SB 234 — Makes revisions relating to Medicaid. (BDR 38-40)

EXEMPT (Reprinted with amendments adopted on April 18, 2025) FIRST REPRINT S.B.

requiring the Department of Health and Human Services to seek an increase to rates of reimbursement under Medicaid for services relating to certain childhood diseases;

LegExistingLegislative federalCounsel’s lawDigest: requires Medicaid to provide to certain aliens, including aliens who are not lawfully present in the United States, limited coverage for health care services that are necessary to treat an emergency medical condition.

(42Existing U.S.C.federal law requires Medicaid to provide to certain aliens, including aliens who are not lawfully present in the United States, limited coverage for health § 1396b(v)(2);

§ 1396b(v)(2);

§ 440.255) Section 1 of this bill prescribes specificspecificU.S.C. requirements governing such coverage under Medicaid in this State.

requirements governing such coverage under Medicaid in this State for persons who are less than 21 years of age.

(1) emergency medical transportation services directly relating to the treatment of the emergency medical condition;

(2) care to treat the emergency medical condition provided in an emergency room or similarand setting(3) incertain ainpatient hospitalservices orrelating anto independentthe centertreatment forof the emergency medical care;condition.

andAdditionally, (3)section certain1 inpatientprovides serviceslimited relatingcoverage for certain care to treat renal disease and cancer in certain circumstances, if the treatmentDepartment of theHealth emergencyand Human Services grants prior approval for such care based on the medical condition.necessity - *SB234_R1* – 2 – of the care.

Additionally,Section section 1 also provides limited coverage forin certain carecircumstances tofor treatcontinuing renalcare diseaserelating andto canceran inemergency certainmedical circumstances,condition ifthat theis Departmentprovided ofin Healtha andfacility Human Services grants prior approval for suchskilled carenursing, basedor onother thesimilar medicaltype necessity of thefacility, care.if:

Section(1) 1such alsocare providesis limited medical conditioncondition; that is provided in a facility for skilled nursing, or other similar type of facility, if:

(1) such care is necessary to prevent the condition of the person - *SB234* – 2 – from becoming an emergency medical condition;

Section 2 of this bill makes a conforming change to require the Director of the Department to administer the provisions of section 1 in the same manner as otherheother provisions relating to Medicaid.

the most common services provided by clinics and hospitals in this State to treatify pediatric cancer and rare childhood diseases;

and (2) apply to the United States Secretary of Health and Human Services to increase the rate of reimbursement under Medicaid for each service identified.

§ 440.255 coverage for care that is necessary to treat an emergency medical condition of a resident of this State who is less than 21 years of age and would otherwise be ineligible for Medicaid solely because of his or her immigration status.

- *SB234_R1* – 3 – (2) Dialysis provided in a hospital or a facility for the treatment of irreversible renal disease;

(3) Care,The including,transplant withoutof limitation,bone surgery,marrow, chemotherapyif andthe radiationperson: therapy, that is necessary to treat cancer which is not in remission;

and(I) (4)Has Thebeen transplantdiagnosed ofwith acancer; kidney, if the person:

(II) Is currently receiving treatment for the cancer;

and (III) Is a candidate for a bone marrow transplant;

(4) Other care that is medically necessary to treat any stage of cancer or to prevent the recurrence of cancer, whether provided on an inpatient or outpatient basis, including, without limitation, surgery, chemotherapy, radiation therapy, targeted therapy and immunotherapy;

and (5) The transplant of a kidney, if the person:

and - *SB234* – 3 – (III) Is a candidate for a kidney transplant;

(m) Except as otherwise provided by subparagraphsubparagraphs (4)(3) and (5) of paragraph (d) of subsection 1, organ transplants and stem cell transplants;

The Department may not provide coverage under Medicaid pursuant to this section for the care described in paragraph (d) of subsection 1 unless the Department determines, before the care - *SB234_R1* – 4 – being rendered, that such care is medically necessary and appropriate, based on the condition of the person to whom the care may be provided.

(b) Fully cooperate in good faith with the Federal Government during the application process to satisfy the requirements of the - *SB234* – 4 – Federal Government for obtaining a waiver or amendment pursuant to paragraph (a).

- *SB234_R1* – 5 – (3) Not primarily provided for the convenience of the patient, physician or other provider of health care;

- *SB234* – 5 – (1) The Administrator of the Aging and Disability Services Division;

- *SB234_R1* – 6 – (1) Identify and assess the plans and programs of the Department for the provision of human services, and any duplication of those services by federal, state and local agencies;

and (6) Contain any other information necessary for the Department to communicate effectively with the Federal - *SB234* – 6 – Government concerning demographic trends, formulas for the distribution of federal money and any need for the modification of programs administered by the Department.

(e) May, by regulation, require nonprofit organizations and state and local governmental agencies to provide information regarding the programs of those organizations and agencies, excludingrdingexcluding detailed information relating to their budgets and payrolls, which the Director deems necessary for the performance of the duties imposed upon him or her pursuant to this section.

2.5.

1.

On or before January 1, 2026, the Director of Department of Health and Human Services shall:

(a) Identify the specific services which are most commonly provided by clinics in this State to recipients of Medicaid for the treatment of pediatric cancer and rare childhood diseases;

and (b) Submit to the United States Secretary of Health and Human Services a request to amend the State Plan for Medicaid to increase the rate of reimbursement by not less than 2 percent, or as close to that amount as the Secretary approves, for each service identified pursuant to paragraph (a).

2.

The request submitted pursuant to subsection 1 must be supported using methods for determining reimbursement rates accepted by the Secretary.