SCS CSHB 459(RLS): "An Act establishing new eligibility for medical assistance for certain disabled persons and giving their eligibility for services the highest priority among optional services and groups under the medical assistance program; amending the definition of 'personal care services in a recipient's home' as used in the medical assistance program; moving midwife services from being the first to being the seventh service eliminated under the medical assistance program when there is insufficient funding; adjusting the priority of optional services and optional eligible groups under the medical assistance program in order to reflect the new priorities given to the newly-eligible disabled persons and to midwife services but without otherwise changing the relative order of the other optional services and optional groups; relating to catastrophic illness assistance; establishing a medical assistance program for chronic and acute medical conditions; and providing for an effective date."
00SENATE CS FOR CS FOR HOUSE BILL NO. 459(RLS) 01 "An Act establishing new eligibility for medical assistance for certain disabled 02 persons and giving their eligibility for services the highest priority among optional 03 services and groups under the medical assistance program; amending the definition 04 of 'personal care services in a recipient's home' as used in the medical 05 assistance program; moving midwife services from being the first to being the 06 seventh service eliminated under the medical assistance program when there is 07 insufficient funding; adjusting the priority of optional services and optional 08 eligible groups under the medical assistance program in order to reflect the new 09 priorities given to the newly-eligible disabled persons and to midwife services but 10 without otherwise changing the relative order of the other optional services and 11 optional groups; relating to catastrophic illness assistance; establishing a medical 12 assistance program for chronic and acute medical conditions; and providing for 13 an effective date." 14 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF ALASKA:
01 * Section 1. AS 47.07.020(b) is amended by adding a new paragraph to read: 02 (12) disabled persons, as described in 42 U.S.C. 03 1396a(a)(10)(A)(ii)(XIII), who are in families whose income, as determined under 04 applicable federal regulations or guidelines, is less than 250 percent of the official 05 poverty line applicable to a family of that size according to the federal Office of 06 Management and Budget, and who, but for earnings in excess of the limit established 07 under 42 U.S.C. 1396d(q)(2)(B), would be considered to be individuals with respect 08 to whom a supplemental security income is being paid under 42 U.S.C. 1381 - 1383c; 09 a person eligible for assistance under this paragraph who is not eligible under another 10 provision of this section shall pay a premium or other cost-sharing charges according 11 to a sliding fee scale that is based on income as established by the department in 12 regulations. 13 * Sec. 2. AS 47.07.035 is amended to read: 14 Sec. 47.07.035. Priority of medical assistance. If the department finds that 15 the cost of medical assistance for all persons eligible under this chapter will exceed 16 the amount allocated in the state budget for that assistance for the fiscal year, the 17 department shall eliminate coverage for optional medical services and optionally 18 eligible groups of individuals in the following order: 19 (1) [MIDWIFE SERVICES; 20 (2)] clinical social workers' services; 21 (2) [(3)] psychologists' services; 22 (3) [(4)] chiropractic services; 23 (4) [(5)] advanced nurse practitioner services; 24 (5) [(6)] adult dental services; 25 (6) [(7)] emergency hospital services; 26 (7) midwife services; 27 (8) treatment of speech, hearing, and language disorders; 28 (9) optometrists' services and eyeglasses; 29 (10) occupational therapy; 30 (11) mammography screening; 31 (12) prosthetic devices;
01 (13) medical supplies and equipment; 02 (14) targeted case management services; 03 (15) rehabilitative services for substance abusers and emotionally 04 disturbed or chronically mentally ill adults; 05 (16) clinic services; 06 (17) physical therapy; 07 (18) personal care services in a recipient's home; 08 (19) prescribed drugs; 09 (20) hospice care; 10 (21) long-term care noninstitutional services; 11 (22) inpatient psychiatric facility services; 12 (23) intermediate care facility services for the mentally retarded; 13 (24) intermediate care facility services; 14 (25) individuals described in AS 47.07.020(b)(11); 15 (26) individuals under age 21 who are not eligible for benefits under 16 the federal program designated as the successor to the aid to families with dependent 17 children program because they are not deprived of one or more of their natural or 18 adoptive parents; 19 (27) skilled nursing facility services for persons under age 21; 20 (28) aged, blind, and disabled individuals who, because they do not 21 meet the