Current Status Bill Number:222 Type of Legislation:General Bill GB Introducing Body:Senate Introduced Date:19950110 Primary Sponsor:Mitchell All Sponsors:Mitchell, Washington Drafted Document Number:RES9501.TWM Residing Body:Senate Current Committee:Banking and Insurance Committee 02 SBI Subject:Medicaid Insurance Demonstration Project Act
Body Date Action Description Com Leg Involved
______ ________ _______________________________________ _______ ____________
Senate 19950110 Introduced, read first time, 02 SBI
referred to Committee
Senate 19941017 Prefiled, referred to Committee 02 SBI
View additional legislative information at the LPITS web site.
TO AMEND CHAPTER 6, TITLE 44, CODE OF LAWS OF SOUTH CAROLINA, 1976, BY ADDING ARTICLE 8 SO AS TO ENACT THE MEDICAID INSURANCE DEMONSTRATION PROJECT ACT.
Be it enacted by the General Assembly of the State of South Carolina:
SECTION 1. This act may be cited as the "Medicaid Insurance Demonstration Project Act".
SECTION 2. Chapter 6, Title 44 of the 1976 Code is amended by adding:
Section 44-6-905. (A) Notwithstanding any other provision of law, this article applies to the following individuals who are eligible to receive Medicaid assistance:
(1) individuals who would be eligible to receive medical services under the aid to dependent children assistance category and who are not aged, blind, disabled;
(2) Aid to Families with Dependent Children recipients who are not aged, blind, or disabled;
(3) pregnant women;
(4) a child described in the State Medicaid Plan.
(B) This article does not apply to Medicaid recipients under the State Medicaid Plan who are not described in subsection (A).
Section 44-6-910. This article does not apply to the provisions of long term care services under the Medicaid program.
Section 44-6-915. (A) This section applies only to a participant who is less than the age established under the State Medicaid Plan for Medicaid eligibility.
(B) If this article authorizes a participant to do an act or to make a choice, the parent or guardian of the participant may do the act or make the choice in the place of the participant.
Section 44-6-920. The definitions in this article apply throughout this article.
(1) `Accident and sickness insurance policy' means a policy or contract providing at least one of the kinds of insurance described in the State Medicaid Plan.
(2) `Demonstration project' refers to the South Carolina Medicaid insurance demonstration project established by this article.
(3) `Health maintenance organization' has the meaning set forth in the State Medicaid Plan.
(4) `Insurer' means a person that offers a policy of accident and sickness insurance under the State Medicaid Plan.
(5) `Participant' means a Medicaid recipient described in the State Medicaid Plan.
(6) `Prepaid health care delivery plan' has the meaning set forth in the State Medicaid Plan.
(7) `Department' refers to the Department of Health and Human Services.
Section 44-6-925. (A) The department shall request a waiver under Section 111 5(b) of the federal Social Security Act from the United States Department of Health and Human Services to establish, on a statewide basis, the South Carolina Medicaid insurance demonstration project.
(B) The purpose of the demonstration project is to provide a more cost effective means of providing health care coverage for certain Medicaid eligible individuals by providing those individuals with private insurance or by enrolling those individuals in prepaid health care delivery plans.
Section 44-6-930. Subject to the requirements of this article, the department shall establish a program described in Sections 44-6-935, 44-6-940, or 44-6-945 of this article.
Section 44-6-935. (A) The department may contract on an annual basis with:
(1) at least two insurers that issue accident and sickness insurance policies; and
(2) at the option of the department, at least two or more health insurance organizations, to provide each participant with either accident and sickness health insurance or coverage under a prepaid health care delivery plan. The department may contract for accident and sickness insurance to be provided on a group basis.
(B) A contract entered into under this section for the provision of accident and sickness insurance may provide for the imposition of a deductible not to exceed two hundred fifty dollars.
Section 44-6-940. The department may contract on an annual basis, for payment on a per capita rate basis, with one or more health maintenance organizations to provide each participant with coverage under a prepaid health care delivery plan.
Section 44-6-945. (A) The department may contract on an annual basis with at least two insurers that issue accident and sickness insurance policies to provide each participant with accident and sickness health insurance. The department may contract for accident and sickness insurance to be provided on a group basis.
(B) Contracts entered into under subsection (A) shall provide that the department shall pay copayments and deductibles directly to the provider providing health care services to participants from the accounts established under this section.
(C) Except as provided in subsection (D), the department shall establish an individual account for each participant and credit two thousand dollars to the account.
(D) The department shall establish a family account for each set of participants described by any of the following:
(1) participants who are spouses;
(2) two or more participants described by the following:
(a) at least one of the participants is a child less than the age established under the State Medicaid Plan for Medicaid eligibility;
(b) at least one of the participants is a parent or legal guardian of all of the participants described in subsection (A). If both parents of all the participants described in subsection (A) are participants, both parents are covered by the family account.
