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H0168.................................................by HEALTH AND WELFARE
PUBLIC ASSISTANCE - Amends existing law relating to public assistance to
define a term; to revise benefits for all medicaid participants; to remove
provisions on personal health account funding, use and disposition; and to
provide for use of preventive health assistance benefits.
02/09 House intro - 1st rdg - to printing
02/12 Rpt prt - to Health/Wel
02/23 Rpt out - rec d/p - to 2nd rdg
02/26 2nd rdg - to 3rd rdg
02/28 3rd rdg - PASSED - 70-0-0
AYES -- Anderson, Andrus, Barrett, Bayer, Bedke, Bell, Bilbao, Black,
Block, Bock, Boe, Bolz, Brackett, Bradford, Chadderdon, Chavez, Chew,
Clark, Collins, Crane, Durst, Edmunson, Eskridge, Hagedorn, Hart,
Harwood, Henbest, Henderson, Jaquet, Killen, King, Kren, Labrador,
Lake, LeFavour, Loertscher, Luker, Marriott, Mathews, McGeachin,
Mortimer, Moyle, Nielsen, Nonini, Pasley-Stuart, Patrick, Pence,
Raybould, Ring, Ringo, Roberts, Ruchti, Rusche, Sayler, Schaefer,
Shepherd(2), Shepherd(8), Shirley, Shively, Smith(30), Smith(24),
Snodgrass, Stevenson, Thayn, Trail, Vander Woude, Wills, Wood(27),
Wood(35), Mr. Speaker
NAYS -- None
Absent and excused -- None
Floor Sponsor - Block
Title apvd - to Senate
03/01 Senate intro - 1st rdg - to Health/Wel
03/13 Rpt out - rec d/p - to 2nd rdg
03/14 2nd rdg - to 3rd rdg
03/19 3rd rdg - PASSED - 32-0-3
AYES -- Andreason, Bair, Bastian, Bilyeu, Broadsword, Burkett,
Cameron, Coiner, Corder, Darrington, Davis, Geddes, Goedde, Hammond,
Heinrich, Hill, Jorgenson, Kelly, Keough, Langhorst, Little, Lodge,
McGee, McKague, McKenzie, Pearce, Richardson, Schroeder, Siddoway,
Stegner, Stennett, Werk
NAYS -- None
Absent and excused -- Fulcher, Gannon, Malepeai
Floor Sponsor - Coiner
Title apvd - to House
03/20 To enrol - Rpt enrol - Sp signed
03/21 Pres signed - To Governor
03/27 Governor signed
Session Law Chapter 200
Effective: 07/01/07
]]]] LEGISLATURE OF THE STATE OF IDAHO ]]]]
