By: Zaffirini, et al. S.B. No. 10
A BILL TO BE ENTITLED
AN ACT
1-1 relating to development of a health care delivery system under the
1-2 state Medicaid program that results in cost savings to the state.
1-3 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-4 SECTION 1. Article 4413(502), Revised Statutes, is amended
1-5 by adding Sections 16A and 16B to read as follows:
1-6 Sec. 16A. HEALTH CARE DELIVERY SYSTEM. (a) The commission,
1-7 in conjunction with each operating agency, shall develop a health
1-8 care delivery system that restructures the delivery of health care
1-9 services provided under the state Medicaid program. The commission
1-10 shall develop the health care delivery system only if the
1-11 commission obtains a waiver or other authorization from all
1-12 necessary federal agencies to implement the system. In developing
1-13 the health care delivery system, the commission shall:
1-14 (1) to the extent possible, design the system in a
1-15 manner that will improve the health of Texans by emphasizing
1-16 prevention, promoting continuity of care, and providing a medical
1-17 home for Medicaid recipients;
1-18 (2) to the extent possible, design the system in a
1-19 manner that will ensure that each recipient can receive high
1-20 quality, comprehensive health care services in the recipient's
1-21 local community;
1-22 (3) design the system in a manner that will enable the
1-23 state and the local governments that make resources available to
1-24 the commission under this section to control the costs associated
2-1 with the state Medicaid program and, to the extent possible, will
2-2 result in cost savings to the state and those local governments;
2-3 (4) to the extent possible:
2-4 (A) maximize the financing of the state Medicaid
2-5 program by obtaining federal matching funds for local and state
2-6 resources spent on indigent health care; and
2-7 (B) expand Medicaid eligibility to include
2-8 persons who were eligible to receive indigent health care services
2-9 through the use of those local and state resources before expansion
2-10 of the program;
2-11 (5) to the extent possible, provide an option for the
2-12 entities that make local and state resources available for federal
2-13 match under this section to administer the health care delivery
2-14 system within their regions, subject to the standards of and
2-15 oversight by the commission and the appropriate operating agency;
2-16 (6) to the extent possible, expand Medicaid
2-17 eligibility to include children who are not eligible under indigent
2-18 health care program requirements by using existing sources of
2-19 funding including state funds, earned federal funds, family
2-20 contributions, and other funds that may be available to the state;
2-21 (7) design the system to:
2-22 (A) include methods for ensuring accountability
2-23 to the state for the provision of health care services under the
2-24 state Medicaid program, including methods for financial reporting,
2-25 quality assurance, and utilization review;
2-26 (B) provide a single point of accountability for
2-27 collection of uniform data in order to assess, compile, and analyze
3-1 outcome quality and cost efficiency;
3-2 (C) conduct comparative analysis of compiled
3-3 data to assess the relative value of alternative delivery systems
3-4 and report to the governor, lieutenant governor, and speaker of the
3-5 house of representatives; and
3-6 (D) oversee the methodology for setting
3-7 capitation and provider payment rates to ensure the cost-effective
3-8 provision of quality care;
3-9 (8) ensure that both private and public health care
3-10 providers and health care plans will have an opportunity to
3-11 participate in the system;
3-12 (9) design the system in a manner that enables the
3-13 state:
3-14 (A) to use different types of health care
3-15 delivery systems in different health care service regions,
3-16 including systems such as a primary care case management system,
3-17 partially capitated system, or fully capitated system or a
3-18 combination of one or more of those systems;
3-19 (B) to use different types of health care
3-20 delivery systems to meet the needs of different populations,
3-21 including the establishment of pilot programs to deliver health
3-22 care services to children with special health care needs; and
3-23 (C) to recognize the unique role of rural
3-24 hospitals, physicians, and other rural health care providers in
3-25 providing access to health care services for rural Texans;
3-26 (10) establish geographic health care service regions
3-27 after consulting with local governmental entities that contribute
4-1 resources under this section and emphasize regional coordination in
4-2 the provision of indigent health care;
4-3 (11) simplify eligibility criteria and streamline
4-4 eligibility determination processes;
4-5 (12) to the extent possible, design a system that
4-6 encourages the training of and access to primary care physicians;
4-7 and
4-8 (13) develop and prepare, in conjunction with the
4-9 following entities, the waiver or other documents necessary to
4-10 obtain federal authorization for the health care delivery system
4-11 developed under this section:
4-12 (A) governmental entities that provide health
4-13 care services and assistance to indigent persons in this state;
4-14 (B) consumer representatives;
4-15 (C) health plan providers; and
4-16 (D) health care providers.
