HBA-DMD C.S.H.B. 2148 76(R)BILL ANALYSIS Office of House Bill AnalysisC.S.H.B. 2148 By: Maxey Human Services 4/5/1999 Committee Report (Substituted) BACKGROUND AND PURPOSE Under current federal law, states are allowed to apply for waivers of certain Medicaid requirements. Legislation passed by the 75th Legislature required the Health and Human Services Commission (commission) to study and make recommendations regarding the feasibility and advisability of consolidating the state's Medicaid long-term care 1915(c) waiver programs, which allow states to provide home and community-based services to individuals who qualify for care in an institution. Currently, Texas operates eight 1915(c) waivers. C.S.H.B. 2148 requires the commission to make uniform the functions relating to the administration and delivery of Section 1915(c) waiver programs. This bill requires the commission to ensure that information on individuals seeking to obtain services from Section 1915(c) waiver programs is maintained in a single computerized database that is accessible to staff of each of the state agencies administering those programs. This bill also requires the commission, by rule, to develop and implement a pilot program to assess the advisability of consolidating the section waiver programs. It also requires the commission to regularly consult with and obtain input from certain persons, groups, or state agencies. C.S.H.B. 2148 requires the commission to submit a report to the legislature on the effectiveness of the pilot program and authorizes a state agency to obtain authorization from a federal agency if the state agency determines that such authorization is needed in order to implement any provision of this Act. RULEMAKING AUTHORITY It is the opinion of the Office of House Bill Analysis that rulemaking authority is expressly delegated to the Health and Human Services Commission in SECTION 2 (Section 531.0219, Government Code) of this bill. SECTION BY SECTION ANALYSIS SECTION 1. Amends Section 531.001, Government Code, by adding Subdivision (6), to define "Section 1915(c) waiver program." SECTION 2. Amends Subchapter B, Chapter 531, Government Code, by adding Sections 531.0218, 531.0219, and 531.02191, as follows: Sec. 531.0218. LONG-TERM CARE MEDICAID PROGRAMS. (a) Requires the Health and Human Services Commission (commission), to the extent authorized by state and federal law, to make uniform the functions relating to the administration and delivery of Section 1915(c) waiver programs, including rate setting, the applicability and use of service definitions, quality assurance, and intake data elements. (b) Sets forth that Subsection (a) does not apply to functions of a Section 1915(c) waiver program that is operated in conjunction with a federally funded Medicaid program of the state authorized under Section 1915(b) of the federal Social Security Act (42 U.S.C. Section 1396n(b)). (c) Requires the commission to ensure that information on individuals seeking to obtain services from Section 1915(c) waiver programs is maintained in a single computerized database that is accessible to staff of each of the state agencies administering those programs. Sec. 531.0219. PILOT PROGRAM RELATING TO SECTION 1915(C) WAIVER PROGRAMS. Requires the commission, by rule, to develop and implement a pilot program to assess the advisability of consolidating the section waiver programs. Sets requirements for the pilot program. Requires the commission to submit to the legislature a report evaluating the administrative efficiencies and effectiveness of serving, in a single program, individuals eligible for a Section 1915(c) waiver program. Sec. 531.02191. PUBLIC INPUT. Requires the commission, in complying with the requirements of Sections 531.0218 and 531.0219, to regularly consult with and obtain input from certain persons, groups, or state agencies. SECTION 3. Requires a state agency, if before implementing any provision of this Act the state agency determines that a waiver or authorization from a federal agency is necessary for implementation, to request the waiver or authorization and authorizes the state agency to delay implementing that provision until the waiver or authorization is granted. Provides that the requirement of Section 531.0219 is contingent on the state receiving any necessary approval from a federal agency. SECTION 4.Effective date: September 1, 1999. SECTION 5.Emergency clause. COMPARISON OF ORIGINAL TO SUBSTITUTE C.S.H.B 2148 differs from the original bill in new SECTION 1 (Section 531.001, Government Code) by adding the definition of "Section 1915(c) waiver program." C.S.H.B. 2148 differs from the original bill in SECTION 2 (Section 531.0218, Government Code) by redesignating SECTION 1 of the original bill to SECTION 2 of the substitute and by modifying Section 531.0218, Government Code to require the commission, to the extent authorized by state and federal law, to make uniform the functions relating to the administration and delivery of Section 1915(c) waiver programs, except as to functions of a Section 1915(c) waiver program that is operated in conjunction with a federally funded Medicaid program of the state authorized under Section 1915(b) of the federal Social Security Act. This substitute also requires the commission to ensure that information on individuals seeking to obtain services from Section 1915(c) waiver programs is maintained in a single computerized database that is accessible to staff of each of the state agencies administering those programs. Proposed Sections 531.0219 and 531.02191, Government Code, relate to the requirement of the commission to develop and implement a pilot program to assess the advisability of consolidating the Section 1915(c) waiver programs and to consult and obtain input from certain sources. This substitute deletes SECTION 2 of the original bill requiring the commission, by rule, to develop a pilot program. This substitute also deletes SECTION 3 of the original bill, relating to the requirement that the commission report to the legislature and replaces it with a new SECTION 3 enabling a state agency to obtain a waiver from the federal government. This substitute deletes SECTIONS 4 and 5 relating of the original bill to the provision enabling a state agency to obtain a waiver from the federal government and requiring the commission to develop the plan making uniform certain functions relating to Medicaid. This substitute deletes SECTION 6 of the original bill relating to the expiration date of certain sections of this Act. This substitute redesignates the effective date and emergency clause from SECTIONS 7 and 8 of the original bill to SECTIONS 4 and 5 of the substitute.