HBA-NMO H.B. 1388 76(R) BILL ANALYSIS Office of House Bill AnalysisH.B. 1388 By: Van de Putte Public Health 3/23/99 Introduced BACKGROUND AND PURPOSE Currently, this state spends Medicaid dollars on special outreach and case management services to address issues relating to the implementation of managed care under Medicaid. Some assert that Medicaid, as a source of public funding, has never been tapped for its job-creation potential in the low-income community. H.B. 1388 requires the commissioner of public health to establish a neighborhood-based peer health outreach and education pilot program to address health care issues, including those concerning managed care. RULEMAKING AUTHORITY It is the opinion of the Office of House Bill Analysis rulemaking authority is expressly delegated to the commissioner of public health in SECTIONS 3 and 4 of this bill. SECTION BY SECTION ANALYSIS SECTION 1. DEFINITIONS. Defines "commissioner" as the commissioner of public health; "local pilot program" as a project operated in an area of this state to implement the program; "medicaid managed care organization" as a managed care organization that is operating a portion of the Medicaid managed care program under Chapter 533 (Implementation of Medicaid Managed Care Program), Government Code; and "program" as the neighborhood-based peer health outreach and education pilot program established under this Act. SECTION 2. PEER HEALTH OUTREACH AND EDUCATION PILOT PROGRAM. Requires the commissioner to establish a neighborhood-based peer health outreach and education program to educate Medicaid recipients (recipients) on the appropriate use of health care resources, promote regular use of preventive care services by recipients, encourage recipients to develop a basic family preventive health plan, and encourage and support Medicaid recipients in keeping up with health care appointments and complying with the instructions of health care providers. SECTION 3. OPERATION OF PROGRAM. Authorizes the commissioner, subject to appropriation, to provide grants to local pilot projects in not more than five areas in the state to provide partial support for the operation of the pilot program in that area. Authorizes the commissioner to adopt rules relating to application for grants under this section and the use of funds granted to local pilot programs. SECTION 4. CONFIDENTIALITY. Authorizes the commissioner, subject to federal law or regulation, to authorize a local pilot program to obtain confidential information from certain health related state agencies, Medicaid contractors, and a health care providers; and to use the information to conduct the peer outreach and education pilot program in the area. Provides that information obtained by a local pilot project is limited to commissioner determination. Authorizes the information obtained to include the recipient's name, address, telephone number, date of birth, Medicaid managed care plan and primary care provider, and appointment scheduling information. Authorizes the information obtained to be used only for purposes for which it was obtained and prohibits the local pilot project from releasing the information to any entity other than those from among which the information was obtained. Authorizes the commissioner to adopt rules that impose additional restrictions on the use of the information. SECTION 5. EVALUATION AND REPORT. Requires the commissioner, not later than December 15, 2000, to submit a report to the governor, lieutenant governor, and speaker of the house of representatives that evaluates the effectiveness and cost-effectiveness of the program. Provides that the report must include the commissioner's recommendations with respect to providing outreach and education services to recipients through regional services contracts that are compensated on a capitated basis and that are implemented by entities other than Medicaid managed care organizations. SECTION 6. TERMINATION; EXPIRATION. Provides that this Act expires September 1, 2001. SECTION 7.Emergency clause. Effective date: upon passage.