BG S.B. 1163 75(R)BILL ANALYSIS Public Health S.B. 1163 By: Zaffirini (Berlanga) 5-8-97 Committee Report (Amended) BACKGROUND Texas began to implement managed care pilot programs in the state Medicaid program in 1993 under 1915(b) waivers from the federal government to control costs while ensuring quality of care. Legislation passed during the 74th Regular Session specifically directed the state Medicaid program to develop a 1115(a) waiver application to implement managed care statewide and to use pilot projects authorized by 1915(b) waivers to continue to roll out Medicaid managed care until the 1115(a) waiver application was approved. In 1996, the state Medicaid program rolled out 1915(b) pilot projects in the Bexar, Lubbock, Tarrant, and Travis County service areas. One of the problems encountered during the implementation of Medicaid managed care was a lack of comprehensive information and training for recipients, who must choose primary care physicians and learn to emphasize preventive care; and providers, who must bill as many as four different entities for reimbursement and obtain preauthorization for many procedures. S.B. 1163 would require the Texas Department of Health (department) to develop and implement a plan, at least 90 days before the date of implementation in a service area, to provide information and training about the requirements of Medicaid managed care to patients, providers, and any other affected parties. In addition, this legislation requires the department to establish a pilot project to test the effectiveness and cost of peer outreach and health education. PURPOSE S.B. 1163 provides for information and training about Medicaid managed care. 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 Chapter 32B, Human Resources Code, by adding Section 32.043, as follows: Sec. 32.043. MANAGED CARE INFORMATION AND TRAINING PLAN. Requires the Texas Department of Health (department) to develop a comprehensive plan to provide information and training about the requirements of a managed care plan to recipients of medical assistance, providers of medical assistance, local health and human services agencies, and other interested parties in each service area as specified. Requires the department to include in the plan 180 days of initial information and training as specified, additional information and training at regular intervals determined by the department, and performance measures to evaluate the effectiveness of the information and training. Requires the department to consult with the Medicaid medical care advisory committee in developing the plan. Requires the department to submit a semiannual report on the effectiveness of the comprehensive plan to individuals and entities as specified. Allows the department to consolidate the report with another report as specified. Requires the department to establish a pilot project, as specified, to test the effectiveness and cost of certain goal oriented peer outreach and health educational activities, in conjunction with the comprehensive plan. SECTION 3. Emergency clause. Establishes that this Act takes effect upon passage. EXPLANATION OF AMENDMENTS The committee amendment inserts the precondition of fund availability to the required development of a a comprehensive informational and training plan about Medicaid managed care.