income requirements, do not receive supplemental security income under Title 22 XVI of the Social Security Act, but who are eligible, or would be eligible if they were 23 not in a skilled nursing facility or intermediate care facility, to receive an optional state 24 supplementary payment; 25 (29) individuals in a hospital, skilled nursing facility, or intermediate 26 care facility whose income while in the facility does not exceed 300 percent of the 27 supplemental security income benefit rate under Title XVI of the Social Security Act, 28 but who, because of income, are not eligible for the optional state supplementary 29 payment; 30 (30) individuals under age 21 under supervision of the department for 31 whom maintenance is being paid in whole or in part from public money and who are
01 in foster homes or private child-care institutions; 02 (31) individuals under age 21 who the department has determined 03 cannot be placed for adoption without medical assistance because of a special need for 04 medical or rehabilitative care and who the department has determined are hard-to-place 05 children eligible for subsidy under AS 25.23.190 - 25.23.220 ; 06 (32) individuals who are eligible under AS 47.07.020(b)(12) . 07 * Sec. 3. AS 47.07.900(15) is amended to read: 08 (15) "personal care services in a recipient's home" means services 09 authorized under a service plan [PRESCRIBED BY A PHYSICIAN] in accordance 10 with applicable federal and state law [THE RECIPIENT'S PLAN OF TREATMENT 11 AND PROVIDED BY AN INDIVIDUAL WHO IS 12 (A) QUALIFIED TO PROVIDE THE SERVICES; 13 (B) SUPERVISED BY A REGISTERED NURSE; AND 14 (C) NOT A MEMBER OF THE RECIPIENT'S FAMILY]; 15 * Sec. 4. AS 47.08.010 is amended to read: 16 Sec. 47.08.010. Reimbursement of providers. (a) Subject to (b) of this 17 section, under AS 47.08.010 - 47.08.140 [UNDER THE PROVISIONS OF THIS 18 CHAPTER], the Department of Health and Social Services may [SHALL] reimburse 19 providers of medical care for unpaid costs incurred in the treatment of a person 20 suffering an illness or accident that results in financial catastrophe to the person or the 21 person's family. 22 * Sec. 5. AS 47.08.010 is repealed and reenacted to read: 23 Sec. 47.08.010. Reimbursement of providers. Under the provisions of this 24 chapter, the Department of Health and Social Services shall reimburse providers of 25 medical care for unpaid costs incurred in the treatment of a person suffering an illness 26 or accident that results in financial catastrophe to the person or the person's family. 27 * Sec. 6. AS 47.08.010 is amended by adding a new subsection to read: 28 (b) At the beginning of each fiscal year, the commissioner of health and social 29 services shall determine whether sufficient appropriations have been made for the 30 anticipated costs of services to needy persons under AS 47.08.150 and the anticipated 31 costs of reimbursements under (a) of this section. The Department of Health and
01 Social Services may not accept applications for reimbursement under (a) of this section 02 for a fiscal year if, at the beginning of the fiscal year the department determines that 03 (1) there are insufficient funds appropriated for the anticipated costs of 04 services for needy persons under AS 47.08.150; or 05 (2) after subtracting anticipated costs under AS 47.08.150, there are 06 insufficient funds appropriated for anticipated reimbursements under (a) of this section. 07 * Sec. 7. AS 47.08 is amended by adding a new section to read: 08 Article 2. Medical Assistance for Chronic 09 or Acute Medical Conditions. 10 Sec. 47.08.150. Assistance for chronic or acute medical conditions. (a) 11 Under the provisions of this section, the Department of Health and Social Services 12 may pay providers of medical care for services described in (c) of this section that are 13 provided to needy persons suffering from a chronic or acute medical condition who 14 may apply for assistance under (b) of this section. 15 (b) A needy person suffering from a chronic or an acute medical condition 16 who is eligible for general relief assistance under AS 47.25.120 and is not eligible for 17 the medical assistance program under AS 47.07 may apply for assistance under this 18 section. The department shall make a determination of eligibility based on a general 19 relief assistance application. The requirements of AS 47.08.020 - 47.08.140 do not 20 apply to assistance sought under this section, except that, notwithstanding (c) of this 21 section, neither reimbursement nor assistance may be paid by the department for 22 services that are listed in AS 47.08.050 as those services are defined in AS 47.08.140. 23 (c) The services eligible for payment under this section for a needy person 24 with a chronic or acute medical condition are the following: 25 (1) prescription drugs and medical supplies prescribed to treat a person 26 who has 27 (A) a terminal illness; 28 (B) cancer and requires chemotherapy; or 29 (C) a chronic condition that would normally, in its untreated 30 course, result in the death or disability of the recipient, but that is amenable to 31 outpatient medication; the chronic conditions for which the cost of prescription
