For this weekly feature, the Texas Council for Developmental Disabilities (TCDD) profiles a noteworthy bill that is currently going through the legislative process. The bill may relate directly to TCDD’s Public Policy Priorities or another disability-related issue.
Bill: House Bill (HB) 2453, relating to the operation and administration of Medicaid, including the Medicaid managed care program.
Bill Author: Rep. Sarah Davis, Texas House District 134 (Harris County)
- Rep. John Zerwas, Texas House District 28 (Fort Bend County)
- Rep. Matt Krause, Texas House District 93 (Tarrant County)
- Rep. Greg Bonnen, Texas House District 24 (Galveston County)
- Rep. Chris Turner, Texas House District 101 (Tarrant County)
- Rep. Giovanni Capriglione
- Rep. Joe Deshotel
- Rep. Bobby Guerra
- Rep. Julie Johnson
- Rep. Rick Miller
- Rep. Joe Moody
- Rep. Lina Ortega
- Rep. Richard Raymond
- Rep. Steve Toth
- Rep. John Turner
As described by the Legislative Budget Board, managed care is a health care delivery system where the State pays managed care organizations (MCOs) a per-member, per-month amount to provide services to Medicaid members. In recent years, Texas has expanded its use of managed care with the belief that expansion would improve service coordination and keep costs down.
HB 2453 comes in response to public scrutiny and backlash over what appeared to be a prioritization of profits over service delivery in the State’s managed care program. In 2018, the Dallas Morning News published an investigative series – Pain & Profit – that described how MCOs seemed to disregard the needs of patients and denied them access to essential care as a means of cutting costs. The series drew attention to the inefficiencies and other shortcomings in the managed care system and state leaders took notice. Legislators are now seeking strategies to improve the quality of the service system for the Texans that it is designed to serve.
What does the bill do?
HB 2453 proposes sweeping reforms of the Medicaid managed care system, including the following provisions:
- Improve the oversight and accountability of MCOs
- Change the patient appeal process, including sending treatment appeals to an independent, unbiased contractor instead of to the staff of the Texas Health & Human Services Commission (HHSC)
- Improve the tracking and analysis of MCOs’ records of refusals of care, patient complaints, and appeals
- Require the state to compare patient experiences under for-profit versus nonprofit MCOs
- Direct HHSC to abide by a more structured system when penalizing MCOs for failing to properly serve patients
Statement from the bill author, Rep. Sarah Davis:
“We are seeing the cracks in the system with our most vulnerable population – with our most medically fragile children and our foster care kids. When you have a healthy population it’s easy to provide good outcomes and quality care, but when you’re going after the sickest kids and you’re getting the most money from the state, there’s going to eventually have to be some sort of tradeoff.”
Where is the bill in the process?
On April 2, HB 2453 received a public hearing before the House Human Services Committee and was left pending. When a bill is left pending, this means that the committee did not vote on the bill and it could be considered again at a future committee meeting. The video of the hearing can be found here. (Discussion on HB 2453 begins at the 58:53 mark)
Who supports the bill and why?
The following comments were taken from the bill’s public hearing on April 2:
- PTFK: Hannah Mehta, Executive Director of Protect TX Fragile Kids (PTFK), voiced her support for the bill’s legislative oversight aspect. She shared that, as the mother of a child in a Medicaid managed care program, she has fully felt the stress of a broken system and has been advocating for change. Mehta wants to ensure that children are getting medically-necessary care and she argued that increased legislative oversight will help alleviate mismanagement by the MCOs.
- THA: Cameron Duncan, Assistant General Counsel of the Texas Hospital Association (THA), applauded the bill’s changes to the complaints process, such as creating a feedback loop for patients and including an unbiased third party in processing complaints. He said this will make the complaint system function more smoothly and work better for the patient.
- CPPP: Anne Dunkelberg, Associate Director of the Center for Public Policy Priorities (CPPP), stated that, of all the bills filed on managed care this session, HB 2453 most-thoroughly encompasses the consumer experience and the consumer perspective. She also appreciated the bill’s attention to transparency and its improvement of due process.
Who opposes the bill and why?
No opposition to HB 2453 has been identified at this time, though concerns were raised at the hearing regarding the bill’s:
- changes to the Prior Authorization process,
- cost, and
- addition of over 60 new State employees.
How much will the bill cost?
According to the Legislative Budget Board, HB 2453 would cost the state roughly $11.7 million through the biennium ending on August 31, 2021. However, Rep. Davis noted that much of this cost has been accounted for in the version of the Appropriations Bill which passed out of the Texas House on March 28.
Is there a Senate companion to the bill?
An identical bill, Senate Bill 1139 by Sen. Kirk Watson, has been referred to the Senate Committee on Health and Human Services. It has not yet been scheduled for a hearing.
For the latest information about where HB 2453 is in the process, follow the bill on the Texas Legislature Online. To receive future legislative updates from TCDD, subscribe to TCDD eNews or follow us on Twitter.