79R17164 UM-F


By:  Nelson                                                       S.B. No. 873

Substitute the following for S.B. No. 873:                                    

By:  McReynolds                                               C.S.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, "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.
	(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.
	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.