SRC-CDH S.B. 1163 75(R)   BILL ANALYSIS


Senate Research Center   S.B. 1163
By: Zaffirini
Health & Human Services
4-7-97
As Filed


DIGEST 

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 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.   

PURPOSE

As proposed, S.B. 1163 provides for information and training about
Medicaid managed care. 

RULEMAKING AUTHORITY

This bill does not grant any additional rulemaking authority to a state
officer, institution, or agency. 

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 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 in which the department plans to provide medical assistance
through a managed care plan.  Requires the department to provide initial
information and training in a service area not later than a certain date.
Requires the department, after the initial information and training, to
provide information and training at regular intervals determined by the
department.   

SECTION 2. Effective date:  September 1, 1997.

SECTION 3. Emergency clause.