HB 2086 Summary

• Establishes a Prescription Drug Monitoring Program (PDMP) requiring pharmacies to report dispensation data for Schedule II, III, and IV controlled substances to the Department of Health and Senior Services within seven days; program sunsets after six years unless reauthorized.

• Expands MO HealthNet eligibility beginning January 1, 2015, to include non-elderly adults ages 19-64 with income at or below 138% of the federal poverty level plus 5%, contingent on federal waiver approval and enhanced federal funding rates.

• Creates managed care plan requirements including adequate provider networks with minimum standards, competitive bidding processes, minimum medical loss ratios of 85%, and quarterly public reporting of utilization, quality, and access data.

• Establishes the Health Care Homes Program providing care coordination and payment to primary care clinics for medically frail MO HealthNet recipients, with requirements for care plans, dedicated care coordinators, and disease registries.

• Extends additional benefits to all MO HealthNet recipients including rehabilitative services (physical therapy, occupational therapy, speech therapy) subject to prior authorization and electronic web-based review systems.