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SPONSOR: |
Miera |
DATE TYPED: |
|
HB |
266/aHGUAC |
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SHORT TITLE: |
Reimbursement of Doctors of Oriental Medicine |
SB |
|
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|
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ANALYST: |
Weber |
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REVENUE
|
Estimated Revenue |
Subsequent Years Impact |
Recurring or
Non-Rec |
Fund Affected |
|
|
FY03 |
FY04 |
|
|
|
|
|
($661.3) |
|
Recurring |
General
Fund |
|
|
$661.3 |
|
Recurring |
State
Medicaid Budget |
|
|
$2,007.2 |
|
Recurring |
Federal/Medicaid |
(Parenthesis ( ) Indicate Revenue Decreases)
Duplicates Senate Bill 274.
Responses
Received From
Human
Services Department
SUMMARY
Synopsis of HGUAC Amendment
The House Government and Urban Affairs Committee
amendment makes the following changes:
On page 2, line 9, strike “The” and insert thereof
“If federal matching funds are available in the Medicaid program for
reimbursement of acupuncture or other services provided by doctors of oriental
medicine, the”
On page 2, line 20, strike “The” and insert in lieu
thereof “ If federal matching funds are available in the Medicaid program for
reimbursement of acupuncture or other services provided by doctors of oriental
medicine, the’.
These changes make the Medicaid program recognize doctors
of oriental medicine as providers eligible for federal reimbursement.
Synopsis
of Original Bill
House Bill 266 proposes that Doctors of Oriental
Medicine (DOM) be recognized as providers in the Medicaid program and
reimbursed at a rate that is commensurate with reasonable and customary rate
for acupuncture services charged by doctors of oriental medicine statewide.
Significant
Issues
The Human Services Department reports that currently,
Medicaid does not now recognize DOM as eligible providers. It does not reimburse for certain services
provided by DOM, such as acupuncture, certain prescriptions, herbs and other
modalities of treatment. Including DOM
as eligible providers would be an expansion of the Medicaid program. Moreover, some of these services would not
likely be services for which federal financial participation (FFP) would be
available. If such services were
required, additional state funds without federal match would be required.
FISCAL IMPLICATIONS
The estimated total
financial impact is $2.66 million, $661.3 in State General Funds and $2,007.7
in federal Medicaid funds. These amounts
reflect only the minimum costs of simple office visits to DOM. It does not include the potential additional
costs of specific modalities of treatment and drugs.
Additional state general
funds would be needed for the Medicaid budget for both fee-for-service
providers and SALUD! contractors to pay for these new
services. Some of the services within
the legal scope of DOM practice, such as herbal prescriptions or biofeedback techniques
using color, light or sound may not be eligible for the federal Medicaid match
necessitating payment by 100 percent general fund.
ADMINISTRATIVE IMPLICATIONS
Since acupuncture is not
currently a covered benefit of the Medicaid program, if the HB 266 is enacted,
the Medical Assistance Division (MAD) would
need to create a new benefit category, promulgate new regulations, write new
billing instructions, seek approval from Centers for Medicare and Medicaid
Services (CMS) to amend the state plan and enroll DOM and other providers of
acupuncture services. MAD would also
have to update the Medicaid Management Information System (“MMIS”) to include
these new providers and relevant codes.
Such expansion would result in new and increased administrative costs
for the Medicaid program.