LEGISLATIVE BUDGET BOARD
                              Austin, Texas
                                     
                    FISCAL NOTE, 77th Regular Session
  
                               May 21, 2001
  
  
          TO:  Honorable Bill Ratliff, Lieutenant Governor,  Senate
  
        FROM:  John Keel, Director, Legislative Budget Board
  
       IN RE:  SB1536  by Madla (Relating to the establishment of pilot
               projects to demonstrate the applications of technology in
               providing certain services under the medical assistance
               program.), As Passed 2nd House
  
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*  No significant fiscal implication to the State is anticipated.        *
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The bill would allow the Health and Human Services Commission (HHSC) to
establish one or more Medicaid pilot projects to demonstrate the
application of technology in the provision of services.  According to the
bill, a pilot project may relate to providing rehabilitation services,
services for the aging or disabled, or long-term care services, including
community care services and support.  Potentially, a pilot program could
have fiscal implications, however, it is assumed the pilot would not (1)
increase the number recipients receiving services, (2) increase the
level of services, or (3) increase the level of reimbursement for
services.

The bill would also provide for a telemedicine or telehealth pilot
project in areas not more than 150 miles from the Texas-Mexico border.
The bill would require the HHSC to establish an advisory committee which
would be required to prepare an implementation report to the Governor,
Lieutenant Governor, Speaker of the House of Representatives, and
appropriate standing committees of the Senate and House of
Representatives by September 1, 2003.  The bill would provide for grants
to health care facilities providing telemedicine or telehealth services
as part of the pilot project.  The bill would be effective on September
1, 2001.  Based upon the Texas Department of Health's cost estimate,
clients who would participate in the pilot project are already receiving
services through Medicaid, the Children's Health Insurance Program, or
the Children with Special Health Care Needs program, thus, there would be
no new costs in providing services.  Reimbursement for travel and
related expenses for the advisory committee would require authorization
in the General Appropriations Act.

Part of the bill would also implement e-Texas recommendation HHS 10,
related to
expanding the use of telemedicine to help disabled children.  It would
require the Children's Health Insurance Program (CHIP), the Children with
Special Health Care Needs (CSHCN) program, and the
Medicaid program to provide reimbursement for telemedicine services for
children with special health care needs.  Both the HHSC, which operates
CHIP, and the Department of Health (TDH), which operates the Medicaid and
CSHCN programs, assume the bill would only require the provision of
telemedicine services if these services are determined to be fiscally
neutral to the relevant operating program.  Therefore, HHSC and TDH
assume implementation of the bill would not have a significant fiscal
impact.  The Department of Human Services assumes the bill would not
apply to community-based services operated by the agency.  The University
of Texas Medical Branch at Galveston (UTMB) assumes the
bill would not have a significant fiscal impact.
  
Local Government Impact
  
No fiscal implication to units of local government is anticipated.
  
  
Source Agencies:   529   Health and Human Services Commission, 324
                   Texas Department of Human Services, 501   Texas
                   Department of Health
LBB Staff:         JK, HD, PP