Medical assistance services; volunteer emergency medical services agencies; supplemental payment for ground emergency medical services vehicle transportation. Directs the State Board of Health to include a provision in the state plan for medical assistance services to implement a supplemental payment program for qualified volunteer emergency medical services agencies to cover the difference between the agency's costs for ground emergency medical services vehicle transport services and the reimbursement amount received from the Department of Medical Assistance Services.
Nursing facilities; related party rent disclosures; incentive payment reduction; penalty. Requires any nursing facility enrolled as a Medicaid provider that makes rent or lease payments to publicly disclose information related to the rent or lease payments, including whether payments are made to a related party, the nature of the related party, and the related party rent expense, as defined in the bill. The bill requires the Department of Medical Assistance Services to determine whether related party rent expenses exceed a fair rental value benchmark and if so, deduct a portion of any incentive payment owed to the nursing facility. A knowingly false attestation or disclosure is punishable as a Class 3 misdemeanor.
Department of Medical Assistance Services; Medicaid waivers; consumer-directed services; employer of record. Directs the Department of Medical Assistance Services (DMAS) to modify the program rules for consumer-directed services available through certain Medicaid waivers to allow an individual receiving services to serve as the employer of record (EOR) for his own service delivery and designate another individual to perform all or a portion of the duties of the EOR on the individual's behalf when the individual receiving services is unable to perform such duties or direct his own care. The bill specifies that when an individual (i) has not yet reached the age of majority, (ii) is ineligible to use his existing employer identification number (EIN) to facilitate the taxation of benefits, or (iii) is otherwise determined to be ineligible by DMAS by administrative rule, the EIN shall be assigned to the individual receiving services and shall not be transferred to another individual. Under the bill, DMAS has the authority to limit such amendments to specify that an individual receiving services may make such designation no more than twice per calendar year.
School boards; courses of instruction; high school courses or dual enrollment programs for certification as a certified nurse aide, emergency medical technician, or firefighter; establishment permitted; requirements. Permits any school board to provide to high school students, either on school premises or through a dual enrollment program or other partnership with a comprehensive community college, courses of instruction that prepare students for and lead to (i) certification as a certified nurse aide, provided that such course is approved by and meets the requirements of the Board of Nursing and is taught by a qualified individual, consistent with the requirements of the Board of Nursing; (ii) certification as an emergency medical technician, provided that such course is consistent with the requirements established by the Office of Emergency Medical Services and taught by an emergency medical technician instructor who meets the requirements set forth in the bill; or (iii) firefighting level 1 certification, as defined by the bill, provided that such course is consistent with the National Fire Protection Association 1001, level one, firefighter standards as administered by the Department of Fire Programs and taught by an individual qualified to provided such instruction. The bill also requires any school board that provides any such course of instruction on school premises to high school students to ensure that any individual employed, contracted, or permitted to volunteer to provide instruction in such course meets the requirements set forth in applicable law relating to data on convictions for certain crimes and child abuse and neglect, fingerprinting, and criminal history records checks.
Certificate of public need; exception; maternal and perinatal health services. Creates an exception to certificate of public need requirements for any project or action related to maternal and perinatal health services. The bill also removes neonatal intensive care from the definition of tertiary care for purposes of determining health planning regions.
Pharmacy benefits managers; various requirements; report. Prohibits a pharmacy benefits manager from (i) reimbursing a pharmacy in an amount less than the national average drug acquisition cost for the prescription drug or pharmacy service at the time the drug is administered or dispensed, plus a professional dispensing fee; (ii) basing pharmacy reimbursement for prescription drugs on patient outcomes, scores, or metrics; (iii) imposing a point-of-sale or retroactive fee on a pharmacy, pharmacist, or covered individual; (iv) receiving deductibles or copayments; (v) redirecting any prescription drug claims submitted by a pharmacy to any third-party discount card program, cash discount program, or any other non-insurance adjudication platform; (vi) using policy agreements incorporation into a pharmacy agreement, to materially change, alter, or modify the pharmacy agreement, reimbursement rates, payment terms, or other financial obligations; (vii) prohibiting a pharmacy from providing an individual certain information; (viii) charging a pharmacy a fee related to participation in a pharmacy network; (ix) requiring multiple specialty pharmacy accreditations as a prerequisite for participation in a pharmacy network that dispenses specialty drugs; or (x) deriving any revenue from a pharmacist, pharmacy, or covered individual in connection with performing pharmacy benefits management services. The bill requires a pharmacy benefits manager to calculate a covered individual's out-of-pocket cost for a covered prescription drug based on the net price of the prescription drug after taking into account all retained rebates associated with the prescription drug. The bill adds certain information to be included in a report that pharmacy benefit managers are currently required to submit and requires such report to be filed quarterly rather than annually. The bill also requires the Commissioner of Insurance to annually prepare and submit a report to the Governor and the General Assembly based on the information submitted by pharmacy benefits managers. Additionally, the bill prohibits a carrier or its pharmacy benefits manager from imposing any payment or condition relating to the purchase of pharmaceutical benefits from any pharmacy that is more costly or more restrictive than that which would be imposed upon such person if the same pharmaceutical services were purchased from a mail order pharmacy provider.
Unregulated pregnancy clinics; unauthorized practice of medicine; unprofessional conduct of medical providers; civil penalty. Requires unregulated pregnancy clinics, as defined by the bill, to have a qualified medical provider who supervises and takes responsibility for the provision of all medical care at such facility. The bill provides that any such clinic is required to provide to a client, upon request, the name and contact information for the qualified medical provider who supervises medical care to such client. A clinic shall notify the Board of Health, in accordance with rules promulgated by the Board, of the name and contact information for its qualified medical providers. Any person who violates the provisions of the bill is subject to a civil penalty of up to $3,000 for a first violation and up to $10,000 for a second or subsequent violation. The bill provides that individuals licensed by the Board of Medicine or the Board of Nursing are subject to disciplinary action for making or knowing of certain willful representations of the care provided at such unregulated pregnancy clinics if such representations are not true.
Board of Health; Stillbirth Support Grant Program established. Establishes the Stillbirth Support Grant Program to provide grants to individuals who deliver a stillborn child, as defined in the bill, to assist with out-of-pocket expenses associated with such delivery. The bill authorizes the Board of Health to administer the Program and establish procedures and issue guidelines for administration of the Program as it deems appropriate. An application for such grant must be submitted within one year of delivery of a stillborn child.