Fifty-ninth Legislature First Regular Session - 2007
IN THE HOUSE OF REPRESENTATIVES
HOUSE BILL NO. 168
BY HEALTH AND WELFARE COMMITTEE
1 AN ACT
2 RELATING TO PUBLIC ASSISTANCE; AMENDING SECTION 56-251, IDAHO CODE, TO PROVIDE
3 CORRECT TERMINOLOGY; AMENDING SECTION 56-252, IDAHO CODE, TO DEFINE A
4 TERM; AMENDING 56-253, IDAHO CODE, TO PROVIDE CORRECT TERMINOLOGY AND TO
5 PROVIDE A FEDERAL LAW REFERENCE; AMENDING SECTION 56-254, IDAHO CODE, TO
6 PROVIDE CORRECT TERMINOLOGY AND TO MAKE A TECHNICAL CORRECTION; AMENDING
7 SECTION 56-255, IDAHO CODE, TO PROVIDE CORRECT TERMINOLOGY AND TO REVISE
8 BENEFITS FOR ALL MEDICAID PARTICIPANTS AND TO MAKE A TECHNICAL CORRECTION;
9 AMENDING SECTION 56-256, IDAHO CODE, TO PROVIDE CORRECT TERMINOLOGY, TO
10 REMOVE PROVISIONS ON PERSONAL HEALTH ACCOUNT FUNDING, USE AND DISPOSITION
11 AND TO PROVIDE FOR USE OF PREVENTIVE HEALTH ASSISTANCE BENEFITS.
12 Be It Enacted by the Legislature of the State of Idaho:
13 SECTION 1. That Section 56-251, Idaho Code, be, and the same is hereby
14 amended to read as follows:
15 56-251. LEGISLATIVE INTENT. (1) The legislature finds that the current
16 federal medicaid law and regulations have not kept pace with modern health
17 care management practices, create obstacles to quality care and impose unnec-
18 essary costs on the delivery of effective and efficient health care. The leg-
19 islature believes that the state of Idaho must strive to balance efforts to
20 contain medicaid costs, improve program quality and improve access to ser-
21 vices. The legislature further believes that the state of Idaho could achieve
22 improved health outcomes for medicaid participants by simplifying eligibility
23 and developing health benefits for medicaid participants according to their
24 health needs, including appropriate preventive and wellness services.
25 (2) The legislature supports development, at a minimum, of the following
26 health-need categories:
27 (a) Low-Income Children and Working-Age Adults with No Special Health
28 Needs. The broad policy goal for the medicaid program for low-income chil-
29 dren and working-age adults with no special health needs is to achieve and
30 maintain wellness by emphasizing prevention and by proactively managing
31 health. Additional specific goals are:
32 (i) To emphasize preventive care and wellness;
33 (ii) To increase participant ability to make good health choices;
34 and
35 (iii) To strengthen the employer-based health insurance system.
36 (b) Persons with Disabilities or Special Health Needs. The broad policy
37 goal for the medicaid program for persons with disabilities or special
38 health needs is to finance and deliver cost-effective individualized care.
39 Additional specific goals are:
40 (i) To emphasize preventive care and wellness;
41 (ii) To empower individuals with disabilities to manage their own
42 lives;
43 (iii) To provide opportunities for employment for persons with dis-
2
1 abilities; and
2 (iv) To provide and to promote family-centered, community-based,
3 coordinated care for children with special health care needs.
4 (c) Elders Persons with Medicare and Medicaid Coverage. The broad policy
5 goal for the medicaid program for elders persons with medicare and medic-
6 aid coverage is to finance and deliver cost-effective individualized care
7 which is integrated, to the greatest extent possible, with medicare cover-
8 age. Additional specific goals are:
9 (i) To emphasize preventive care and wellness;
10 (ii) To improve coordination between medicaid and medicare coverage;
11 (iii) To increase nonpublic financing options for long-term care; and
12 (iv) To ensure participants' dignity and quality of life.
13 (3) To the extent practicable, the department shall achieve savings and
14 efficiencies through use of modern care management practices, in areas such as
15 network management, cost-sharing, benefit design and premium assistance.
16 (4) The department's duty to implement these changes in accordance with
17 the intent of the legislature is contingent upon federal approval.
18 SECTION 2. That Section 56-252, Idaho Code, be, and the same is hereby
19 amended to read as follows:
20 56-252. DEFINITIONS. As used in sections 56-250 through 56-255, Idaho
21 Code:
22 (1) "Benchmark plan" means a package of health benefits coverage that
23 provides coverage for a specified population in accordance with section 6044
24 of the deficit reduction act of 2005.
25 (2) "Benefit design" means selection of services, providers and benefi-
26 ciary cost-sharing to create the scope of coverage for participants.
27 (23) "Community supports" means services that promote the ability of per-
28 sons with disabilities to be self-sufficient and live independently in their
29 own communities.
30 (34) "Cost-sharing" means participant payment for a portion of medicaid
31 service costs such as deductibles, coinsurance or copayment amounts.
32 (45) "Department" means the department of health and welfare.
33 (56) "Director" means the director of the department of health and wel-
34 fare.
35 (67) "Health risk assessment" means a process of assessing the health
36 status and health needs of participants.
