HBA-MPM H.B. 2227 77(R)    BILL ANALYSIS


Office of House Bill AnalysisH.B. 2227
By: Isett
Human Services
3/9/2001
Introduced



BACKGROUND AND PURPOSE 

The Program for All-Inclusive Care for the Elderly (PACE) is a nationwide,
fully-integrated, managed care system that provides an alternative to
nursing home care for the elderly.  PACE programs are authorized in the
federal Balanced Budget Act of 1997 to provide states with cost-effective
options under state Medicaid plans.  PACE enables the elderly to remain as
healthy as possible at home in their communities, and maintain their
independence, dignity, and quality of life.  Those who are older than 55,
medically frail, and eligible for nursing home placement are eligible for
the PACE program.  Health care provided by the PACE program includes
everything from prescription drugs and rehabilitations services to
hospitalization. The program also provides the elderly with recreational
therapists, home health aides, dieticians, and drivers.  PACE  programs
cost the state less than traditional Medicaid payments for those who are
eligible for nursing home placement.  Currently, the only PACE program site
in Texas is Bienvivir in El Paso.  Since 1986, this site has provided
comprehensive care for the frail elderly in their community.  House Bill
2227 requires the Texas Department of Human Services to implement and
expand the PACE program throughout Texas. 

RULEMAKING AUTHORITY

It is the opinion of the Office of House Bill Analysis that rulemaking
authority is expressly delegated to the Health and Human Services
Commission in SECTION 1 (Section 32.053, Human Resources Code) of this
bill. 

ANALYSIS

House Bill 2227 amends the Human Resources Code to require the Health and
Human Services Commission (HHSC) to develop and implement, as a part of the
medical assistance program, a program of all-inclusive care for the elderly
(PACE).  The bill requires HHSC to provide medical assistance to a
participant in the PACE program in the manner and to the extent authorized
by federal law.  The bill requires HHSC to adopt rules as necessary to
implement the PACE program and in doing so to use the Bienvivir Senior
Health Services of El Paso initiative as a model and to ensure that a
person is not required to hold a certificate of authority as a health
maintenance organization (HMO) under the Texas Health Maintenance
Organization Act to provide services under the PACE program. 

The bill prohibits HHSC from contracting with a person to provide services
under the PACE program unless the person purchases reinsurance in an amount
sufficient to ensure the person's continued solvency or has the financial
resources sufficient to cover expenses in the event of insolvency.  The
bill sets forth methods by which a person may demonstrate sufficiency of
financial resources. 

The bill requires HHSC, with the cooperation of the Texas Department on
Aging and area agencies on aging, to develop and implement a coordinated
plan to promote PACE program sites.  HHSC is required to adopt policies and
procedures to ensure that caseworkers and other appropriate HHSC staff
discuss the benefits of participating in the PACE program with long-term
care clients. 

The bill establishes a time-table for implementation of the provisions of
the bill. 
 
EFFECTIVE DATE

September 1, 2001.