Effective - 28 Aug 2018, 4 histories
208.955. Committee established, members, duties — issuance of findings. — 1. There is hereby established in the department of social services the "MO HealthNet Oversight Committee", which shall be appointed by January 1, 2008, and shall consist of nineteen members as follows:
(1) Two members of the house of representatives, one from each party, appointed by the speaker of the house of representatives and the minority floor leader of the house of representatives;
(2) Two members of the Senate, one from each party, appointed by the president pro tem of the senate and the minority floor leader of the senate;
(3) One consumer representative who has no financial interest in the health care industry and who has not been an employee of the state within the last five years;
(4) Two primary care physicians, licensed under chapter 334, who care for participants, not from the same geographic area, chosen in the same manner as described in section 334.120;
(5) Two physicians, licensed under chapter 334, who care for participants but who are not primary care physicians and are not from the same geographic area, chosen in the same manner as described in section 334.120;
(6) One representative of the state hospital association;
(7) Two nonphysician health care professionals, the first nonphysician health care professional licensed under chapter 335 and the second nonphysician health care professional licensed under chapter 337, who care for participants;
(8) One dentist, who cares for participants, chosen in the same manner as described in section 332.021;
(9) Two patient advocates who have no financial interest in the health care industry and who have not been employees of the state within the last five years;
(10) One public member who has no financial interest in the health care industry and who has not been an employee of the state within the last five years; and
(11) The directors of the department of social services, the department of mental health, the department of health and senior services, or the respective directors' designees, who shall serve as ex officio members of the committee.
2. The members of the oversight committee, other than the members from the general assembly and ex officio members, shall be appointed by the governor with the advice and consent of the senate. A chair of the oversight committee shall be selected by the members of the oversight committee. Of the members first appointed to the oversight committee by the governor, eight members shall serve a term of two years, seven members shall serve a term of one year, and thereafter, members shall serve a term of two years. Members shall continue to serve until their successor is duly appointed and qualified. Any vacancy on the oversight committee shall be filled in the same manner as the original appointment. Members shall serve on the oversight committee without compensation but may be reimbursed for their actual and necessary expenses from moneys appropriated to the department of social services for that purpose. The department of social services shall provide technical, actuarial, and administrative support services as required by the oversight committee. The oversight committee shall:
(1) Meet on at least four occasions annually, including at least four before the end of December of the first year the committee is established. Meetings can be held by telephone or video conference at the discretion of the committee;
(2) Review the participant and provider satisfaction reports and the reports of health outcomes, social and behavioral outcomes, use of evidence-based medicine and best practices as required of the health improvement plans and the department of social services under section 208.950;
(3) Review the results from other states of the relative success or failure of various models of health delivery attempted;
(4) Review the results of studies comparing health plans conducted under section 208.950;
(5) Review the data from health risk assessments collected and reported under section 208.950;
(6) Review the results of the public process input collected under section 208.950;
(7) Advise and approve proposed design and implementation proposals for new health improvement plans submitted by the department, as well as make recommendations and suggest modifications when necessary;
(8) Determine how best to analyze and present the data reviewed under section 208.950 so that the health outcomes, participant and provider satisfaction, results from other states, health plan comparisons, financial impact of the various health improvement plans and models of care, study of provider access, and results of public input can be used by consumers, health care providers, and public officials;
(9) Present significant findings of the analysis required in subdivision (8) of this subsection in a report to the general assembly and governor, at least annually, beginning January 1, 2009;
(10) Review the budget forecast issued by the legislative budget office, and the report required under subsection (22) of subsection 1 of section 208.151, and after study:
(a) Consider ways to maximize the federal drawdown of funds;
(b) Study the demographics of the state and of the MO HealthNet population, and how those demographics are changing;
(c) Consider what steps are needed to prepare for the increasing numbers of participants as a result of the baby boom following World War II;
(11) Conduct a study to determine whether an office of inspector general shall be established. Such office would be responsible for oversight, auditing, investigation, and performance review to provide increased accountability, integrity, and oversight of state medical assistance programs, to assist in improving agency and program operations, and to deter and identify fraud, abuse, and illegal acts. The committee shall review the experience of all states that have created a similar office to determine the impact of creating a similar office in this state; and
(12) Perform other tasks as necessary, including but not limited to making recommendations to the division concerning the promulgation of rules and emergency rules so that quality of care, provider availability, and participant satisfaction can be assured.