4-17 (b) In accordance with this article and other applicable
4-18 state and federal statutes, the commission and each appropriate
4-19 operating agency shall jointly:
4-20 (1) implement a health care delivery system developed
4-21 under this section;
4-22 (2) adopt rules as necessary to carry out the purposes
4-23 of this section; and
4-24 (3) monitor compliance with and take any action the
4-25 commission and operating agency consider appropriate to enforce
4-26 this section and related rules, federal waivers, and orders and
4-27 decisions of the commission or operating agency.
5-1 (c) In this section, "resources" means:
5-2 (1) for an entity listed in Subsection (d)(1), (d)(2),
5-3 (d)(3), (d)(7), (d)(8), or (e) of this section, tax or other public
5-4 revenues spent on indigent health care; and
5-5 (2) for an entity listed in Subsection (d)(4), (d)(5),
5-6 or (d)(6) of this section, charity care as defined by the General
5-7 Appropriations Act provided by that entity to indigent persons.
5-8 (d) If a health care delivery system developed under this
5-9 section includes a method to finance the state Medicaid program by
5-10 obtaining federal matching funds for local and state resources
5-11 spent on indigent health care and if the commission has obtained
5-12 federal authorization to implement the system, the following
5-13 entities, in accordance with final, binding matching funds
5-14 agreements executed by those entities under Subsections (h) and (i)
5-15 of this section, shall make resources available to the commission
5-16 for use in implementing the health care delivery system:
5-17 (1) a hospital district created and established under
5-18 the authority of Sections 4 through 11, Article IX, Texas
5-19 Constitution;
5-20 (2) a hospital authority created and established under
5-21 Chapter 262 or 264, Health and Safety Code;
5-22 (3) a hospital owned and operated by a municipality,
5-23 county, or hospital authority created under Chapter 262 or 264,
5-24 Health and Safety Code;
5-25 (4) a medical school operated by the state;
5-26 (5) a medical school that receives state funds under
5-27 Section 61.093, Education Code;
6-1 (6) a teaching hospital operated by The University of
6-2 Texas System;
6-3 (7) a county that provides health care services and
6-4 assistance to indigent residents of the county under Subchapter B,
6-5 Chapter 61, Health and Safety Code, if the commissioners court of
6-6 the county adopts a resolution requesting that the county
6-7 participate in the health care delivery system; and
6-8 (8) a governmental entity that provides funds to a
6-9 public hospital for the provision of health care services to
6-10 indigent persons under Section 61.062, Health and Safety Code.
6-11 (e) In addition to the entities listed in Subsection (d) of
6-12 this section, an entity described by this subsection may make
6-13 resources available to the commission as provided by this section
6-14 if the clients of the entity and health care services provided by
6-15 the entity are included in the health care delivery system:
6-16 (1) a local mental health and mental retardation
6-17 authority as authorized by Section 531.002(8) or Section
6-18 531.002(9), Health and Safety Code, located in a county which
6-19 integrates mental health services into the health care delivery
6-20 system under a pilot program or pursuant to the Health and Human
6-21 Services Commission plan for statewide expansion;
6-22 (2) a city or county health department; and
6-23 (3) any other governmental entity that provides health
6-24 care services to indigent persons.
