NOTE: As provided in LFC policy, this report is
intended only for use by the standing finance committees of the
legislature. The Legislative Finance Committee does not assume
responsibility for the accuracy of the information in this report when used for
other purposes.
The most recent FIR
version (in HTML & Adobe PDF formats) is available on the Legislative
Website. The Adobe PDF version includes
all attachments, whereas the HTML version does not. Previously issued FIRs and attachments may be obtained from the
LFC in Suite 101 of the State Capitol Building North.
|
SPONSOR: |
Papen |
DATE TYPED: |
02/26/03 |
HB |
|
||
|
SHORT TITLE: |
Medicaid Behavioral Health Program Act |
SB |
862 |
||||
|
|
ANALYST: |
Weber |
|||||
APPROPRIATION
|
Appropriation
Contained |
Estimated
Additional Impact |
Recurring or
Non-Rec |
Fund Affected |
||
|
FY03 |
FY04 |
FY03 |
FY04 |
|
|
|
|
|
|
See Narrative |
|
|
|
|
|
|
|
|
|
(Parenthesis
( ) Indicate Expenditure Decreases)
Duplicates HB 651
Responses
Received From
Human
Services Department
SUMMARY
Synopsis
of Bill
Senate Bill 862 (SB 862)
establishes a Medicaid behavioral health program to provide behavioral health
services for Medicaid recipients to begin no later than July 1, 2004. The program would operate with its own
dedicated budget to be expended solely on the provision of services, and be
operated by Human Services Department or an alternative entity with experience
in, and knowledge of, the provision and management of behavioral health
services. SB 862 requires the
initiation of a planning process involving a cross-section of behavioral health
stakeholders to advise the department on the structure of the program and the
services to be included.
The goals of the program
as outlined in SB 862 include:
1) Delivery of a full range
of behavioral health services;
2) Delivery of services
that are specifically designed to meet a recipient’s individual needs;
3) Accommodation of special
needs related to where a recipient resides, e.g., urban/rural/border areas;
4) Expenditure of the
maximum amount of funding possible on the delivery of direct services;
5) Provision and assurance
of effective monitoring and accountability related to funds and services.
Significant
Issues
Senate Bill 862
essentially “carves out” the behavioral health component of the MCO
responsibility. Management of these
services would become the direct responsibility of the Human Services
Department (HSD) or its experienced designee.
It is unclear how a designee is different from some form of managed care
except this new form of managed care cannot include physical care
simultaneously.
Without a designee, the
behavioral care component would become a category of the Medicaid
fee-for-service component. This would
create a need for an internal administrative process to manage utilization,
review, evaluation and oversight. These
functions would typically be accomplished through a combination of additional
Medical Assistance Division (MAD) employees and contractual services. Reimbursement for such administrative
expenses in MAD are eligible for a 2 to 1 federal match while equivalent costs
paid through a MCO contractual environment are eligible for a 3 to 1 federal
match. The different matching
requirement would require an extremely efficient MAD operation to achieve
savings.
The Human Services
Department reports that the result would be a dismantling of a currently
well-established system of care. The
huge investment in both dollars and effort to establish this system over the
last 18 months would be lost.
FISCAL IMPLICATIONS
The fiscal
implications are unclear and would be dependent on the design of the new
program and the associated operating expenses.
SB 862 does not contain an appropriation but there would be considerable
FY04 MAD “start up” costs to design and prepare implementation the program.
ADMINISTRATIVE IMPLICATIONS
MAD would need to
assume the administrative responsibilities of the program.
MW/yr