Existing federal law requires Medicaid to provide to certain aliens, including aliens who are not lawfully present in the United States, limited coverage for health care services that are necessary to treat an emergency medical condition. (42 U.S.C. § 1396b(v)(2); 42 C.F.R. § 440.255) Section 1 of this bill prescribes specific requirements governing such coverage under Medicaid in this State for persons who are less than 21 years of age. Specifically, section 1 provides that such coverage must consist of coverage for: (1) emergency medical transportation services directly relating to the treatment of the emergency medical condition; (2) care to treat the emergency medical condition provided in an emergency room or similar setting in a hospital or an independent center for emergency medical care; and (3) certain inpatient services relating to the treatment of the emergency medical condition. Additionally, section 1 provides limited coverage for certain care to treat renal disease and cancer in certain circumstances, if the Department of Health and Human Services grants prior approval for such care based on the medical necessity of the care. Section 1 also provides limited coverage in certain circumstances for continuing care relating to an emergency medical condition that is provided in a facility for skilled nursing, or other similar type of facility, if: (1) such care is necessary to prevent the condition of the person from becoming an emergency medical condition; and (2) the Department grants prior approval for such care based on the medical necessity of the care. Section 2 of this bill makes a conforming change to require the Director of the Department to administer the provisions of section 1 in the same manner as other provisions relating to Medicaid. Section 2.5 of this bill requires the Director of the Department to: (1) identify the most common services provided by clinics and hospitals in this State to treat pediatric cancer and rare childhood diseases; and (2) apply to the United States Secretary of Health and Human Services to increase the rate of reimbursement under Medicaid for each service identified.

Statutes affected:
As Introduced: 232.320
Reprint 1: 232.320
BDR: 232.320