1-1 By: Zaffirini, et al. S.B. No. 10
1-2 (In the Senate - Filed February 16, 1995; February 16, 1995,
1-3 read first time and referred to Committee on Health and Human
1-4 Services; March 16, 1995, reported adversely, with favorable
1-5 Committee Substitute by the following vote: Yeas 9, Nays 0;
1-6 March 16, 1995, sent to printer.)
1-7 COMMITTEE SUBSTITUTE FOR S.B. No. 10 By: Zaffirini
1-8 A BILL TO BE ENTITLED
1-9 AN ACT
1-10 relating to development of a health care delivery system under the
1-11 state Medicaid program that results in cost savings to the state.
1-12 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-13 SECTION 1. Article 4413(502), Revised Statutes, is amended
1-14 by adding Sections 16A and 16B to read as follows:
1-15 Sec. 16A. HEALTH CARE DELIVERY SYSTEM. (a) The commission,
1-16 in conjunction with each operating agency, shall develop a health
1-17 care delivery system that restructures the delivery of health care
1-18 services provided under the state Medicaid program. The commission
1-19 shall develop the health care delivery system only if the
1-20 commission obtains a waiver or other authorization from all
1-21 necessary federal agencies to implement the system. In developing
1-22 the health care delivery system, the commission shall:
1-23 (1) to the extent possible, design the system in a
1-24 manner that will improve the health of Texans by emphasizing
1-25 prevention, promoting continuity of care, and providing a medical
1-26 home for Medicaid recipients;
1-27 (2) to the extent possible, design the system in a
1-28 manner that will ensure that each recipient can receive high
1-29 quality, comprehensive health care services in the recipient's
1-30 local community;
1-31 (3) design the system in a manner that will enable the
1-32 state and the local governments that make resources available to
1-33 the commission under this section to control the costs associated
1-34 with the state Medicaid program and, to the extent possible, will
1-35 result in cost savings to the state and those local governments;
1-36 (4) to the extent possible:
1-37 (A) maximize the financing of the state Medicaid
1-38 program by obtaining federal matching funds for local and state
1-39 resources spent on indigent health care; and
1-40 (B) expand Medicaid eligibility to include
1-41 persons who were eligible to receive indigent health care services
1-42 through the use of those local and state resources before expansion
1-43 of the program;
1-44 (5) to the extent possible, provide an option for the
1-45 entities that make local and state resources available for federal
1-46 match under this section to administer the health care delivery
1-47 system within their regions, subject to the standards of and
1-48 oversight by the commission and the appropriate operating agency;
1-49 (6) to the extent possible, expand Medicaid
1-50 eligibility to include children who are not eligible under indigent
1-51 health care program requirements by using existing sources of
1-52 funding including state funds, earned federal funds, family
1-53 contributions, and other funds that may be available to the state;
1-54 (7) design the system to:
1-55 (A) include methods for ensuring accountability
1-56 to the state for the provision of health care services under the
1-57 state Medicaid program, including methods for financial reporting,
1-58 quality assurance, and utilization review;
1-59 (B) provide a single point of accountability for
1-60 collection of uniform data in order to assess, compile, and analyze
1-61 outcome quality and cost efficiency;
1-62 (C) conduct comparative analysis of compiled
1-63 data to assess the relative value of alternative delivery systems
1-64 and report to the governor, lieutenant governor, and speaker of the
1-65 house of representatives; and
1-66 (D) oversee the methodology for setting
1-67 capitation and provider payment rates to ensure the cost-effective
1-68 provision of quality care;
2-1 (8) ensure that both private and public health care
2-2 providers and health care plans will have an opportunity to
2-3 participate in the system;
2-4 (9) design the system in a manner that enables the
2-5 state:
2-6 (A) to use different types of health care
2-7 delivery systems in different health care service regions,
2-8 including systems such as a primary care case management system,
2-9 partially capitated system, or fully capitated system or a
2-10 combination of one or more of those systems;
2-11 (B) to use different types of health care
2-12 delivery systems to meet the needs of different populations,
2-13 including the establishment of pilot programs to deliver health
2-14 care services to children with special health care needs; and
2-15 (C) to recognize the unique role of rural
2-16 hospitals, physicians, and other rural health care providers in
2-17 providing access to health care services for rural Texans;
2-18 (10) establish geographic health care service regions
2-19 after consulting with local governmental entities that contribute
2-20 resources under this section and emphasize regional coordination in
2-21 the provision of indigent health care;
2-22 (11) simplify eligibility criteria and streamline
2-23 eligibility determination processes;
2-24 (12) to the extent possible, design a system that
2-25 encourages the training of and access to primary care physicians;
2-26 and
2-27 (13) develop and prepare, in conjunction with the
2-28 following entities, the waiver or other documents necessary to
2-29 obtain federal authorization for the health care delivery system
2-30 developed under this section:
2-31 (A) governmental entities that provide health
2-32 care services and assistance to indigent persons in this state;
2-33 (B) consumer representatives;
2-34 (C) health plan providers; and
2-35 (D) health care providers.
