00 SENATE CS FOR CS FOR HOUSE BILL NO. 459(HES) 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 14th service eliminated under the medical assistance program when there is 07 insufficient funding; and 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." 12 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF ALASKA: 13 * Section 1. AS 47.07.020(b) is amended by adding a new paragraph to read: 14 (12) disabled persons, as described in 42 U.S.C. 01 1396a(a)(10)(A)(ii)(XIII), who are in families whose income, as determined under 02 applicable federal regulations or guidelines, is less than 250 percent of the official 03 poverty line applicable to a family of that size according to the federal Office of 04 Management and Budget, and who, but for earnings in excess of the limit established 05 under 42 U.S.C. 1396d(q)(2)(B), would be considered to be individuals with respect 06 to whom a supplemental security income is being paid under 42 U.S.C. 1381 - 1383c; 07 a person eligible for assistance under this paragraph who is not eligible under another 08 provision of this section shall pay a premium or other cost-sharing charges according 09 to a sliding fee scale that is based on income as established by the department in 10 regulations. 11 * Sec. 2. AS 47.07.035 is amended to read: 12 Sec. 47.07.035. Priority of medical assistance. If the department finds that 13 the cost of medical assistance for all persons eligible under this chapter will exceed 14 the amount allocated in the state budget for that assistance for the fiscal year, the 15 department shall eliminate coverage for optional medical services and optionally 16 eligible groups of individuals in the following order: 17 (1) [MIDWIFE SERVICES; 18 (2)] clinical social workers' services; 19 (2) [(3)] psychologists' services; 20 (3) [(4)] chiropractic services; 21 (4) [(5)] advanced nurse practitioner services; 22 (5) [(6)] adult dental services; 23 (6) [(7)] emergency hospital services; 24 (7) [(8)] treatment of speech, hearing, and language disorders; 25 (8) [(9)] optometrists' services and eyeglasses; 26 (9) [(10)] occupational therapy; 27 (10) [(11)] mammography screening; 28 (11) [(12)] prosthetic devices; 29 (12) [(13)] medical supplies and equipment; 30 (13) [(14)] targeted case management services; 31 (14) midwife services; 01 (15) rehabilitative services for substance abusers and emotionally 02 disturbed or chronically mentally ill adults; 03 (16) clinic services; 04 (17) physical therapy; 05 (18) personal care services in a recipient's home; 06 (19) prescribed drugs; 07 (20) hospice care; 08 (21) long-term care noninstitutional services; 09 (22) inpatient psychiatric facility services; 10 (23) intermediate care facility services for the mentally retarded; 11 (24) intermediate care facility services; 12 (25) individuals described in AS 47.07.020(b)(11); 13 (26) individuals under age 21 who are not eligible for benefits under 14 the federal program designated as the successor to the aid to families with dependent 15 children program because they are not deprived of one or more of their natural or 16 adoptive parents; 17 (27) skilled nursing facility services for persons under age 21; 18 (28) aged, blind, and disabled individuals who, because they do not 19 meet the income requirements, do not receive supplemental security income under Title 20 XVI of the Social Security Act, but who are eligible, or would be eligible if they were 21 not in a skilled nursing facility or intermediate care facility, to receive an optional state 22 supplementary payment; 23 (29) individuals in a hospital, skilled nursing facility, or intermediate 24 care facility whose income while in the facility does not exceed 300 percent of the 25 supplemental security income benefit rate under Title XVI of the Social Security Act, 26 but who, because of income, are not eligible for the optional state supplementary 27 payment; 28 (30) individuals under age 21 under supervision of the department for 29 whom maintenance is being paid in whole or in part from public money and who are 30 in foster homes or private child-care institutions; 31 (31) individuals under age 21 who the department has determined 01 cannot be placed for adoption without medical assistance because of a special need for 02 medical or rehabilitative care and who the department has determined are hard-to-place 03 children eligible for subsidy under AS 25.23.190 - 25.23.220 ; 04 (32) individuals who are eligible under AS 47.07.020(b)(12) . 05 * Sec. 3. AS 47.07.900(15) is amended to read: 06 (15) "personal care services in a recipient's home" means services 07 authorized under a service plan [PRESCRIBED BY A PHYSICIAN] in accordance 08 with applicable federal and state law [THE RECIPIENT'S PLAN OF TREATMENT 09 AND PROVIDED BY AN INDIVIDUAL WHO IS 10 (A) QUALIFIED TO PROVIDE THE SERVICES; 11 (B) SUPERVISED BY A REGISTERED NURSE; AND 12 (C) NOT A MEMBER OF THE RECIPIENT'S FAMILY]; 13 * Sec. 4. TRANSITIONAL PROVISION. Notwithstanding AS 47.07.020(b)(12), added 14 by sec. 1 of this Act, an individual described in that provision is eligible for medical 15 assistance under AS 47.07 without the payment of a premium or other cost-sharing charges 16 for the first two months of the individual's receipt of assistance under AS 47.07.020(b)(12). 17 Beginning in the third month of the individual's receipt of assistance under 18 AS 47.07.020(b)(12), the individual shall pay one-twelfth of an annual premium that is 19 determined by applying a percentage to the annual net income of the individual's family. The 20 applicable percentage, Y, shall be calculated according to the formula of Y = (X-100)/15 - 21 0.75(N-1), where X is the annual net income of the individual's family expressed as a 22 percentage of the official federal poverty line for a family of the size involved and N is the 23 number of persons in the individual's family; however, an individual is not required to pay 24 a premium under this section if the individual's family has a net income that is less than the 25 applicable federal poverty line for a family of the size involved or if the value of Y calculated 26 under this section is a negative number. The premium required under this section is payable 27 until the Department of Health and Social Services, by regulation, establishes another system 28 for setting and collecting a premium or other cost-sharing charges for persons who receive 29 medical assistance because they are eligible under AS 47.07.020(b)(12), as enacted by sec. 1 30 of this Act. For purposes of this section, the annual net income of the individual's family 31 shall be determined under applicable federal regulations and guidelines. 01 * Sec. 5. REGULATIONS. The Department of Health and Social Services shall adopt 02 regulations establishing the sliding fee scale for premiums or other cost-sharing charges 03 described in this Act by July 1, 1999.