208.955. Committee established, members, duties--issuance of findings--subcommittee designated, duties, members.
Committee established, members, duties--issuance offindings--subcommittee designated, duties, members.
208.955. 1. There is hereby established in the department of socialservices the "MO HealthNet Oversight Committee", which shall be appointedby January 1, 2008, and shall consist of eighteen 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 minorityfloor leader of the house of representatives;
(2) Two members of the Senate, one from each party, appointed by thepresident pro tem of the senate and the minority floor leader of thesenate;
(3) One consumer representative;
(4) Two primary care physicians, licensed under chapter 334, RSMo,recommended by any Missouri organization or association that represents asignificant number of physicians licensed in this state, who care forparticipants, not from the same geographic area;
(5) Two physicians, licensed under chapter 334, RSMo, who care forparticipants but who are not primary care physicians and are not from thesame geographic area, recommended by any Missouri organization orassociation that represents a significant number of physicians licensed inthis state;
(6) One representative of the state hospital association;
(7) One nonphysician health care professional who cares forparticipants, recommended by the director of the department of insurance,financial institutions and professional registration;
(8) One dentist, who cares for participants. The dentist shall berecommended by any Missouri organization or association that represents asignificant number of dentists licensed in this state;
(9) Two patient advocates;
(10) One public member; and
(11) The directors of the department of social services, thedepartment of mental health, the department of health and senior services,or the respective directors' designees, who shall serve as ex-officiomembers of the committee.
2. The members of the oversight committee, other than the membersfrom the general assembly and ex-officio members, shall be appointed by thegovernor with the advice and consent of the senate. A chair of theoversight committee shall be selected by the members of the oversightcommittee. Of the members first appointed to the oversight committee bythe governor, eight members shall serve a term of two years, seven membersshall serve a term of one year, and thereafter, members shall serve a termof two years. Members shall continue to serve until their successor isduly appointed and qualified. Any vacancy on the oversight committee shallbe filled in the same manner as the original appointment. Members shallserve on the oversight committee without compensation but may be reimbursedfor their actual and necessary expenses from moneys appropriated to thedepartment of social services for that purpose. The department of socialservices shall provide technical, actuarial, and administrative supportservices as required by the oversight committee. The oversight committeeshall:
(1) Meet on at least four occasions annually, including at least fourbefore the end of December of the first year the committee is established.Meetings can be held by telephone or video conference at the discretion ofthe committee;
(2) Review the participant and provider satisfaction reports and thereports of health outcomes, social and behavioral outcomes, use ofevidence-based medicine and best practices as required of the healthimprovement plans and the department of social services under section208.950;
(3) Review the results from other states of the relative success orfailure of various models of health delivery attempted;
(4) Review the results of studies comparing health plans conductedunder section 208.950;
(5) Review the data from health risk assessments collected andreported under section 208.950;
(6) Review the results of the public process input collected undersection 208.950;
(7) Advise and approve proposed design and implementation proposalsfor new health improvement plans submitted by the department, as well asmake recommendations and suggest modifications when necessary;
(8) Determine how best to analyze and present the data reviewed undersection 208.950 so that the health outcomes, participant and providersatisfaction, results from other states, health plan comparisons, financialimpact of the various health improvement plans and models of care, study ofprovider 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 insubdivision (8) of this subsection in a report to the general assembly andgovernor, at least annually, beginning January 1, 2009;
(10) Review the budget forecast issued by the legislative budgetoffice, and the report required under subsection (22) of subsection 1 ofsection 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 HealthNetpopulation, and how those demographics are changing;
(c) Consider what steps are needed to prepare for the increasingnumbers of participants as a result of the baby boom following World WarII;
(11) Conduct a study to determine whether an office of inspectorgeneral shall be established. Such office would be responsible foroversight, auditing, investigation, and performance review to provideincreased accountability, integrity, and oversight of state medicalassistance programs, to assist in improving agency and program operations,and to deter and identify fraud, abuse, and illegal acts. The committeeshall review the experience of all states that have created a similaroffice to determine the impact of creating a similar office in this state;and
(12) Perform other tasks as necessary, including but not limited tomaking recommendations to the division concerning the promulgation of rulesand emergency rules so that quality of care, provider availability, andparticipant satisfaction can be assured.
