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.