If you have a loved one or know of someone who is presently receiving services from the State of Texas for intellectual disability you read about this upcoming bill that could change how the state handles such cases.
Senate Bill 7, sponsored by Senator Jane Nelson, would change how the state manages and pays for medical and long-term services and supports for Texans with intellectual disabilities. Under this bill, current services in Texas would transition to managed care organizations (MCOs) over a four or five year period. SB 7 was recently referred to the Texas Senate Health and Human Services Committee. The proposed timeline would begin September 2013 – September 2018.
In case you are not aware, managed care is basically an insurance company. This means the insurance companies will be the ones to decide which services are justified. Under this system, the MCO (Managed Care Organization) will get one fee per individual and they decide what services to approve and retain the remaining funds not utilized.
The following is the bill as sent to this Examiner:
SB 7 by SENATOR NELSON: RESIGNING LONG-TERM CARE
Background: Currently, Medicaid provides long-term care services and supports to individuals with physical, intellectual and developmental disabilities, as well as Texans 60 and over. Improved coordinated care of these services is needed to better serve this population, especially as they grow older. Life expectancy for individuals with intellectual and developmental disabilities has steadily increased -- from 18.5 years to 66.2 years over the last six decades, and the number of these individuals 60 and over is expected to nearly double nationwide from 641,860 in 2000 to 1.2 million by 2030. Texas also has one of the nation's highest senior populations, and seniors make up the fastest growing age group in our state's population with the Texans 60 and over expected to grow from 14 percent of the population today to more than 20 percent in 2040. These factors will significantly impact the need for Medicaid long-term care services and support.
Draft Provisions: SB 7 redesigns the Medicaid long-term services and supports system by:
• Redesigning long-term care services for individuals with intellectual and developmental disabilities;
• Directing the Health and Human Services Commission to develop quality-based payment systems that will reduce preventable events and improve outcomes for patients in the Medicaid long-term care system;
• Strengthening requirements to ensure that quality-based payment initiatives apply in managed care; and
• Expanding managed
Many aspects of this bill are subject to change before the final vote is taken by the Legislature. Below is a list of actions that those opposed to the bill are saying could impact the services received by your loved one if SB7 is not modified.
• Services available under the program in which a person is currently enrolled will most likely not be the same services available under a managed care model.
• The manner in which services are managed and how determinations of what services and at what level, amount or frequency are authorized will also most likely undergo significant change as they will be determined by the insurance company.
• Choice in services, where one receives those services and who provides those services are at risk.
• Many providers, including the one that provides your services or the services your loved one receives, may not be able to survive operating under a managed care model.
• More critically, many of the Managed Care Organizations (MCOs) that currently operate in Texas (and even those operating in other states) have no experience in providing services to persons with IDD or in managing the needs of persons with significant behavioral issues. Heretofore, their experience has been limited to managing persons' medical needs.
If you would like to have your voice heard you may contact a member of the Senate Health & Human Services Committee:
Committee Office Room # Phone # email
+Jane Nelson, Chair – Lewisville 1E.5 512-463-0112 email@example.com
+Bob Deuell, V-Chair, Greenville E1.704 512-463-0102 firstname.lastname@example.org
+Joan Huffman, Lake Jackson GE.5 512-463-0117 email@example.com
Robert Nichols, Jacksonville E1.808 512-463-0103 firstname.lastname@example.org
Charles Schwertner, Georgetown E1.608 512-463-0105 Charles.Schwertner@senate.state.tx.us
Larry Taylor, Friendswood GE.5 512-463-0111 email@example.com
Carlos Uresti, San Antonio E1.706 512-463-0119 firstname.lastname@example.org
+Royce West, Dallas 1E.12 512-463-0123 email@example.com
+Judith Zaffirini, Laredo 1E.14 512-463-0121 firstname.lastname@example.org
(+) Member also of Senate Finance Committee
Or you can contact the Lieutenant Governor’s office at 512-463-0001. Those opposing this bill are asking for a delayed decision until the concerns of people with disabilities and their families can be addressed.
This Examiner contact Senator Jane Nelson’s office to get her take on this bill and why she introduced it. I received the following statement from Senator Nelson:
Statement from Senator Nelson: "These are some of the most vulnerable people we serve. We need to make sure they get the best possible care -- and that we are delivering services in a way that ensures we can keep caring for them into the future."
The vote on this bill is set for Tuesday, February 26, 2013 at 9:00 a.m.