3. The provisions of section 23.253 shall not apply to sections 208.950 to 208.955.
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(L. 2007 S.B. 577, A.L. 2011 H.B. 464 merged with H.B. 555 merged with H.B. 648, A.L. 2014 H.B. 1298 Revision, A.L. 2018 S.B. 843)
Structure Missouri Revised Statutes
Title XII - Public Health and Welfare
Chapter 208 - Old Age Assistance, Aid to Dependent Children and General Relief
Section 208.001 - Citation of law — MO HealthNet created — division created — rulemaking authority.
Section 208.022 - TANF electronic benefit cards to include photograph of recipient.
Section 208.044 - Child day care services to be provided certain persons — eligible providers.
Section 208.048 - Aid to families with dependent child — school attendance required — rules.
Section 208.050 - Aid to dependent children denied, when.
Section 208.060 - Applications for benefits, how and where filed.
Section 208.065 - Verification of eligibility for public assistance, contract for.
Section 208.067 - TANF set-aside minimums for certain programs.
Section 208.071 - Individualized assessment of applicant — rulemaking authority.
Section 208.080 - Appeal to director of the respective division, when — procedure.
Section 208.090 - Reinstatement and payment of benefits to applicant.
Section 208.100 - Appeal to circuit court — procedure.
Section 208.110 - Appeals from circuit court.
Section 208.120 - Records, when evidence, restrictions on disclosure — penalty.
Section 208.125 - Records may be destroyed, when.
Section 208.130 - Benefits granted may be reconsidered.
Section 208.140 - Grants subject to any change of law.
Section 208.145 - Medical assistance benefits, eligibility based on receipt of AFDC benefits, when.
Section 208.146 - Ticket-to-work health assurance program — eligibility — expiration date.
Section 208.150 - Monthly benefits, how determined.
Section 208.154 - Insufficient funds, benefits to be paid pro rata.
Section 208.155 - Records concerning applicants and recipients of medical assistance confidential.
Section 208.158 - Payments to be made only when federal grants-in-aid are provided.
Section 208.159 - Payments for nursing home services, how administered — rules.
Section 208.160 - Payment rolls, how prepared — checks and warrants, how issued.
Section 208.163 - Direct payment on request by authorized providers of services.
Section 208.170 - Duties of state treasurer — special funds created.
Section 208.171 - Effective date of certain sections.
Section 208.172 - Reduction or denial of benefits, basis for, restrictions on.
Section 208.173 - Committee established.
Section 208.175 - Drug utilization review board established, members, terms, compensation, duties.
Section 208.176 - Division to provide for prospective review of drug therapy.
Section 208.180 - Payment of benefits, to whom — disposition of benefit check of deceased person.
Section 208.181 - Expedited eligibility process, pregnant women.
Section 208.190 - Division to comply with acts of congress relating to Social Security benefits.
Section 208.198 - Same or similar services, equal reimbursement rate required.
Section 208.210 - Undeclared income or property — benefits may be recovered by division, when.
Section 208.212 - Annuities, affect on Medicaid eligibility — rulemaking authority.
Section 208.213 - Personal care contracts, effect on eligibility.
Section 208.221 - Jurisdiction, administrative hearing commission, procedure.
Section 208.223 - Reimbursement for ambulance service to be based on mileage.
Section 208.225 - Medicaid per diem rate recalculation for nursing homes, amount.
Section 208.229 - Rebates on outpatient drugs — definitions.
Section 208.230 - Public assistance beneficiary employer disclosure act — report, content.
Section 208.238 - Eligibility, automated process to check applicants and recipients.
Section 208.240 - Statewide dental delivery system authorized.
Section 208.247 - Food stamp eligibility, felony conviction not to make ineligible, when.
Section 208.250 - Definitions.
Section 208.265 - Rules and procedures, developed by whom, published, where.
Section 208.341 - School programs — postponing sexual involvement — QUEST — rites of passage.
Section 208.342 - Earned income tax credit program, AFDC recipients.
Section 208.345 - Protocols for referral of public assistance recipients to federal programs.
Section 208.400 - Definitions.
Section 208.405 - JOBS program established, duties of department.
Section 208.420 - Department to apply for and accept federal funds.
