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Senate Bill 10 |
Senate Author: Nelson et al. |
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Effective: See below |
House Sponsor: Delisi |
Senate Bill 10 amends the Government Code, Health and Safety Code, and Human Resources Code to direct the Health and Human Services Commission to study, develop, and implement a number of reforms relating to the operation and financing of the state Medicaid program and other programs that provide health care benefits and services and the costs associated with the delivery of uncompensated hospital care.
The bill directs the Health and Human Services Commission to establish outcome-based performance measures and incentives for contracts between health maintenance organizations and the commission, actively encourage managed care organizations that contract with the commission to include certain value-added services, and require certain recipients of Medicaid to designate a primary care provider. Senate Bill 10 transfers administration and operation of the medical transportation program from the Texas Department of Transportation to the commission and requires the commission to directly supervise the program. The bill includes provisions relating to eligibility for Medicaid matching funds for a woman who receives a breast or cervical cancer screening, Medicaid benefits for certain former foster care adolescents enrolled at an institution of higher education, the health insurance premium payment reimbursement program for Medicaid beneficiaries, cost limits for care provided in certain alternative community-based services settings, access to eye health care services, the establishment and financial support of regional or local health care programs for employees of small employers, and the use of technology to facilitate electronic communications for purposes of determining eligibility, enrollment, verification procedures, and the exchange of recipient medical information.
The bill directs the executive commissioner to adopt a cost-sharing method for high-cost medical services provided through hospital emergency rooms, promote Medicaid beneficiary access to federally qualified health centers and rural health clinic services, and contract for an acute care Medicaid billing system to be implemented by March 1, 2008. The executive commissioner is authorized to seek federal waivers to develop and implement tailored benefit packages for certain categories of Medicaid recipients and the Texas Health Opportunity Pool Trust Fund to optimize federal matching funds to pay for uncompensated care costs.
Senate Bill 10 includes several provisions relating to uncompensated hospital care costs. It requires the executive commissioner to adopt rules providing for a methodology to compute the cost of uncompensated care and to report and analyze those costs, creates penalties for a hospital reporting false, incomplete, or inaccurate information to the commission, and directs the executive commissioner to establish a work group on uncompensated care.
The commission is required to develop, implement, or provide guidance for the establishment of various pilot programs, including: a health savings account pilot program, contingent on a determination that the program is cost-effective and feasible; a pilot program in Bexar County to prevent the spread of certain infectious or communicable disease; a physician-centered nursing facility model demonstration project; and an electronic health information pilot program for use by primary care providers under the Medicaid program. The commission is also required to conduct or participate in a number of studies, including: a joint study with the commission's office of inspector general on the increased use of technology to strengthen fraud detection and deterrence; a study regarding the feasibility and cost-effectiveness of developing and implementing an integrated Medicaid managed care model; a feasibility study of providing a health passport for certain recipients under the Children's Health Insurance Program; and a joint study with the Texas Department of Insurance relating to a small employer premium assistance program to provide financial assistance for the purchase of small employer health benefit plans. The bill directs the Texas Health Care Policy Council, in coordination with other entities, to conduct a study regarding increasing the number of medical residency programs, medical residents, and physicians practicing medical specialties in Texas.
The bill establishes the committee on health and long-term care insurance incentives to study and develop methods to reduce the need for residents to rely on Medicaid and to reduce the number of Texans who are not covered by health insurance or long-term care insurance. It creates the Medicaid reform legislative oversight committee to facilitate the reform efforts in Medicaid, the process of addressing the issues of uncompensated hospital care, and the establishment of programs addressing the uninsured. It also amends the Insurance Code to direct the commissioner of insurance to conduct a study concerning a Healthy Texas Program under which small employer health benefit coverage would be offered.
Provisions of the bill relating to the creation of the Medicaid reform legislative oversight committee take effect June 14, 2007; provisions relating to the transfer of the medical transportation program take effect September 1, 2008; all other provisions of the bill take effect September 1, 2007.