TCDD Bill of the Week: HB 4543

Bill of the Week HB 4543 Banner

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) 4543, relating to implementation of the system redesign for the delivery of Medicaid benefits to persons with intellectual or developmental disabilities.

Bill Author: Rep. Stephanie Klick, House District 91 (Tarrant County)

Background information:
In 2013, the 83rd Texas Legislature approved Senate Bill (SB) 7, which aimed to redesign the Medicaid delivery system for individuals with intellectual and developmental disabilities (IDD) who needed both acute care and long-term services and supports (LTSS). The bill established a timeline for transitioning those individuals into Medicaid’s STAR+PLUS managed care program.

SB 7 allowed the Texas Health and Human Services Commission (HHSC) to develop and implement Medicaid managed care pilot programs to deliver LTSS to individuals with IDD using a capitated – or capped – payment method. With the pilot programs, providers would be reimbursed based on a flat fee for each enrollee per month, rather than a traditional fee-for-service model. Upon completion of the pilot programs, the full transition to managed care would occur; however, subsequent legislation pushed back the deadlines that were established in the original bill.

SB 7 also established the IDD System Redesign Advisory Committee (IDD SRAC), which was created to advise HHSC on the implementation of the acute care and LTSS system redesign. Under the terms of the bill, the IDD SRAC is made up of stakeholders from the IDD community, including people who receive Medicaid waiver program services, representatives of Medicaid managed care and non-managed care health providers, representatives of entities delivering LTSS, and representatives of managed care organizations.

Leading up to the current legislative session, the IDD SRAC issued a recommendation that any implementation of a new program be further postponed. This recommendation was based on the idea that HHSC was still behind in carrying out tasks and tests that are necessary for understanding the depth of challenges to the overall support system and the impact on stakeholders. Carrying on with the initial schedule would mean that HHSC would continue without being fully informed as to the effectiveness and potential roadblocks to implementing a new managed care delivery system for individuals with IDD.

The specific primary concern of the IDD SRAC was that HHSC has yet to develop an IDD Pilot to test capitation models for the delivery of services to people with IDD. The group noted that, though the IDD SRAC is legislatively mandated to evaluate the results of such a pilot program to then provide recommendations for changes and improvements, HHSC left the IDD SRAC out of the process and instead contracted with outside organizations to conduct an analysis of the impact of moving towards managed care. The results from this outside analysis would not be available in time for the advisory committee to conduct a proper review before certain other redesign deadlines needed to be met. Other organizations, such as The Arc of Texas and the Texas Disability Policy Consortium, have echoed the IDD SRAC’s concerns.

What does the bill do?
HB 4543 would delay the scheduled redesign for Medicaid benefits delivery programs for individuals with IDD. The bill would push back the implementation date for pilot programs, providing a 2022 deadline. It would also shift the full transition to managed care back by up to six years, depending on the program impacted. Lastly, HB 4543 would extend the IDD SRAC through January 1, 2029.

Statement from the bill author, Rep. Stephanie Klick: 

Headshot of Representative Klick“HB 4543 just delays the date certain IDD services will be carved into managed care. The stakeholders all agree that we are not ready for this population to move into managed care yet, so HB 4543 will give HHSC the extra time needed to prepare for this transition.”

Where is the bill in the process?
On April 30, HB 4543 received a public hearing before the House Human Services Committee, and was passed out on a vote of 6-0. The video of the hearing can be found here and discussion on the bill begins at the 1:35:40 mark. HB 4543 now heads to the Local and Consent Calendars Committee to await scheduling for consideration by the full Texas House.

Who supports the bill and why?
No oral testimony was provided in support of HB 4543; however, a number of organizations registered their support for the bill, including:

  • Center for Public Policy Priorities
  • Coalition of Texans with Disabilities
  • Disability Rights Texas
  • Texas Council of Community Centers
  • The Arc of Texas

Who opposes the bill and why?
No oral testimony was provided in opposition to HB 4543, though a single individual did register against the bill for reasons currently unknown.

Additional testimony:

  • TCDD: Linda Logan, TCDD Public Policy Specialist, submitted written testimony on HB 4543 and suggested that the extra time allotted by the bill would allow HHSC and the IDD SRAC to apply extensive care in creating an effective new system. She stated that the delay is also needed to address problems within current managed care systems, since a new system is unlikely to be functional when the existing systems are not.

How much will the bill cost?
The Legislative Budget Board has stated that the fiscal implications of HB 4543 cannot be determined at this time because there is no information available on the cost or savings to the managed care programs that will be affected by the bill.

Is there a Senate companion to the bill?
No identical bill has been filed in the Senate.

Stay informed:
For the latest information about where HB 4543 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.