Section 208.955

Title XII PUBLIC HEALTH AND WELFARE

Chapter 208

Effective - 28 Aug 2007, 4 histories, see footnote   (history) 

  208.955.  Committee established, members, duties — issuance of findings — subcommittee designated, duties, members. — 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 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 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;

  (4) Two primary care physicians, licensed under chapter 334, recommended by any Missouri organization or association that represents a significant number of physicians licensed in this state, who care for participants, not from the same geographic area;

  (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, recommended by any Missouri organization or association that represents a significant number of physicians licensed in this state;

  (6) One representative of the state hospital association;

  (7) One nonphysician health care professional who cares for participants, recommended by the director of the department of insurance, financial institutions and professional registration;

  (8) One dentist, who cares for participants. The dentist shall be recommended by any Missouri organization or association that represents a significant 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, 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. By July 1, 2011, the oversight committee shall issue findings to the general assembly on the success and failure of health improvement plans and shall recommend whether or not any health improvement plans should be discontinued.

  4. The oversight committee shall designate a subcommittee devoted to advising the department on the development of a comprehensive entry point system 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-term care services to Missourians;

  (3) Create a delivery system that is easy to understand and access through multiple points, which shall include but shall not be limited to providers 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 quality improvement system;

  (6) Establish a long-term care system that seeks to achieve timely access to and payment for care, foster quality and excellence in service delivery, and promote innovative and cost-effective strategies; and

  (7) Study one-stop shopping for seniors as established in section 208.612.

  5. The subcommittee shall include the following members:

  (1) The lieutenant governor or his or her designee, who shall serve as the subcommittee chair;

  (2) One member from a Missouri area agency on aging, designated by the governor;

  (3) One member representing the in-home care profession, designated by the governor;

  (4) One member representing residential care facilities, predominantly serving MO HealthNet participants, designated by the governor;

  (5) One member representing assisted living facilities or continuing care retirement communities, predominantly serving MO HealthNet participants, designated by the governor;

  (6) One member representing skilled nursing facilities, predominantly serving MO HealthNet participants, designated by the governor;

  (7) One member from the office of the state ombudsman for long-term care 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 for seniors or the disabled, designated by the governor;

  (10) One member with expertise in Alzheimer's disease or related dementia;

  (11) One member from a county developmental disability board, designated by the governor;

  (12) One member representing the hospice care profession, designated by 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 disabled population, not of the same geographic area or demographic group designated by the governor;

  (17) The directors of the departments of social services, mental health, and health and senior services, or their designees; and

  (18) One member of the house of representatives and one member of the senate serving on the oversight committee, designated by the oversight committee chair.

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Members shall serve on the subcommittee without compensation but may be reimbursed for their actual and necessary expenses from moneys appropriated to the department of health and senior services for that purpose. The department of health and senior services shall provide technical and administrative support services as required by the committee.

  6. By October 1, 2008, the comprehensive entry point system subcommittee shall submit its report to the governor and general assembly containing recommendations for the implementation of the comprehensive entry point system, offering suggested legislative or administrative proposals deemed necessary by the subcommittee to minimize conflict of interests for successful implementation of the system. Such report shall contain, but not be limited to, recommendations for implementation of the following consistent with the provisions of section 208.950:

  (1) A complete statewide universal information and assistance system that is integrated into the web-based electronic patient health record that can be accessible by phone, in-person, via MO HealthNet providers and via the Internet that connects consumers to services or providers and is used to establish consumers' needs for services. Through the system, consumers shall be able to independently choose from a full range of home, community-based, and facility-based health and social services as well as access appropriate services to meet individual needs and preferences from the provider of the consumer's choice;

  (2) A mechanism for developing a plan of service or care via the web-based electronic patient health record to authorize appropriate services;

  (3) A preadmission screening mechanism for MO HealthNet participants for nursing home care;

  (4) A case management or care coordination system to be available as needed; and

  (5) An electronic system or database to coordinate and monitor the services provided which are integrated into the web-based electronic patient health record.

  7. Starting July 1, 2009, and for three years thereafter, the subcommittee shall provide to the governor, lieutenant governor and the general assembly a yearly report that provides an update on progress made by the subcommittee toward implementing the comprehensive entry point system.

  8. 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)