HBA-MPM H.B. 2541 77(R) BILL ANALYSIS Office of House Bill AnalysisH.B. 2541 By: Coleman Public Health 3/28/2001 Introduced BACKGROUND AND PURPOSE The state Medicaid program was created to provide health care for poor, elderly, and disabled Texas citizens. Currently, Medicaid provides acute and long-term care services for approximately 1.7 million individuals in Texas. While the scope of the Medicaid program has expanded over the years, there are still substantial gaps in coverage for certain individuals. For example, many low-income children are eligible for health care benefits under Medicaid, yet remain unenrolled due to administrative hurdles. House Bill 2541 simplifies the application process for children's Medicaid, removes the three-prescription drug limit, establishes various demonstration projects, and reduces administrative requirements for managed care organizations that contract with Medicaid. 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 5 (Section 32.0261, Human Resources Code) of this bill. ANALYSIS House Bill 2541 amends the Human Resources Code to prohibit the Health and Human Services Commission (HHSC) from limiting benefits for the number of medications prescribed to a recipient of prescription drug benefits under the medical assistance program (Sec. 32.024). The bill prohibits HHSC to the extent allowed by federal law from considering the assets and resources of a child under 19 years old or the assets and resources of the child's parents or other caretaker when determining the child's eligibility for medical assistance (Sec. 32.02415). The bill requires HHSC to the extent allowed by federal law and except as otherwise provided by state law to adopt application forms and procedures for a request for medical assistance provided to a child under 19 that are similar to those used by the state child health plan (CHIP). HHSC is required to permit an application for assistance to be conducted by mail (Sec. 32.025). The bill requires HHSC in adopting rules and to the extent allowed by federal law to ensure that documentation and verification procedures used in determining and certifying eligibility for a child under 19 are similar to those used to determine eligibility for CHIP and to permit a recertification review to be conducted by telephone or mail (Sec. 32.026). H.B. 2541 requires HHSC to adopt rules in accordance with federal law no later than October 1, 2001 to provide for a period of continuous eligibility for a child under 19 years of age who is eligible for medical assistance. The bill requires the rules to provide that the child remains eligible for the assistance without additional review by HHSC and regardless of changes in the child's resources until the first anniversary of the date the child's eligibility was determined or the child's 19th birthday, whichever date is earlier (Sec. 32.026). Demonstration Project: Psychotropic Medications and Related Services H.B. 2541 requires HHSC to establish a five-year demonstration project (project) to provide a person psychotropic medications and related laboratory and physician services through the state medical assistance program. The bill sets forth the eligibility criteria for a person to participate in the project and specifies that participants are not subject to the monthly three-prescription limit under the medical assistance program. The bill specifies that participation in the project does not entitle a participant to other services provided under the medical assistance program. The bill sets forth reporting and evaluation procedures. The program ends September 1, 2007 (Sec. 32.053). Demonstration Project: HIV/AIDS The bill requires HHSC to establish a demonstration project (project) to provide specified services and medications to a person infected with HIV or AIDS through the medical assistance program in at least two counties with a high prevalence of HIV or AIDS. HHSC is authorized to request financial participation from the counties where the project is established. The bill sets forth eligibility criteria for a person to participate in the project and specifies that participants are not subject to the monthly three-prescription limit. The bill specifies that participation in the project does not entitle a participant to other services provided under the medical assistance program. The bill sets forth reporting and evaluation procedures. The project ends September 1, 2007 (Sec. 32.054). Demonstration Project: Women's Health Care Services The bill requires HHSC to establish a five-year demonstration project (project) through the medical assistance program to expand access to preventive health and family planning services for women and specifies which services an eligible woman may receive under the project. The bill sets forth eligibility criteria for a woman to participate in the project. HHSC is required to compile a list of potential funding sources that a participant can use to help pay for treatment for health problems identified using services provided to the participant under the project and for which the participant is not eligible to receive treatment under the medical assistance program. The bill sets forth reporting requirements. The project ends September 1, 2007 (Sec. 32.055). Demonstration Project: Recipients with Disabilities The bill requires HHSC to establish a demonstration project (project) to implement in five sites a medical assistance buy-in program in accordance with the federal Ticket to Work and Work Incentives Improvement Act of 1999 to provide medical assistance to specified persons. In developing the project, HHSC is authorized to establish income, assets, and resource limitations for participation and require a participant to pay premiums and other cost-sharing charges in accordance with federal law. The bill requires HHSC to require a participant in the project to pay premiums to the extent required by federal law. The bill sets forth reporting and evaluation procedures. The project ends September 1, 2003 (Sec. 32.056). Medicaid Managed Care: Reporting Requirements, Inspection Procedures, Sharing of Information H.B. 2541 amends the Government Code to require HHSC to evaluate on-site inspection procedures of managed care organizations (organizations) contracting with HHSC for purposes of providing services under the Medicaid managed care program (program), and methods to streamline inspection procedures and reporting requirements. The bill also requires HHSC to require the organizations to evaluate reporting requirements to identify methods of reducing the administrative burden of health care providers. The bill requires HHSC to submit a report on streamlining methods to the legislature no later than November 1, 2002. This provision expires September 1, 2002 (Sec. 533.0055 and SECTION 12). HHSC is required to require a health and human services agency (agency) implementing a Medicaid managed care program to provide to each other agency implementing the program information reported to that agency by an organization or health care provider providing services to recipients (Sec. 533.016). The bill requires the state agencies responsible for implementing the demonstration projects for psychotropic medications, HIV/AIDS services, and women's health care services to request and actively pursue any necessary waivers or authorizations no later than September 1, 2002 (SECTION 11). EFFECTIVE DATE September 1, 2001. Provisions related to demonstration projects for psychotropic medications, HIV and AIDS services, and women's health care services and provisions regarding evaluation of reporting requirements and inspection procedures for Medicaid managed care take effect on passage, or if this Act does not receive the necessary vote, the provisions take effect September 1, 2001.