SENATE BILL NO. 81
INTRODUCED BY J. HARP, S. BARTLETT, J. BOHLINGER, C. CHRISTIAENS, V. COCCHIARELLA, R. DALE, S. DOHERTY, D. ECK, B. EGGERS, J. ELLINGSON, A. ELLIS, E. FRANKLIN, S. GALLUS, B. GLASER, M. GUGGENHEIM, M. HALLIGAN, D. HARGROVE, H. HARPER, D. HARRINGTON, D. HEDGES, C. HIBBARD, J. HURDLE, R. JOHNSON, C. JUNEAU, S. KITZENBERG, B. KRENZLER, B. LAWSON, R. LENHART, M. LINDEEN, J. LYNCH, D. MAHLUM, B. MCCARTHY, L. MCCULLOCH, R. MENAHAN, L. NELSON, R. PECK, J. QUILICI, B. RANEY, S. ROSE, G. ROUSH, T. SCHMIDT, D. SHEA, L. SOFT, R. SOMERVILLE, C. SQUIRES, S. STANG, J. STOVALL, E. SWANSON, J. TESTER, B. THOMAS, F. THOMAS, M. WATERMAN, C. WILLIAMS, B. WILSON, D. WYATT
BY REQUEST OF THE GOVERNOR
AN ACT ESTABLISHING THE CHILDREN'S HEALTH INSURANCE PROGRAM; PROHIBITING THE DEPARTMENT OF PUBLIC HEALTH AND HUMAN SERVICES FROM USING FUNDS APPROPRIATED FOR THE PROGRAM TO EXPAND MEDICAID ELIGIBILITY CRITERIA; PROVIDING ELIGIBILITY CRITERIA; LISTING THE BENEFITS TO BE PROVIDED; ALLOWING THE DEPARTMENT TO ALTER ELIGIBILITY REQUIREMENTS IF FUNDING IS INSUFFICIENT; ALLOWING THE DEPARTMENT TO CONTRACT WITH INSURANCE PROVIDERS; ALLOWING THE DEPARTMENT TO ESTABLISH COST-SHARING MECHANISMS; PROVIDING RULEMAKING AUTHORITY AND GUIDELINES TO THE DEPARTMENT; ALLOWING DISCLOSURE OF INFORMATION NECESSARY FOR THE ADMINISTRATION OF THE PROGRAM; REQUIRING THAT RULES BE REVIEWED BY AN APPROPRIATE INTERIM COMMITTEE; REQUIRING THAT TOBACCO SETTLEMENT PROCEED FUNDS BE DEPOSITED INTO THE GENERAL FUND; APPROPRIATING TOBACCO SETTLEMENT PROCEEDS TO FUND THE PROGRAM; PROVIDING A CONTINGENT APPROPRIATION; AND PROVIDING AN IMMEDIATE EFFECTIVE DATE AND A CONTINGENT TERMINATION PROVISION.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MONTANA:
Section 1. Short title. [Sections 1 through 9] may be cited as the "Children's Health Insurance Program Act".
Section 2. Purpose -- definition. (1) The purpose of [sections 1 through 9] is to create a program to provide health care to children who are not eligible for health care services under the Montana medicaid program. These health care services may be provided by the payment for health care through an insurance plan, a health maintenance organization, or a managed care plan.
(2) As used in [sections 3 through 9], "program" means the state children's health insurance program.
Section 3. Establishment and administration of program. The department of public health and human services may establish, administer, and monitor a program to provide health care to uninsured children. The department may not use money appropriated for this program to expand eligibility criteria for the Montana medicaid program.
Section 4. Eligibility for program -- rulemaking. (1) To be considered eligible for the program, a child:
(a) must be 18 years of age or younger;
(b) except as provided in subsection (4), must have a combined family income at or below 150% of the federal poverty level;
(c) may not already be covered by private insurance that offers creditable coverage, as defined in 42 U.S.C. 300gg(c);
(d) may not be eligible for medicaid benefits; and
(e) must be a United States citizen or qualified alien and a Montana resident.
(2) The department of public health and human services shall adopt rules that establish the program's criteria for residency. The criteria must conform as nearly as practicable with the residency requirements for medicaid eligibility.
(3) Subject to [section 8(3)], rules governing eligibility may also include financial standards and criteria for income and resources, treatment of resources, and nonfinancial criteria.
