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.