H.B. 1559 78(R) BILL ANALYSIS
H.B. 1559
By: Coleman
State Health Care Expenditures, Select
Committee Report (Unamended)
BACKGROUND AND PURPOSE
Recent advancements in HIV and AIDS treatment have brought renewed health
to many people living with HIV and AIDS. New medications have been
developed that, taken together, can slow the spread of the HIV virus and
in some cases prevent the onset of full-blown AIDS. These "combination
therapy" medications or "multi-drug cocktails" are expensive, however,
costing as much as $10,000 to $12,000 per year per person, which puts the
cost of treatment out of reach for limited-income working Texans without
health insurance.
When limited-income people with HIV and AIDS do not receive appropriate
treatment, they debilitate physically to the point where they meet the
federal definition of "disabled." Once that happens, they automatically
qualify for disability-related (SSI) Medicaid, one of the most expensive
categories of Medicaid coverage. Actuarial studies indicate that the
state spends approximately $24,000 per year per person on these
individuals from the time they enter the Medicaid program until their
deaths.
Investing up front in appropriate care for this population would divert
some of these costs. The same actuarial studies noted above indicate that
the average cost of providing combination therapy and appropriate support
services to individuals with HIV would be approximately $13,000 per person
per year, which is a savings of about $9,000 per person per year.
In 1997, the Legislature by rider directed the Texas Department of Health
(TDH) to maximize federal funding under Medicaid for pharmaceutical
treatment, including treatment of HIV and AIDS. TDH worked with
stakeholders to develop a demonstration project that would expand Medicaid
coverage in a non-entitlement fashion to approximately 4,400 people who
meet the following criteria: (1) diagnosed with HIV or AIDS; (2) family
income at or below 200 percent of the federal poverty level; (3) age 64 or
younger; and (4) reside in or receive care from one of the two counties
chosen for the project. The project uses local funds from those two
counties to finance the state share of the Medicaid costs.
House Bill 1559 requires TDH to continue developing the project first
authorized in 1997. The bill also outlines the limited benefits package
that would be provided to participants in the project (for example
pharmaceuticals, physician visits and laboratory services), and requires
TDH to report to the Legislature on the cost-effectiveness of the project.
The bill also requires the department to apply for a "waiver" to implement
the demonstration project. Because Medicaid is jointly financed by the
state and federal government, the state must ask the federal government
for permission to conduct this project by using the waiver process
outlined in Section 1115 of the Social Security Act (SSA). Section 1115
of the SSA requires state demonstration projects to be budget neutral over
a five-year period, which means the Medicaid costs with the waiver in
place must not exceed the Medicaid costs without the waiver in place. The
federal government will not approve a waiver request that does not meet
this requirement. The project authorized by House Bill 1559 meets this
requirement by offsetting the increased costs under Medicaid by providing
services to newly-eligible individuals with savings from diverting
individuals from disability-related (SSI) Medicaid, one of the most
expensive categories of Medicaid coverage.
RULEMAKING AUTHORITY
It is the committee's opinion that this bill does not expressly grant any
additional rulemaking authority to a state officer, department, agency,
or institution.
ANALYSIS
SECTION 1. Amends Subchapter B, Chapter 32, Human Resources Code, by
adding new Section 32.057 to read as follows:
Sec. 32.057. DEMONSTRATION PROJECT FOR PERSONS WITH HIV INFECTION OR AIDS.
(a) Defines the terms "AIDS" and "HIV" to have the meanings assigned by
Sec. 81.101, Health and Safety Code.
(b) Requires the department to establish a demonstration project that
provides persons with AIDS or HIV with the following services and
medications through the medical assistance program: health care providers
specified by the department, such as a physician, physician assistant, or
advanced practice nurse; anti-retroviral drug treatments; other
medications determined to be necessary for treatment of a condition
related to HIV infection or AIDS; vaccinations for hepatitis B and
pneumonia; pap smears, colonscopy and other diagnostic procedures required
to monitor gynecologic complications resulting from HIV infection or AIDS
in women; laboratory and other diagnostic services, including periodic
testing for CD4+ T-Cell counts, viral load determination, and phenotype or
genotype testing if clinically indicated; and other laboratory and
radiological testing necessary to monitor potential toxicity of therapy.
(c) Requires the department to establish the demonstration project in two
counties with high prevalence of HIV infection and AIDS.
(d) Provides that persons must meet the following requirements to
participate in the demonstration project: diagnosed with HIV infection or
AIDS by a physician; under 65 years of age; net family income that is at
or below 200 percent of the federal poverty level; resident of the county
included in the project or, subject to department guidelines, is receiving
medical care for HIV infection or AIDS through a facility located in a
county included in the project; not covered by an adequate health plan, as
defined by the department; and not otherwise eligible for the Medicaid
program.
(e) Provides that participants are not entitled to other benefits under
the medical assistance program
(f) Requires the department to establish a participation limit in the
pilot project and to not allow the enrollment in the pilot project to
exceed that limit. A waiting list will be created once the project
reaches its enrollment limit. Individuals on the waiting list will be
permitted to enroll in the HIV medication project operated by the
department.
(g) Requires the department to ensure that individuals on the waiting list
for the project enroll in the HIV medication program operated by the
department.
(h) Requires the department to provide each participant in the project
with a six-month period of continuous eligibility.
(i) Requires the department to submit a biennial report demonstrating the
progress and operations of the project no later than December 1 of each
even-numbered year.
(j) Requires the department to evaluate the cost-effectiveness of the
project no later than December 1, 2008. Requires the department, if the
results indicate the project is costeffective, to incorporate a request
for funding to expand the project to other counties throughout the state
as appropriate in the department's budget.
(k) Provides that this section expires September 1, 2009.
SECTION 2. Requires the agency, if it determines that before implementing
any provision of the Act a waiver or authorization from a federal agency
is necessary, to submit the necessary waiver or authorization request.
SECTION 3. This Act takes effect immediately if it receives a vote of
two-thirds of all the members of each house, as provided by Section 39,
Article III, Texas Constitution. If the Act does not receive the
necessary vote for immediate effect, this Act takes effect September 1,
2003.
EFFECTIVE DATE
This Act takes effect immediately if it receives a vote of two-thirds of
all the members of each house, as provided by Section 39, Article III,
Texas Constitution. If the Act does not receive the necessary vote for
immediate effect, this Act takes effect September 1, 2003.