        (f)  Eyeglasses  prescribed  by a physician skilled in diseases of the eye
  6        or by an optometrist;
  7        (g)  Services provided by essential providers, including:
  8             (i)   Rural health clinic services and other ambulatory services fur-
  9             nished    by  a  rural  health  clinic  in  accordance  with  section
 10             1905(l)(1) of the social security act;
 11             (ii)  Federally qualified health center  (FQHC)  services  and  other
 12             ambulatory  services that are covered under the plan and furnished by
 13             an FQHC in accordance with section 1905(l)(2) of the social  security
 14             act;
 15             (iii) Indian health services; and
 16             (iv)  District health departments;
 17        (h)  Any other medical care and any other type of remedial care recognized
 18        under  state  law, specified by the secretary of the federal department of
 19        health and human services;
 20        (i)  Nonemergency medical transportation; and
 21        (j)  Physician,  hospital  or  other  services  deemed  experimental   are
 22        excluded  from  coverage. The director may allow coverage of procedures or
 23        services deemed investigational if  the  procedures  or  services  are  as
 24        cost-effective as traditional, standard treatments.

Statement of Purpose / Fiscal Impact



                       STATEMENT OF PURPOSE

                             RS 16219

This bill authorizes the Director of the Idaho Department of
Health and Welfare to restructure the Idaho Medicaid program in
order to achieve improved health outcomes for Medicaid
participants and slow the rate of growth in Medicaid costs. The
bill simplifies current eligibility categories by establishing
three new population groups, based on participants' health needs.
The bill authorizes the Director to develop a State Plan for
Medical Assistance for each of the three groups. The bill further
describes the benefits for each of the three groups, in addition
to a global benefit list for all Idaho Medicaid participants.



                         FISCAL IMPACT

There is no impact to the general fund.






Contact
Name: Representative Sharon Block 
      Senator Richard L. "Dick" Compton
Phone: (208) 332-1000


STATEMENT OF PURPOSE/FISCAL NOTE                          H 776