37 (78) "Medicaid" means Idaho's medical assistance program.
38 (89) "Medical assistance" means payments for part or all of the cost of
39 services funded by titles XIX or XXI of the federal social security act as
40 amended, as may be designated by department rule.
41 (910) "Medical home" means a primary care case manager designated by the
42 participant or the department to coordinate the participant's care.
43 (101) "Network management" means establishment and management of contracts
44 between the department and limited groups of providers or suppliers of medical
45 and other services to participants.
46 (112) "Participant" means a person eligible for and enrolled in the Idaho
47 medical assistance program.
48 (123) "Premium assistance" means use of medicaid funds to pay part or all
49 of the costs of enrolling eligible individuals into private insurance cover-
50 age.
51 (134) "Primary care case manager" means a primary care physician who con-
52 tracts with medicaid to coordinate the care of certain participants.
53 (145) "Provider" means any individual, partnership, association, corpora-
3
1 tion or organization, public or private, which provides residential or
2 assisted living services, certified family home services, nursing facility
3 services or services offered pursuant to medical assistance.
4 (156) "Self-determination" means medicaid services that allow persons with
5 disabilities to exercise choice and control over the services and supports
6 they receive.
7 (167) "State plan" means the contract between the state and federal gov-
8 ernment under 42 U.S.C. section 1396a(a).
9 SECTION 3. That Section 56-253, Idaho Code, be, and the same is hereby
10 amended to read as follows:
11 56-253. POWERS AND DUTIES OF THE DIRECTOR. (1) The director is hereby
12 encouraged and empowered to obtain federal approval in order that Idaho design
13 and implement changes to its medicaid program that advance the quality of ser-
14 vices to participants while allowing access to needed services and containing
15 excessive costs. The design of Idaho's medicaid program shall incorporate the
16 concepts expressed in section 56-251, Idaho Code.
17 (2) The director may create health-need categories other than those
18 stated in section 56-251(2)(a), Idaho Code, subject to legislative approval,
19 and may develop a medicaid state benchmark plan for each category.
20 (3) Each state benchmark plan shall include explicit policy goals for the
21 covered population identified in the plan, as well as specific benefit pack-
22 ages, delivery system components and performance measures in accordance with
23 section 67-1904, Idaho Code.
24 (4) The director shall establish a mechanism to ensure placement of par-
25 ticipants into the appropriate state benchmark plan as allowed under section
26 6044 of the deficit reduction act of 2005. This mechanism shall include, but
27 not be limited to, a health risk assessment. This assessment shall comply with
28 federal requirements for early and periodic screening, diagnosis and treatment
29 (EPSDT) services for children, in accordance with section 1905(a)(4)(B) of the
30 social security act.
31 (5) The director may require, subject to federal approval, participants
32 to designate a medical home. Applicants for medical assistance shall receive
33 information about primary care case management, and, if required to so desig-
34 nate, shall select a primary care provider as part of the eligibility determi-
35 nation process.
36 (6) The director may, subject to federal approval, enter into contracts
37 for medical and other services when such contracts are beneficial to partici-
38 pant health outcomes as well as economically prudent for the medicaid program.
39 (7) The director may obtain agreements from medicare, school districts
40 and other entities to provide medical care if it is practical and cost-effec-
41 tive.
42 (8) The director is given authority to promulgate rules consistent with
43 this act.
44 SECTION 4. That Section 56-254, Idaho Code, be, and the same is hereby
45 amended to read as follows:
46 56-254. ELIGIBILITY FOR MEDICAL ASSISTANCE. The department shall make
47 payments for medical assistance to, or on behalf of, the following persons
48 eligible for medical assistance.
