SB 266: "An Act relating to Medicaid coverage for certain eligible children and pregnant women; relating to primary care case management and managed care services as optional services and to premiums and cost-sharing contributions under the Medicaid program; establishing the Healthy Families Alaska program; and providing for an effective date."
00SENATE BILL NO. 266 01 "An Act relating to Medicaid coverage for certain eligible children and pregnant 02 women; relating to primary care case management and managed care services 03 as optional services and to premiums and cost-sharing contributions under the 04 Medicaid program; establishing the Healthy Families Alaska program; and 05 providing for an effective date." 06 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF ALASKA: 07 * Section 1. AS 47.07.020(b) is amended by adding new paragraphs to read: 08 (12) persons under age 19 who are not covered under (a) of this section 09 and whose household income does not exceed 200 percent of the federal poverty line 10 as defined by the federal office of management and budget and revised under 11 42 U.S.C. 9902(2); 12 (13) pregnant women who are not covered under (a) of this section and 13 whose household income does not exceed 200 percent of the federal poverty line as 14 defined by the federal office of management and budget and revised under
01 42 U.S.C. 9902(2). 02 * Sec. 2. AS 47.07.020 is amended by adding a new subsection to read: 03 (i) The department may allow a person under 19 years of age who is 04 determined to be eligible for benefits under this chapter to remain eligible for those 05 benefits for up to 11 calendar months following the month that the person is 06 determined eligible for benefits or until the person is 19 years old, whichever occurs 07 earlier. 08 * Sec. 3. AS 47.07.030(b) is amended to read: 09 (b) In addition to the mandatory services specified in (a) of this section and 10 the services provided under (d) of this section , the department may offer only the 11 following optional services: case management and nutrition services for pregnant 12 women; personal care services in a recipient's home; emergency hospital services; 13 long-term care noninstitutional services; medical supplies and equipment; advanced 14 nurse practitioner services; clinic services; rehabilitative services for substance abusers 15 and emotionally disturbed or chronically mentally ill adults; targeted case management 16 services for substance abusers, chronically mentally ill adults, and severely emotionally 17 disturbed persons under the age of 21; targeted case management services for 18 pregnant women and for children under the age of five; comprehensive 19 pregnancy-related services; inpatient psychiatric facility services for individuals age 20 65 or older and individuals under age 21; psychologists' services; clinical social 21 workers' services; midwife services; prescribed drugs; physical therapy; occupational 22 therapy; chiropractic services; low-dose mammography screening, as defined in 23 AS 21.42.375(e); hospice care; treatment of speech, hearing, and language disorders; 24 adult dental services; prosthetic devices and eyeglasses; optometrists' services; 25 intermediate care facility services, including intermediate care facility services for the 26 mentally retarded; skilled nursing facility services for individuals under age 21; and 27 reasonable transportation to and from the point of medical care. 28 * Sec. 4. AS 47.07.030(d) is repealed and reenacted to read: 29 (d) The department may establish as optional services a primary care case 30 management system or a managed care organization contract in which certain eligible 31 individuals are required to enroll and seek approval from a case manager or the
01 managed care organization before receiving certain services. The department shall 02 establish enrollment criteria and determine eligibility for services consistent with 03 federal and state law. 04 * Sec. 5. AS 47.07.042(a) is amended to read: 05 (a) Except as provided in (b) - (d) [(b) AND (c)] of this section, the state plan 06 developed under AS 47.07.040 shall impose deductible, coinsurance, and copayment 07 requirements [OR SIMILAR CHARGES] on persons eligible for assistance under this 08 chapter to the maximum extent allowed under federal law and regulations. The plan 09 must provide that health care providers shall collect the allowable charge. The 10 department shall reduce payments to each provider by the amount of the allowable 11 charge. A provider may not deny services because a recipient is unable to share costs, 12 but an inability to share costs imposed under this section does not relieve the recipient 13 of liability for the costs. 14 * Sec. 6. AS 47.07.042 is amended by adding a new subsection to read: 15 (d) In addition to the requirements established under (a) and (b) of this section, 16 the department may require premiums or cost-sharing contributions from recipients 17 who are eligible for benefits under AS 47.07.020(b)(12) or (13) and whose household 18 income is between 150 and 200 percent of the federal poverty line. If the department 19 requires premiums or cost-sharing contributions under this subsection, the department 20 (1) shall adopt in regulation a sliding scale for those premiums or 21 contributions based on household income; 22 (2) may not exceed the maximums allowed under federal law; and 23 (3) shall implement a system by which the department or its designee 24 collects those premiums or contributions. 25 * Sec. 7. AS 47.07.900(19) is amended to read: 26 (19) "targeted case management services" means case management 27 services 28 (A) for substance abusers, chronically mentally ill adults, and 29 severely emotionally disturbed persons under age 21 that are provided by 30 (i) [(A)] a drug or alcohol treatment center that is funded 31 with a grant under AS 47.30.475; or