2-36 (b) In accordance with this article and other applicable
2-37 state and federal statutes, the commission and each appropriate
2-38 operating agency shall jointly:
2-39 (1) implement a health care delivery system developed
2-40 under this section;
2-41 (2) adopt rules as necessary to carry out the purposes
2-42 of this section; and
2-43 (3) monitor compliance with and take any action the
2-44 commission and operating agency consider appropriate to enforce
2-45 this section and related rules, federal waivers, and orders and
2-46 decisions of the commission or operating agency.
2-47 (c) In this section, "resources" means:
2-48 (1) for an entity listed in Subsection (d)(1), (d)(2),
2-49 (d)(3), (d)(7), (d)(8), or (e) of this section, tax or other public
2-50 revenues spent on indigent health care; and
2-51 (2) for an entity listed in Subsection (d)(4), (d)(5),
2-52 or (d)(6) of this section, charity care as defined by the General
2-53 Appropriations Act provided by that entity to indigent persons.
2-54 (d) If a health care delivery system developed under this
2-55 section includes a method to finance the state Medicaid program by
2-56 obtaining federal matching funds for local and state resources
2-57 spent on indigent health care and if the commission has obtained
2-58 federal authorization to implement the system, the following
2-59 entities, in accordance with final, binding matching funds
2-60 agreements executed by those entities under Subsections (h) and (i)
2-61 of this section, shall make resources available to the commission
2-62 for use in implementing the health care delivery system:
2-63 (1) a hospital district created and established under
2-64 the authority of Sections 4 through 11, Article IX, Texas
2-65 Constitution;
2-66 (2) a hospital authority created and established under
2-67 Chapter 262 or 264, Health and Safety Code;
2-68 (3) a hospital owned and operated by a municipality,
2-69 county, or hospital authority created under Chapter 262 or 264,
2-70 Health and Safety Code;
3-1 (4) a medical school operated by the state;
3-2 (5) a medical school that receives state funds under
3-3 Section 61.093, Education Code;
3-4 (6) a teaching hospital operated by The University of
3-5 Texas System;
3-6 (7) a county that provides health care services and
3-7 assistance to indigent residents of the county under Subchapter B,
3-8 Chapter 61, Health and Safety Code, if the commissioners court of
3-9 the county adopts a resolution requesting that the county
3-10 participate in the health care delivery system; and
3-11 (8) a governmental entity that provides funds to a
3-12 public hospital for the provision of health care services to
3-13 indigent persons under Section 61.062, Health and Safety Code.
3-14 (e) In addition to the entities listed in Subsection (d) of
3-15 this section, an entity described by this subsection may make
3-16 resources available to the commission as provided by this section
3-17 if the clients of the entity and health care services provided by
3-18 the entity are included in the health care delivery system:
3-19 (1) a mental health and mental retardation community
3-20 center located in a county in which a pilot program to integrate
3-21 mental health services into the health care delivery system is
3-22 established;
3-23 (2) a city or county health department; and
3-24 (3) any other governmental entity that provides health
3-25 care services to indigent persons.
3-26 (f) The amount of resources an entity makes available to the
3-27 commission in a fiscal year under Subsection (d) or (e) of this
3-28 section is computed by:
3-29 (1) adding the total amount of resources the entity
3-30 spent on indigent health care during the entity's fiscal year
3-31 ending in 1994; and
3-32 (2) subtracting from the amount computed under
3-33 Subdivision (1) of this subsection the following adjustments:
3-34 (A) the amount of resources the entity spent
3-35 during the entity's fiscal year ending in 1994 on health care
3-36 services provided by the entity or on the entity's behalf to
3-37 indigent persons who would not have been eligible to receive
3-38 services under the eligibility criteria developed under Subsection
3-39 (a)(4)(B) of this section;
3-40 (B) to the extent and while the current Medicaid
3-41 disproportionate share program is continued in this state, the
3-42 estimate of the amount of resources the entity will transfer in
3-43 each fiscal year to the Texas Department of Health under the
3-44 Medicaid disproportionate share program; and
3-45 (C) any other necessary or equitable adjustment.
3-46 (g) The commission and the governing body of an entity that
3-47 makes resources available to the commission under this section may
3-48 agree that the entity may make available to the commission
3-49 resources or other funds in addition to those amounts computed
3-50 under Subsection (f) of this section. The additional resources or
3-51 funds may include an amount that reflects the costs associated with
3-52 the growth in the Medicaid program as estimated in a federal waiver
3-53 application that is required to be submitted to implement the
3-54 health care delivery system. Additional amounts of resources or
3-55 funds made available by an entity under this subsection must be
3-56 contained in the final, binding matching funds agreement executed
3-57 by the entity under Subsections (h) and (i) of this section.
