1-1 By: Zaffirini, Moncrief S.C.R. No. 55
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.C.R. No. 55 By: Zaffirini
1-8 SENATE CONCURRENT RESOLUTION
1-9 WHEREAS, In its report to the 74th Legislature, the Senate
1-10 Health and Human Services Committee concluded that significant
1-11 reform and improvement of the Medicaid program could be achieved if
1-12 the State of Texas obtains waivers of current federal requirements
1-13 in the areas of cost sharing and eligibility and obtains additional
1-14 waivers to conduct pilot studies of long-term care, mental health
1-15 and substance abuse, and consumer-oriented support for persons with
1-16 mental retardation; and
1-17 WHEREAS, With respect to cost sharing, copayments for medical
1-18 services have been shown to reduce inappropriate utilization of
1-19 services and to promote a client's sense of responsibility for the
1-20 client's own care; therefore, a waiver of federal regulations
1-21 prohibiting cost sharing should benefit both the Medicaid
1-22 beneficiary and the State of Texas; and
1-23 WHEREAS, Managed care organizations may develop policies in
1-24 addition to copayments to encourage a client's responsibility for
1-25 the client's own care; and
1-26 WHEREAS, Client access to a 24-hour telephone health advice
1-27 line may reduce inappropriate use of health care services by
1-28 increasing client confidence in health care decision-making; and
1-29 WHEREAS, A waiver to allow a guaranteed eligibility period of
1-30 12 months is advantageous since most clients who become ineligible
1-31 for Medicaid benefits are not able to secure other health insurance
1-32 coverage, with the result that: a client has a disincentive to
1-33 find work and lose eligibility; local governments incur additional
1-34 expense, since there is no federal match for providing care to the
1-35 uninsured; and managed care will be more difficult to implement,
1-36 since there is no incentive for managed care organizations to
1-37 participate in Medicaid if clients are only eligible for a short
1-38 period; and
1-39 WHEREAS, A waiver to allow an integrated managed care pilot
1-40 study of long-term care for the elderly and persons with
1-41 disabilities would be advantageous because integration of these
1-42 services into a statewide managed care program promises to reduce
1-43 cost shifting and the need for institutional care, improve access
1-44 and quality, and create greater accountability for outcomes;
1-45 however, very few states have implemented such services, and a
1-46 pilot study is necessary to accurately estimate potential savings;
1-47 and
1-48 WHEREAS, A waiver to allow an integrated managed care pilot
1-49 program for mental health and substance abuse services would be
1-50 advantageous because integration of these services promises to
1-51 reduce cost shifting between the acute care system and the mental
1-52 health and substance abuse services system; however, a pilot study
1-53 is necessary to determine how best to implement the program and to
1-54 accurately estimate potential savings; and
1-55 WHEREAS, A waiver to allow a consumer-oriented pilot program
1-56 for persons with mental retardation and other developmental
1-57 disabilities would be advantageous because consumer-centered
1-58 decision-making would increase competition, improve quality of
1-59 care, and allow families and individuals to make choices that best
1-60 suit their needs; however, there is insufficient experience with
1-61 such programs in other states, and a pilot study is needed before
1-62 statewide implementation; now, therefore, be it
1-63 RESOLVED, That the 74th Legislature of the State of Texas
1-64 hereby direct the State Medicaid Office to apply for a federal
1-65 waiver to allow copayments by Medicaid clients if those clients
1-66 have access to a 24-hour telephone health advice line; and, be it
1-67 further
1-68 RESOLVED, That the waiver application provide that services
2-1 not be denied to a client who is unable to make the copayment and
2-2 that the schedule of copayments specified in the application be as
2-3 follows: $1 copayment for an office visit, $1 copayment for a
2-4 prescription drug, and $6 copayment for a nonemergency visit to an
2-5 emergency room; and, be it further
2-6 RESOLVED, That the waiver application provide that prenatal
2-7 and well-child visits be exempted from the copayment for office
2-8 visits and include provisions for capping contributions from a
2-9 client who a physician determines should make regular office visits
2-10 to address a chronic medical condition and from a long-term care
2-11 client who has already made a copayment; and, be it further
2-12 RESOLVED, That the State Medicaid Office encourage managed
2-13 care organizations to develop policies in addition to copayments to
2-14 encourage a client's responsibility for the client's own care; and,
2-15 be it further
2-16 RESOLVED, That the State Medicaid Office apply for a federal
2-17 waiver to allow a guaranteed Medicaid eligibility period of 12
2-18 months; and, be it further
2-19 RESOLVED, That the State Medicaid Office apply for a federal
2-20 waiver to allow an integrated managed care pilot program for
2-21 long-term care for the elderly and for persons with disabilities
2-22 and that the program be developed with input from the public and be
2-23 implemented in both an urban and a rural area, if possible; and, be
2-24 it further
2-25 RESOLVED, That the State Medicaid Office apply for a federal
2-26 waiver to allow an integrated managed care pilot program for mental
2-27 health and substance abuse services and that the program be
2-28 developed with input from the public and be implemented in both an
2-29 urban and a rural area, if possible; and, be it further
2-30 RESOLVED, That the Health and Human Services Commission
2-31 develop a plan for statewide expansion of integrated mental health
2-32 and substance abuse services; and, be it further
2-33 RESOLVED, That the Health and Human Services Commission
2-34 submit a preliminary plan for expansion of sites to the Senate
2-35 Health and Human Services Committee by November 1, 1996, and a plan
2-36 for statewide expansion by November 1, 1998, and that the plan be
2-37 included in the consolidated budget request; and, be it further
2-38 RESOLVED, That the State Medicaid Office apply for a federal
2-39 waiver to allow a pilot program for individuals with mental
2-40 retardation and other developmental disabilities and that the pilot
2-41 program be consumer-oriented and include a decision support system
2-42 and functional assessment; and, be it further
2-43 RESOLVED, That the State Medicaid Office apply for a federal
2-44 waiver to allow a cost-sharing pilot program for certain recipients
2-45 of ICF-MR and waiver services, to be implemented in both an urban
2-46 and a rural area, if possible; and, be it further
2-47 RESOLVED, That the secretary of state forward an official
2-48 copy of this resolution to the State Medicaid Office and to the
2-49 Health and Human Services Commission.
2-50 * * * * *