6-25 (f) The amount of resources an entity makes available to the
6-26 commission in a fiscal year under Subsection (d) or (e) of this
6-27 section is computed by:
7-1 (1) adding the total amount of resources the entity
7-2 spent on indigent health care during the entity's fiscal year
7-3 ending in 1994; and
7-4 (2) subtracting from the amount computed under
7-5 Subdivision (1) of this subsection the following adjustments:
7-6 (A) the amount of resources the entity spent
7-7 during the entity's fiscal year ending in 1994 on health care
7-8 services provided by the entity or on the entity's behalf to
7-9 indigent persons who would not have been eligible to receive
7-10 services under the eligibility criteria developed under Subsection
7-11 (a)(4)(B) of this section;
7-12 (B) to the extent and while the current Medicaid
7-13 disproportionate share program is continued in this state, the
7-14 estimate of the amount of resources the entity will transfer in
7-15 each fiscal year to the Texas Department of Health under the
7-16 Medicaid disproportionate share program; and
7-17 (C) any other necessary or equitable adjustment.
7-18 (g) The commission and the governing body of an entity that
7-19 makes resources available to the commission under this section may
7-20 agree that the entity may make available to the commission
7-21 resources or other funds in addition to those amounts computed
7-22 under Subsection (f) of this section. The additional resources or
7-23 funds may include an amount that reflects the costs associated with
7-24 the growth in the Medicaid program as estimated in a federal waiver
7-25 application that is required to be submitted to implement the
7-26 health care delivery system. Additional amounts of resources or
7-27 funds made available by an entity under this subsection must be
8-1 contained in the final, binding matching funds agreement executed
8-2 by the entity under Subsections (h) and (i) of this section.
8-3 (h) The commission shall prepare for an entity that makes
8-4 resources available to the commission under this section a proposed
8-5 memorandum of understanding that states the amount of resources and
8-6 other funds the entity will make available to the commission each
8-7 year under Subsections (f) and (g) of this section. The memorandum
8-8 of understanding serves as the basis for the negotiation of a
8-9 final, binding agreement called a "matching funds agreement"
8-10 between the governing body of the entity, the commissioners court,
8-11 if applicable, and the commission. If the entity is a hospital
8-12 district whose tax rate is set by the commissioners court of a
8-13 county in which the hospital district is located, the commissioners
8-14 court must also agree to the amount of resources made available by
8-15 the hospital district under Subsections (f) and (g) of this
8-16 section. The matching funds agreement must be executed before the
8-17 commission implements provisions affecting that entity by
8-18 submitting either a waiver application or a renewal waiver
8-19 application that a federal agency may require to implement the
8-20 health care delivery system.
8-21 (i) A matching funds agreement executed under Subsection (h)
8-22 of this section must include:
8-23 (1) a statement of the amount of resources or other
8-24 funds the entity agrees to make available to the commission under
8-25 Subsections (f) and (g) of this section;
8-26 (2) an estimate of the cost of providing services to
8-27 eligible individuals;
9-1 (3) an estimate of the number of eligible individuals
9-2 served;
9-3 (4) a description of the scope of services to be
9-4 provided to eligible individuals;
9-5 (5) a provision stating that the commission shall
9-6 design the system to ensure that the amount of resources spent by
9-7 each participating entity listed in Subsection (d)(1), (d)(2),
9-8 (d)(3), (d)(7), (d)(8), or (e) of this section to provide Medicaid
9-9 health care services to persons who are eligible for Medicaid as a
9-10 result of the expanded eligibility criteria developed under
9-11 Subsection (a)(4)(B) of this section is at least equal to the
9-12 amount of resources made available to the commission by the entity;
9-13 (6) a provision stating that if the federal Health
9-14 Care Financing Administration and the commission modify the waiver
9-15 application submitted by the commission with respect to financing,
9-16 eligibility criteria, or scope of services, the commission or an
9-17 entity that executes a final matching funds agreement is entitled
9-18 to modify the terms of the agreement; and
9-19 (7) other information the commission requires.
9-20 (j) The commission by rule shall determine the manner in
9-21 which an entity described by Subsections (d) and (e) of this
9-22 section shall make resources available to the commission under this
9-23 section. If an intergovernmental initiative is formed under
9-24 Section 16B of this article, each entity listed under Subsections
9-25 (d) and (e) of this section that participates in the
9-26 intergovernmental initiative shall make its resources available to
9-27 the commission by making its resources available to the
10-1 intergovernmental initiative.
