BILL ANALYSIS



C.S.S.B. 601
By: Zaffirini, Moncrief (Berlanga, et al.)
04-27-95
Committee Report (Substituted)


BACKGROUND

The Texas Medicaid program has grown from a total budget of $7.5
billion in the 1990-91 biennium to an appropriation of $18.7
billion for the current 1994-95 biennium, including $6.8 billion in
general revenue and $11.7 billion in federal funds.  This growth is
due to federal mandates regarding eligibility expansions, required
services, and provider reimbursement rules.

Lt. Gov. Bob Bullock charged the Senate Committee on Health and
Human Services with the challenging task of developing
recommendations for wholesale reform.  In response the committee
began an intensive investigation that included a public hearing May
31-June 1, 1994, and on-site visits to Medicaid managed care pilot
projects in Texas, to a rural health clinic, and to a
rehabilitation center. On November 29-30, 1994, the House
Committees on Public Health and on Human Services joined the Senate
committee in a second public hearing in which public testimony was
taken. The Senate Committee on Health and Human Services then
adopted the recommendations that are the basis of this legislation.

PURPOSE

S.B. 601 as substituted, would require the Health and Human
Services Commission to oversee the provision of education
programs under a managed care Medicaid program.

RULEMAKING AUTHORITY

It is the committee's opinion that rulemaking authority is
granted to the Health and Human Services Commission under SECTION
1 of this bill (Sections 16(b) and (e), Article 4413(502),
Revised Statutes).

SECTION BY SECTION ANALYSIS

SECTION 1. Amends Section 16, Article 4413(502), Revised
Statutes, to add the text in subsections (b)-(g), as follows:

     Sec. 16. ADMINISTRATION OF MEDICAID PROGRAM.  (a) Created from
     existing text.
            (b) Requires the Health and Human Services Commission
       (commission), in adopting rules implementing a managed care
       Medicaid program, to establish guidelines for and require
       managed care organizations to provide education programs for
       providers and clients using a variety of techniques and
       mediums.
       
       (c) Requires a provider education program to include
       information on Medicaid policies, procedures, eligibility
       standards, and benefits; specific problems and needs of
       clients; and the rights and responsibilities of Medicaid
       clients under this section.
       
       (d) Requires a client education program to present
       information in an easily understood manner and include
       information on rights and responsibilities; how to access
       health care services; how to access complaint procedures;
       Medicaid policies, procedures, eligibility standards, and
       benefits; the policies and procedures of the managed care
       organization; and the importance of prevention, early
       intervention, and appropriate use of services.
       
       (e) Requires the commission, by rule, to adopt a bill of
       rights and a bill of responsibilities for each person
       enrolled in the Medicaid program. Outlines rights which must
       be addressed.
       
       (f) Outlines responsibilities which must be addressed by the
       bill of responsibilities.
       
       (g) Requires the commission to provide support and
       information services to a person enrolled in or applying for
       coverage who experiences barriers to receiving health-care
       services, and to give precedence to persons with urgent
       medical or support needs.  Authorizes the commission, in
       providing those support and information services, to
       contract with a nonprofit organization not involved in
       providing health care, health insurance, or health benefits.
       Outlines specific support and information services the
       commission or nonprofit organization must provide.
       
SECTION 2. Emergency clause.
           Effective date: upon passage.


COMPARISON OF ORIGINAL TO SUBSTITUTE

The substitute provides greater detail than the engrossed version
of the bill regarding the scope of support and information
services to be provided by the commission or a nonprofit
organization, including:

      A statewide toll-free assistance telephone line. 

      Client education.

      Maintaining statistical information by region and
     publishing reports regarding trends.

      Identifying and correcting problems, including site visits
     to affected regions, if necessary.

SUMMARY OF COMMITTEE ACTION

S.B. 601 was considered by the Public Health Committee in a
formal meeting on April 27, 1995. The committee considered a
complete substitute for the bill. The substitute was adopted
without objection. The bill was reported favorably as
substituted, with the recommendation that it do pass and be
printed, by a record vote of 9 Ayes, 0 Nays, 0 PNV, and 0 Absent.