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  85R14552 EES-D
 
  By: Kolkhorst S.B. No. 1927
 
 
 
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.