House Insurance met on May 18 to take up a number of bills. This report focuses on SB 1648 (Perry) and SB 2028 (Kolkhorst) A video of the hearing can be found here.
This report is intended to give you an overview and highlight of the discussions on the various topics the committee took up. It is not a verbatim transcript of the hearing but is based upon what was audible or understandable to the observer and the desire to get details out as quickly as possible with few errors or omissions.
Vote Outs
SB 2051 (Menendez) (8-0)
- Companion to HB 2504 (Gonzales)
SB 1648 (Perry) Relating to the provision of benefits to certain Medicaid recipients with complex medical needs.
- Continues progress on efforts for medically fragile kids
- Conflicts with continuity of care interpretations; want to make it clear that third-party insurer is not needed
- Took out expiration date on one program that is working very well
Terri Carriker, Protect TX Fragile Kids – For
- Many medically complex kids require multiple different specialists
- Want to protect relationships with specialists
Laurie Vanhoose, Texas Association of Health Plans – On
- Medicaid managed care works like insurance; Texas pays premium each month to cover expenses
- Medicaid patients have nurse coordinator and other services to ensure they are staying healthy
- HHSC shows managed care has saved state more the $5 billion dollars
- Bill clarifies provisions in SB 1207 from prior session
- Allows MDCP to continue seeing specialty physicians even if they are not in the same network,
- Clarifies that this applies to clients whether or not they have commercial coverage
- Protection will not significantly impact Medicaid program, but many want to take advantage of it
- Better prices result in tax savings
- Oliverson – When you say pass it out as filed are you talking about the bill before the committee right now?
- Yes; some tweaks made in committee that further clarified intent
- Oliverson – DME thing is not in this bill?
- No, just an example
- Oliverson – Bill specifically talks about specialty physicians; if they go out of the network, client can continue to use their specialty physician?
- Correct
- Oliverson – You do not have a problem with that?
- We do not
- Understand that this is a problem, subset of patients have unique problems that need to be protected
SB 1648 voted out of committee (8-0)
SB 2028 (Kolhorst) Relating to the Medicaid program, including the administration and operation of the Medicaid managed care program
- Noble – purpose is to improve function, benefits, efficiency, and effectiveness for most vulnerable Texans served by Medicaid programs
- Requires HHSC adopts Medicare model of treatment, triage, and transfer
- Requires HHSC studies feasibility of using CNA program model to reduce rehospitalization and lower costs in Medicaid
- Requires HHSC determine feasibility of creating online portal for those on interest list and create automated level of need assessment
- Requires that MCOs document if individuals have been informed about and decline consumer directed services
- Requires that HHSC advances ACE pilot
- Requires school district to receive parental consent for Medicaid reimbursed services under School Health Related Services program (must obtain waiver if parental consent unavailable)
- Requires HHSC to expand medication therapy management pilot, specifically to reduce adverse drug events
- Adds preventative dental benefit for STAR plus recipients
- Requires HHSC to set minimum standards for performance measures in STAR plus for nursing homes
- Directs HHSC to implement recommendations from community attendant strategic plan published in rider 157 report
- Directs HHSC to hold comprehensive study on all outstanding remaining acute care benefits not carved into managed care
- Delays transition to managed care rate setting from 2021 to 2023 due to COVID
- Directs HHSC to study Medicaid staff enhancement programs, improves QIPP, identifies factors preventing active participation, Examines Medicaid managed care option of providing early childcare intervention services, examines dual eligible population on Medicaid etc.
- Israel – What is MCO?
- Managed care organizations
- Resources here if you need information
- Israel – Can you repeat the part about diabetes?
- Study portion of the bill examines diabetes self-management education
Emily Kidd, EMS Coalition for Innovation – For
- Many do not realize that EMS is a practice of medicine
- Many times, individuals call 911 when they do not need emergency care, don’t know who else to call
- Can offer alternative transportation for Medicare patients, less expensive, want to expand to Medicaid
Kenneth Smith, Texas Health Institute – For
- Conducted study to estimate cost and potential cost offsets for implementing dental benefits consistent with SB 2028
- Estimate annual cost of Medicaid dental benefit at $26.7 million with potential offsets of $95 million
- Model captures prevention, improved disease management, and other benefits from regular dental care
- Oliverson – This is for adults; would it include adults with down-syndrome or syndromes like that?
- Yes, it would
- Oliverson – Strong connection between oral health and heart disease, we would probably see an even bigger change?
- Our assumptions on the modest scale when looking at expected population; actually much more severe
- Strong synergy between oral health and physical health, missing that element in managed care
Amanda Frederickson, AARP – For
- Focus on QIPP program in Section 8
- Pot of money that nursing homes earn by meeting certain performance metrics
- Texas has many 1-star nursing homes; Staffing levels a big part of the problem
- Dedicating money to staffing will make a big difference
Laura Klein, Independent Coalition of Nursing Home Providers – On
- Respectfully ask QIPP program language to be removed; allow HHSC to instead focus on relevant patient outcomes as best measure of quality of care
- Generally support bill but believe unintended consequences of language around staffing
- QIPP known to be established quality-based program, changing it may or may not improve outcomes but would affect process
- Oliverson – Everywhere I’ve worked staffing is an indication of quality, why would that be different in nursing homes?
- RNs are already so difficult to come by
- Oliverson – But ratio is the clearest indicator?
- Lots of details that go into STAR rating, very complex
- Oliverson – Is it a payment issue?
- That could be part of it, Medicaid in Texas is already lower
- Moving date from 2023 to 2027 could help give time to staff up
Dennis Borel, Coalition of Texans with Disabilities – For
- Have been talking about the things in this bill for a long time
- Focus on dental benefit; about prevention, keeping people healthy keeps costs down
- 75% of Texas Medicaid children get dental care, waiver programs get it; those outside of waiver programs do not
- Fundamental medical practice that you prevent serious medical conditions by controlling chronic ones; dental care essential for health
Stephanie Stevens, HHSC – On
- Israel – Is this the only bill in the session that is considered a provisional bill to Medicaid?
- It is certainly one of the few that come to mind
- Others include changes to
- Israel – Do this is a big deal; surprised you do not have more prepared for us
- Happy to meet with the office
- Israel – What does Texas consider the threshold for Medicaid eligibility? How poor do you have to be to get Medicaid?
- Have to be in a certain group of people, children largest group covered
- Do not have dollar amount but could provide
- Israel – This is for everyone on Medicaid, who all would be assisted and what kinds of qualifications would you need?
- Number of provisions would relate to children
- Would have to be of low income
- Provisions relating to adults with disabilities and those with chronic diseases; covers huge range
- Israel – My question is about qualifying
- It is different by group
- For pregnant women it goes up to 198% of poverty level
Closing remarks, Noble
- Voted out of Senate unanimously, appreciate your consideration
SB 2028 left pending