01 (ii) [(B)] an outpatient community mental health clinic 02 that has a contract to provide community mental health services under 03 AS 47.30.520 - 47.30.620 ; or 04 (B) that will assist pregnant women and families of children 05 under the age of five in gaining access to needed medical, social, 06 educational, or other services under AS 47.19 . 07 * Sec. 8. AS 47.07.900 is amended by adding a new paragraph to read: 08 (20) "comprehensive pregnancy-related services" means all mandatory 09 and optional medical services that 10 (A) are established under AS 47.07.030, even though coverage 11 for the services may have been eliminated under AS 47.07.035; 12 (B) may be greater in amount, duration, or scope than is 13 generally available to other Medicaid recipients, if allowed by AS 47.07 and 14 federal law; and 15 (C) are pregnancy-related or related to any other condition that 16 may complicate the recipient's pregnancy. 17 * Sec. 9. AS 47 is amended by adding a new chapter to read: 18 Chapter 19. Healthy Families Alaska Program. 19 Sec. 47.19.010. Purpose. The purpose of this chapter is to prevent poor 20 childhood outcomes, including abuse and neglect, by making available education and 21 support services to all pregnant women and families of children under the age of five, 22 including newborn infants, by providing early intervention family support services to 23 pregnant women and families eligible under this chapter and facing the greatest 24 challenges. 25 Sec. 47.19.020. Establishment of program. (a) The department shall 26 establish a coordinated, comprehensive, statewide Healthy Families Alaska program 27 that provides appropriate prevention and early intervention family support services to 28 pregnant women and families of children under the age of five. 29 (b) The Healthy Families Alaska program shall 30 (1) be centered on the family and focused on individual family needs; 31 (2) serve eligible pregnant women and families who volunteer for the
01 program; 02 (3) provide education and support services to families to reduce the risk 03 of poor childhood outcomes, including child abuse and neglect, and to contribute to 04 positive, healthy, child-rearing practices; 05 (4) provide targeted case management and assist pregnant women and 06 families in accessing needed services; 07 (5) initiate services during pregnancy or as early as possible after the 08 birth of an infant; and 09 (6) continue services to the family for up to three to five years, using 10 criteria defined in regulation to increase or decrease the scope or type of services. 11 (c) Program services shall be provided in a culturally appropriate and 12 collaborative manner by community-based private, nonprofit corporations, including 13 regional Native health corporations; Indian Reorganization Act and traditional councils; 14 municipal governments; or a combination of these entities. 15 Sec. 47.19.030. Eligibility. Pregnant women, children under the age of five, 16 and families of children under the age of five are eligible for services under this 17 chapter if they or their families volunteer for the program and are determined to be 18 able to benefit from the services provided under the program. 19 Sec. 47.19.040. Duties of the department. The department shall 20 (1) organize and encourage training programs for persons who provide 21 services under this chapter; 22 (2) establish a training program for paraprofessionals who provide 23 services under this chapter; 24 (3) identify and use all appropriate public and private resources 25 available to the state to provide needed services to the families eligible for this 26 program; 27 (4) issue contracts or grants for the provision of services under this 28 chapter; 29 (5) establish a comprehensive system for screening pregnant women 30 and families of children under the age of five who are eligible for services under this 31 chapter;
01 (6) establish the priority of services provided if available money is 02 insufficient to provide services to all persons who are eligible under this chapter; 03 (7) facilitate the coordination among public agencies or service 04 providers supplying services under this program, the resolution of disputes among 05 those agencies or providers about the provision of services under the program, and the 06 determination of financial responsibility of the respective persons for those services; 07 (8) ensure that services under the program are provided in a timely 08 manner pending the resolution of disputes among public agencies or service providers 09 as to the provision of or payment for those services; 10 (9) monitor and evaluate the services provided under the program and 11 establish a system for compiling data on the pregnant women, children, and families 12 in the state who are eligible for services, the numbers being served, and the types of 13 services provided; and 14 (10) adopt regulations necessary to implement or interpret this chapter. 15 Sec. 47.19.050. Individualized family support plan. (a) In consultation 16 with, and based on an assessment of, the eligible pregnant woman or the eligible 17 family, a written individualized family support plan shall be developed. The plan shall 18 include 19 (1) a description of the pregnant woman's or family's concerns, 20 priorities, resources, and goals for the child and family; and 21 (2) a description of the specific early intervention services that are 22 planned to help meet the unique needs of the child and the family. 23 (b) The plan required in (a) of this section shall be prepared within 45 days 24 after the initiation of service under the program. The plan shall be reviewed and 25 updated every six months that the pregnant woman, child, or family participates in the 26 program. 27 Sec. 47.19.050. Confidentiality and access to records. Medical, social, and 28 other client records received or developed under this chapter are confidential and are 29 not open to inspection, except as provided in regulations of the department to further 30 the purposes of the program or to better coordinate services. Nothing in this section 31 prohibits the department from releasing non-identifying information in aggregate form
01 for research or other purposes. 02 Sec. 47.19.900. Definitions. In this chapter 03 (1) "department" means the Department of Health and Social Services; 04 (2) "program" means the Healthy Families Alaska program. 05 * Sec. 10. TRANSITION: REGULATIONS. Notwithstanding sec. 12 of this Act, the 06 Department of Health and Social Services may proceed to adopt regulations necessary to 07 implement the changes made by this Act. The regulations take effect under AS 44.62 08 (Administrative Procedure Act), but not before the effective date of secs. 1 - 9 of this Act. 09 * Sec. 11. Section 10 of this Act takes effect immediately under AS 01.10.070(c). 10 * Sec. 12. Except as provided in sec. 11 of this Act, this Act takes effect July 1, 1998.