By Hilderbran H.B. No. 2299
74R7712 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;
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; and
3-4 (9) ensure that the initial contracts with health plan
3-5 providers will save the state at least an amount equal to 10
3-6 percent of the cost to the state of providing the contracted
3-7 services immediately before September 1, 1995.
3-8 (b) The Texas Department of Health shall implement a health
3-9 care delivery system developed under this section, subject to the
3-10 administrative authority of the commission.
3-11 (c) In this section, "resources" means:
3-12 (1) for an entity listed in Subsection (d)(1), (d)(5),
3-13 or (d)(6) of this section, tax and other revenues spent on indigent
3-14 health care; and
3-15 (2) for an entity listed in Subsection (d)(2), (d)(3),
3-16 or (d)(4) of this section, charity care provided by that entity to
3-17 indigent persons.
3-18 (d) If a health care delivery system developed under this
3-19 section includes a method to finance the state Medicaid program by
3-20 obtaining federal matching funds for local and state resources
3-21 spent on indigent health care, the following entities shall make
3-22 resources available to the commission for use by the Texas
3-23 Department of Health in implementing the health care delivery
3-24 system:
3-25 (1) a hospital district created and established under
3-26 the authority of Sections 4 through 11, Article IX, Texas
3-27 Constitution;
4-1 (2) a medical school operated by the state;
4-2 (3) a medical school that receives state funds under
4-3 Section 61.093, Education Code;
4-4 (4) a teaching hospital operated by The University of
4-5 Texas System;
4-6 (5) a county that provides health care services and
4-7 assistance to indigent residents of the county under Subchapter B,
4-8 Chapter 61, Health and Safety Code; and
4-9 (6) a governmental entity that provides funds to a
4-10 public hospital as defined by Section 61.002, Health and Safety
4-11 Code, for the provision of health care services and assistance to
4-12 indigent persons under Chapter 61, Health and Safety Code.
4-13 (e) The amount of resources an entity makes available to the
4-14 commission under Subsection (d) of this section in a fiscal year as
4-15 determined under this subsection shall be agreed on by the
4-16 commission and the entity before the commission submits a waiver
4-17 application or a renewal waiver application that a federal agency
4-18 may require to implement the health care delivery system. The
4-19 commission shall design the system so that the value of Medicaid
4-20 health care services provided in the area of each participating
4-21 entity to persons who are eligible for Medicaid as a result of the
4-22 expanded eligibility criteria developed under Subsection (a)(3)(B)
4-23 of this section is at least equal to the amount of resources made
4-24 available to the commission by the entity. The amount is
4-25 computed by:
4-26 (1) adding the total amount of resources the entity
4-27 spends on indigent health care during the 1993-1994 fiscal year and
5-1 an amount equal to the estimate of the entity's annual growth in
5-2 expenditures for indigent health care for the fiscal year in which
5-3 the amount is computed; and
5-4 (2) subtracting from the amount computed under
5-5 Subdivision (1) of this subsection the following adjustments:
5-6 (A) the estimate of the amount of resources the
5-7 entity spent on health care services and assistance provided by the
5-8 entity or on the entity's behalf to indigent persons who are not
5-9 eligible to receive services and assistance under the state
5-10 Medicaid program;
5-11 (B) the estimate of the amount of resources the
5-12 entity makes available for federal matching funds under the
5-13 Medicaid disproportionate share program; and
5-14 (C) any other adjustment determined necessary or
5-15 equitable.
5-16 (f) The governing body of an entity may elect to make
5-17 available to the commission an amount greater than the amount
5-18 computed under Subsection (e) of this section.
5-19 (g) The commission by rule shall determine the manner in
5-20 which an entity described by Subsection (d) of this section shall
5-21 make resources available to the commission under this section.
5-22 (h) To the extent of conflict between this section and
5-23 another provision of state law relating to the state Medicaid
5-24 program, this section prevails.
5-25 SECTION 2. If before implementing Section 16A, Article
5-26 4413(502), Revised Statutes, as added by this Act, the Health and
5-27 Human Services Commission determines that a waiver or authorization
6-1 from a federal agency is necessary for implementation, the
6-2 commission shall request the waiver or authorization and may
6-3 authorize a delay in implementing that provision until the waiver
6-4 or authorization is granted.
6-5 SECTION 3. This Act takes effect September 1, 1995.
6-6 SECTION 4. The importance of this legislation and the
6-7 crowded condition of the calendars in both houses create an
6-8 emergency and an imperative public necessity that the
6-9 constitutional rule requiring bills to be read on three several
6-10 days in each house be suspended, and this rule is hereby suspended.