DSS implementer bill allows agency to cut benefits without legislative approval

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Section 116 of SB 1240, passed by the Senate yesterday, would allow DSS to cut benefits provided to consumers in the LIA program, formerly known as SAGA. Cuts could include, but is not limited to, office and hospital visits, therapy services, medical equipment and supplies, medications, non-emergency medical transportation, and home care. If unchanged, the language would also allow DSS to develop lesser benefit packages for the estimated 140,000 new Medicaid enrollees entering the program in 2014 under national health reform. Section 100 of the bill allows DSS to create a patient-centered medical home program for people with chronic illnesses, a hospital bundled payment demonstration, and create an Accountable Care Organization for pediatricians. The bill also requires that DSS ensure provider rates are sufficient to ensure access to care and reduce inappropriate ER use, possibly including cost sharing and intensive case management. The bill now goes to the House of Representatives.