S.C.R. No. 55 SENATE CONCURRENT RESOLUTION 1-1 WHEREAS, In its report to the 74th Legislature, the Senate 1-2 Health and Human Services Committee concluded that cost containment 1-3 and significant reform and improvement of the Medicaid program 1-4 could be achieved if the State of Texas obtains waivers of current 1-5 federal requirements in the areas of cost sharing and eligibility 1-6 and obtains additional waivers to conduct pilot studies of 1-7 long-term care, mental health and substance abuse, and 1-8 consumer-oriented support for persons with mental retardation; and 1-9 WHEREAS, With respect to cost sharing, copayments for medical 1-10 services have been shown to reduce inappropriate utilization of 1-11 services and to promote a client's sense of responsibility for the 1-12 client's own care; therefore, a waiver of federal regulations 1-13 prohibiting cost sharing should benefit both the Medicaid 1-14 beneficiary and the State of Texas; and 1-15 WHEREAS, Managed care organizations may develop policies in 1-16 addition to copayments to encourage a client's responsibility for 1-17 the client's own care; and 1-18 WHEREAS, Client access to a 24-hour telephone health advice 1-19 line may reduce inappropriate use of health care services by 1-20 increasing client confidence in health care decision-making; and 1-21 WHEREAS, A waiver to allow a guaranteed eligibility period of 1-22 12 months is advantageous since most clients who become ineligible 1-23 for Medicaid benefits are not able to secure other health insurance 1-24 coverage, with the result that: a client has a disincentive to 2-1 find work and lose eligibility; local governments incur additional 2-2 expense, since there is no federal match for providing care to the 2-3 uninsured; and managed care will be more difficult to implement, 2-4 since there is no incentive for managed care organizations to 2-5 participate in Medicaid if clients are only eligible for a short 2-6 period; and 2-7 WHEREAS, A waiver to allow an integrated managed care pilot 2-8 study of long-term care for the elderly and persons with 2-9 disabilities would be advantageous because integration of these 2-10 services into a statewide managed care program promises to reduce 2-11 cost shifting and the need for institutional care, improve access 2-12 and quality, and create greater accountability for outcomes; 2-13 however, very few states have implemented such services, and a 2-14 pilot study is necessary to accurately estimate potential savings; 2-15 and 2-16 WHEREAS, A waiver to allow an integrated managed care pilot 2-17 program for mental health and substance abuse services would be 2-18 advantageous because integration of these services promises to 2-19 reduce cost shifting between the acute care system and the mental 2-20 health and substance abuse services system; however, a pilot study 2-21 is necessary to determine how best to implement the program and to 2-22 accurately estimate potential savings; and 2-23 WHEREAS, A waiver to allow a consumer-oriented pilot program 2-24 for persons with mental retardation and other developmental 2-25 disabilities would be advantageous because consumer-centered 2-26 decision-making would increase competition, improve quality of 2-27 care, and allow families and individuals to make choices that best 3-1 suit their needs; however, there is insufficient experience with 3-2 such programs in other states, and a pilot study is needed before 3-3 statewide implementation; now, therefore, be it 3-4 RESOLVED, That the 74th Legislature of the State of Texas 3-5 hereby direct the State Medicaid Office to apply for a federal 3-6 waiver to allow copayments by Medicaid clients if those clients 3-7 have access to a 24-hour telephone health advice line; and, be it 3-8 further 3-9 RESOLVED, That the waiver application provide that prenatal 3-10 and well-child visits be exempted from the copayment for office 3-11 visits and include provisions for capping contributions from a 3-12 client who a physician determines should make regular office visits 3-13 to address a chronic medical condition and from a long-term care 3-14 client who has already made a copayment; and, be it further 3-15 RESOLVED, That the State Medicaid Office encourage managed 3-16 care organizations to develop policies in addition to copayments to 3-17 encourage a client's responsibility for the client's own care; and, 3-18 be it further 3-19 RESOLVED, That the State Medicaid Office apply for a federal 3-20 waiver to allow a guaranteed Medicaid eligibility period of 12 3-21 months; and, be it further 3-22 RESOLVED, That the State Medicaid Office apply for a federal 3-23 waiver to allow an integrated managed care pilot program for 3-24 long-term care for the elderly and for persons with disabilities 3-25 and that the program be developed with input from the public and be 3-26 implemented in both an urban and a rural area, if possible; and, be 3-27 it further 4-1 RESOLVED, That the State Medicaid Office apply for a federal 4-2 waiver to allow an integrated managed care pilot program for mental 4-3 health and substance abuse services and that the program be 4-4 developed with input from the public and be implemented in both an 4-5 urban and a rural area, if possible; and, be it further 4-6 RESOLVED, That the Health and Human Services Commission 4-7 develop a plan for statewide expansion of integrated mental health 4-8 and substance abuse services; and, be it further 4-9 RESOLVED, That the Health and Human Services Commission 4-10 submit a preliminary plan for expansion of sites to the Senate 4-11 Health and Human Services Committee by November 1, 1996, and a plan 4-12 for statewide expansion by November 1, 1998, and that the plan be 4-13 included in the consolidated budget request; and, be it further 4-14 RESOLVED, That the State Medicaid Office apply for a federal 4-15 waiver to allow a pilot program for individuals with mental 4-16 retardation and other developmental disabilities and that the pilot 4-17 program be consumer-oriented and include a decision support system 4-18 and functional assessment; and, be it further 4-19 RESOLVED, That the State Medicaid Office apply for a federal 4-20 waiver to allow a cost-sharing pilot program for certain recipients 4-21 of ICF-MR and waiver services, to be implemented in both an urban 4-22 and a rural area, if possible; and, be it further 4-23 RESOLVED, That the secretary of state forward an official 4-24 copy of this resolution to the State Medicaid Office and to the 4-25 Health and Human Services Commission.