3. By July 1, 2011, the oversight committee shall issue findings tothe general assembly on the success and failure of health improvement plansand shall recommend whether or not any health improvement plans should bediscontinued.
4. The oversight committee shall designate a subcommittee devoted toadvising the department on the development of a comprehensive entry pointsystem for long-term care that shall:
(1) Offer Missourians an array of choices including community-based,in-home, residential and institutional services;
(2) Provide information and assistance about the array of long-termcare services to Missourians;
(3) Create a delivery system that is easy to understand and accessthrough multiple points, which shall include but shall not be limited toproviders of services;
(4) Create a delivery system that is efficient, reduces duplication,and streamlines access to multiple funding sources and programs;
(5) Strengthen the long-term care quality assurance and qualityimprovement system;
(6) Establish a long-term care system that seeks to achieve timelyaccess to and payment for care, foster quality and excellence in servicedelivery, and promote innovative and cost-effective strategies; and
(7) Study one-stop shopping for seniors as established in section208.612.
5. The subcommittee shall include the following members:
(1) The lieutenant governor or his or her designee, who shall serveas the subcommittee chair;
(2) One member from a Missouri area agency on aging, designated bythe governor;
(3) One member representing the in-home care profession, designatedby the governor;
(4) One member representing residential care facilities,predominantly serving MO HealthNet participants, designated by thegovernor;
(5) One member representing assisted living facilities or continuingcare retirement communities, predominantly serving MO HealthNetparticipants, designated by the governor;
(6) One member representing skilled nursing facilities, predominantlyserving MO HealthNet participants, designated by the governor;
(7) One member from the office of the state ombudsman for long-termcare facility residents, designated by the governor;
(8) One member representing Missouri centers for independent living,designated by the governor;
(9) One consumer representative with expertise in services forseniors or the disabled, designated by the governor;
(10) One member with expertise in Alzheimer's disease or relateddementia;
(11) One member from a county developmental disability board,designated by the governor;
(12) One member representing the hospice care profession, designatedby the governor;
(13) One member representing the home health care profession,designated by the governor;
(14) One member representing the adult day care profession,designated by the governor;
(15) One member gerontologist, designated by the governor;
(16) Two members representing the aged, blind, and disabledpopulation, not of the same geographic area or demographic group designatedby the governor;
(17) The directors of the departments of social services, mentalhealth, and health and senior services, or their designees; and
(18) One member of the house of representatives and one member of thesenate serving on the oversight committee, designated by the oversightcommittee chair.
Members shall serve on the subcommittee without compensation but may bereimbursed for their actual and necessary expenses from moneys appropriatedto the department of health and senior services for that purpose. Thedepartment of health and senior services shall provide technical andadministrative support services as required by the committee.
6. By October 1, 2008, the comprehensive entry point systemsubcommittee shall submit its report to the governor and general assemblycontaining recommendations for the implementation of the comprehensiveentry point system, offering suggested legislative or administrativeproposals deemed necessary by the subcommittee to minimize conflict ofinterests for successful implementation of the system. Such report shallcontain, but not be limited to, recommendations for implementation of thefollowing consistent with the provisions of section 208.950:
(1) A complete statewide universal information and assistance systemthat is integrated into the web-based electronic patient health record thatcan be accessible by phone, in-person, via MO HealthNet providers and viathe Internet that connects consumers to services or providers and is usedto establish consumers' needs for services. Through the system, consumersshall be able to independently choose from a full range of home,community-based, and facility-based health and social services as well asaccess appropriate services to meet individual needs and preferences fromthe provider of the consumer's choice;
(2) A mechanism for developing a plan of service or care via theweb-based electronic patient health record to authorize appropriateservices;
(3) A preadmission screening mechanism for MO HealthNet participantsfor nursing home care;
(4) A case management or care coordination system to be available asneeded; and
(5) An electronic system or database to coordinate and monitor theservices provided which are integrated into the web-based electronicpatient health record.
7. Starting July 1, 2009, and for three years thereafter, thesubcommittee shall provide to the governor, lieutenant governor and thegeneral assembly a yearly report that providesan update on progress made by the subcommittee toward implementing thecomprehensive entry point system.
8. The provisions of section 23.253, RSMo, shall not apply tosections 208.950 to 208.955.
(L. 2007 S.B. 577)