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Senate Bill 1188 |
Senate Author: Nelson |
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Effective: 9-1-05 |
House Sponsor: Delisi |
Senate Bill 1188 amends provisions of the Government Code, Health and Safety Code, Human Resources Code, and Occupations Code to direct the Health and Human Services Commission and the Department of Aging and Disability Services to study, develop, or implement a number of reforms intended to ensure the cost-effectiveness, streamline the administration, improve the efficacy of, and optimize and maximize the funding for the state Medicaid program.
The bill sets the period for continuous eligibility for Medicaid coverage for a child under the age of 19 at six months and requires the executive commissioner to develop an integrated care management model of Medicaid managed care. It requires the department, subject to available funds, to assure that a Medicaid recipient is permitted to select a licensed psychologist, licensed marriage and family counselor, licensed professional counselor, or licensed master social worker to perform certain services covered under the program. The executive commissioner is authorized to provide for Medicaid reimbursement for certain online medical consultations, and the department is directed to develop and implement a comprehensive medical assistance education program to improve patient outcomes and cost-effectiveness.
The bill also directs the commission to optimize the Medicaid financing system to maximize federal funds, create incentives for the use of preventive care, increase and retain providers, more accurately reflect the costs borne by providers, improve data collection and analysis related to the program, reduce paperwork and streamline certain administrative processes, and improve the administration of contracts with managed care organizations.
The commission is required to examine and evaluate several policy options, including: using certain state funds to maximize federal matching funds; increasing reimbursement rates and employer contributions to cover Medicaid premiums; expanding home health benefits and other long-term care services; controlling costs of pharmaceutical usage by certain recipients of long-term care services through polypharmacy reviews; establishing a sliding-scale case management fee for the primary care case management program; considering the cost‑effectiveness of implementing intensive case management for the aged, disabled, and blind; studying the feasibility of combining certain quality control and cost-containment measures under a single federal waiver; improving the delivery of services to individuals enrolled in the managed care program; and considering the commission's authority under federal law to offer stipends and premium payment assistance for private insurance plans as an alternative to Medicaid for certain beneficiaries.
Senate Bill 1188 requires the commission to establish the office of community collaboration to collaborate and share information with certain stakeholders to improve the system of delivery for Medicaid services and the office of medical technology to evaluate and propose the use of emerging medical technology in the Medicaid program. The commission is also required to develop and implement a comprehensive plan to reduce the use of hospital emergency room services by Medicaid enrollees. The bill requires the commission to develop a proposal for a performance bonus pilot program to provide higher reimbursement rates to primary care case management providers. The commission is also directed to implement a Medicaid medical information telephone hotline pilot program under which physicians provide medical information and answers to medical questions by telephone to Medicaid recipients.
The bill abolishes the long-term care legislative oversight committee, the health and human services transition legislative oversight committee, and the interagency council on pharmaceuticals bulk purchasing. Finally, the bill includes provisions relating to disease management programs, notice of availability of certain benefits, prohibitions against the prescription of certain drugs, managed care contract requirements, eligibility requirements for a managed care organization, public disclosure of the preferred drug list, and an analysis required to be included in the commission's annual report relating to the effects of the implementation of the federal Medicare Prescription Drug, Improvement, and Modernization Act of 2003.
Senate Bill 1188 requires the commission to take each action and implement each reform required in the bill not later than September 1, 2007. All other provisions of the bill take effect September 1, 2005.