Bill Summary – FastDemocracy

Unofficial Draft Copy
67th Legislature                                                                                                    LC 1341
                                          _____________ BILL NO. _____________
                      INTRODUCED BY _________________________________________________
                                               (Primary Sponsor)
  3
   A BILL FOR AN ACT ENTITLED: “AN ACT REVISING THE MEDICAID BUY-IN PROGRAM TO INCLUDE
   CHILDREN WITH PHYSICAL OR DEVELOPMENTAL DISABILITIES; EXTENDING RULEMAKING
   AUTHORITY; PROVIDING AN APPROPRIATION; AMENDING SECTIONS 53-6-113, 53-6-131, AND 53-6-
   195, MCA; AND PROVIDING AN EFFECTIVE DATE.”
  8
   BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MONTANA:
 10
              Section 1. Section 53-6-113, MCA, is amended to read:
              "53-6-113.    Department to adopt rules. (1) The department shall adopt appropriate rules necessary
   for the administration of the Montana medicaid program as provided for in this part and that may be required by
   federal laws and regulations governing state participation in medicaid under Title XIX of the Social Security Act,
   42 U.S.C. 1396, et seq., as amended.
              (2)   The department shall adopt rules that are necessary to further define for the purposes of this part
   the services provided under 53-6-101 and to provide that services being used are medically necessary and that
   the services are the most efficient and cost-effective available. The rules may establish the amount, scope, and
   duration of services provided under the Montana medicaid program, including the items and components
   constituting the services.
              (3)   The department shall establish by rule the rates for reimbursement of services provided under this
   part. The department may in its discretion set rates of reimbursement that it determines necessary for the
   purposes of the program. In establishing rates of reimbursement, the department may consider but is not
   limited to considering:
              (a)   the availability of appropriated funds;
              (b)   the actual cost of services;
              (c)   the quality of services;
              (d)   the professional knowledge and skills necessary for the delivery of services; and
                                                                   -1-                                              LC 1341
Unofficial Draft Copy
67th Legislature                                                                                                        LC 1341
              (e)   the availability of services.
              (4)   The department shall specify by rule those professionals who may deliver or direct the delivery of
   particular services.
              (5)   The department may provide by rule for payment by a recipient of a portion of the reimbursements
   established by the department for services provided under this part.
              (6)   (a) The department may adopt rules consistent with this part to govern eligibility for the Montana
   medicaid program, including the medicaid program provided for in 53-6-195. Rules may include but are not
   limited to financial standards and criteria for income and resources, treatment of resources, nonfinancial
   criteria, family responsibilities, residency, application, termination, definition of terms, confidentiality of applicant
   and recipient information, and cooperation with the state agency administering the child support enforcement
   program under Title IV-D of the Social Security Act, 42 U.S.C. 651, et seq.
              (b)   The department may not apply financial criteria below $15,000 for resources other than income in
   determining the eligibility of a child under 19 years of age for poverty level-related children's medicaid coverage
   groups, as provided in 42 U.S.C. 1396a(l)(1)(B) through (l)(1)(D).
              (c)   The department may not apply financial criteria below $15,000 for an individual and $30,000 for a
   couple for resources other than income in determining the eligibility of individuals under 53-6-195(1)(a) for the
   medicaid buy-in program for workers with disabilities provided for in53-6-195.
              (7)   The department may adopt rules limiting eligibility based on criteria more restrictive than that
   provided in 53-6-131 if required by Title XIX of the Social Security Act, 42 U.S.C. 1396, et seq., as may be
   amended, or if funds appropriated are not sufficient to provide medical care for all eligible persons.
              (8)   The department may adopt rules necessary for the administration of medicaid managed care
   systems. Rules to be adopted may include but are not limited to rules concerning:
              (a)   participation in managed care;
              (b)   selection and qualifications for providers of managed care; and
              (c)   standards for the provision of managed care.
              (9)   Subject to subsection (6), the department shall establish by rule income limits for eligibility for
   extended medical assistance of persons receiving section 1931 medicaid benefits, as defined in 53-4-602, who
   lose eligibility because of increased income to the assistance unit, as that term is defined in the rules of the
                                                                    -2-                                                 LC 1341
Unofficial Draft Copy
67th Legislature                                                                                                         LC 1341
   department, as provided in 53-6-134, and shall also establish by rule the length of time for which extended
   medical assistance will be provided. The department, in exercising its discretion to set income limits and
   duration of assistance, may consider the amount of funds appropriated by the legislature.