49 (1) The state benchmark plan for low-income children and working-age
50 adults with no special health needs includes the following persons:
51 (a) Children in families whose family income does not exceed one hundred
4
1 eighty-five percent (185%) of the federal poverty guideline and who meet
2 age-related and other eligibility standards in accordance with department
3 rule;
4 (b) Pregnant women of any age whose family income does not exceed one
5 hundred thirty-three percent (133%) of the federal poverty guideline and
6 who meet other eligibility standards in accordance with department rule,
7 or who meet the presumptive eligibility guidelines in accordance with sec-
8 tion 1920 of the social security act;
9 (c) Infants born to medicaid-eligible pregnant women. Medicaid eligibil-
10 ity must be offered throughout the first year of life so long as the
11 infant remains in the mother's household and she remains eligible, or
12 would be eligible if she were still pregnant;
13 (d) Adults in families with dependent children as described in section
14 1931 of the social security act, who meet the requirements in the state's
15 assistance to families with dependent children (AFDC) plan in effect on
16 July 16, 1996;
17 (e) Families who are provided six (6) to twelve (12) months of medicaid
18 coverage following loss of eligibility under section 1931 of the social
19 security act due to earnings, or four (4) months of medicaid coverage fol-
20 lowing loss of eligibility under section 1931 of the social security act
21 due to an increase in child or spousal support;
22 (f) Employees of small businesses who meet the definition of "eligible
23 adult" as described in section 56-238, Idaho Code, whose eligibility is
24 limited to the medical assistance program described in section 56-241,
25 Idaho Code; and
26 (g) All other mandatory groups as defined in title XIX of the social
27 security act, if not listed separately in subsection (2) or (3) of this
28 section.
29 (2) The state benchmark plan for persons with disabilities or special
30 health needs includes the following persons:
31 (a) Persons under age sixty-five (65) years eligible in accordance with
32 title XVI of the social security act, as well as persons eligible for aid
33 to the aged, blind and disabled (AABD) under titles I, X and XIV of the
34 social security act;
35 (b) Persons under age sixty-five (65) years who are in need of the ser-
36 vices of a licensed nursing facility, a licensed intermediate care facil-
37 ity for the developmentally disabled, a state mental hospital, or home-
38 based and community-based care, whose income does not exceed three hundred
39 percent (300%) of the social security income (SSI) standard and who meet
40 the asset standards and other eligibility standards in accordance with
41 federal law and regulation, Idaho law and department rule;
42 (c) Certain disabled children described in 42 CFR 435.225 who meet
43 resource limits for aid to the aged, blind and disabled (AABD) and income
44 limits for social security income (SSI) and other eligibility standards in
45 accordance with department rules;
46 (d) Persons under age sixty-five (65) years who are eligible for services
47 under both titles XVIII and XIX of the social security act;
48 (e) Children who are eligible under title IV-E of the social security act
49 for subsidized board payments, foster care or adoption subsidies, and
50 children for whom the state has assumed temporary or permanent responsi-
51 bility and who do not qualify for title IV-E assistance but are in foster
52 care, shelter or emergency shelter care, or subsidized adoption, and who
53 meet eligibility standards in accordance with department rule;
54 (f) Eligible women under age sixty-five (65) years with incomes at or
55 below two hundred percent (200%) of the federal poverty level, for cancer
5
1 treatment pursuant to the federal breast and cervical cancer prevention
2 and treatment act of 2000;
3 (g) Low-income children and working-age adults under age sixty-five (65)
4 years who qualify under subsection (1) of this section and who require the
5 services for persons with disabilities or special health needs listed in
6 subsection 56-255(3), Idaho Code; and
7 (h) Persons over age sixty-five (65) years who choose to enroll in this
8 state plan.
