SRC-MKV C.S.S.B. 1156 77(R)BILL ANALYSIS


Senate Research CenterC.S.S.B. 1156
77R8137 KKA-DBy: Zaffirini
Finance
4/10/2001
Committee Report (Substituted)

DIGEST AND PURPOSE 

Currently, the state of Texas, along with the nation, is experiencing an
increase in cost per Medicaid recipient.  This is due to the general rise
in health care utilization, the recent rise in caseload, the increasing
utilization and prices of prescription drugs, and the decrease in Texas'
Federal Medical Assistance Percentage.  C.S.S.B. 1156 relates to the
financing of, and eligibility for, the state Medicaid program.  The bill
contains provisions for Medicaid reform and includes changes to the limits
for the vendor drug program; the removal of assets test for Medicaid
children; continuous eligibility for children transitioning from Medicaid
to CHIP or private insurers; waivers for medications and related services
for persons with HIV infection or AIDS; and women's health care services
and a medical assistance buy-in program for certain recipients with
disabilities. 

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 32.024, Human Resources Code, by adding
Subsection (x), to require the Health and Human Services Commission
(department), in its rules and standards governing the vendor drug program,
to provide for cost-sharing by recipients of prescription drug benefits
under the medical assistance program in a manner that ensures that
recipients with higher levels of income are required to pay progressively
higher percentages of the costs of prescription drugs. 
 
SECTION 2.   Amends Chapter 32B, Human Resources Code, by adding Section
32.053, as follows: 
 
Sec. 32.053.  DEMONSTRATION PROJECT FOR CERTAIN MEDICATIONS AND RELATED
SERVICES.  Requires the department to establish a demonstration project to
provide to a person through the medical assistance program psychotropic
medications and related laboratory and medical services necessary to
conform to a prescribed medical regime for those medications. 
 
(b)  Provides that a person is eligible to participate in the demonstration
project if the person meets certain requirements. 
 
(c) Requires the department, notwithstanding any other provision of this
section, to provide each participant in the demonstration project with a
12-month period of continuous eligibility for participation in the project. 

(d)  Provides that a participant in the demonstration project is not
subject to the monthly three-prescription limit under the medical
assistance program. 

(e) Requires the department to establish an appropriate enrollment limit
for the demonstration project and prohibits allowing participation in the
project to exceed that limit.  Requires the department, once the limit is
reached, to establish a waiting list for  enrollment in the demonstration
project. 


(f) Authorizes the department, to the extent permitted by federal law, to
require a participant in the demonstration project to make cost-sharing
payments for services provided through the project. 

(g) Requires the department, to the maximum extent possible, to use
existing resources to fund the demonstration project. 
 
(h)  Requires the department, not later than December 1 of each
even-numbered year, to submit a biennial report to the legislature
regarding the department's progress in establishing and operating the
demonstration project. 
 
(i)  Requires the department, not later than December 1, 2006, to evaluate
the cost-effectiveness of the demonstration project, including whether the
preventive drug treatments and related services provided under the project
offset future long-term care costs for project participants.  Requires the
department, if the results of the evaluation indicate that the project is
cost-effective, to incorporate a request for funding for the continuation
of the program in the department's budget request for the next state fiscal
biennium. 
 
  (j)  Provides that this section expires September 1, 2009.

SECTION 3.  Amends Chapter 531B, Government Code, by adding Sections
531.02101 and 531.02102, a follows: 

Sec. 531.02101.  TRANSFER AUTHORITY RELATING TO ADMINISTRATION OF MEDICAID
PROGRAM.   (a) Authorizes the commission, under certain specific
conditions, to transfer any power, duty, function, program, activity,
obligation, right, contract, record, employee, property, appropriation, or
other money relating to administration of the Medicaid program from a
health and human services agency to the commission. 

(b) Prohibits a transfer authorized by Subsection (a) from taking effect
unless approved by the Medicaid legislative oversight committee created
under Section 531.02102. 

(c) Requires the commission to notify the Legislative Budget Board and the
governor's office of budget and planning not later than the 30th day before
the effective date of a transfer authorized by Subsection (a). 

