BILL ANALYSIS


                                                     C.S.S.B. 601
                                                    By: Zaffirini
                                        Health and Human Services
                                                          3-16-95
                                   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 $11.9 billion in federal funds.  This growth is
due to federal mandates regarding eligibility expansions, mandatory
services, and provider reimbursement rules.  Although caseload
growth in the program slowed recently, the demand for new state
funds for Medicaid in the 1996-97 biennium will be approximately
$2.2 billion.

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 on
May 31-June 1, 1994; on-site visits to Medicaid managed care pilot
projects in Texas, to a facility for persons with mental
retardation, to special homes for children, to a rural health
clinic and to a rehabilitation center; and a second hearing on
November 29-30, 1994.  The committee heard public testimony with
the House Committees on Public Health and on Human Services and
then adopted the recommendations that are the basis of this
legislation.

PURPOSE

As proposed, C.S.S.B. 601 requires 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
(Sections 16(b) and (e), Article 4413(502), V.T.C.S.) of this bill.

SECTION BY SECTION ANALYSIS

SECTION 1. Amends Section 16, Article 4413(502), V.T.C.S., 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 include
       information in an easily understood manner on rights and
       responsibilities; access to health care services; access to
       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)-(f) Requires the commission, by rule, to adopt a bill of
       rights and a bill of responsibilities for each person
       enrolled in the Medicaid program, and requires the bill to
       address specific client rights and 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 services, and
       to give precedence to persons with urgent medical or support
       needs.  Authorizes the commission, in providing those
       services, to contract with a nonprofit organization not
       involved in providing health care, health insurance, or
       health benefits.
       
SECTION 2. Emergency clause.
           Effective date: upon passage.