10-2 (k) To the extent of conflict between this section and
10-3 another provision of state law relating to the state Medicaid
10-4 program, this section prevails.
10-5 (l) This section expires September 1, 2001.
10-6 Sec. 16B. INTERGOVERNMENTAL INITIATIVES. (a) If a health
10-7 care delivery system developed under Section 16A of this article
10-8 includes a method to finance the state Medicaid program by
10-9 obtaining federal matching funds for local and state resources
10-10 spent on indigent health care, one or more of the entities listed
10-11 in Sections 16A(d) and (e) of this article that make resources
10-12 available for matching under a matching funds agreement may form an
10-13 intergovernmental initiative to administer the health care delivery
10-14 system in a geographical area, subject to the standards of and
10-15 oversight by the commission and the appropriate operating agency.
10-16 (b) An intergovernmental initiative formed under this
10-17 section may serve more than one county. A county may not be served
10-18 by more than one intergovernmental initiative. The commission with
10-19 the consent of each entity that forms the intergovernmental
10-20 initiative may modify the geographical area the intergovernmental
10-21 initiative serves to:
10-22 (1) promote client access to services and continuity
10-23 of care; and
10-24 (2) move toward full regionalization of the health
10-25 care delivery system.
10-26 (c) An intergovernmental initiative must be formed as:
10-27 (1) a nonprofit corporation under the Texas Non-Profit
11-1 Corporation Act (Article 1396-1.01 et seq., Vernon's Texas Civil
11-2 Statutes); or
11-3 (2) any other nonstock, nonprofit entity that is
11-4 approved by the commission.
11-5 (d) An intergovernmental initiative formed under this
11-6 section is a governmental unit for purposes of Chapter 101, Civil
11-7 Practice and Remedies Code.
11-8 (e)(1) An intergovernmental initiative formed under this
11-9 section shall be governed as provided by this subsection.
11-10 (2) Each intergovernmental initiative has an executive
11-11 committee composed of representatives of each of the entities that
11-12 formed the intergovernmental initiative. The executive committee
11-13 shall appoint a governing board of the intergovernmental initiative
11-14 that shall include but not be limited to:
11-15 (A) executive committee members;
11-16 (B) a representative of clients of the
11-17 intergovernmental initiative;
11-18 (C) a representative of a children's hospital,
11-19 where applicable;
11-20 (D) a physician or other health care provider;
11-21 (E) a representative of a nonprofit and
11-22 for-profit hospital; and
11-23 (F) a representative of a licensed managed care
11-24 organization, where applicable.
11-25 (3) If more than one entity forms an intergovernmental
11-26 initiative, the entities shall share governance of the executive
11-27 committee of the intergovernmental initiative in proportion to the
12-1 amount of resources they make available for matching under the
12-2 matching funds agreement.
12-3 (4) Representation on the governing board and the
12-4 manner in which votes are apportioned among members of the
12-5 governing board who are not members of the executive committee must
12-6 be based primarily on the relative level of Medicaid and charity
12-7 care services, as defined by Section 311.031, Health and Safety
12-8 Code, provided by those nonexecutive committee members of the
12-9 governing board over the previous two years. The executive
12-10 committee must have at least 51 percent of the voting rights on the
12-11 governing board. The votes of the executive committee must be
12-12 apportioned in the manner described by Subdivision (3) of this
12-13 subsection.
12-14 (5) The executive committee of an intergovernmental
12-15 initiative has exclusive authority to manage the public funds of
12-16 the intergovernmental initiative, including the authority to spend
12-17 those funds. The governing board of an intergovernmental
12-18 initiative shall address health care delivery system issues for the
12-19 intergovernmental initiative, including the preparation and
12-20 negotiation of the proposed health care delivery plan for the
12-21 intergovernmental initiative under Subsection (i) of this section.