(3) two or more participants described by both of the following:
(a) all the participants are children less than the age established under the State Medicaid Plan for Medicaid eligibility;
(b) all the participants have at least one common parent.
The department shall credit three thousand dollars to a family account. One adult participant in a family account for participants described by item (1) or (2) must be designated as responsible for the account. If more than one adult is covered by a family account, the adult participants shall designate one of the covered adult participants as the responsible participant. A parent or the guardian of the participants in a family account described in item (3) must be responsible for the account. The individual designated as responsible for a family account has the responsibilities and rights with respect to the account that an individual participant has with respect to an individual account.
(E) Money in an account may be used to pay the following:
(1) deductibles required to be paid under the contract;
(2) copayments required to be paid under the contract;
(3) other medical costs not covered by the contract and authorized to be paid by the participant.
(F) Contracts entered into under subsection (A) must provide that the total of deductibles and copayments that may be charged may not exceed the following during the one year period beginning on the anniversary date of the establishment of an account:
(1) two thousand dollars for an individual participant:
(2) three thousand dollars for all participants under a family account.
(G) After the anniversary date of the establishment of an account, the department shall:
(1) Except as provided in subsection (H), give a voucher to the participant in an account equal to the balance remaining in the account after payment of all copayments and deductibles required to be paid for health care services rendered before the anniversary date. A voucher given under this item may be used for any of the following purposes:
(a) education for one or more participants covered by the account;
(b) job training services for one or more participants covered by the account;
(c) child care services for one or more participants covered by the account;
(d) other expenses described in rules adopted under the State Medicaid Plan by the department.
(2) Except as provided in subsection (J), credit to the account the following:
(a) two thousand dollars if the account is an individual account;
(b) three thousand dollars if the account is a family account.
(H)A participant may choose to leave the balance of the account in the account after the anniversary date of the establishment of the account.
(I) If the department enters into contracts under subsection (A), the department may not pay the following for a participant, other than from the account:
(1) copayments;
(2) deductibles;
(3) other health care costs not covered by the contract.
(J) The department may close an account on the anniversary date if an individual who was a participant is not eligible to be a participant.
(K) The State may pool the money in all accounts established under this section for investment purposes. Interest from investments of money in the accounts must be deposited in the state general fund.
Section 44-6-950. (A) An insurer that contracts with the department to issue accident and sickness insurance under Section 44-6-915 may not contract with the department as a health maintenance organization under Section 44-6-920 to also provide coverage under a prepaid health care delivery plan under Section 44-6-920.
(B) A health maintenance organization that contracts with the department to provide coverage under a prepaid health care delivery plan under Section 44-6-915 may not contract with the department as an insurer under Section 44-6-920 to also issue accident and sickness insurance under Section 44-6-920.
Section 44-6-955. If the department elects to provide both kinds of coverage described in Section 44-6-915, the decision whether to be covered under either a group accident and sickness insurance policy or a prepaid health care delivery plan is at the option of the participant.
Section 44-6-960. The department shall pay on behalf of each participant in the demonstration project:
(1) the premium for each group accident and sickness insurance policy issued for a participant; and
(2) the enrollment fees for a participant's participation in a prepaid health care delivery plan in accordance with the contract entered into between the department and the insurer or health maintenance organization under this article.
Section 44-6-965. The department may enter into a contract under this article only after taking competitive bids. However, the department shall reserve the right to:
(1) accept no bid;
(2) rebid the contract; or
(3) discontinue the demonstration project after giving reasonable notice to affected parties.
Section 44-6-970. If the demonstration project is interrupted or discontinued under Section 44-6-965 of this article, payment of claims shall be made under the State Medicaid Plan. This section does not relieve an insurer or health maintenance organization of any contractual obligation incurred under this article.
Section 44-6-975. A contract entered into under this article between the department and an insurer or a health maintenance organization must provide coverage for any services offered to Medicaid recipients under the State Medicaid Plan with the exception of long-term care services.
Section 44-6-980. Upon approval of the necessary waiver requested under Section 44-6-905, the department shall administer the demonstration project.
Section 44-6-985. The department may promulgate regulations necessary to implement this article."
SECTION 3. (A) Within one year of this act's effective date, the department shall seek a waiver from the United States Department of Health and Human Services under Section 1115(b) of the federal Social Security Act to establish a demonstration project as described in this act. The department shall include in its waiver proposal a request for the federal government to match state funds used for the payment of the following in the same ratio as for other Medicaid expenditures:
(1) insurance premiums;
(2) enrollment fees for prepaid health care delivery plans;
(3) amounts deposited in accounts established under the State Medicaid Plan, as added by this act.
(B) If the department receives a waiver from the United States Department of Health and Human Services, the department shall implement this act not more than ninety days after the department receives the waiver.
SECTION 4. This act takes effect upon approval by the Governor.