Sec. 531.02102.  MEDICAID LEGISLATIVE OVERSIGHT COMMITTEE.  (a) Sets forth
the composition of the Medicaid legislative oversight committee. 

(b) Provides that a member of the committee serves at the pleasure of the
appointing official. 

(c) Requires the lieutenant governor and the speaker of the house of
representatives to appoint the presiding officer of the committee on an
alternating basis.  Requires the presiding officer to serve a two-year term
expiring February 1 of each odd-numbered year. 

  (d) Requires the committee to carry out certain duties.

(e) Authorizes the committee to use staff of standing committees in the
senate and house of representatives with appropriate jurisdiction, the
Department of Information  Resources, the state auditor, the Texas
Legislative Council, and the Legislative Budget Board in carrying out its
responsibilities. 

SECTION 4.  Amends Section 531.0214(d), Government Code, to delete language
regarding information relating to Medicaid clients for whom more than three
medications have been prescribed and the medical effect denial of Medicaid
coverage for more than three medications has had on Medicaid client. 
 
SECTION 5.  Amends Section 531.026(a), Government Code, to add language
specifying new individuals and groups to whom the commission is required to
submit a consolidated health and human services budget recommendation not
later than October 15 of each even-numbered year. 
 
SECTION 6.  Amends Chapter 531B, Government Code, by adding Section
531.0261, as follows: 

Sec. 531.0261.  CONSOLIDATED MEDICAID APPROPRIATIONS REQUEST.  (a) Requires
the commission to include in the consolidated budget recommendation
required by Section 531.026 a consolidated Medicaid appropriations request
for the subsequent fiscal biennium. 

(b) Requires the commission to carry out certain duties related to the
Medicaid appropriations request.  
 
SECTION 7.  Amends Chapter 531B, Government Code, by adding Section
531.0272, as follows: 

Sec. 531.0272.  COMPREHENSIVE MEDICAID OPERATING BUDGET; QUARTERLY
EXPENDITURE REPORTS.  (a) Requires the commission to prepare a
comprehensive Medicaid operating budget at the beginning of each fiscal
year, with input as appropriate from each health and human services agency
that receives legislative appropriations relating to the Medicaid program. 

(b) Requires the commission to monitor all Medicaid expenditures by the
commission and health and human services agencies and submit quarterly
Medicaid expenditure reports to certain individuals and groups. 

(c) Requires the commission to prepare the comprehensive Medicaid operating
budget and quarterly Medicaid expenditure reports with input from the
Legislative Budget Board and the governor's office of budget and planning
to ensure that the information described by Section 531.0261(b)(1) is
reflected. 
 
SECTION 8.  Amends Chapter 533A, Government Code, by adding Sections
533.0055 and 533.016, as follows: 
 
Sec. 533.0055.  EVALUATION OF REPORTING REQUIREMENTS AND INSPECTION
PROCEDURES.  (a)  Requires the commission to perform certain duties. 
  
(b)  Requires the Health and Human Services Commission (commission) to
submit a report to the legislature regarding the evaluation of and methods
for streamlining on-site inspection procedures and reporting requirements
for managed care organizations and health care providers providing health
care services to recipients.  Requires the report to include
recommendations on which methods should be implemented and a schedule for
implementation. 
 
  (c)  Provides that this section expires September 1,2002.
 
Sec. 533.016.  INTERAGENCY SHARING OF INFORMATION.  Requires the
commission to require a health and human services agency implementing the
Medicaid managed care program to provide to each other health and human
services agency implementing the Medicaid managed care program information
reported to that agency by a managed care organization or health care
provider providing services to recipients. 
 
SECTION 9.   Transfers the functions of the Texas Department of Health
relating to the Medicaid program to the Health and Human Services
Commission on January 1, 2002, or on an earlier date specified by the
Health and Human Services Commission. 
 
SECTION 10. Requires the state agency responsible for implementing the
demonstration projects required by Sections 32.053, Human Resources Code,
as added by this Act, to request and actively pursue any necessary waivers
or authorizations from the Health Care Financing Administration or other
appropriate entities to enable the agency to implement the demonstration
projects not later than September 1, 2002.  Authorizes the agency to delay
implementing the demonstration projects until the necessary waivers or
authorizations are granted. 
 