12-22 (6) If an intergovernmental initiative formed under
12-23 this section includes a hospital district whose tax rate is set by
12-24 the commissioners court of a county in the hospital district, the
12-25 commissioners court of that county must also agree to the structure
12-26 of governance of the intergovernmental initiative. The
12-27 commissioners court shall take action required under this
13-1 subdivision no later than the date on which the health care
13-2 delivery plan agreement is approved by the commissioners court
13-3 pursuant to Subsection (n) of this section.
13-4 (f) An intergovernmental initiative formed under this
13-5 section shall:
13-6 (1) administer the health care delivery system
13-7 developed under Section 16A of this article in the geographical
13-8 area described by the plan agreement of the intergovernmental
13-9 initiative under this section subject to standards and oversight
13-10 contained in:
13-11 (A) applicable state and federal statutes and
13-12 rules;
13-13 (B) federal waivers or other authorizations
13-14 required to implement the health care delivery system; and
13-15 (C) the plan agreement executed under this
13-16 section by the entities forming the intergovernmental initiative;
13-17 (2) perform the functions in administering the health
13-18 care delivery system that are prescribed by the plan agreement
13-19 executed by the entities forming the intergovernmental initiative
13-20 and the appropriate operating agency;
13-21 (3) make supplemental payments as necessary to satisfy
13-22 the requirement in Section 16A(h) of this article and Subsection
13-23 (l)(8) of this section that the entities receive payments at least
13-24 equal to the resources the entities made available to the
13-25 commission; and
13-26 (4) to the extent possible, manage care to lower the
13-27 cost of providing Medicaid services, through the use of health care
14-1 delivery systems such as a primary care case management system,
14-2 partially capitated system, or fully capitated system or a
14-3 combination of one or more of those systems.
14-4 (g) An intergovernmental initiative formed under this
14-5 section may contract with any public or private entity to perform
14-6 any of the intergovernmental initiative's powers or duties. The
14-7 entities that form the intergovernmental initiative may contract,
14-8 collaborate, or enter into a joint venture with other entities as
14-9 necessary or appropriate to form or carry out the functions of or
14-10 provide services to the intergovernmental initiative.
14-11 (h) Not later than the 60th day after the date on which the
14-12 commission submits to the federal government an application for a
14-13 waiver or other authorization required to implement the health care
14-14 delivery system developed under Section 16A of this article, the
14-15 entities listed in Sections 16A(d) and (e) of this article that
14-16 intend to form an intergovernmental initiative shall submit to the
14-17 commission a letter of intent to form the intergovernmental
14-18 initiative. The letter of intent must include any information
14-19 required by the commission, including at a minimum the names and
14-20 addresses of the entities that intend to participate in the
14-21 intergovernmental initiative and the geographical area to be served
14-22 by the intergovernmental initiative. The letter of intent is not
14-23 binding on the entities or the commission and only serves to inform
14-24 the commission of the areas of the state that intend to be part of
14-25 an intergovernmental initiative.
14-26 (i) Within the time specified by the appropriate operating
14-27 agency after approval of any waiver or federal authorization
15-1 required to implement the health care delivery system developed
15-2 under Section 16A of this article, the entities that have submitted
15-3 a letter of intent to form an intergovernmental initiative under
15-4 this section shall submit to the appropriate operating agency a
15-5 proposed health care delivery plan that contains the information
15-6 required by the operating agency. The proposed health care
15-7 delivery plan is not binding on the entities or the operating
15-8 agency but only serves as the basis for negotiation of a final,
15-9 binding plan agreement between the entities and the operating
15-10 agency. The operating agency by rule shall set a reasonable date
15-11 by which the entities must submit and negotiate the proposed health
15-12 care delivery plan. The date must be based on the schedule
15-13 developed for phasing in the health care delivery system statewide.
15-14 (j) The commission or the commission's designated
15-15 representative must approve the plan agreement, the structure of
15-16 the governing board, and the service area of an intergovernmental
15-17 initiative before the intergovernmental initiative can administer
15-18 the health care delivery system in accordance with the plan
15-19 agreement.
