BG S.B. 1165 75(R)BILL ANALYSIS



PUBLIC HEALTH
S.B. 1165
By: Zaffirini (Berlanga)
5-8-97
Committee Report (Unamended)


BACKGROUND
 
Currently, children with special health care needs are given no special
consideration and must enroll along with all Medicaid-eligible patients in
the Medicaid managed care pilot programs that are being rolled out across
the state.  The Senate Committee on Health and Human Services recommended
in a report that the Health and Human Services Commission (commission)
give special consideration to children with special health care needs to
ensure that these children are being adequately served by the state
Medicaid program.  To accomplish this goal, this bill requires the
commission to develop a standard operational definition of children with
special health care needs, to develop a pilot program for children with
special health care needs to determine the best way to serve these
children in a managed care setting, and to allow the children with special
health care needs to voluntarily enroll in Medicaid managed care. 

PURPOSE

S.B. 1165 sets forth the provisions and exceptions of managed care under
the state Medicaid program for children with special health care needs. 

RULEMAKING AUTHORITY

It is the committee's opinion that this bill expressly grants additional
rulemaking authority to the Health and Human Services Commission, in
cooperation with Texas Department of Health, in SECTION 1.01 (Section
16A(p), Article 4413(502), Revised Statutes). Additional rulemaking
authority is also granted to the commission in SECTION 2.01 (Section
532.112(c), Chapter 532B, Government Code).  

SECTION BY SECTION ANALYSIS

ARTICLE 1.

SECTION 1.01.  Amends Section 16A, Article 4413(502), Revised Statutes, as
follows: 

Subsection (n) requires the Health and Human Services Commission
(commission), in cooperation with the Texas Department of Health (TDH), to
monitor and assess health care services as specified, adopt specific
applicable quality of care standards, and undertake initiatives to
develop, test, and implement optimal methods of delivery of appropriate,
comprehensive and cost-effective care as specified.  

Subsection (o) is added to prohibit the commission from requiring a child
with special health care needs who receives supplemental security income
from the federal government to enroll in a managed care plan under the
state Medicaid program. Allows the commission to require children with
special needs or classes of children with special needs to enroll in a
managed care plan or primary care case management program, as specified,
if the commission makes certain determinations and establishes good cause
exemption procedures. 

Subsection (p) requires the commission, in cooperation with the TDH, to
prescribe, by rule, qualifications for classification of a child as a
"child with special health care needs" as specified.  Sets forth types of
disabilities the commission must include in prescribing  qualifications
for children.   

Subsection (q) makes a conforming change.

ARTICLE 2.  

SECTION 2.01.  Amends Chapter 532B, Government Code, by adding Section
532.112, entitled "Children With Special Health Care Needs," to conform to
changes made by Article 1 of this Act. 

ARTICLE 3.  

SECTION 3.01.  Provides that Article 1 of this Act takes effect on the
first date that it may take effect under Section 39, Article III, Texas
Constitution. 

SECTION 3.02.  Provides that if H.B. 1845 or S.B. 898, Acts of the 75th
Legislature, Regular Session, 1997, relating to nonsubstantive additions
to and corrections in enacted codes becomes law, Sections 16A(n)-(q),
Article 4413(502), Revised Statutes, as amended or added by Article 1 of
this Act, expire on September 1, 1997. 

SECTION 3.03.  Provides that Article 2 of this Act takes effect September
1, 1997, but only if H.B. 1845 or S.B. 898, Acts of the 75th Legislature,
Regular Session, 1997, becomes law. 

SECTION 3.04.  Emergency clause.
      Effective date: upon passage.