01 drugs may be paid include the following diagnoses: 02 (i) diabetes and diabetes insipidus; 03 (ii) seizure disorders; 04 (iii) chronic mental illness; 05 (iv) hypertension; 06 (2) physician services 07 (A) related to care under (3) of this subsection; 08 (B) provided in a hospital emergency room the same day on 09 which the recipient is admitted for care under (3) of this subsection; 10 (C) provided to a recipient residing in a nursing home; or 11 (D) provided in either an outpatient or an inpatient setting to a 12 recipient with a diagnosis described in (1) of this subsection; 13 (3) inpatient hospital services that cannot be performed on an outpatient 14 basis and that are certified as necessary by a professional review organization 15 consulted by the Department of Health and Social Services but not including inpatient 16 psychiatric hospital services; 17 (4) outpatient laboratory and x-ray services; 18 (5) medical transportation related to care under (3) of this subsection 19 or nursing facility care; 20 (6) outpatient surgical services; 21 (7) nursing facility care. 22 (d) The payment rate for facilities under this section shall be the same as that 23 established by regulation for medical services under AS 47.25.195, and payment rates 24 under this section for other providers may not exceed those established under 25 AS 47.07. 26 (e) The Department of Health and Social Services may limit the amount, 27 duration, and scope of services covered under this section by regulation. If the 28 Department of Health and Social Services finds that the cost of assistance for all 29 persons eligible under this section will exceed the amount allocated for that assistance 30 during the fiscal year, the Department of Health and Social Services may limit 31 coverage for certain medical services by regulation in order to provide the most critical
01 care within the available appropriations. 02 (f) The Department of Health and Social Services may adopt regulations to 03 implement this section. 04 * Sec. 8. AS 47.08.010(b) and 47.08.150 are repealed. 05 * Sec. 9. TRANSITIONAL PROVISION. Notwithstanding AS 47.07.020(b)(12), added 06 by sec. 1 of this Act, an individual described in that provision is eligible for medical 07 assistance under AS 47.07 without the payment of a premium or other cost-sharing charges 08 for the first two months of the individual's receipt of assistance under AS 47.07.020(b)(12). 09 Beginning in the third month of the individual's receipt of assistance under 10 AS 47.07.020(b)(12), the individual shall pay one-twelfth of an annual premium that is 11 determined by applying a percentage to the annual net income of the individual's family. The 12 applicable percentage, Y, shall be calculated according to the formula of Y = (X-100)/15 - 13 0.75(N-1), where X is the annual net income of the individual's family expressed as a 14 percentage of the official federal poverty line for a family of the size involved and N is the 15 number of persons in the individual's family; however, an individual is not required to pay 16 a premium under this section if the individual's family has a net income that is less than the 17 applicable federal poverty line for a family of the size involved or if the value of Y calculated 18 under this section is a negative number. The premium required under this section is payable 19 until the Department of Health and Social Services, by regulation, establishes another system 20 for setting and collecting a premium or other cost-sharing charges for persons who receive 21 medical assistance because they are eligible under AS 47.07.020(b)(12), as enacted by sec. 1 22 of this Act. For purposes of this section, the annual net income of the individual's family 23 shall be determined under applicable federal regulations and guidelines. 24 * Sec. 10. REGULATIONS. The Department of Health and Social Services shall adopt 25 regulations establishing the sliding fee scale for premiums or other cost-sharing charges 26 described in sec. 1 of this Act by July 1, 1999. 27 * Sec. 11. REVISOR INSTRUCTION. In the following statute sections, the revisor of 28 statutes shall substitute the spanned reference "AS 47.08.010 - 47.08.140" for references to 29 "this chapter": AS 47.08.040, 47.08.050, 47.08.120, 47.08.130, and 47.08.140. 30 * Sec. 12. Sections 4, 6, 7, and 11 of this Act take effect July 1, 1998. 31 * Sec. 13. Sections 5 and 8 of this Act take effect on the day after the later of (1) the date
01 on which time expires for appeal of a judgment declaring any part of AS 47.08.150, enacted 02 by sec. 7 of this Act, unconstitutional, or (2) if an appeal is taken, the date of entry of the 03 final order on appeal that any part of AS 47.08.150, enacted by sec. 7 of this Act, is 04 unconstitutional. The attorney general shall notify the revisor of statutes of a judgment 05 described in this section.