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HOUSE BILL 1918

The State of Missouri hired a consulting organization called The Lewin Group to review Missouri’s Medicaid and present strategies for containing costs for Medicaid services in Missouri’s Medicaid program, MO HealthNet.

After a review of the entire Medicaid program, Governor Nixon recommends various program changes, which will affect people with disabilities.

Fiscal Year 2011 efforts include:

Third Party Assessment

The department will pursue a contract with an independent third party to conduct intake and reassessment. These assessments

determine eligibility and level of service need for in-home care services.

· The Lewin Group recommended the State of Missouri hire an independent third party to perform these assessments at a rate of $172.00 per assessment.

· At the present time DHSS staff or a medical professional hired by a provider perform these assessments. Some providers conduct the assessment at no cost to the State. The providers who do receive a fee for this assessment are paid just over $40.00 per assessment, which includes a nurse visit.

· Per the Lewin Group, The savings would come from denying people with disabilities based upon level of care scores necessary for eligibility and reducing hours.

High Cost Review

A team will be established to review high cost cases to ensure that recipients are receiving appropriate service levels. The department will establish a threshold that will prompt a review of an individual’s service plan involving all agencies authorizing and reimbursing for services. This will establish a process for reduction of unnecessary services or justification of these services.

Telephony

Providers will use an electronic voice interactive system in which all personal care assistants will have to call in to report attendance and work performed. This system is supposed to improve accuracy in record keeping resulting in long term savings.

· We are unsure if this will be mandatory even if a consumer of services does not have a phone or is limited by the amount of minutes on their cell phones.

Utilization Management

Personal care assistance services will be capped at a monthly average of 3.5 hours per day.

· Meaning this will be the maximum an individual will receive per day at generally 5 days per week.

· 60 hours per month

For clients with advanced care needs, an alternative option will be available.

· An additional 20 hours per month

· There is even a possibility of 40 additional hours per month however, this is still only an average of 3.3 hours per day.

The advanced personal care service rate will be eliminated; these services will be provided under the personal care rate.

Additionally, the Adult Day Health Care benefit will be reduced from seven to five days per week.
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HOUSE BILL 1918 contains many of these recommendations.

Toll Free: 866 797-6080 Voice: 573-244-5402 TTY: 573-244-3315 Fax: 573-244-5609
Email: DCAI P.O. Box 675 Viburnum MO 65566