LEGISLATIVE BUDGET BOARD Austin, Texas FISCAL NOTE 74th Regular Session March 2, 1995 TO: Honorable Judith Zaffirini, Chair IN RE: Senate Bill No. 10 Committee on Health & Human Services By: Zaffirini Senate Austin, Texas FROM: John Keel, Director In response to your request for a Fiscal Note on Senate Bill No. 10 (Relating to the development of a health care delivery system under the state Medicaid program that results in cost savings to the state.) this office has determined the following: The bill would make no appropriation but could provide the legal basis for an appropriation of funds to implement the provisions of the bill. This bill would allow the Health and Human Services Commission to develop a health care delivery system that restructures the delivery of health care services provided under the Texas Medicaid Program. The bill would allow the Commission, to the extent possible, to develop a system which would emphasize prevention, promote continuity of care, and provide a medical home for Medicaid recipients. The bill instructs the Commission to attempt, to the extent possible, to design a system which allows the state to control costs associated with growth in the Medicaid program. The bill also directs the Commission to maximize financing of the Medicaid program by using local and state resources currently spent on indigent health care to obtain federal matching funds and to expand Medicaid eligibility to include persons who were eligible to receive indigent health care services through these local and state programs. The bill requires that the system design include methods for ensuring accountability to the state for the provision of health care services by providing for financial reporting, quality assurance, and utilization review and would ensure that both private and public health care providers have the opportunity to participate in the system. The Commission is required to design the system in a manner that would enable the state to use different types of health care delivery systems in different state health care service regions which would be established in consultation with local governmental entities. The Commission is authorized to propose the waiver necessary to obtain federal authorization for a restructuring of the health care delivery system. The Department of Health would be required to implement a health care delivery system developed by the Commission. The Department of Health and the Health and Human Services Commission indicated there would be no fiscal impact. The University of Texas System reported that "the actual fiscal impact will be dictated by the level of federal matching funds, the degree of expanded Medicaid eligibility, and the aggressiveness and rapidity with which managed care plans are implemented." The fiscal implication to the State or units of local government cannot be determined. Source: Department of Health, Health and Human Services Commission, The University of Texas System LBB Staff: JK, KF, AZ, DF