1-1 By: Nelson, et al. S.B. No. 604
1-2 (In the Senate - Filed February 16, 1995; February 16, 1995,
1-3 read first time and referred to Committee on Health and Human
1-4 Services; March 16, 1995, reported adversely, with favorable
1-5 Committee Substitute by the following vote: Yeas 9, Nays 0;
1-6 March 16, 1995, sent to printer.)
1-7 COMMITTEE SUBSTITUTE FOR S.B. No. 604 By: Nelson
1-8 A BILL TO BE ENTITLED
1-9 AN ACT
1-10 relating to a pilot program for the establishment of medical
1-11 savings accounts to assist Medicaid recipients.
1-12 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-13 SECTION 1. MEDICAID MEDICAL SAVINGS ACCOUNT PILOT PROGRAM.
1-14 (a) Not later than December 1, 1995, the Health and Human Services
1-15 Commission shall develop a plan for a pilot program that uses
1-16 Medicaid funds to establish medical savings accounts for recipients
1-17 of acute care services under the state Medicaid program.
1-18 (b) The goals of the pilot program are to:
1-19 (1) create patient awareness of the high cost of
1-20 medical care;
1-21 (2) provide incentives to patients to seek preventive
1-22 and primary care services;
1-23 (3) reduce inappropriate use of health care services;
1-24 and
1-25 (4) enable clients to take responsibility for healthy
1-26 outcomes.
1-27 (c) The commission may examine each available medical
1-28 savings account model to determine if the model can be used in this
1-29 state.
1-30 (d) In developing the pilot program, the commission may
1-31 provide that:
1-32 (1) providers receive payment at a negotiated rate for
1-33 each patient;
1-34 (2) the savings realized by the pilot program are
1-35 shared by the provider, client, and this state;
1-36 (3) the client's share of the savings is placed in a
1-37 savings pool and credited to an individual medical savings account
1-38 established by the provider for that client, provided that certain
1-39 health maintenance standards are met;
1-40 (4) copayments and deductibles for inappropriate use
1-41 of health care are paid by deducting an amount prescribed by the
1-42 commission from the client's individual medical savings account;
1-43 and
1-44 (5) bonus deposits are credited to a client's
1-45 individual medical savings account for achieving health maintenance
1-46 standards prescribed by the commission.
1-47 (e) The commission shall:
1-48 (1) determine the size and location of each pilot
1-49 program;
1-50 (2) include urban and rural counties in determining
1-51 location;
1-52 (3) develop health maintenance standards for each life
1-53 cycle for use in determining if money should be credited to or
1-54 deducted from an individual medical savings account;
1-55 (4) determine the amount of each bonus payment and
1-56 deduction from an individual medical savings account;
1-57 (5) determine the appropriate method, other than a
1-58 cash payment, for releasing to a client money in an individual
1-59 medical savings account when the person no longer participates in
1-60 the Medicaid program;
1-61 (6) exclude medical savings account funds in
1-62 determining income, assets, or resources for purposes of
1-63 eligibility for a public benefits program in this state, regardless
1-64 of whether the funds are used by the household; and
1-65 (7) design the program so that the state controls the
1-66 costs associated with the Medicaid program and, to the extent
1-67 possible, saves money.
1-68 (f)(1) Except as otherwise provided by this subsection, the
2-1 commission shall implement the pilot program not later than
2-2 January 1, 1997.
2-3 (2) The commission may choose not to implement the
2-4 pilot program if the commission or the commission's designee
2-5 determines that the pilot program will not result in any cost
2-6 savings to the state during the next five years.
2-7 (3) If the commission or the commission's designee
2-8 decides not to implement the provisions of this Act, it will report
2-9 its findings to the governor, lieutenant governor, speaker of the
2-10 house of representatives, chair of the Senate Health and Human
2-11 Services Committee, and the chair of the House Public Health
2-12 Committee. The report shall include:
2-13 (A) the concept paper drafted to develop and
2-14 implement the pilot program;
2-15 (B) any fiscal implications and specific
2-16 methodologies used in determining the fiscal implications of
2-17 implementing the pilot program; and
2-18 (C) the basis for the determination that the
2-19 pilot program will not result in any cost savings to the state.
2-20 SECTION 2. REPORT. Not later than January 15, 1999, the
2-21 Health and Human Services Commission shall submit to the governor
2-22 and the 76th Legislature a report concerning the effectiveness of
2-23 the pilot program.
2-24 SECTION 3. WAIVERS. If, before implementing Section 1 of
2-25 this Act, the Health and Human Services Commission determines that
2-26 a waiver or authorization from a federal agency is necessary for
2-27 implementation, the commission shall request the waiver or
2-28 authorization and may delay implementing those provisions until the
2-29 waiver or authorization is granted.
2-30 SECTION 4. EXPIRATION DATE. This Act expires September 1,
2-31 1999.
2-32 SECTION 5. EMERGENCY. The importance of this legislation
2-33 and the crowded condition of the calendars in both houses create an
2-34 emergency and an imperative public necessity that the
2-35 constitutional rule requiring bills to be read on three several
2-36 days in each house be suspended, and this rule is hereby suspended,
2-37 and that this Act take effect and be in force from and after its
2-38 passage, and it is so enacted.
2-39 * * * * *