15-20 (k) The appropriate operating agency shall implement the
15-21 health care delivery system in accordance with an approved waiver
15-22 in a geographical area for which the commission does not receive a
15-23 letter of intent and that is not covered by a plan agreement that
15-24 has become final and binding by the date specified by the operating
15-25 agency under Subsection (i) of this section.
15-26 (l) The appropriate operating agency by rule shall develop a
15-27 model plan agreement to establish the minimum requirements for a
16-1 health care delivery plan under a plan agreement developed and
16-2 implemented by an intergovernmental initiative under this section.
16-3 In adopting rules under this section, the operating agency shall
16-4 ensure that an intergovernmental initiative:
16-5 (1) seeks public input regarding the development and
16-6 provisions of the health care delivery plan of the
16-7 intergovernmental initiative;
16-8 (2) to the extent payments to the intergovernmental
16-9 initiative are made on a capitated basis, receives payments that
16-10 reflect the geographic, risk-adjusted cost of providing care to
16-11 persons eligible for Medicaid;
16-12 (3) develops a sufficient provider network to ensure
16-13 adequate access to quality health care services consistent with the
16-14 applicable waiver and any standards prescribed by the federal
16-15 Health Care Financing Administration, commission, or operating
16-16 agency, including standards relating to travel time and distance
16-17 that are designed to ensure access by patients to providers in
16-18 their own communities;
16-19 (4) develops and administers policies regarding
16-20 financial management, quality assurance, utilization review, and
16-21 patient access by the intergovernmental initiative, and the plans
16-22 or providers with which the intergovernmental initiative contracts,
16-23 in accordance with standards consistent with the applicable waiver
16-24 and any standards prescribed by the federal Health Care Financing
16-25 Administration, commission, or operating agency;
16-26 (5) includes in the plan agreement of the
16-27 intergovernmental initiative provisions relating to participation
17-1 of public and private health care plans and providers in the health
17-2 care delivery system in accordance with standards established by
17-3 the operating agency, including provisions relating to:
17-4 (A) a methodology within a region for selection
17-5 of participating health care plans and providers, which methodology
17-6 shall provide added weight for additional services of value to the
17-7 state such as trauma, Level I emergency services, neonatal
17-8 intensive care, medical education, or other specialty services; and
17-9 (B) a methodology within a region for
17-10 establishing capitation rates and provider payment rates, which
17-11 rates may be supplemented in exchange for the provision of
17-12 specified additional services;
17-13 (6) maintains adequate stop-loss coverage of the
17-14 intergovernmental initiative or any health care plans under
17-15 contract with the intergovernmental initiative, including
17-16 provisions to ensure that adequate stop-loss coverage is available;
17-17 (7) in accordance with any waiver application approval
17-18 or other federal authorization to implement the health care
17-19 delivery system, includes in the plan agreement adequate
17-20 provisions, as appropriate to the area served by the
17-21 intergovernmental initiative, for phasing in implementation of the
17-22 health care delivery system, which may include provisions that
17-23 include methods, such as reserve funds, for phasing
17-24 disproportionate share funds into the Medicaid program;
17-25 (8) includes in the plan agreement adequate provisions
17-26 to ensure that the amount of resources spent by each participating
17-27 entity listed in Section 16A(d)(1), (d)(2), (d)(3), (d)(7), (d)(8),
18-1 or (e) of this article for Medicaid health care services provided
18-2 to persons who are eligible for Medicaid as a result of the
18-3 expanded eligibility criteria developed under Section 16A(a)(4)(B)
18-4 of this article is at least equal to the amount of resources made
18-5 available to the commission by the entity;
18-6 (9) provides notice to health care providers of the
18-7 procedures used by the intergovernmental initiative or any health
18-8 care plans under contract with the intergovernmental initiative to
18-9 solicit bids for the delivery of services by health care providers;
18-10 (10) includes in the plan agreement grievance and
18-11 appeal procedures for persons who are denied services or have a
18-12 complaint regarding the quality of services under the health care
18-13 delivery plan; and
18-14 (11) includes in the plan agreement appeal procedures
18-15 for health care providers who are denied participation in the
18-16 health care delivery plan.
