BILL ANALYSIS



HUMAN SERVICES
HCR 151
By: Naishtat
5-06-97
Committee Report (Amended)



BACKGROUND

In 1993, the Texas Department of Human Services (DHS) received  a federal
Medicaid waiver from the Health Care Financing Administration (HCFA).  The
waiver allowed DHS to serve up to 22,000 clients in community care,
through the Community Based Alternatives (CBA) program, rather than in
nursing homes.  The waiver program was not fully funded by the state for
the current biennium, but proved to be in high demand, and has a waiting
list of approximately 8,000 individuals.  In addition to the need to fund
the current 22,000 available slots, there is a need for additional CBA
slots under the federal Medicaid  waiver.  In order to make full use of
the current available waiver and to request more slots from HCFA, state
law requires DHS to have legislative direction. 

PURPOSE

HCR 151 directs  the Texas Department of Human Services to transfer funds
as necessary from the nursing home line item to fully fund  the Community
Based Alternatives (CBA) program.   

HCR 151 further directs DHS to request additional waiver slots from the
Health Care Financing Administration.   

HCR 151's directions are contingent upon the adoption by DHS' board of new
eligibility rules for community care proposed in September, 1996. 

HCR 151 directs DHS to demonstrate in its budget outcome measures that CBA
clients are being diverted from nursing home care in a manner that
conforms to state and federal requirements  of budget neutrality. 

RULEMAKING AUTHORITY

It is the committee's opinion that this  resolution does not delegate any
rulemaking authority, but does provide the basis for possible rulemaking
authority. 

EXPLANATION OF AMENDMENTS

Adds the Health and Human Services Commission to the Texas Department of
Human Services as a commission that may, as appropriate, take steps in
implementing the directive.  Allows TDHS and HHSC to monitor expenditures
by HHS agencies and to the extent possible transfer funds not needed by
the HHS agencies to fill the slots in the Community Based Alternatives
program.  Strikes language in the original bill that allows TDHS to
transfer funds from the nursing facility line item to fund additional
Community Based Alternative slots.  Strikes language requiring the TDHS
and HHSC, in showing in it's budget outcome measures a level of certainty
that Community Based Alternatives clients are diverted from nursing home
care, from conforming to state and federal requirements of budget
neutrality.