January 2009 Emergency Justification

MSB 08-12-04-A
New legislation passed this past year requires that rules be implemented to provide guidelines on what is required from insurers and other responsible third parties to do proper data matching and claims recovery.  These rules are necessary to implement the requirements of HB-1409 and the federal Deficit Reduction Act of 2005.

MSB 08-11-21-B
Effective January 9, 2009, this rule implements increases for specific provider rates so that the Old Age Pension Health and Medical Care Program can reimburse providers closer to the program's statutory spending limits.  Program expenditures at the current provider rates are forecast to fall below the program's estimated spending authority for FY 2008-09.  The proposed increased provider rates may be sustained throughout FY 2009-10 by using reserve funds in the Supplemental Old Age Pension Health and Medical Care Fund if such additional funding is approved by the General Assembly.

The Board last addressed reimbursement rates for this program in April 2007.  In June 2007 the process for determining eligibility for financial and medical assistance services for all non-citizen residents changed.  One change was made so that non-citizens who have been in the United States at least five years may be found eligible for Medicaid on a timely basis in accordance with federal law.  The other change related to the process for verification of lawful presence.  Between these two changes, caseload in the OAP Health and Medical Care Program dropped significantly from July 2007 through January 2008.  This unexpected drop in caseload has been the primary reason that expenditures for this program have been much lower than forecasted in April 2007.

The Safety Net Programs section has worked closely with the Eligibility Systems staff to understand the effects of these eligibility systems changes and some modifications to the verification of lawful presence process have occurred as a result of ongoing analysis.  Caseload has now stabilized and is now growing at an expected rate.  The Department will continue to monitor the program.

The proposed rule also adds in clarifying language under Section 8.941.1(E) relating to the authority of the Executive Director of the Department to increase reimbursement rates to providers within constitutional and statutory limits.  

Increasing provider reimbursement rates as soon as possible ensures clients will have continued access to health care services, despite the current economic downturn.  The rate increase can be supported within existing funding.