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Senate Bill 7 |
Senate Author: Nelson et al. |
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Effective: See below |
House Sponsor: Raymond |
Senate Bill 7 amends provisions of the Government Code, the Health and Safety Code, and the Human Resources Code relating to the delivery and quality of certain health and human services. The bill requires the Health and Human Services Commission (HHSC) and the Department of Aging and Disability Services (DADS) to jointly design and implement an acute care services and long-term services and supports system for individuals with intellectual and developmental disabilities. Among other provisions, the bill:
· establishes the Intellectual and Developmental Disability System Redesign Advisory Committee to advise HHSC and DADS on the implementation of the system;
· sets out reporting requirements for HHSC regarding the implementation of the system and the role of local intellectual and developmental disability authorities as service providers;
· provides for the development and implementation of pilot programs to test one or more service delivery models involving a managed care strategy based on capitation to deliver Medicaid long-term services and supports;
· institutes the delivery of acute care Medicaid program benefits and certain basic attendant and habilitation services to individuals with intellectual and developmental disabilities through the STAR + PLUS Medicaid managed care program or the most appropriate integrated capitated managed care program delivery model;
· provides for the transition of the provision of benefits for certain long-term care Medicaid waiver program recipients to the STAR + PLUS Medicaid managed care program delivery model or the most appropriate integrated capitated managed care program delivery model; and
· revises the list of persons who are not required to obtain a home and community support services license.
Senate Bill 7 expands the state's Medicaid managed care program by:
· requiring mandatory participation in a Medicaid capitated managed care program for all persons eligible for acute care Medicaid benefits, but authorizing HHSC to implement alternative models or arrangements, including a traditional fee-for-service arrangement, if determined to be more cost-effective or efficient;
· requiring the expansion of the STAR + PLUS Medicaid managed care program to all areas of the state to serve individuals eligible for Medicaid acute care services and long-term care services and supports, including nursing facility benefits;
· providing for the development of a plan for the delivery of nursing facility benefits through the STAR + PLUS Medicaid managed care program and requiring the plan to be completed in a contract planning phase and an initial testing phase;
· establishing a mandatory STAR Kids capitated managed care program tailored to provide Medicaid benefits to children with disabilities, including children who are receiving benefits under the medically dependent children waiver program;
· establishing the STAR + PLUS Nursing Facility Advisory Committee, the STAR Kids managed care advisory committee, and the STAR + PLUS Quality Council;
· revising the elements required to be contained in a contract between a managed care organization and HHSC for the organization to provide health care services to recipients under the managed care program, including provisions relating to the payment of claims by an organization, an organization's system for tracking and resolving provider appeals related to claims payment, the organization's provider network and recipient access to care, and a prohibition against certain rate reductions; and
· revising provisions relating to the appointment, composition, meetings, powers and duties, and compensation of the state Medicaid managed care advisory committee.
Senate Bill 7 sets out additional provisions relating to individuals with intellectual and developmental disabilities, including provisions relating to the development and implementation of a comprehensive assessment instrument and a resource allocation process for those individuals, the development of additional housing supports for individuals with disabilities in urban and rural areas, and the development and implementation of specialized training for certain persons providing direct services and supports to individuals with intellectual and developmental disabilities and behavioral health needs who are at risk of institutionalization and of behavioral health intervention teams for those individuals. The bill requires HHSC and DADS to conduct a study to identify crisis intervention programs currently available to, evaluate the needs for appropriate housing for, and develop strategies for serving the needs of persons with Prader-Willi syndrome and requires HHSC to conduct a study to evaluate the need for applying income disregards to persons with intellectual and developmental disabilities receiving Medicaid benefits.
Senate Bill 7 contains provisions regarding quality-based outcomes, including provisions related to a clinical improvement program to identify goals designed to improve quality of care and care management and reduce potentially preventable events, a quality-based incentive program for managed care organizations that automatically enrolls a greater percentage of recipients who did not actively choose their managed care plan in a managed care plan that meets certain criteria, and quality-based payment systems for Medicaid long-term services and supports providers designed to improve quality of care and reduce the provision of unnecessary services. The bill revises provisions relating to the use of profits shared by a managed care organization by HHSC, the composition of the Medicaid and CHIP Quality-Based Payment Advisory Committee, the development of quality-based outcome and process measures and payment systems, conversion of outpatient hospital reimbursement systems under the child health plan and Medicaid programs, transparency in the child health plan and Medicaid programs, annual quality-based outcome and process measures reporting requirements for HHSC, managed care organization premiums and incentives, adjustments to child health plan and Medicaid reimbursements to hospitals, and the goals of certain payment initiatives established by HHSC.
Senate Bill 7 requires HHSC to pursue and, if appropriate, implement premium rate-setting strategies that encourage provider payment reform and more efficient service delivery and provider practices. The bill includes provisions relating to data sharing to facilitate patient care coordination, quality improvement, and cost savings in health and human services programs; the alignment of service delivery areas under the Medicaid and child health plan programs; the implementation of a wellness screening program for Medicaid recipients designed to evaluate a recipient's risk for having certain diseases and medical conditions; the calculation of payments under certain supplemental hospital payment programs; and the transfer of certain funds to provide the program of all-inclusive care for the elderly services to certain eligible recipients who would otherwise receive services through the STAR + PLUS Medicaid managed care program. The bill's provisions are effective September 1, 2013, except for the authorization to expand the types of services a local mental health authority provides and the mental health disorders for which services are provided as part of an authority's disease management and jail diversion measures, which is effective January 1, 2014.