HBA-MPM S.B. 1394 77(R) BILL ANALYSIS Office of House Bill AnalysisC.S.S.B. 1394 By: Fraser Insurance 5/7/2001 Engrossed BACKGROUND AND PURPOSE The statewide rural health care system (RHCS) is the state-designated rural health care system created by the 75th Legislature in 1997. While the legislature appropriated no funding for the system during that session or the subsequent session in 1999, the system has coordinated with private sector program partners to create a model for a viable rural health care system. Allowing RHCS to participate in a voluntary Medicaid demonstration could enable RHCS to implement the model, which emphasizes preventive care, disease management, care coordination, and quality improvement and which could extend health care services to uninsured individuals who live in rural communities. Senate Bill 1394 authorizes the commissioner of health and human services to use RHCS for a voluntary pilot or demonstration program for Medicaid and a study of the use of promotoras. RULEMAKING AUTHORITY It is the opinion of the Office of House Bill Analysis that this bill does not expressly delegate additional rulemaking authority to a state officer, department, agency, or institution. ANALYSIS Senate Bill 1394 amends the Insurance Code to authorize the commissioner of health and human services to use the statewide rural health care system (RHCS) for a voluntary pilot or demonstration program that evaluates the use of an insured model for beneficiaries of a medical assistance program in a rural area that is not currently included in an existing Medicaid managed care pilot program area and that incorporates the principles of prevention and disease management and for a study of the use of promotoras (Art. 20C.14). The bill provides that RHCS is established and authorized to sponsor, arrange for, or provide health care services for programs in rural areas that are not subject to: _a law requiring coverage or the offer of coverage for services by a particular health care provider under the state child health plan (CHIP), Medicaid, any state, county, or local government sponsored indigent care initiative, or any federal Medicare Plus Choice program; or _provisions governing group and blanket accident and health insurance under any state, county, or local government sponsored uninsured or indigent care initiative (Art. 20C.03). The bill provides that if RHCS seeks to sponsor, arrange for, or provide such health care services under a private or commercial program, RHCS must comply with all requirements under the Insurance Code imposed on health plans, including health maintenance organizations, except the requirements the commissioner of insurance determines are inapplicable to RHCS relating to mileage, distance, network adequacy, and scope of coverage and any additional requirements the commissioner determines necessary to ensure enrollees access to health care providers and services (Art. 20C.04). The bill removes the requirement that the governor appoint 12 members of the board of directors of RHCS (board), and requires these board members to be appointed in accordance with the bylaws of RHCS (Art. 20C.06). The bill also modifies the goals of RHCS (SECTION 1). EFFECTIVE DATE September 1, 2001.