9 (3) The state benchmark plan for elders persons over twenty-one (21)
10 years of age who have medicare and medicaid coverage includes the following
11 persons:
12 (a) Persons aged sixty-five (65) years or older eligible in accordance
13 with title XVI of the social security act, as well as persons eligible for
14 aid to the aged, blind and disabled (AABD) under titles I, X and XIV of
15 the social security act;
16 (b) Persons aged sixty-five (65) years or older who are in need of the
17 services of a licensed nursing facility, a licensed intermediate care
18 facility for the developmentally disabled, a state mental hospital, or
19 home-based and community-based care, whose income does not exceed three
20 hundred percent (300%) of the social security income (SSI) standard and
21 who meet the assets standards and other eligibility standards in accor-
22 dance with federal and state law and department rule;
23 (c) Persons aged sixty-five (65) years or older who are eligible for ser-
24 vices under both titles XVIII and XIX of the social security act who have
25 enrolled in the medicare program; and
26 (d) Persons under age sixty-five (65) years who are eligible for services
27 under both titles XVIII and XIX of the social security act and who elect
28 to enroll in this state plan.
29 SECTION 5. That Section 56-255, Idaho Code, be, and the same is hereby
30 amended to read as follows:
31 56-255. MEDICAL ASSISTANCE PROGRAM -- SERVICES TO BE PROVIDED. (1) The
32 department may make payments for the following services furnished by providers
33 to participants who are determined to be eligible on the dates on which the
34 services were provided. Any service under this section shall be reimbursed
35 only when medically necessary and in accordance with federal law and regula-
36 tion, Idaho law and department rule. Notwithstanding any other provision of
37 this chapter, medical assistance includes the following benefits specific to
38 the eligibility categories established in section 56-254(1), (2) and (3),
39 Idaho Code, as well as a list of benefits to which all Idaho medicaid partici-
40 pants are entitled, defined in subsection (5) of this section.
41 (2) Specific health benefits and limitations for low-income children and
42 working-age adults with no special health needs include:
43 (a) All services described in subsection (5) of this section;
44 (b) Early and periodic screening, diagnosis and treatment services for
45 individuals under age twenty-one (21) years, and treatment of conditions
46 found; and
47 (c) Cost-sharing required of participants. Participants in the low-income
48 children and working-age adult group are subject to the following premium
49 payments, as stated in department rules:
50 (i) Participants with family incomes equal to or less than one hun-
51 dred thirty-three percent (133%) of the federal poverty guideline are
52 not required to pay premiums; and
53 (ii) Participants with family incomes above one hundred thirty-three
6
1 percent (133%) of the federal poverty guideline will be required to
2 pay premiums in accordance with department rule.
3 (3) Specific health benefits for persons with disabilities or special
4 health needs include:
5 (a) All services described in subsection (5) of this section;
6 (b) Early and periodic screening, diagnosis and treatment services for
7 individuals under age twenty-one (21) years, and treatment of conditions
8 found;
9 (c) Case management services as defined in accordance with subsection
10 1905(a)(19) or section 1915(g) of the social security act; and
11 (d) Mental health services, including:
12 (i) Inpatient psychiatric facility services whether in a hospital,
13 or for persons under age twenty-two (22) years in a freestanding psy-
14 chiatric facility, as permitted by federal law, in excess of those
15 limits in department rules on inpatient psychiatric facility services
16 provided under subsection (5) of this section;
17 (ii) Outpatient mental health services in excess of those limits in
18 department rules on outpatient mental health services provided under
19 subsection (5) of this section; and
20 (iii) Psychosocial rehabilitation for reduction of mental disability
21 for children under the age of eighteen (18) years with a serious emo-
22 tional disturbance (SED) and for severely and persistently mentally
23 ill adults, aged eighteen (18) years or older, with severe and per-
24 sistent mental illness;
25 (e) Long-term care services, including:
26 (i) Nursing facility services, other than services in an institu-
27 tion for mental diseases, subject to participant cost-sharing;
28 (ii) Home-based and community-based services, subject to federal
29 approval, provided to individuals who require nursing facility level
