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A BILL TO BE ENTITLED
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AN ACT
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relating to establishment of the prescription drug savings program |
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for certain uninsured individuals. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. This Act shall be known as the "Texas Cares Act." |
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SECTION 2. Subtitle C, Title 2, Health and Safety Code, is |
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amended by adding Chapter 65 to read as follows: |
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CHAPTER 65. PRESCRIPTION DRUG SAVINGS PROGRAM FOR CERTAIN |
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UNINSURED INDIVIDUALS |
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SUBCHAPTER A. GENERAL PROVISIONS |
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Sec. 65.001. DEFINITIONS. In this chapter: |
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(1) "Account" means the Texas cares account |
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established under Section 65.101. |
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(2) "Enrollee" means an individual enrolled in the |
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program. |
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(3) "Pharmacy benefit manager" means a person, other |
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than a pharmacy or pharmacist, who acts as an administrator in |
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connection with prescription drug discounts provided under the |
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program. |
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(4) "Program" means the prescription drug savings |
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program established under this chapter. |
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(5) "Uninsured individual" means an individual |
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without health benefit plan coverage for a prescription drug |
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benefit. |
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Sec. 65.002. CONSTRUCTION OF CHAPTER; PURPOSE. (a) This |
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chapter does not establish an entitlement to assistance in |
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obtaining benefits for uninsured individuals. |
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(b) The purpose of this chapter is to make this state's risk |
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pool whole by providing services to uninsured individuals without |
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access to prescription drug benefits. |
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Sec. 65.003. CONFLICT WITH FEDERAL LAW; REPORT. (a) The |
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executive commissioner shall monitor federal law affecting the |
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administration or facilitation of a prescription drug savings |
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program. |
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(b) If the executive commissioner determines that a federal |
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law, rule, or regulation conflicts with this chapter, the executive |
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commissioner shall provide a written report of the conflict to the |
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governor, lieutenant governor, and speaker of the house of |
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representatives. The report must include recommendations for |
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legislation necessary to comply with federal law or recommendations |
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for dissolution of a program established by this chapter that is |
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duplicative of federal law. |
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Sec. 65.004. RULES. (a) Except as provided by Subsection |
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(b), the executive commissioner shall adopt rules as necessary to |
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implement this chapter. |
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(b) The executive commissioner may delegate rulemaking to |
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another state agency with that agency's approval. If the executive |
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commissioner delegates rulemaking under this subsection, the |
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executive commissioner must approve the proposed rules of the |
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delegated agency before the delegated agency adopts the rules. |
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SUBCHAPTER B. ESTABLISHMENT AND ADMINISTRATION OF PRESCRIPTION |
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DRUG SAVINGS PROGRAM |
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Sec. 65.051. ESTABLISHMENT OF PROGRAM. (a) The commission |
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shall develop and design a prescription drug savings program that |
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partners with a pharmacy benefit manager to make prescription drugs |
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available at a discounted rate to uninsured individuals. |
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(b) In developing and implementing the program, the |
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commission shall ensure that program benefits do not include |
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prescription drugs to be used for the elective termination of a |
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pregnancy. |
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(c) The executive commissioner shall ensure that the |
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program is designed in a manner that provides the greatest possible |
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value to the uninsured individuals it serves, with considerations |
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given to the adequacy of the prescription drug formulary, costs of |
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drugs, cost to the state, and other important factors. |
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Sec. 65.052. GENERAL DUTIES OF COMMISSION RELATED TO |
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PROGRAM. (a) The commission shall oversee the implementation of |
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the program and coordinate the activities of each state agency |
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necessary for the implementation of the program, including the |
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Texas Department of Insurance. |
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(b) The commission shall maximize the use of private |
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resources in administering the program. |
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(c) The commission shall ensure that money spent |
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administering the program does not exceed a limit on program |
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expenditures imposed by the legislature. |
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(d) The commission shall develop a method to accept |
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applications for participation in the program, including a process |
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to: |
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(1) determine eligibility, screening, and enrollment |
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procedures; and |
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(2) resolve disputes related to eligibility |
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determinations. |
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Sec. 65.053. TEXAS DEPARTMENT OF INSURANCE DUTIES. At the |
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request of the commission, the Texas Department of Insurance shall |
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provide any necessary assistance with the development of the |
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program. The Texas Department of Insurance shall monitor the |
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quality of the services provided by a pharmacy benefit manager and |
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resolve disputes relating to those services. |
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Sec. 65.054. PHARMACY BENEFIT MANAGER CONTRACT AND |
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REQUIREMENTS. (a) The commission shall enter into a contract with |
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a pharmacy benefit manager to provide enrollment and related |
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services throughout this state under the program. |
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(b) The commission shall monitor, through reporting |
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requirements or other means, the contracted pharmacy benefit |
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manager to ensure performance under the contract and quality |
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delivery of services. |
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(c) The commission shall provide payments under a contract |
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entered into under this section to the contracted pharmacy benefit |
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manager. |
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(d) A pharmacy benefit manager must hold a certificate of |
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authority or other appropriate license issued by the Texas |
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Department of Insurance that authorizes the pharmacy benefit |
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manager to provide the type of coverage related to the services |
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provided under the program. |
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(e) A pharmacy benefit manager that provides health care |
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services under the program must satisfy certification and licensure |
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requirements prescribed by the commission and consistent with law. |
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Sec. 65.055. CONTRACT ADMINISTRATION. (a) The commission |
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may contract with a third-party administrator or other entity to |
