HOUSE AUTHOR: Wohlgemuth et al. |
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EFFECTIVE: See below |
SENATE SPONSOR: Nelson |
House Bill 2292 provides for the reorganization of health and human services agencies. It eliminates the (1) Interagency Council on Early Childhood Intervention, (2) Texas Department on Aging, (3) Texas Commission on Alcohol and Drug Abuse, (4) Texas Commission for the Blind, (5) Texas Commission for the Deaf and Hard of Hearing, (6) Texas Department of Health, (7) Texas Department of Human Services, (8) Texas Department of Mental Health and Mental Retardation, (9) Texas Rehabilitation Commission, and (10) Texas Health Care Information Council. It creates the Department of Aging and Disability Services, the Department of State Health Services, and the Department of Assistive and Rehabilitative Services. It also makes changes to the organization and administration of the Department of Protective and Regulatory Services and the Health and Human Services Commission.
The bill transfers total responsibility to the Health and Human Services Commission for the operation of the Children's Health Insurance Program (CHIP), Temporary Assistance for Needy Families (TANF), Medicaid, food stamps, and other health and human services programs, as appropriate; it transfers the authority for determining eligibility for benefits under these programs and for long-term care and community-based support services; and it transfers authority for programs intended to prevent family violence and programs providing services to victims of family violence. The commission has all rulemaking and policymaking authority for the provision of health and human services and is required to perform information systems duties and administrative support services for the health and human services agencies operating under the direction of the commission. The bill also moves the sunset date for the commission to September 1, 2009.
House Bill 2292 establishes the executive commissioner of the Health and Human Services Commission, who has the authority to adopt rules and policies for the operation of, and provision of services by, the health and human services agencies and to appoint agency directors, with the approval of the governor. The executive commissioner is also required to establish certain divisions and the offices within the commission, including the eligibility services division and the office of the inspector general to perform fraud and abuse investigation and enforcement. The governor appoints the inspector general for a one-year term. The bill creates the Health and Human Services Council, composed of nine members appointed by the governor with the advice and consent of the senate, to assist the executive commissioner in developing rules and policies for the commission. The presiding officer of the council is designated by the governor.
The bill eliminates the agencies listed above and consolidates certain functions into the three new health and human services agencies: the Department of Aging and Disability Services responsible for providing long-term care, community care, and services for the aging and mentally retarded; the Department of State Health Services responsible for basic health, mental health, and substance abuse services; and the Department of Assistive and Rehabilitative Services responsible for early childhood intervention and services for the disabled (other than developmental delay and mental retardation), for persons who are blind, and for persons who are deaf or hard of hearing. The Department of Protective and Regulatory Services is renamed the Department of Family and Protective Services. The bill creates a council for each agency, under the same terms of membership and appointment as the Health and Human Services Council, to assist each agency director in developing rules and policies.
The bill creates a Health and Human Services Transition Legislative Oversight Committee, to be made up of two senators, two members of the house, and three public members to be appointed by the governor, to facilitate the transfer of powers, duties, functions, programs, and activities of the affected agencies without interrupting the delivery of services and to advise the executive commissioner regarding those transfers. The executive commissioner is required to submit a transition plan and schedule to the governor and the Legislative Budget Board not later than December 1, 2003.
The bill changes income eligibility for benefits under the CHIP program to gross, rather than net, family income at or below 200 percent of the federal poverty guidelines, eliminates income reductions for offsets for certain expenses, such as child care and work-related expenses, and provides for a six-month eligibility period, rather than 12-month continuous eligibility, for the biennium ending September 1, 2005. The bill authorizes the commission, if it is cost-effective, to limit the outpatient brand-name prescription drugs for children enrolled in the program and changes the calculation of the starting point of the 90-day waiting period for CHIP coverage to be after CHIP enrollment, rather than after the last date of coverage under another health benefits plan.