30 of care who, without home-based and community-based services, would
31 require institutionalization. These services will include community
32 supports, including an option for self-determination, which will
33 enable individuals to have greater freedom to manage their own care;
34 and
35 (iii) Personal care services in a participant's home, prescribed in
36 accordance with a plan of treatment and provided by a qualified per-
37 son under supervision of a registered nurse;
38 (f) Services for persons with developmental disabilities, including:
39 (i) Intermediate care facility services, other than such services
40 in an institution for mental diseases, for persons determined in
41 accordance with section 1902(a)(31) of the social security act to be
42 in need of such care, including such services in a public institu-
43 tion, or distinct part thereof, for the mentally retarded or persons
44 with related conditions;
45 (ii) Home-based and community-based services, subject to federal
46 approval, provided to individuals who require an intermediate care
47 facility for the mentally retarded (ICF/MR) level of care who, with-
48 out home-based and community-based services, would require institu-
49 tionalization. These services will include community supports,
50 including an option for self-determination, which will enable indi-
51 viduals to have greater freedom to manage their own care; and
52 (iii) Developmental services. The department shall pay for rehabili-
53 tative services, including medical or remedial services provided by a
54 facility that has entered into a provider agreement with the depart-
55 ment and is certified as a developmental disabilities agency by the
7
1 department;
2 (g) Home health services, including:
3 (i) Intermittent or part-time nursing services provided by a home
4 health agency or by a registered nurse when no home health agency
5 exists in the area;
6 (ii) Home health aide services provided by a home health agency; and
7 (iii) Physical therapy, occupational therapy or speech pathology and
8 audiology services provided by a home health agency or medical reha-
9 bilitation facility;
10 (h) Hospice care in accordance with section 1905(o) of the social secu-
11 rity act;
12 (i) Specialized medical equipment and supplies; and
13 (j) Medicare cost-sharing, including:
14 (i) Medicare cost-sharing for qualified medicare beneficiaries
15 described in section 1905(p) of the social security act;
16 (ii) Medicare part A premiums for qualified disabled and working
17 individuals described in section 1902(a)(10)(E)(ii) of the social
18 security act;
19 (iii) Medicare part B premiums for specified low-income medicare ben-
20 eficiaries described in section 1902(a)(10)(E)(iii) of the social
21 security act; and
22 (iv) Medicare part B premiums for qualifying individuals described
23 in section 1902(a)(10)(E)(iv) and subject to section 1933 of the
24 social security act.
25 (4) Specific health benefits for elders persons over twenty-one (21)
26 years of age who have medicare and medicaid coverage include:
27 (a) All services described in subsection (5) of this section, other than
28 if provided under the federal medicare program;
29 (b) All services described in subsection (3) of this section, other than
30 if provided under the federal medicare program; and
31 (c) Other services that supplement medicare coverage.
32 (5) Benefits for all medicaid participants, unless specifically limited
33 in subsection (2), (3) or (4) of this section include the following:
34 (a) Health care coverage including, but not limited to, basic inpatient
35 and outpatient medical services, and including:
36 (i) Physicians' services, whether furnished in the office, the
37 patient's home, a hospital, a nursing facility or elsewhere;
38 (ii) Services provided by a physician or other licensed practitio-
39 ner to prevent disease, disability and other health conditions or
40 their progressions, to prolong life, or to promote physical or mental
41 health; and
42 (iii) Hospital care, including:
43 1. Inpatient hospital services other than those services pro-
44 vided in an institution for mental diseases;
45 2. Outpatient hospital services; and
46 3. Emergency hospital services;
47 (iv) Laboratory and x-ray services;
48 (v) Prescribed drugs;
49 (vi) Family planning services and supplies for individuals of
50 child-bearing age;
51 (vii) Certified pediatric or family nurse practitioners' services;
52 (viii) Emergency medical transportation;
53 (ix) Mental health services, including:
54 1. Outpatient mental health services that are appropriate,
55 within limits stated in department rules; and
8
1 2. Inpatient psychiatric facility services within limits stated
2 in department rules;