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administer the program for the commission under this chapter. |
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(b) A third-party administrator or other entity may perform |
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tasks under a contract entered into under Subsection (a) that would |
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otherwise be performed by the commission. |
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(c) The commission may not delegate decisions about the |
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policies of the program to a third party administrator or other |
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entity. |
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Sec. 65.056. CONTRACT OVERSIGHT. (a) The commission shall |
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conduct a review of each entity that enters into a contract under |
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this subchapter to ensure the entity is available, prepared, and |
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able to fulfill the entity's obligations under the contract in |
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compliance with the contract, this chapter, and rules adopted under |
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this chapter. |
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(b) The commission's review of contractors under Subsection |
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(a) must be based on the following criteria: |
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(1) adequate and appropriate staffing, including |
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contracts with third parties; |
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(2) adequate and properly documented policies and |
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procedures; |
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(3) fiscal soundness; and |
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(4) adequate information systems, electronic |
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interfaces, and business practices. |
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(c) The commission shall ensure that each contract entered |
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into under this subchapter is procured using a competitive |
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procurement process in compliance with all applicable federal and |
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state laws, rules, and regulations. |
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Sec. 65.057. COMMUNITY OUTREACH CAMPAIGN. The commission |
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shall conduct a community outreach and education campaign in the |
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form and manner determined by the commission to provide information |
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relating to the availability of the program. |
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SUBCHAPTER C. TEXAS CARES ACCOUNT; PROGRAM TERMINATION |
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Sec. 65.101. ESTABLISHMENT OF TEXAS CARES ACCOUNT. (a) |
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The Texas cares account is a dedicated account in the general |
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revenue fund. |
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(b) The account consists of: |
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(1) gifts, grants, and donations received for the |
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account; |
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(2) legislative appropriations; |
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(3) federal money available to be used for this |
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purpose; and |
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(4) interest, dividends, and other income of the |
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account. |
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(c) Section 403.0956, Government Code, does not apply to the |
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account. |
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(d) Money in the account may be appropriated only for the |
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administration of the program and the provision of program |
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services. |
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(e) The commission may solicit and accept gifts, grants, and |
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donations for the account. |
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Sec. 65.102. TERMINATION OF PROGRAM. The commission may |
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terminate the program if the commission determines the account |
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under Section 65.101 lacks sufficient funding to administer the |
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program. |
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SUBCHAPTER D. PROGRAM ELIGIBILITY AND ENROLLEE REQUIREMENTS |
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Sec. 65.151. ELIGIBILITY CRITERIA. (a) Except as provided |
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by Subsection (b), an individual is eligible for benefits under the |
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program if the individual: |
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(1) is a resident of this state; |
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(2) is a citizen of the United States; and |
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(3) is uninsured, as determined by the commission. |
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(b) If the commission determines necessary, the commission |
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may consider an applicant's financial vulnerability as an |
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additional factor for determining program eligibility. |
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(c) The executive commissioner by rule shall establish |
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eligibility levels consistent with any other applicable federal and |
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state laws, rules, and regulations. |
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Sec. 65.152. COST SHARING. To the extent necessary, the |
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commission shall require enrollees to share the cost of the |
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program, including provisions requiring enrollees to pay a |
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copayment at the point of service. |
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SUBCHAPTER E. OPERATION OF PROGRAM |
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Sec. 65.201. PROGRAM BENEFITS. (a) The commission may use |
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money appropriated to the program in accordance with the General |
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Appropriations Act and in the account to finance benefits for |
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enrollees. |
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(b) The commission must approve program benefits offered |
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under this chapter. The commission shall ensure that the benefits |
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comply with all applicable federal and state laws, rules, and |
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regulations. |
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Sec. 65.202. REPORTING. (a) A third-party administrator |
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or other entity the commission contracts with under Section 65.055 |
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shall report to the commission in the form and manner prescribed by |
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the commission on the benefits and services provided under the |
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program. |
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(b) The commission shall establish a procedure to monitor |
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the provision of benefits and services under this chapter. |
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Sec. 65.203. FRAUD PREVENTION. The executive commissioner |
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shall develop and implement rules for the prevention and detection |
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of fraud in the program. |
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SECTION 3. (a) In this section, "commission" means the |
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Health and Human Services Commission. |
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(b) The commission shall conduct a study on the development |
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and implementation of the prescription drug savings program |
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established by Chapter 65, Health and Safety Code, as added by this |
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Act. The commission shall determine the effectiveness of the |
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program in providing services to uninsured individuals in this |
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state and any legislative recommendations for improvements to the |
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program. |
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(c) Not later than October 16, 2022, the commission shall |
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provide a written report of the results of the study conducted under |
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Subsection (b) of this section to the governor, lieutenant |
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governor, speaker of the house of representatives, and members of |
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the standing committees of the legislature with primary |
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jurisdiction over the commission. |
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SECTION 4. As soon as practicable after the effective date |
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of this Act, the executive commissioner of the Health and Human |
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Services Commission and any other state agency designated by the |
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executive commissioner shall adopt rules necessary to implement |
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Chapter 65, Health and Safety Code, as added by this Act. |
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SECTION 5. This Act takes effect September 1, 2021. |