              (10) Unless required by federal law or regulation, the department may not adopt rules that exclude a
   child from medicaid services or require prior authorization for a child to access medicaid services if the child
   would be eligible for or able to access the services without prior authorization if the child was not in foster care."
  7
              Section 2. Section 53-6-131, MCA, is amended to read:
              "53-6-131.    (Temporary) Eligibility requirements. (1) Medical assistance under the Montana
   medicaid program may be granted to a U.S. citizen or a qualified alien as defined in 8 U.S.C. 1641 who is
   determined by the department of public health and human services to be a Montana resident and, in its
   discretion, to be eligible as follows:
              (a)   The person receives or is considered to be receiving supplemental security income benefits under
   Title XVI of the Social Security Act, 42 U.S.C. 1381, et seq., and does not have income or resources in excess
   of the applicable medical assistance limits.
              (b)   The person would be eligible for assistance under the program described in subsection (1)(a) if
   that person were to apply for that assistance.
              (c)   The person is in a medical facility that is a medicaid provider and, but for residence in the facility,
   the person would be receiving assistance under the program in subsection (1)(a).
              (d)   The person is:
              (i)   under 21 years of age and in foster care under the supervision of the state or was in foster care
   under the supervision of the state and has been adopted as a child with special needs; or
              (ii) under 18 years of age and is in a guardianship subsidized by the department pursuant to 41-3-444.
              (e)   The person meets the nonfinancial criteria of the categories in subsections (1)(a) through (1)(d)
   and:
              (i)   the person's income does not exceed the income level specified for federally aided categories of
   assistance and the person's resources are within the resource standards of the federal supplemental security
   income program; or
                                                                    -3-                                                  LC 1341
Unofficial Draft Copy
67th Legislature                                                                                                     LC 1341
              (ii) the person, while having income greater than the medically needy income level specified for
   federally aided categories of assistance:
              (A)    has an adjusted income level, after incurring medical expenses, that does not exceed the
   medically needy income level specified for federally aided categories of assistance or, alternatively, has paid in
   cash to the department the amount by which the person's income exceeds the medically needy income level
   specified for federally aided categories of assistance; and
              (B)    (I) in the case of a person who meets the nonfinancial criteria for medical assistance because the
   person is aged, blind, or disabled, has resources that do not exceed the resource standards of the federal
   supplemental security income program; or
              (II) in the case of a person who meets the nonfinancial criteria for medical assistance because the
   person is pregnant, is an infant or child, or is the caretaker of an infant or child, has resources that do not
   exceed the resource standards adopted by the department.
              (f)   The person is a qualified pregnant woman or a child as defined in 42 U.S.C. 1396d(n).
              (g)   The person is under 19 years of age and lives with a family having a combined income that does
   not exceed 185% of the federal poverty level. The department may establish lower income levels to the extent
   necessary to maximize federal matching funds provided for in 53-4-1104.
              (2)   The department shall require an applicant to provide proof of the applicant's residency in this
   state.
              (3)   (a) The department may establish income and resource limitations. Limitations of income and
   resources must be within the amounts permitted by federal law for the medicaid program. Any otherwise
   applicable eligibility resource test prescribed by the department does not apply to enrollees in the healthy
   Montana kids plan provided for in 53-4-1104.
              (b)   The department may not count as a resource an individual retirement account that was
   established by a person participating in the medicaid buy-in program for workers with disabilities provided for in
   53-6-195 if:
              (i)   the person is no longer eligible for coverage under 53-6-195; and
              (ii) the individual retirement account was established during the time the person was eligible for, under
   53-6-195(1)(a), and receiving benefits through the medicaid program for workers with disabilities.
                                                                  -4-                                                LC 1341
Unofficial Draft Copy
67th Legislature                                                                                                     LC 1341
              (4)   The Montana medicaid program shall pay, as required by federal law, the premiums necessary for
   medicaid-eligible persons participating in the medicare program and may, within the discretion of the
   department, pay all or a portion of the medicare premiums, deductibles, and coinsurance for a qualified
   medicare-eligible person or for a qualified disabled and working individual, as defined in section 6408(d)(2) of
   the federal Omnibus Budget Reconciliation Act of 1989, Public Law 101-239, who:
              (a)   has income that does not exceed income standards as may be required by the Social Security
   Act; and
              (b)   has resources that do not exceed standards that the department determines reasonable for
   purposes of the program.
              (5)   The department may pay a medicaid-eligible person's expenses for premiums, coinsurance, and
   similar costs for health insurance or other available health coverage, as provided in 42 U.S.C. 1396b(a)(1).
