LEGISLATIVE BUDGET BOARD
                                   Austin, Texas
         
                                   FISCAL NOTE
                               75th Regular Session
         
                                  April 29, 1997
         
         
      TO: Honorable Hugo Berlanga, Chair            IN RE:  House Bill No. 3258, Committee Report 1st House, Substituted
          Committee on Public Health                              By: Coleman
          House
          Austin, Texas
         
         
         
         
         FROM:  John Keel, Director    
         
In response to your request for a Fiscal Note on HB3258 ( Relating 
to the implementation of the Medicaid managed care program.) 
this office has detemined the following:
         
         Biennial Net Impact to General Revenue Funds by HB3258-Committee Report 1st House, Substituted
         
Implementing the provisions of the bill would result in a net 
negative impact of $(97,788) to General Revenue Related Funds 
through the biennium ending August 31, 1999.
         
The bill would make no appropriation but could provide the legal 
basis for an appropriation of funds to implement the provisions 
of the bill.
         
 
Fiscal Analysis
 
The bill would amend current law governing the development of 
the health and human service delivery system by the Health and 
Human Services Commission.  The bill would require the Commission 
to include certain considerations related to Medicaid managed 
care contracts to providers; ensure that Medicaid recipients 
are aware of care options available; ensure that contracting 
organization develop special disease management programs for 
conditions such as asthma and diabetes; appoint regional Medicaid 
Managed Care Advisory Committees; direct the Department of Health 
and Department of Human Services to submit a plan to the Governor 
and Legislative Budget Board that would realize cost savings 
for the state by simplifying eligibility criteria and streamlining 
eligibility processes for recipients of public assistance; and 
provide a number of reports related to Medicaid managed care 
implementation to the Governor, Lieutenant Governor and Speaker 
of the House of Representatives.   
 
Methodolgy
 
It is assumed that HHSC would delegate some of the responsibilities 
to TDH and DHS but that the State Medicaid Office would add 
two full-time equivalent positions which would be phased in 
during the 1998-99 biennium to implement the provisions of the 
bill.  In addition to the staff, it is assumed that other costs 
such as travel, postage, printing, sign language interpreters, 
personal computers and office supplies would be required.  It 
is assumed that the costs would be funded in part with Medicaid 
matching federal dollars (50% federal and 50% state).
The probable fiscal implications of implementing the provisions 
of the bill during each of the first five years following passage 
is estimated as follows:
 
Five Year Impact:
 
Fiscal Year Probable (Cost)    Probable 
(Cost)  Change in Number   
            from General       from Federal Funds of State                                                
            Revenue Fund                          Employees from                                          
                                                  FY 1997                                                 
            0001               0555                                                                        
       1998         ($43,008)         ($43,008)               1.3                                    
       1998          (54,780)          (54,780)               2.0                                    
       2000          (54,780)          (54,780)               2.0                                    
       2001          (54,780)          (54,780)               2.0                                    
       2002          (54,780)          (54,780)               2.0                                    
 
 
         Net Impact on General Revenue Related Funds:
 
The probable fiscal implication to General Revenue related funds 
during each of the first five years is estimated as follows:
 
              Fiscal Year      Probable Net Postive/(Negative)
                               General Revenue Related Funds
                                             Funds
               1998            ($43,008)
               1999             (54,780)
               2000             (54,780)
               2001             (54,780)
               2002             (54,780)
 
Similar annual fiscal implications would continue as long as 
the provisions of the bill are in effect.
          
No significant fiscal implication to units of local government 
is anticipated.
          
   Source:            Agencies:   501   Department of Health
                                         529   Health and Human Services Commission
                                         
                      LBB Staff:   JK ,BB ,AZ