House Bill 2292 requires the Health and Human Services Commission to adopt preferred drug lists for the Medicaid vendor drug program that includes only drugs provided by manufacturers or labelers that reach an agreement with the commission on supplemental rebates and requires prior authorization, with certain exceptions, for the reimbursement of a drug that is not included on the appropriate preferred drug list. The bill permits the use of third-party information to assist in determining Medicaid eligibility, including information from consumer reporting agencies, appraisal districts, and the vehicle registration record database maintained by the Texas Department of Transportation. It also permits the use of tobacco settlement funds to provide certain preventive medical and dental services to children and reduces the personal needs allowance from $60 to $45 for Medicaid recipients in a convalescent or nursing home or similar institution, including an intermediate care facility for the mentally retarded (ICF-MR). The bill requires Medicaid recipients to share the cost of medical assistance through enrollment fees, deductibles, coinsurance, or payment of a portion of the plan premium, to the extent permitted by federal law. House Bill 2292 establishes a Medicaid fraud pilot program to address provider fraud and certain cases of third-party and recipient fraud and requires the program to include participant smart cards and biometric readers and a secure finger-imaging system. The bill includes the same authorization for the commission to limit certain brand-name prescriptions to beneficiaries as under CHIP.
The bill changes the eligibility requirements for assistance under TANF by reducing from $2,000 to $1,000 the amount the department is required to exclude from an applicant's available resources when determining eligibility. This provision is specifically applied to households in which there is a person with a disability or over the age of 60. Under previous law, the department excluded $3,000 from the resources of such households. The bill requires a payee, defined as a person who resides in a household with a dependent child and who is within the degree of relationship with the child that is required of a caretaker, but whose needs are not included in determining the TANF benefit, to sign a responsibility agreement; it requires the cooperation, rather than compliance, with an applicable responsibility agreement, and it requires the immediate application of a sanction terminating the total amount of financial assistance for a person and the person's family if, after an investigation, it is determined that a person is not cooperating with a requirement of a responsibility agreement. The bill requires the adoption of rules governing sanctions and penalties to be applied to the family of a person who fails to cooperate with the agreement. To the extent allowed by federal law, sanctions may include the denial of Medicaid benefits for a person who is eligible for TANF but is not receiving assistance because of a failure to cooperate. Medicaid may not be denied to the person's family or to a person who is under 19 years of age or who is pregnant. On determination that a recipient of TANF has committed fraud, the person will lose eligibility for one year for the first violation and will lose eligibility permanently for the second violation. On conviction of a state or federal offense or if a person is granted deferred adjudication or placed on community supervision for the conduct determined to constitute fraud, the person permanently loses eligibility for financial assistance under TANF. The bill requires certain postemployment strategies to assist TANF recipients in making a transition to stable employment, including an employment services referral program. The bill also provides for a temporary exclusion of a new spouse's income for purposes of determining eligibility for certain assistance for the support of dependent children.
House Bill 2292 authorizes contracts for the privatization of state schools and state mental hospitals after August 31, 2004, and before September 1, 2005, subject to a determination by HHSC that the private service provider will operate the facility at a cost that is at least 25 percent less than the cost of the department operating the hospital and to certain quality of service requirements. The bill provides that a local mental health and mental retardation authority may serve as a provider only as a provider of last resort and only under certain circumstances. It also requires the development and implementation of a plan to privatize all services by intermediate facilities for persons with mental retardation and related waiver services programs operated by an authority. The transfer of services may not occur on or before August 31, 2006.
The bill requires clearly defined minimum standards that relate directly to the quality of care for residents of certain nursing facilities and requires that contracts with those facilities include specific performance measures for evaluating whether those standards are being met. It requires certain Medicare-certified long-term care providers, including nursing facilities and home health services providers, to seek reimbursement for services provided from Medicare before billing Medicaid. It also repeals a provision requiring convalescent and nursing homes and related institutions to maintain certain liability insurance coverage for health care liability claims.
House Bill 2292 is an omnibus bill, and it also includes many other provisions relating to the provision of health and human services in Texas that are not specified in the summary above.
The bill takes effect September 1, 2003, except as follows: (1) the Department of Aging and Disability Services, the Department of State Health Services, and the Department of Assistive and Rehabilitative Services are created on the date the executive commissioner appoints the director or commissioner of each agency (SECTION 1.29); (2) certain provisions relating to third-party billing vendors under CHIP take effect January 1, 2006 (SECTION 2.44); (3) provisions relating to the privatization of state schools and state mental hospitals take effect September 1, 2004 (SECTIONS 2.77 and 2.78); (4) certain provisions relating to community centers take effect September 1, 2006 (SECTION 2.82); (5) certain provisions relating to local mental health and mental retardation authorities take effect September 1, 2006 (SECTION 2.82A); and (6) certain provisions relating to third-party billing vendors under Medicaid take effect January 1, 2004 (SECTION 2.111).