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.