| |
| |
|
|
A BILL TO BE ENTITLED
|
|
|
AN ACT
|
|
|
relating to requiring the Health and Human Services Commission to |
|
|
evaluate and implement changes to the Medicaid program to make the |
|
|
program more cost-effective, increase competition among providers, |
|
|
and improve health outcomes for recipients. |
|
|
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
|
|
SECTION 1. Subchapter A, Chapter 533, Government Code, is |
|
|
amended by adding Sections 533.023, 533.024, and 533.025 to read as |
|
|
follows: |
|
|
Sec. 533.023. COMPETITIVE BIDS. The commission shall |
|
|
establish a range of rates within which a managed care organization |
|
|
must bid during a competitive bidding process to contract with the |
|
|
commission to arrange for or provide a managed care plan. |
|
|
Sec. 533.024. ASSESSMENT OF STATEWIDE MANAGED CARE PLANS. |
|
|
The commission shall assess the feasibility and cost-effectiveness |
|
|
of contracting with managed care organizations to arrange for or |
|
|
provide managed care plans to recipients throughout the state |
|
|
instead of on a regional basis. |
|
|
Sec. 533.025. SHARING OF MONEY RECOVERED. A managed care |
|
|
organization participating in Medicaid must share with the |
|
|
commission any money recovered by the managed care organization as |
|
|
a result of a fraud investigation of or a recoupment of an |
|
|
overpayment or debt from a network provider or recipient. |
|
|
SECTION 2. (a) To the extent funds are appropriated to the |
|
|
Health and Human Services Commission for that purpose, the |
|
|
commission shall: |
|
|
(1) identify and evaluate barriers preventing |
|
|
Medicaid recipients enrolled in the STAR + PLUS Medicaid managed |
|
|
care program or a home and community-based services waiver program |
|
|
from choosing the consumer directed services option and develop |
|
|
recommendations for increasing the percentage of Medicaid |
|
|
recipients enrolled in those programs who choose the consumer |
|
|
directed services option; and |
|
|
(2) study the feasibility of establishing a community |
|
|
attendant registry to assist Medicaid recipients enrolled in the |
|
|
community attendant services program in locating providers. |
|
|
(b) Not later than December 1, 2018, the Health and Human |
|
|
Services Commission shall submit a report containing the |
|
|
commission's findings and recommendations under Subsection (a) of |
|
|
this section to the governor, the Legislative Budget Board, and the |
|
|
standing committees of the senate and the house of representatives |
|
|
with primary jurisdiction over health and human services. |
|
|
SECTION 3. (a) The Health and Human Services Commission |
|
|
shall conduct a study of the provision of dental services to adults |
|
|
with disabilities under the Medicaid program, including: |
|
|
(1) the types of dental services provided, including |
|
|
preventive dental care, emergency dental services, and |
|
|
periodontal, restorative, and prosthodontic services; |
|
|
(2) limits or caps on the types and costs of dental |
|
|
services provided; |
|
|
(3) unique considerations in providing dental care to |
|
|
adults with disabilities, including additional services necessary |
|
|
for adults with particular disabilities; and |
|
|
(4) the availability and accessibility of dentists who |
|
|
provide dental care to adults with disabilities, including the |
|
|
availability of dentists who provide additional services necessary |
|
|
for adults with particular disabilities. |
|
|
(b) In conducting the study under Subsection (a) of this |
|
|
section, the Health and Human Services Commission shall: |
|
|
(1) identify the number of adults with disabilities |
|
|
whose Medicaid benefits include limited or no dental services and |
|
|
who, as a result, have sought medically necessary dental services |
|
|
during an emergency room visit; |
|
|
(2) estimate the number of adults with disabilities |
|
|
who are receiving services under the Medicaid program and who have |
|
|
access to alternative sources of dental care, including pro bono |
|
|
dental services, faith-based dental services providers, and other |
|
|
public health care providers; and |
|
|
(3) collect data on the receipt of dental services |
|
|
during emergency rooms visits by adults with disabilities who are |
|
|
receiving services under the Medicaid program, including the |
|
|
reasons for seeking dental services during an emergency room visit |
|
|
and the costs of providing the dental services during an emergency |
|
|
room visit, as compared to the cost of providing the dental services |
|
|
in the community. |
|
|
(c) Not later than December 1, 2018, the Health and Human |
|
|
Services Commission shall submit a report containing the results of |
|
|
the study conducted under Subsection (a) of this section and the |
|
|
commission's recommendations for improving access to dental |
|
|
services in the community for and reducing the provision of dental |
|
|
services during emergency room visits to adults with disabilities |
|
|
receiving services under the Medicaid program to the governor, the |
|
|
lieutenant governor, the speaker of the house of representatives, |
|
|
the Senate Finance Committee, the House Appropriations Committee, |
|
|
the Senate Health and Human Services Committee, the House Public |
|
|
Health Committee, and the House Human Services Committee. |
|
|
SECTION 4. (a) The Health and Human Services Commission |
|
|
shall evaluate delivery models for the provision of services under |
|
|
the Medicaid program based on: |
|
|
(1) cost-effectiveness; |
|
|
(2) competition among providers; and |
|
|
(3) health outcomes for Medicaid recipients as |
|
|
calculated using a clinically based risk adjustment methodology. |
|
|
(b) Not later than December 1, 2018, the Health and Human |
|
|
Services Commission shall submit a report to the governor, the |
|
|
Legislative Budget Board, and the appropriate standing committees |
|
|
of the senate and the house of representatives containing the |
|
|
results of the evaluation conducted under Subsection (a) of this |
|
|
section, including: |
|
|
(1) a summary of previously submitted reports relating |
|
|
to alternative delivery models for the provision of services under |
|
|
the Medicaid program; and |
|
|
(2) a summary of efforts undertaken by the commission |
|
|
to make the current delivery models as effective as possible and an |
|
|
assessment of any cost savings achieved by and any improved health |
|
|
outcomes that have resulted from the current delivery models. |
|
|
SECTION 5. 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 6. This Act takes effect September 1, 2017. |