SRC-MKV S.B. 283 77(R)BILL ANALYSIS


Senate Research CenterS.B. 283
By: Nelson
Health & Human Services
6/11/2001
Enrolled


DIGEST AND PURPOSE 

Healthcare for patients suffering from chronic disease consumes a majority
of all health expenditures.  In the managed care population, studies have
indicated as few as ten percent of enrollees with chronic illnesses may
consume as much as seventy percent of a group's healthcare costs.  Risk
factors such as obesity and lack of exercise are increasing among Texas'
children, setting the stage for an epidemic of chronic conditions such as
diabetes and heart disease.  More children are experiencing problems with
asthma than ever before; between 1982 and 1993 the prevalence of asthma in
the United States increased by forty-six percent overall and eighty percent
in children.  In 1995 Texas Medicaid spent over $31 million on
asthma-related hospitalizations.  Recent reports suggest that many patients
with chronic disease are not receiving the appropriate level of care to
effectively manage their conditions. Contributing factors include
medication noncompliance, inadequate patient education and secondary
prevention services, unexplained clinical variation in treatment, and
inconsistency among physicians in following established treatment
recommendations.  S.B. 283 requires the Health and Human Services
Commission to develop and implement a targeted pilot project to determine
the effectiveness of a disease management program in the reduction of
long-term health care costs, improved care, better utilization patterns,
and improved coordination of care. 

RULEMAKING AUTHORITY

This bill does not expressly grant any additional rulemaking authority to a
state officer, institution, or agency. 

SECTION BY SECTION ANALYSIS

SECTION 1.  Amends Section 533.009, Government Code, as follows:

Sec. 533.009.  (a) Requires the Health and Human Services Commission or an
agency operating part of the state Medicaid managed care program
(commission) to ensure that managed care organizations under contract with
the commission to provide health care services to recipients develop and
implement special disease management programs to address chronic health
conditions and use outcome measures to assess the programs.  Deletes the
phrase "to the extent possible." 

(b) Requires the commission to study the benefits and costs of applying
disease management principles in the delivery of Medicaid managed care
services to recipients with chronic health conditions.  Requires the
commission, in conducting the study, to evaluate the effectiveness of those
principles in certain areas.   

(c) Authorizes the commission to conduct the study under Subsection (b) in
conjunction with an academic center. 

SECTION 2.  Requires that, if before implementing any provision of this Act
a state agency determines that a waiver or authorization from a federal
agency is necessary for implementation, the state agency request the waiver
or authorization and authorizes the delay of implementation of that
provision until the  waiver or authorization is granted. 

SECTION 3.  Effective date: September 1, 2001.