Highlights of the 79th Texas Legislature - Senate

HEALTH AND HUMAN SERVICES/MEDICAID
Medicaid Services for Persons with Chronic Kidney Disease─H.B. 1252
By Representative Guillen et al.—Senate Sponsor: Senator Zaffirini
Chronic renal failure affects an estimated 44,200 Texans, and diabetes and hypertension are two of the most
common causes, accounting for approximately two-thirds of the cases of chronic kidney failure. This bill:
Amends Section 533.009(a), Government Code, to include chronic kidney disease and its medical complications as
one of the health conditions for which Medicaid managed care organizations may provide disease management.
Provides that if a managed care organization implements such a program, it must use generally recognized clinical
practice guidelines and lab assessments that identify kidney disease on the basis of impaired kidney function or the
presence of kidney damage.
Adds chronic kidney disease to the list of conditions for which the Health and Human Services Commission (HHSC)
may pursue disease management contracts.
Requires providers of disease management to develop a program of screening for and diagnosis and treatment of
chronic kidney disease and its medical complications under the medical assistance program.
Authorizes HHSC to modify an existing contract between the commission and a provider of a disease management
program under the medical assistance program or between the commission and a managed care organization under
the medical assistance program, as applicable, to provide program services to persons with chronic kidney disease
under the medical assistance program.
Authorizes HHSC to seek necessary federal authorization or waivers, and to delay implementation until necessary
federal approvals are received.
Medical Assistance for Dually Eligible Individuals─H.B. 1502
By Representative John Davis—Senate Sponsor: Senator Nelson
Federal law required that state Medicaid programs pay any applicable deductible or coinsurance amounts for
Medicare services provided to individuals who are dually eligible for both the Medicare and Medicaid programs until
1997 when the federal statute allowed states to reduce or eliminate those deductible or coinsurance payments to an
amount which, when combined with the Medicare payment, would equal the rate set by the state for a comparable
Medicaid covered service.
H.B. 2292, 78th Legislature, Regular Session, 2003, included language that was intended to require the state
Medicaid program to eliminate the payments of coinsurance or deductible amounts that would otherwise be required
to be paid on behalf of dually eligible persons, if the rate for a comparable Medicaid covered service were lower than
the amount paid by Medicare. However, the requirement for comparable services restricts the applicability of this
provision. This bill:
Repeals Section 32.050(f) (relating to Medicare deductibles and coinsurance payments for ambulance services paid
for by the medical assistance program), Human Resources Code.
HIGHLIGHTS - 79 TH TEXAS LEGISLATURE 107