(4) If the department determines that there is insufficient funding for the program, it may lower the percentage of the federal poverty level established in subsection (1)(b) in order to reduce the number of persons who may be eligible to participate.
Section 5. Benefits provided. (1) Benefits provided to participants in the program include but are not limited to:
(a) inpatient and outpatient hospital services;
(b) physician and advanced practice registered nurse services;
(c) laboratory and x-ray services;
(d) well-child and well-baby services;
(e) immunizations;
(f) clinic services;
(g) dental services;
(h) prescription drugs;
(i) mental health and substance abuse treatment services;
(j) hearing and vision exams; and
(k) eyeglasses.
(2) The department is specifically prohibited from providing payment for birth control contraceptives under this program.
Section 6. Department may contract for services. The department of public health and human services may contract with insurance companies or other entities to provide services for a set monthly or yearly fee based on the number of participants in the program and the types of services provided.
Section 7. Participant cost-sharing. The department of public health and human services may charge fees to participants in the program. The fees may include:
(1) monthly or yearly enrollment fees;
(2) minimum charges to be incurred or spent before benefits are paid;
(3) cost-sharing for individual benefits; and
(4) other types of charges assessed as part of the program.
Section 8. Department to adopt rules -- review by interim committee. (1) The department of public health and human services shall adopt rules necessary for the administration of the program, including rules governing the application process, termination, and confidentiality.
(2) The rules may include, as necessary:
(a) the amount, scope, and duration of specific services provided;
(b) criteria to ensure that the services provided are medically necessary and cost-effective;
(c) provisions for participant cost-sharing, including, at the department's discretion:
(i) the establishment of enrollment fees, premiums, deductibles, and copayments; and
(ii) the process for setting the amounts of enrollment fees, premiums, deductibles, and copayments, taking into account a participant's family income and resources; and
(d) the type of professionals who may deliver services or direct the delivery of services and the qualifications required of those professionals.
(3) In adopting rules, the department shall consider the federal requirements on which the receipt of the federal share of program funds are contingent and may not include any provision that places that funding at risk.
(4) Rules adopted by the department pursuant to [sections 4 and 8] must be presented to and reviewed by an appropriate interim committee that examines issues related to children and families.
Section 9. Sharing of information. The department of public health and human services, health care providers, insurance companies, and other entities may share only health care information, medical records, income, and other participant eligibility information for the purposes of administering the program. The limitations on disclosure of information provided in 33-19-306 do not apply if they conflict with [sections 1 through 9]. To the extent possible, the information may not be disclosed in a manner that would violate the privacy of an individual or be released to any entity that is not necessary for the administration of the program.
Section 10. Tobacco settlement funds to general fund. Funds received from the tobacco settlement must be deposited in the general fund. Any funds appropriated for the children's health insurance program that remain unexpended at the end of the biennium must be transferred to the general fund.
Section 11. Appropriation. There is appropriated $8 million for the 2001 biennium from the general fund from money recovered by the state of Montana from January 1, 1999, through June 30, 2001, from any judgment, settlement, or fine received as a result of a criminal or civil claim against a tobacco company related to the production, marketing, or use of tobacco products. The appropriation must be used for the children's health insurance program established in [sections 1 through 9]. The appropriation may also be used to fund any increases in medicaid program costs resulting from the children's health insurance program outreach.
Section 12. Contingent appropriation. If money is not recovered as provided for in [section 11], the department of public health and human services is authorized to receive a general fund loan pursuant to 17-2-107 in the amount of $8 million for the purposes of the children's health insurance program provided for in [sections 1 through 9] for the 2001 biennium. The general fund loan must be repaid from any money recovered by the state of Montana, by June 30, 2001, from any judgment, settlement, or fine received as a result of a criminal or civil claim against a tobacco company related to the production, marketing, or use of tobacco products.
Section 13. Codification instruction. [Sections 1 through 10] are intended to be codified as an integral part of Title 53, chapter 4, and the provisions of Title 53, chapter 4, apply to [sections 1 through 10].
Section 14. Effective date. [This act] is effective on passage and approval.
Section 15. Contingent termination. (1) [This act] terminates on the date that the director of the department of public health and human services certifies to the governor that the federal government has terminated the program or that federal funding for the program has been discontinued.
(2) The governor shall transmit a copy of the certification to the code commissioner.
(3) Any excess funds remaining upon the termination of the program must be transferred to the general fund.
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