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


Senate Research CenterC.S.S.B. 1163
By: Zaffirini
Health & Human Services
4-17-97
Committee Report (Substituted)


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.  C.S.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

As proposed, C.S.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 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 in which the department plans to provide
medical assistance through a managed care plan.  Requires the department
to include in the plan 180 days of initial information and training in a
service area beginning not later than a certain date, 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.  Sets
forth the terms by which the department is required to submit a semiannual
report on the effectiveness of the comprehensive plan to certain
individuals and entities by a set date.  Establishes the conditions under
which the department, in conjunction with the plan, is required to
establish a pilot project to test the effectiveness and cost of peer
outreach and health education designed to accomplish certain goals.

SECTION 3. Emergency clause.  
  Effective date:  upon passage.
 

SUMMARY OF COMMITTEE CHANGES

SECTION 1.

Amends Section 32.043, Human Resources Code, to replace all references to
"plan" with "comprehensive plan".  Requires the department to include 180
days of initial information and training, and performance measures.
Requires the department to consult with the Medicaid medical care advisory
committee in developing the plan.  Sets forth the terms by which the
department is required to submit a report to certain individuals and
entities, and is required to establish a pilot project to test the
effectiveness and cost of peer outreach and health education.   

Deletes former SECTION 2.

SECTION 3.

Changes the effective date from "September 1, 1997" to "upon passage."