By: Nelson S.B. No. 873
A BILL TO BE ENTITLED
AN ACT
relating to a medical information telephone hotline pilot program
under the state Medicaid program.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Subchapter B, Chapter 531, Government Code, is
amended by adding Section 531.02131 to read as follows:
Sec. 531.02131. MEDICAID MEDICAL INFORMATION TELEPHONE
HOTLINE PILOT PROGRAM. (a) In this section:
(1) "Net cost-savings" means the total projected cost
of Medicaid benefits for an area served under the pilot program
minus the actual cost of Medicaid benefits for the area.
(2) "Physician" means an individual licensed to
practice medicine in this state or another state of the United
States.
(b) The commission shall evaluate the cost-effectiveness,
in regard to preventing unnecessary emergency room visits and
ensuring that Medicaid recipients seek medical treatment in the
most medically appropriate and cost-effective setting, of
developing a Medicaid medical information telephone hotline pilot
program under which physicians are available by telephone to answer
medical questions and provide medical information for recipients.
If the commission determines that the pilot program is likely to
result in net cost-savings, the commission shall develop the pilot
program.
(c) The commission shall select the area in which to
implement the pilot program. The selected area must include:
(1) at least two counties; and
(2) not more than 100,000 Medicaid recipients, with
approximately 50 percent of the recipients enrolled in a managed
care program in which the recipients receive services from a health
maintenance organization.
(d) The commission shall request proposals from private
vendors for the operation of a telephone hotline under the pilot
program. The commission may not award a contract to a vendor unless
the vendor agrees to contractual terms:
(1) requiring the vendor to answer medical questions
and provide medical information by telephone to recipients using
only physicians;
(2) providing that the value of the contract is
contingent on achievement of net cost-savings in the area served by
the vendor; and
(3) permitting the commission to terminate the
contract after a reasonable period if the vendor's services do not
result in net cost-savings in the area served by the vendor.
(e) The commission shall periodically determine whether the
pilot program is resulting in net cost-savings. The commission
shall discontinue the pilot program if the commission determines
that the pilot program is not resulting in net cost-savings after a
reasonable period.
(f) Notwithstanding any other provision of this section,
including Subsection (b), the commission is not required to develop
the pilot program if suitable private vendors are not available to
operate the telephone hotline.
(g) The executive commissioner shall adopt rules necessary
for implementation of this section.
(h) The participation of a physician in a telephone hotline
that is part of a pilot program established under this section does
not constitute the practice of medicine in this state.
SECTION 2. (a) Not later than December 1, 2005, the Health
and Human Services Commission shall determine whether the pilot
program described by Section 531.02131, Government Code, as added
by this Act, is likely to result in net cost-savings. If the
determination indicates that net cost-savings are likely, the
commission shall take the action required by Subsections (b), (c),
and (d) of this section.
(b) Not later than January 1, 2006, the Health and Human
Services Commission shall select the counties in which the pilot
program will be implemented.
(c) Not later than February 1, 2006, the Health and Human
Services Commission shall request proposals from private vendors
for the operation of a medical information telephone hotline. The
commission shall evaluate the proposals and choose one or more
vendors as soon as possible after the receipt of the proposals.
(d) Not later than January 1, 2007, the Health and Human
Services Commission shall report to the governor, the lieutenant
governor, and the speaker of the house of representatives regarding
the pilot program. The report must include:
(1) a description of the status of the pilot program,
including whether the commission was unable to contract with a
suitable vendor;
(2) if the pilot program has been implemented:
(A) an evaluation of the effects of the pilot
program on emergency room visits by program participants; and
(B) a description of cost savings in the area
included in the pilot program; and
(3) recommendations regarding expanding or revising
the pilot program.
SECTION 3. 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 of that provision,
the agency affected by the provision shall request the waiver or
authorization and may delay implementing that provision until the
waiver or authorization is granted.
SECTION 4. This Act takes effect September 1, 2005.