The Select House Committee on Health Care Reform interim report to the 88th Legislature covers health care cost impact on Medicaid and private insurance, price transparency requirements, health care access and affordability, Medicaid and CHIP outreach, and impact of delayed care on the state’s health care delivery system. For more information see the full report here.
Spotlight on Recommendations
Charge 1. Study the implications of excessive health care costs on the efficacy of Texas Medicaid and the private health insurance market and the resulting impact on individual Texans, businesses, and state government.
- Consider opportunities to leverage the Texas All-Payor Claims Database to determine true cost impact of benefit mandates.
- Continue to review prescription drug rebate data and consider opportunities to ensure rebates are used to lower the cost of coverage.
- Ensure that Medicaid prescription drugs maintain continuity of care for members who move between managed care plans and minimizes administrative burden for physicians.
- To increase competition, the Legislature should consider prohibiting providers from engaging in price discrimination against those who are uninsured or choosing to not pay with their insurance.
- Explore ways to empower patients to shop for their care, select the options that suit them best, and be financially rewarded when they choose lower-cost services (as consumers are in any functioning market). In particular, the Legislature should address that insurance plans are currently prohibited from offering enrollees lower cost-sharing amounts for seeking more-efficient, high-quality care.
- Consider removing the prohibitions on Multiple Employer Welfare Arrangements serving employees across industries and self-employed people.
- Explore ways to prohibit hospitals from charging facility fees for services not provided on a hospital’s campus.
- Explore the Legislature’s role in keeping costs down for state paid medical plans, specifically ERS and TRS.
Charge 2. Monitor the implementation of, and compliance with current price transparency requirements and study ways that the state can support patients and increase competition. Make legislative and administrative recommendations as appropriate.
- Uniformly apply price transparency requirements for shoppable services to all provider types.
- Prohibit anti-competitive contracting terms, such as all-or-nothing contracts, gag clauses, etc.
Charge 3. Evaluate innovative, fiscally positive options to ensure that Texans have access to affordable, quality, and comprehensive health care, with an emphasis on reaching low-income and at-risk populations.
- Establish new alternative coverage option that allows insurers to offer “Consumer Choice” plans that forego certain state-imposed regulations and mandates.
- Explore opportunities to expand coverage requirements in Medicaid Managed Care to include preventive services that reduce or eliminate the development and/or progression of chronic disease.
- Explore ways to implement a pilot program in which low-income or at-risk Texans could access Direct Primary Care at Federally Qualified Health Centers.
Charge 4. Study ways to improved outreach to families with children who are eligible for, but not enrolled in, Medicaid or CHIP, including children in rural areas.
- Consider funding for outreach initiatives, including state funding for community-based organizations to conduct outreach and provide application assistance to families with eligible children. Additionally, HHSC should continue the “case assistant affiliate” designation to allow Medicaid Managed Care Organizations to assist with applications and case management.
- Consider legislation directing HHSC to review eligibility processes to identify efficiencies, including allowing the state to utilize already-verified data from other state programs to assist in determining eligibility for Medicaid and CHIP.
Charge 5. Examine the potential impact of delayed care on the state’s health care delivery system, health care costs, and patient health outcomes, as well as best practices for getting patients with foregone or delayed health interventions back into the health care system.
- Pass legislation extending Medicaid coverage for pregnant women to 12 months post-partum.
- Increase funding for medical education and health care workforce development initiatives to increase the number of physicians, nurses, and mental health professionals.
- Continue to explore opportunities to increase access to telemedicine and telehealth services.
