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.