              (6)   In accordance with waivers of federal law that are granted by the secretary of the U.S. department
   of health and human services, the department of public health and human services may grant eligibility for
   basic medicaid benefits as described in 53-6-101 to an individual receiving section 1931 medicaid benefits, as
   defined in 53-4-602, as the specified caretaker relative of a dependent child under the section 1931 medicaid
   program. A recipient who is pregnant, meets the criteria for disability provided in Title II of the Social Security
   Act, 42 U.S.C. 416, et seq., or is less than 21 years of age is entitled to full medicaid coverage, as provided in
   53-6-101.
              (7)   The department, under the Montana medicaid program, may provide, if a waiver is not available
   from the federal government, medicaid and other assistance mandated by Title XIX of the Social Security Act,
   42 U.S.C. 1396, et seq., as may be amended, and not specifically listed in this part to categories of persons
   that may be designated by the act for receipt of assistance.
              (8)   Notwithstanding any other provision of this chapter, medical assistance must be provided to
   infants and pregnant women whose family income does not exceed income standards adopted by the
   department that comply with the requirements of 42 U.S.C. 1396a(l)(2)(A)(i) and whose family resources do not
   exceed standards that the department determines reasonable for purposes of the program.
              (9)   Subject to appropriations, the department may cooperate with and make grants to a nonprofit
   corporation that uses donated funds to provide basic preventive and primary health care medical benefits to
                                                                 -5-                                                 LC 1341
Unofficial Draft Copy
67th Legislature                                                                                                      LC 1341
   children whose families are ineligible for the Montana medicaid program and who are ineligible for any other
   health care coverage, are under 19 years of age, and are enrolled in school if of school age.
              (10) A person described in subsection (8) must be provided continuous eligibility for medical
   assistance, as authorized in 42 U.S.C. 1396a(e)(5) through (e)(7).
              (11) Full medical assistance under the Montana medicaid program may be granted to an individual
   during the period in which the individual requires treatment of breast or cervical cancer, or both, or of a
   precancerous condition of the breast or cervix, if the individual:
              (a)   has been screened for breast and cervical cancer under the Montana breast and cervical health
   program funded by the centers for disease control and prevention program established under Title XV of the
   Public Health Service Act, 42 U.S.C. 300k, or in accordance with federal requirements;
              (b)   needs treatment for breast or cervical cancer, or both, or a precancerous condition of the breast or
   cervix;
              (c)   is not otherwise covered under creditable coverage, as provided by federal law or regulation;
              (d)   is not eligible for medical assistance under any mandatory categorically needy eligibility group;
   and
              (e)   has not attained 65 years of age.
              (12) Subject to the limitation in 53-6-195, the department shall provide medicaid coverage to workers
   and children with disabilities as provided in 53-6-195 and in accordance with 42 U.S.C. 1396a(a)(10)(A)(ii)(XIII),
   (a)(10)(A)(ii)(XIX), and (r)(2) and 42 U.S.C. 1396o.
              (13) Nothing in subsection (1) may be construed as allowing the department to deny enrollment for a
   reason that is impermissible under federal law or regulation. (Terminates June 30, 2025, on occurrence of
   contingency--sec. 48, Ch. 415, L. 2019.)
              53-6-131. (Effective on occurrence of contingency) Eligibility requirements. (1) Medical
   assistance under the Montana medicaid program may be granted to a person who is determined by the
   department of public health and human services, in its discretion, to be eligible as follows:
              (a)   The person receives or is considered to be receiving supplemental security income benefits under
   Title XVI of the Social Security Act, 42 U.S.C. 1381, et seq., and does not have income or resources in excess
   of the applicable medical assistance limits.
                                                                  -6-                                                 LC 1341
Unofficial Draft Copy
67th Legislature                                                                                                         LC 1341
              (b)   The person would be eligible for assistance under the program described in subsection (1)(a) if
   that person were to apply for that assistance.
              (c)   The person is in a medical facility that is a medicaid provider and, but for residence in the facility,
   the person would be receiving assistance under the program in subsection (1)(a).
              (d)   The person is:
              (i)   under 21 years of age and in foster care under the supervision of the state or was in foster care
   under the supervision of the state and has been adopted as a child with special needs; or
              (ii) under 18 years of age and is in a guardianship subsidized by the department pursuant to 41-3-444.
              (e)   The person meets the nonfinancial criteria of the categories in subsections (1)(a) through (1)(d)
 10