2015 Session

Budget Amendments - SB800 (Member Request)

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Chief Patron: Howell
Healthly Transitions Program

Item 301 #17s

Item 301 #17s

First Year - FY2015 Second Year - FY2016
Health and Human Resources
Medical Assistance Services, Department of FY2015 $0 FY2016 ($232,500,000) GF
FY2015 $0 FY2016 $1,296,000,000 NGF

Page 257, line 32, strike "$8,515,698,638" and insert "$9,579,198,638".
Page 281, after line 10, insert:
"OOOO.  The Department of Medical Assistance Services shall seek a § 1115 waiver from the Centers for Medicare  and Medicaid Services (CMS) to implement the "Healthy Transitions Program" for individuals identified in 42 U.S.C. § 1396a(a)(10)(A)(i)(VIII). The waiver shall be designed to take effect on July 1, 2015 and shall include the following elements:
a  Coverage for low income, uninsured individuals, including those without access to affordable employer based coverage, students in degree programs, persons temporarily unemployed, and the disabled awaiting Medicare coverage. "Affordable" means coverage for the employee  and dependents that costs less than 8.5 percent of family income.
b. Increased personal responsibility by establishing a schedule of co-payments that is the maximum allowed under current federal law for individuals  with income below 100 percent federal poverty line (FPL) and higher than the current  maximum  for individuals  with income above 100 percent FPL. The co-payment schedule shall include incentives for primary care and appropriate treatment of chronic conditions  and discourage non-emergency use of emergency rooms.
c. Services that are more closely aligned to commercial insurance, including the restriction of non-emergency transportation services for individuals  with income above 100 percent FPL.
d. Incentives for preventive services, an initial primary  care visit, wellness activities and healthy behaviors.
e. Incentives to encourage employment for individuals  who are unemployed, not attending school as full time students, not receiving Unemployment Compensation or Social Security Disability benefits  and not caring for dependent family members under 12 months of age or a disabled family members of any age.
f. Options to pay premiums  for available employer-based coverage.
g. Protections for Virginia in the event federal funding is reduced below levels set forth in
42 U.S.C. § 1396d(y)(1)[2010].
h. Payments to health plans and providers that are conditioned on quality care measures and support  patient-centered medical homes.
i. Strengthened efforts  to prevent, detect and punish fraud and abuse.
j. Coverage is contingent upon approval and duration of the federal waiver.

(This amendment directs DMAS to establish and implement a waiver program called "Healthy Transitions". It uses available nongeneral funds to provide transitional insurance coverage for low income, uninsured Virginians, including those without access to affordable employer based coverage, students in degree programs, persons temporarily unemployed, and the disabled awaiting Medicare coverage. Based on the Department of Medical Assistance Services' estimates of the cost of increasing access to health care, the amendment also assumes general fund savings of $232.5 million in FY 2016 as the result of supplanting general fund appropriations with federal funding for behavioral health services, inmate health care and indigent care currently paid for with 100 percent general fund dollars. The estimated GF savings will be transferred to the Virginia Health Reform and Innovation Fund pursuant to language in the Appropriation Act for health innovation grants to public and private entities and for future state health care costs. The specific waiver requirements are self-explanatory.)