3 (x) Medical supplies, equipment, and appliances suitable for use
4 in the home; and
5 (xi) Physical therapy and related services;
6 (b) Primary care case management;
7 (c) Dental services, and medical and surgical services furnished by a
8 dentist in accordance with section 1905(a)(5)(B) of the social security
9 act;
10 (d) Medical care and any other type of remedial care recognized under
11 Idaho law, furnished by licensed practitioners within the scope of their
12 practice as defined by Idaho law, including:
13 (i) Podiatrists' services;
14 (ii) Optometrists' services;
15 (iii) Chiropractors' services; and
16 (iv) Other practitioners' services, in accordance with department
17 rules;
18 (e) Services for individuals with speech, hearing and language disorders,
19 provided by or under the supervision of a speech pathologist or audiolo-
20 gist;
21 (f) Eyeglasses prescribed by a physician skilled in diseases of the eye
22 or by an optometrist;
23 (g) Services provided by essential providers, including:
24 (i) Rural health clinic services and other ambulatory services fur-
25 nished by a rural health clinic in accordance with section 1905(l)(1)
26 of the social security act;
27 (ii) Federally qualified health center (FQHC) services and other
28 ambulatory services that are covered under the plan and furnished by
29 an FQHC in accordance with section 1905(l)(2) of the social security
30 act;
31 (iii) Indian health services; and
32 (iv) District health departments; and
33 (v) The family medicine residency of Idaho and the Idaho state uni-
34 versity family medicine residency;
35 (h) Any other medical care and any other type of remedial care recognized
36 under state law, specified by the secretary of the federal department of
37 health and human services;
38 (i) Nonemergency medical transportation; and
39 (j) Physician, hospital or other services deemed experimental are
40 excluded from coverage. The director may allow coverage of procedures or
41 services deemed investigational if the procedures or services are as
42 cost-effective as traditional, standard treatments.
43 SECTION 6. That Section 56-256, Idaho Code, be, and the same is hereby
44 amended to read as follows:
45 56-256. PERSONAL PREVENTIVE HEALTH ACCOUNTS ASSISTANCE. (1) The depart-
46 ment of health and welfare may establish a personal preventive health account
47 assistance benefits available to a medicaid participant in order to provide
48 incentives to promote healthy behavior and responsible use of health care ser-
49 vices.
50 (2) Each personal health account shall be funded by a base amount deter-
51 mined by department rule. Amounts may be added to the account Preventive
52 health assistance benefits are available when the participant complies with
53 recommended preventive care and demonstrates healthy behaviors or conducts
9
1 other activities as specified in department rule. Funds in a personal health
2 account are not the personal property of the participant, but represent the
3 value of benefits available for use by the participant while eligible. If
4 funds remain in a personal health account when a participant terminates par-
5 ticipation, such unexpended funds revert to the state Preventive health assis-
6 tance benefits are only available during a participant's period of
7 eligibility.
8 (3) The uses of funds in personal preventive health accounts assistance
9 may include, but not be limited to, participant payments for preventive health
10 products and services and participant cost-sharing payments as specified in
11 department rule.
12 (4) Copayments for services and delinquent premium payments may be auto-
13 matically deducted from personal health account funds by the department, sub-
14 ject to notice and opportunity for hearing Preventive health assistance bene-
15 fits may be used to cover delinquent cost-sharing obligations when partici-
16 pants have complied with recommended preventive care as described in depart-
17 ment rule.
STATEMENT OF PURPOSE
RS 16950
This proposal amends Chapter 2, Title 56, Idaho Code, by updating
terms and references consistent with the Deficit Reduction Act of
2005 and the federal government's approval of Idaho's Medicaid
state plan amendments to modernize its program.
The amendments also specifically identify the Idaho Residency
Programs as essential Medicaid providers. These providers were
unintentionally left out of the statute even though they have
been Medicaid providers for decades.
FISCAL NOTE
There is no fiscal impact associated with these changes. The
amendments align state statute with federal law and the newly
identified providers are existing providers in the program.
Contact
Name: Rep. Block
Phone: 208 332-1000
Russ Newcomb, M.D.
STATEMENT OF PURPOSE/FISCAL NOTE H 168