SECTION 11.  Requires The Health and Human Services Commission to submit
the report required by Section 533.0055(b), Government Code, as added by
this Act, not later than November 1, 2002. 
 
SECTION 12.  Requires the lieutenant governor and the speaker of the house,
as soon as possible after the effective date of this Act, to appoint the
members of the Medicaid legislative oversight committee created by Section
531.02102, Government Code, as added by this Act.  Requires the lieutenant
governor to appoint the initial presiding officer of the committee. 
 
SECTION 13.  (a)  Requires a state agency affected by a provision of this
Act to request a waiver or authorization and authorizes the agency to delay
implementing that provision until the waiver or authorization is granted,
if the agency determines before implementing any provision of this Act that
a waiver or authorization from a federal agency is necessary, subject to
Subsection (b) of this section. 
 
(b)  Provides that implementation of Section 32.053, Human Resources Code,
as added by this Act, is governed by Section 10 of this Act. 
 
SECTION 14.   (a)  Effective date: September 1, 2001, except as provided by
Subsection (b) of this section.  Provides that this Act applies to a person
receiving medical assistance on or after that date regardless of the date
on which the person began receiving that medical assistance. 
 
(b)  Effective date: upon passage or September 1, 2001, for Sections 2, 8,
and 10 of this Act. 
 

SUMMARY OF COMMITTEE CHANGES

Differs from original as follows:

 _SECTION 1.  Adds language requiring the Health and Human Services
Commission (department), in its rules and standards governing the vendor
drug program, to provide for cost-sharing by recipients of prescription
drug benefits under the medical assistance program in a manner that ensures
that recipients with higher levels of income are required to pay
progressively higher percentages of the costs of prescription drugs. 

 _Deletes original SECTIONS 2-5.

 _Redesignates original SECTION 6 as SECTION 2, deletes proposed Sections
32.054 and 32.055, Human Resources Code, and adds language relating to
which persons are eligible to participate in the demonstration project in
proposed Section 32.053(b). Adds new Subsections (c), (e), (f), and (g),
and redesignates original Subsections (f)  and (g) to (i) and (j).  In
Subsection (j) it changes the expiration date of the section from September
1, 2007, to September 1, 2009. 

 _SECTION 3.  Adds a new SECTION 3 relating to the transfer of authority
relating to administration of the Medicaid program. 

 _Redesignates original SECTION 8 as SECTION 4.

 _SECTION 5.  Adds a new SECTION 5 to amend Section 531.026(a), Government
Code, to add language specifying new individuals and groups to whom the
commission is required to prepare and submit a consolidated health and
human services budget recommendation not later than October 15 of each
even-numbered year. 

 _SECTION 6.  Adds a new SECTION 6 relating to a consolidated Medicaid
appropriations request. 

 _Deletes original SECTION 7 relating to a demonstration project for a
medical assistance buy-in program for certain recipients with disabilities.

 _SECTION 7.  Adds a new SECTION 7 relating to a comprehensive Medicaid
operating budget and quarterly expenditure reports. 

 _Redesignates original SECTION 9 as SECTION 8.

 _SECTION 9.  Adds a new SECTION 9 to transfer the functions of the Texas
Department of Health relating to the Medicaid program to the Health and
Human Services Commission on January 1, 2002, or on an earlier date
specified by the Health and Human Services Commission. 

 _Deletes original SECTION 10  relating to a given sum being appropriated
to the commission for the implementation of this Act. 

 _Deletes original SECTION 11 relating to the adoption of rules by the
commission or other appropriate state agency operating part of the medical
assistance program. 

 _Redesignates original SECTION 12 as SECTION 10.

 _Redesignates original SECTION 13 as SECTION 11.

 _SECTION 12.  Adds a new SECTION 12 relating to the appointment of members
to the Medicaid legislative oversight committee. 

 _SECTION 13.  Makes conforming changes in Subsection (b).

 _SECTION 14.  Makes conforming changes in Subsection (b).