Section 208.425 - Welfare reform coordinating committee established.
Section 208.431 - Medicaid managed care organization reimbursement allowance, amount.
Section 208.432 - Record keeping required, submission to department.
Section 208.434 - Amount final, when — protest, procedure.
Section 208.435 - Rulemaking authority.
Section 208.436 - Remittance to the department — deposit in dedicated fund.
Section 208.455 - Formula for federal reimbursement allowance established by rule — procedure.
Section 208.463 - Documents content and form prescribed by rule.
Section 208.469 - Tax exempt or nonprofit status granted by state not to be affected.
Section 208.471 - Medicaid reimbursement payments to hospitals, amount, how calculated.
Section 208.475 - Effective date of allowance.
Section 208.477 - Medicaid eligibility, criteria used, effect when more restrictive than FY2003.
Section 208.480 - Federal reimbursement allowance expiration date.
Section 208.530 - Definitions.
Section 208.533 - Commission established — members, qualifications — terms — expenses.
Section 208.535 - Commission, duties.
Section 208.600 - Citation of law, definitions.
Section 208.603 - Department of health and senior services to administer federal program.
Section 208.618 - Program to address mental health needs.
Section 208.621 - Program, at-risk elderly.
Section 208.624 - Invest in caring, model program — intergenerational care and training program.
Section 208.627 - Report, delivery of case management services, contents — delivery of report.
Section 208.631 - Program established, terminates, when — definitions.
Section 208.633 - Eligible children, income limits of parents or guardians.
Section 208.636 - Requirements of parents or guardians.
Section 208.640 - Co-payments required, when, amount, limitations.
Section 208.643 - Rules, compliance with federal law.
Section 208.646 - Waiting period required, when.
Section 208.647 - Special health care needs, waiver of waiting period for coverage.
Section 208.650 - Studies and reports required by department of social services.
Section 208.655 - Abortion counseling prohibited, exceptions.
Section 208.657 - Rules, effective when, invalid when.
Section 208.659 - Revision of eligibility requirements for uninsured women's health program.
Section 208.670 - Practice of telehealth, definitions — reimbursement of providers.
Section 208.677 - School children, parental authorization required for telehealth.
Section 208.690 - Citation of law — definitions.
Section 208.692 - Program established, purpose — asset disregard — departments duties — rules.
Section 208.694 - Eligibility — discontinuance of program, effect of — reciprocal agreements.
Section 208.696 - Director's duties — rules.
Section 208.698 - Reports required.
Section 208.750 - Title — definitions.
Section 208.760 - Eligibility — withdrawal of moneys, when.
Section 208.765 - Forfeiture of account moneys, when — death of account holder, effect of.
Section 208.770 - Tax exemption, credit, when.
Section 208.775 - Independent evaluation — report.
Section 208.780 - Definitions.
Section 208.782 - Missouri Rx plan established, purpose — rulemaking authority.
Section 208.786 - Authority of department in providing benefits — start of program benefits, when.
Section 208.788 - Program not an entitlement — payer of last resort requirements.
Section 208.794 - Fund created.
Section 208.798 - Termination date.
Section 208.853 - Findings and purpose.
Section 208.856 - Council created, expenses, members, terms, removal.
Section 208.859 - Powers and duties of the council.
Section 208.862 - Consumer rights and employment relations.
Section 208.865 - Definitions.
Section 208.868 - Federal approval and funding.
Section 208.871 - Severability clause.
Section 208.900 - Definitions.
Section 208.903 - Financial assistance for personal care, eligibility requirements.
Section 208.909 - Responsibilities of recipients and vendors.
Section 208.918 - Vendor requirements, philosophy and services.
Section 208.921 - Denial of eligibility, applicant entitled to hearing.
Section 208.924 - Discontinuation of services, when.
Section 208.927 - Rulemaking authority.
Section 208.935 - Assessment tool, home and community-based services.
Section 208.951 - Request for proposals.
Section 208.952 - Committee established, members, duties.
Section 208.955 - Committee established, members, duties — issuance of findings.
Section 208.990 - MO HealthNet eligibility requirements.
Section 208.991 - Definitions — persons eligible for MO HealthNet — rulemaking authority.
Section 208.1050 - Fund created, use of moneys.
Section 208.1060 - Food banks, state plan to be submitted for federal project.