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Amend Floor Amendment No. 38 on page 48 of the amendment
packet by striking everything following "Medicaid Reform Waiver."
and substituting the following:
"Contingent on findings that a Medicaid reform waiver is cost
effective and feasible, the Health and Human Services Commission
shall seek a Medicaid reform waiver or waivers from the Centers for
Medicare and Medicaid Services that protect the interests of Texas
Medicaid recipients and taxpayers by incorporating the following
principles:
(a) efficiently leverage state, local, federal and other
funding to:
(1) increase state flexibility in its use of Medicaid
funding by authorizing tailored benefit plans designed to manage
health conditions, not reduce plan benefits for any Medicaid
recipient population;
(2) allow the state to be a more prudent purchaser and
payer of health care ensuring positive health outcomes while
pursuing value-conscious pricing;
(3) build on private market approaches and
insurance-based premiums by establishing multi-share programs
and/or low income pools that create more private coverage;
(4) reduce the state's uninsured through market-based
solutions coupled with best state practices to maximize federal
funds; and
(5) promote the transition of consumers from public
insurance to private insurance by guaranteeing that any pooling of
disproportionate share hospital (DSH) and upper payment limit (UPL)
funds will include inflation and population growth factors.
(b) support the increased personal planning and investments
in long term care needs;
(c) support consumer empowerment and choice by authorizing
Health Savings Accounts, Premium Assistance, Health Insurance
Premium Payment (HIPP) programs, or "Opt-out" programs that:
(1) include a provision requiring that the Health and
Human Services Commission first determine that it is cost
effective;
(2) either exempt recipients under age 21 or
explicitly require that the program be designed to protect and
promote children's access to preventive care and medical
treatments; and
(3) guarantee that recipient participation is
voluntary, and guarantee that a prompt return to regular Medicaid
coverage is allowed on request by the recipient.
(d) create incentives for healthier behaviors by
establishing programs that provide positive rewards for healthy
behaviors, and not punitive incentives;
(e) align state policy and financial incentives by creating
a more transparent, systematic, and efficient approach for
allocating available funding within the health care system; and
(f) solicit broad-based stakeholder input.
Further it is the intent of the Legislature that any Medicaid
reform waiver(s) sought from the federal government will not
include a waiver of children's comprehensive health care under
Early and Periodic Screening, Diagnosis and Treatment (EPSDT). The
authority of the Health and Human Services Commission to impose any
cost-sharing policies on Medicaid recipients is limited to
non-emergent ER use co-payments. The Legislature also recognizes
the unique needs of the state's rural providers, trauma centers,
and primary care residency programs.