CS/HB 7109 - Medicaid Bill Summary

• Home and Community-Based Services: Requires the Agency for Persons with Disabilities to collect premiums/cost sharing, establishes a four-tiered waiver system with annual spending limits per client ($14,422-$150,000 depending on tier), and requires cost containment provisions in provider contracts.

• Hospital Reimbursement: Shifts hospital payment methodology from per diem rates to allowable-cost-based rates with limits/ceilings, directs development of diagnosis-related group (DRG) prospective payment system, and eliminates automatic rate adjustments.

• Managed Care and Enrollment: Reorganizes Medicaid managed care programs with mandatory enrollment provisions, allows recipients with employer coverage to opt out, establishes encounter data system for tracking services, and creates mechanisms for cost containment and quality assurance.

• Medicaid Eligibility and Coverage: Restricts eligibility to U.S. citizens and lawfully admitted noncitizens meeting specific criteria, modifies fraud penalty provisions (10-year forfeiture), and creates caps on noneconomic damages ($300,000 per claimant) for malpractice involving Medicaid recipients.

• Program Sunset Provisions: Multiple provisions expire October 1, 2013-2014, including pilot programs, nursing home diversion initiatives, and aging resource center operations, to align with broader Medicaid managed care reorganization.