S.B. 819                                                 VETOES

FACILITY, OR ADULT DAY CARE FACILITY, PSYCHIATRIC REHABILITATION PROGRAM,
OR RESIDENTIAL REHABILITATION PROGRAM.

(3)      AN ENROLLEE OF THE PROGRAM WHO QUALIFIES FOR NURSING
LEVEL CARE MAY CHOOSE TO RECEIVE SERVICES IN A NURSING HOME OR IN THE
COMMUNITY, IF THE COMMUNITY PLACEMENT IS COST-EFFECTIVE.

(4)      THE COMMUNITY CHOICE PROGRAM SHALL ENSURE THAT ALL
ENROLLEES IN THE PROGRAM MAINTAIN ACCESS TO PHARMACY BENEFITS,
INCLUDING ALL CLASSES OF DRUGS, THAT ARE COMPARABLE TO THE BENEFITS
PROVIDED IN THE MEDICAL ASSISTANCE PROGRAM.

(G) (1) EACH COMMUNITY CARE ORGANIZATION SHALL PROVIDE FOR THE
BENEFITS DESCRIBED IN SUBSECTION (D) OF THIS SECTION.

(2)      THIS SECTION MAY NOT BE CONSTRUED TO PREVENT A COMMUNITY
CARE ORGANIZATION FROM PROVIDING ADDITIONAL BENEFITS THAT ARE NOT
COVERED BY A CAPITATED RATE.

(3)      (I) THE DEPARTMENT SHALL MAKE CAPITATION PAYMENTS TO
EACH COMMUNITY CARE ORGANIZATION AS PROVIDED IN THIS PARAGRAPH.

(II)     THE SECRETARY SHALL SET CAPITATION PAYMENTS AT A
LEVEL THAT IS ACTUARIALLY ADJUSTED FOR THE BENEFITS PROVIDED.

(III)   THE SECRETARY SHALL ADJUST CAPITATION PAYMENTS TO
REFLECT THE RELATIVE RISK ASSUMED BY THE COMMUNITY CARE ORGANIZATION.

(H) THE DEPARTMENT SHALL REQUIRE COMMUNITY CARE ORGANIZATIONS
TO BE CERTIFIED TO ACCEPT CAPITATED PAYMENTS FROM THE FEDERAL MEDICARE
PROGRAM FOR INDIVIDUALS WHO ARE DUALLY ELIGIBLE.

(I) THE COMMUNITY CHOICE PROGRAM SHALL INCLUDE:

(1)      ADULTS WHO ARE DUALLY ELIGIBLE;

(2)      ADULT MEDICAID RECIPIENTS WHO MEET THE NURSING HOME
LEVEL OF CARE STANDARD; AND

(3)      MEDICAID RECIPIENTS OVER 65 YEARS OF AGE.

(J) (1) INDIVIDUALS ELIGIBLE FOR THE COMMUNITY CHOICE PROGRAM
SHALL HAVE THE RIGHT TO ELECT TO RECEIVE SERVICES UNDER THE COMMUNITY
CHOICE PROGRAM OR AN APPROVED PROGRAM OF ALL-INCLUSIVE CARE FOR THE
ELDERLY.

(2) IF AN INDIVIDUAL ELIGIBLE FOR THE COMMUNITY CHOICE
PROGRAM REQUIRES HOSPICE CARE, THE INDIVIDUAL SHALL ELECT TO RECEIVE
HOSPICE CARE FROM A LICENSED HOSPICE PROGRAM UNDER A SEPARATE
ARRANGEMENT AND PAYMENT FOR HOSPICE CARE PROVIDED TO THE INDIVIDUAL
SHALL BE MADE DIRECTLY TO THE HOSPICE PROGRAM BY THE DEPARTMENT UNDER
THE MEDICAID-ESTABLISHED RATE FOR HOSPICE CARE REIMBURSEMENT.

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