By Berlanga, Maxey, McDonald, Serna H.B. No. 1969 74R5898 CLG-D A BILL TO BE ENTITLED 1-1 AN ACT 1-2 relating to the development of a health care delivery system under 1-3 the state Medicaid program that results in cost savings to the 1-4 state. 1-5 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: 1-6 SECTION 1. Article 4413(502), Revised Statutes, is amended 1-7 by adding Section 16A to read as follows: 1-8 Sec. 16A. HEALTH CARE DELIVERY SYSTEM. (a) The commission 1-9 may develop a health care delivery system that restructures the 1-10 delivery of health care services provided under the state Medicaid 1-11 program. In developing the health care delivery system, the 1-12 commission shall: 1-13 (1) to the extent possible, design the system in a 1-14 manner that will improve the health of Texans by emphasizing 1-15 prevention, promoting continuity of care and providing a medical 1-16 home for Medicaid recipients, and promoting the access of Medicaid 1-17 recipients to quality health care services; 1-18 (2) to the extent possible, design the system in a 1-19 manner that will enable the state to control the costs associated 1-20 with growth in the state Medicaid program and result in cost 1-21 savings to the state; 1-22 (3) to the extent possible: 1-23 (A) maximize the financing of the state Medicaid 1-24 program by obtaining federal matching funds for local and state 2-1 resources spent on indigent health care; and 2-2 (B) expand Medicaid eligibility to include 2-3 persons who were eligible to receive indigent health care services 2-4 through the use of those local and state resources before expansion 2-5 of the program; 2-6 (4) design the system to include methods for ensuring 2-7 accountability to the state for the provision of health care 2-8 services under the state Medicaid program, including methods for 2-9 financial reporting, quality assurance, and utilization review; 2-10 (5) ensure that both private and public health care 2-11 providers will have an opportunity to participate in the provision 2-12 of health care services under the system; 2-13 (6) design the system in a manner that enables the 2-14 state to use different types of health care delivery systems in 2-15 different health care service regions, including systems such as a 2-16 primary care case management system, partially capitated system, or 2-17 fully capitated system or a combination of one or more of those 2-18 systems; 2-19 (7) emphasize coordination in the provision of 2-20 indigent health care by establishing geographic health care service 2-21 regions after consulting with local governmental entities; and 2-22 (8) write, in conjunction with the following entities, 2-23 the waiver or other documents necessary to obtain federal 2-24 authorization for the health care delivery system developed under 2-25 this section: 2-26 (A) governmental entities that provide health 2-27 care services and assistance to indigent persons in this state; 3-1 (B) consumer representatives; 3-2 (C) health plan providers; and 3-3 (D) health care providers. 3-4 (b) The Texas Department of Health shall implement a health 3-5 care delivery system developed under this section, subject to the 3-6 administrative authority of the commission. 3-7 (c) In this section, "resources" means: 3-8 (1) for an entity listed in Subsection (d)(1), (d)(5), 3-9 or (d)(6) of this section, tax and other revenues spent on indigent 3-10 health care; and 3-11 (2) for an entity listed in Subsection (d)(2), (d)(3), 3-12 or (d)(4) of this section, charity care provided by that entity to 3-13 indigent persons. 3-14 (d) If a health care delivery system developed under this 3-15 section includes a method to finance the state Medicaid program by 3-16 obtaining federal matching funds for local and state resources 3-17 spent on indigent health care, the following entities shall make 3-18 resources available to the commission for use by the Texas 3-19 Department of Health in implementing the health care delivery 3-20 system: 3-21 (1) a hospital district created and established under 3-22 the authority of Sections 4 through 11, Article IX, Texas 3-23 Constitution; 3-24 (2) a medical school operated by the state; 3-25 (3) a medical school that receives state funds under 3-26 Section 61.093, Education Code; 3-27 (4) a teaching hospital operated by The University of 4-1 Texas System; 4-2 (5) a county that provides health care services and 4-3 assistance to indigent residents of the county under Subchapter B, 4-4 Chapter 61, Health and Safety Code; and 4-5 (6) a governmental entity that provides funds to a 4-6 public hospital as defined by Section 61.002, Health and Safety 4-7 Code, for the provision of health care services and assistance to 4-8 indigent persons under Chapter 61, Health and Safety Code. 4-9 (e) The amount of resources an entity makes available to the 4-10 commission under Subsection (d) of this section in a fiscal year as 4-11 determined under this subsection shall be agreed on by the 4-12 commission and the entity before the commission submits a waiver 4-13 application or a renewal waiver application that a federal agency 4-14 may require to implement the health care delivery system. The 4-15 commission shall design the system so that the value of Medicaid 4-16 health care services provided in the area of each participating 4-17 entity to persons who are eligible for Medicaid as a result of the 4-18 expanded eligibility criteria developed under Subsection (a)(3)(B) 4-19 of this section is at least equal to the amount of resources made 4-20 available to the commission by the entity. The amount is 4-21 computed by: 4-22 (1) adding the total amount of resources the entity 4-23 spends on indigent health care during the 1993-1994 fiscal year and 4-24 an amount equal to the estimate of the entity's annual growth in 4-25 expenditures for indigent health care for the fiscal year in which 4-26 the amount is computed; and 4-27 (2) subtracting from the amount computed under 5-1 Subdivision (1) of this subsection the following adjustments: 5-2 (A) the estimate of the amount of resources the 5-3 entity spent on health care services and assistance provided by the 5-4 entity or on the entity's behalf to indigent persons who are not 5-5 eligible to receive services and assistance under the state 5-6 Medicaid program; 5-7 (B) the estimate of the amount of resources the 5-8 entity makes available for federal matching funds under the 5-9 Medicaid disproportionate share program; and 5-10 (C) any other adjustment determined necessary or 5-11 equitable. 5-12 (f) The governing body of an entity may elect to make 5-13 available to the commission an amount greater than the amount 5-14 computed under Subsection (e) of this section. 5-15 (g) The commission by rule shall determine the manner in 5-16 which an entity described by Subsection (d) of this section shall 5-17 make resources available to the commission under this section. 5-18 (h) To the extent of conflict between this section and 5-19 another provision of state law relating to the state Medicaid 5-20 program, this section prevails. 5-21 SECTION 2. If before implementing Section 16A, Article 5-22 4413(502), Revised Statutes, as added by this Act, the Health and 5-23 Human Services Commission determines that a waiver or authorization 5-24 from a federal agency is necessary for implementation, the 5-25 commission shall request the waiver or authorization and may 5-26 authorize a delay in implementing that provision until the waiver 5-27 or authorization is granted. 6-1 SECTION 3. This Act takes effect September 1, 1995. 6-2 SECTION 4. The importance of this legislation and the 6-3 crowded condition of the calendars in both houses create an 6-4 emergency and an imperative public necessity that the 6-5 constitutional rule requiring bills to be read on three several 6-6 days in each house be suspended, and this rule is hereby suspended.