18-17 (m) The plan agreement for an intergovernmental initiative
18-18 must be completed before the appropriate operating agency
18-19 implements an approved waiver within the area covered by the
18-20 intergovernmental initiative. If an approved waiver is terminated,
18-21 both the intergovernmental initiative and the operating agency may
18-22 terminate the plan agreement. If the waiver is modified in a way
18-23 that affects the provision of services in the area covered by the
18-24 plan agreement, the intergovernmental initiative or the appropriate
18-25 operating agency may renegotiate the plan agreement.
18-26 (n) If an intergovernmental initiative formed under this
18-27 section includes a hospital district whose tax rate is set by the
19-1 commissioners court of a county in the hospital district, the
19-2 intergovernmental initiative shall file the plan agreement with the
19-3 commissioners court. The plan agreement is considered approved by
19-4 the commissioners court on the 30th day after the date on which the
19-5 intergovernmental initiative files the agreement unless the
19-6 commissioners court adopts a resolution rejecting the plan
19-7 agreement. The commissioners court may adopt a resolution to
19-8 delegate the authority to reject the plan agreement to the board of
19-9 directors of the hospital district.
19-10 (o) To the extent of conflict between this section and
19-11 another provision of state law relating to the state Medicaid
19-12 program, this section prevails.
19-13 (p) This section expires September 1, 2001.
19-14 SECTION 2. Section 1, Article 4413(502), Revised Statutes,
19-15 is amended by adding Subdivision (3) to read as follows:
19-16 (3) "Operating agency" means a health and human
19-17 services agency that administers a part of the state Medicaid
19-18 program.
19-19 SECTION 3. Chapter 285, Health and Safety Code, is amended
19-20 by adding Subchapter H to read as follows:
19-21 SUBCHAPTER H. CONTRACTS, COLLABORATIONS, AND JOINT VENTURES
19-22 Sec. 285.091. HOSPITAL DISTRICT CONTRACTS, COLLABORATIONS,
19-23 AND JOINT VENTURES. A hospital district created under general or
19-24 special law may contract, collaborate, or enter into a joint
19-25 venture with any public or private entity as necessary to form or
19-26 carry out the functions of or provide services to an
19-27 intergovernmental initiative under Section 16B, Article 4413(502),
20-1 Revised Statutes.
20-2 SECTION 4. The Health and Human Services Commission or a
20-3 health and human services agency that administers a part of the
20-4 state Medicaid program may not implement Sections 16A and 16B,
20-5 Article 4413(502), Revised Statutes, as added by this Act, unless
20-6 the commission has obtained a waiver or other authorization from
20-7 all necessary federal agencies to implement those provisions. Not
20-8 later than July 31, 1995, the commission shall submit to the
20-9 federal government the waiver or other authorizations required to
20-10 develop or implement the health care delivery system.
20-11 SECTION 5. (a) If a federal waiver or other authorization
20-12 is not obtained from all necessary federal agencies to implement
20-13 the health care delivery system developed under Section 16A,
20-14 Article 4413(502), Revised Statutes, as added by this Act, the
20-15 Texas Department of Health shall continue to establish additional
20-16 Medicaid managed care pilot programs statewide to decrease the cost
20-17 to the state of providing Medicaid services while improving access
20-18 to health care services for Medicaid recipients. The Texas
20-19 Department of Health shall begin the process of establishing
20-20 additional Medicaid managed care pilot programs not later than the
20-21 date on which the Health and Human Services Commission submits the
20-22 waiver application to the federal government.
20-23 (b) The Texas Department of Health may contract with public
20-24 or private entities as necessary for the department to perform its
20-25 functions under this section.
20-26 SECTION 6. The importance of this legislation and the
20-27 crowded condition of the calendars in both houses create an
21-1 emergency and an imperative public necessity that the
21-2 constitutional rule requiring bills to be read on three several
21-3 days in each house be suspended, and this rule is hereby suspended,
21-4 and that this Act take effect and be in force from and after its
21-5 passage, and it is so enacted.