Texas Bills Seek to Move Long Term Services and Supports into Managed Care
May 23, 2013 08:54 AM
The Texas legislature continues to work out language for legislation that would begin to transition long-term services and supports into managed care. The two chambers have until Monday, when the legislative session ends, to work out the differences in their bills.
Among other things, Senate Bill 7 (S.B. 7) calls for test pilot programs to move long-term services and supports (LTSS) into managed-care models. S.B. 7 would also establish an advisory committee, with members from the disability community, to advise state officials on how to improve efficiencies in Medicaid acute care services. Finally, it would call on state officials to investigate the feasibility of automatically enrolling the disabled in a Medicaid managed care plan, and to implement this plan if feasible.
Senator Jane Nelson (R), the author of S.B. 7, remarked that the bill would decrease costs to Medicaid while “greatly improv[ing] efficiency and quality in our long-term care system.”
The House version of the bill differs from S.B. 7 in several respects. The House bill creates a “two-phase plan” of enrolling the disabled into managed care: acute care services for patients with intellectual disabilities would first shift over, followed by long-term services. The House bill also mandates contracts between the state and managed care organizations so that patients can have continuity of care and choice of providers.
On May 21, the Texas House passed an amendment to S.B. 7, stating that the governor can only expand Medicaid with the approval of the Texas legislature. Specifically, the amendment prohibits the state from providing “medical assistance to any person who would not have been eligible for that assistance and for whom federal matching funds were not available.”
While the amendment, drafted by State Representative Jeff Leach (R), was intended to prevent unilateral Medicaid expansion by the governor, some have expressed concern that its language is overly broad. Specifically, State Representative John Zerwas (R) stated that the amendment’s “broad stroke” would prevent the state from using federal matching dollars towards programs such as the 1115 Medicaid waiver program. “This particular provision,” Zerwas said, “in terms of restricting any ability to utilize matching funds for the provision of health care, is not the right amendment for this bill.”
The disability rights community has remained vocally opposed to both bills, stating that transitioning to managed care would disrupt patients’ access to their community living centers and providers.
To read the full story in Texas, click here and here.
Home health providers should be aware that the move to managed care in Medicaid faces opposition from beneficiaries and interest groups alike – and that providers are also not powerless or voiceless in the matter.
Stakeholders can be very useful in improving a state’s transition to managed care in Medicaid. Likewise, if these stakeholders have outright opposition to using managed care in Medicaid, the forums are there to voice those opinions. The main point is that the nature and scope of any state’s consideration or movement to Medicaid managed care is neither automatic nor a decision made in a vacuum.
Home health providers are encouraged to keep abreast of managed care transitions in their states, advocate on a state level, and to contact the Medicaid Council with any questions or concerns.