BG C.S.H.B. 2913 75(R)BILL ANALYSIS PUBLIC HEALTH C.S.H.B. 2913 By: Berlanga 4-25-97 Committee Report (Substituted) BACKGROUND Texas began the transition to managed care for recipients of Medicaid services in 1993 with pilot programs in Travis County and the tri-county area of Galveston, Chambers, and Jefferson counties. Fully implemented, those pilot programs moved 60,000 individuals into managed care through contracts with an HMO and a pre-paid health plan and through a state-administered primary care case management system (PCCM). Since that time, managed care has been expanded to five additional sites around the state, covering a total of 280,000 individuals through contracts with seven HMOs and through three PCCM systems. By the fall of 1999, five more sites are scheduled for conversion to managed care, bringing the number of Texans in Medicaid managed care to roughly 829,000, and increasing the number of contracts with HMOs several times. In addition, the state will begin piloting a managed care program for the long-term care population. Implementing change of this magnitude always will be accompanied by problems. Improving employee coordination and accountability among the state agencies for the administration of Medicaid managed care would yield several benefits to the state, to recipients, and to Medicaid providers as Texas enters this next phase of managed care conversion. Communication among the heads of the state agencies is critical because the next phase of managed care expansion will create new demand not only on contract monitoring, but also on oversight, utilization review, audit, hotline, and provider and member service functions. While the upcoming Sunset Commission review may determine that more drastic steps are necessary to better coordinate Medicaid service delivery and management, a small advisory committee composed of the state agencies performing these functions will help ensure that current communication efforts are optimized. PURPOSE CSHB 2913 facilitates the administration and operation of Medicaid managed care by consolidating responsibility to the Health and Human Services Commission (HHSC) and establishing an interagency advisory committee. RULEMAKING AUTHORITY It is the committee's opinion that this bill does not expressly grant any additional rulemaking authority to a state officer, department, agency or institution. SECTION BY SECTION ANALYSIS SECTION 1. Amends Sec. 531.021, Government Code, as follows: Subsection (b) is added to establish that HHSC is responsible for policy, administration evaluation and operation of the Medicaid managed care program. Subsection (c) requires HHSC to consult with and consider input from the advisory committee created under Section 531.047 and from each health and human services agency that operates part of the Medicaid program. Subsection (d) requires the commissioner or designee to supervise employees of health and human services agencies as specified. Allows the commissioner or designee to assign employee duties and require the agencies to assign duties as specified. SECTION 2. Amends Subchapter B, Chapter 531, Government Code by adding Section 531.047, entitled "Medicaid Managed Care Interagency Advisory Committee" as follows: Subsection (a) establishes the creation of an interagency advisory committee to provide assistance and recommendations to the commission as specified. Provides that the advisory committee consist of members and representatives as specified. Subsection (b) allows the commissioner to designate someone to act as the state Medicaid director to serve on the committee on the commissioner's behalf. Subsection (c) establishes that a member of the advisory committee serves at the will of the designating agency. Subsection (d) establishes that the commissioner or person acting as the state medicaid director serves as the presiding officer as specified. Allows committee members to elect other necessary officers. Subsection (e) requires the advisory committee to meet at the presiding officer's call. Requires the presiding officer to call a meeting at least once every 2 months. Subsection (f) provides that the designating agency is responsible for a member's expenses as specified, and that the committee members receive no additional compensation for serving. Subsection (g) establishes that the advisory committee is not subject to Article 6252-33, Revised Statutes. SECTION 3. Effective date: September 1, 1997. SECTION 4. Emergency clause. COMPARISON OF ORIGINAL TO SUBSTITUTE SECTION 1. Subsection (b) of the substitute version removes the specification of the aspects of the Medicaid managed care program for which the HHSC is responsible, and adds more general wording. Subsection (c) is changed in the substitute to require HHSC to consult with and seek input from the interagency advisory committee. This change conforms with the addition of this committee in SECTION 2. Subsection (d) is added to CSHB 2913 and requires the HHSC commissioner to supervise employees of health and human services agencies in the performance of Medicaid managed care, as specified. SECTION 2. The substitute version establishes an interagency advisory committee to provide recommendations to HHSC, and it is composed of those state agencies with duties relating to the Medicaid managed care program. SECTIONS 2, 3 and 4 of the original bill, which moved all Medicaid managed care functions to HHSC, are deleted from the substitute. SECTIONS 3 and 4 of the substitute are the same as the language in the original bill, but are renumbered to conform with the aforementioned changes.