3-58 (h) The commission shall prepare for an entity that makes
3-59 resources available to the commission under this section a proposed
3-60 memorandum of understanding that states the amount of resources and
3-61 other funds the entity will make available to the commission each
3-62 year under Subsections (f) and (g) of this section. The memorandum
3-63 of understanding serves as the basis for the negotiation of a
3-64 final, binding agreement called a "matching funds agreement"
3-65 between the governing body of the entity, the commissioners court,
3-66 if applicable, and the commission. If the entity is a hospital
3-67 district whose tax rate is set by the commissioners court of a
3-68 county in which the hospital district is located, the commissioners
3-69 court must also agree to the amount of resources made available by
3-70 the hospital district under Subsections (f) and (g) of this
4-1 section. The matching funds agreement must be executed before the
4-2 commission implements provisions affecting that entity by
4-3 submitting either a waiver application or a renewal waiver
4-4 application that a federal agency may require to implement the
4-5 health care delivery system.
4-6 (i) A matching funds agreement executed under Subsection (h)
4-7 of this section must include:
4-8 (1) a statement of the amount of resources or other
4-9 funds the entity agrees to make available to the commission under
4-10 Subsections (f) and (g) of this section;
4-11 (2) an estimate of the cost of providing services to
4-12 eligible individuals;
4-13 (3) an estimate of the number of eligible individuals
4-14 served;
4-15 (4) a description of the scope of services to be
4-16 provided to eligible individuals;
4-17 (5) a provision stating that the commission shall
4-18 design the system to ensure that the amount of resources spent by
4-19 each participating entity listed in Subsection (d)(1), (d)(2),
4-20 (d)(3), (d)(7), (d)(8), or (e) of this section to provide Medicaid
4-21 health care services to persons who are eligible for Medicaid as a
4-22 result of the expanded eligibility criteria developed under
4-23 Subsection (a)(4)(B) of this section is at least equal to the
4-24 amount of resources made available to the commission by the entity;
4-25 (6) a provision stating that if the federal Health
4-26 Care Financing Administration and the commission modify the waiver
4-27 application submitted by the commission with respect to financing,
4-28 eligibility criteria, or scope of services, the commission or an
4-29 entity that executes a final matching funds agreement is entitled
4-30 to modify the terms of the agreement; and
4-31 (7) other information the commission requires.
4-32 (j) The commission by rule shall determine the manner in
4-33 which an entity described by Subsections (d) and (e) of this
4-34 section shall make resources available to the commission under this
4-35 section. If an intergovernmental initiative is formed under
4-36 Section 16B of this article, each entity listed under Subsections
4-37 (d) and (e) of this section that participates in the
4-38 intergovernmental initiative shall make its resources available to
4-39 the commission by making its resources available to the
4-40 intergovernmental initiative.
4-41 (k) To the extent of conflict between this section and
4-42 another provision of state law relating to the state Medicaid
4-43 program, this section prevails.
4-44 (l) This section expires September 1, 2001.
4-45 Sec. 16B. INTERGOVERNMENTAL INITIATIVES. (a) If a health
4-46 care delivery system developed under Section 16A of this article
4-47 includes a method to finance the state Medicaid program by
4-48 obtaining federal matching funds for local and state resources
4-49 spent on indigent health care, one or more of the entities listed
4-50 in Sections 16A(d) and (e) of this article that make resources
4-51 available for matching under a matching funds agreement may form an
4-52 intergovernmental initiative to administer the health care delivery
4-53 system in a geographical area, subject to the standards of and
4-54 oversight by the commission and the appropriate operating agency.
4-55 (b) An intergovernmental initiative formed under this
4-56 section may serve more than one county. A county may not be served
4-57 by more than one intergovernmental initiative. The commission with
4-58 the consent of each entity that forms the intergovernmental
4-59 initiative may modify the geographical area the intergovernmental
4-60 initiative serves to:
4-61 (1) promote client access to services and continuity
4-62 of care; and
4-63 (2) move toward full regionalization of the health
4-64 care delivery system.
4-65 (c) An intergovernmental initiative must be formed as:
4-66 (1) a nonprofit corporation under the Texas Non-Profit
4-67 Corporation Act (Article 1396-1.01 et seq., Vernon's Texas Civil
4-68 Statutes); or
4-69 (2) any other nonstock, nonprofit entity that is
4-70 approved by the commission.
5-1 (d) An intergovernmental initiative formed under this
5-2 section is a governmental unit for purposes of Chapter 101, Civil
5-3 Practice and Remedies Code.
5-4 (e)(1) An intergovernmental initiative formed under this
5-5 section shall be governed as provided by this subsection.
5-6 (2) Each intergovernmental initiative has an executive
5-7 committee composed of representatives of each of the entities that
5-8 formed the intergovernmental initiative. The governing board of an
5-9 intergovernmental initiative is composed of the executive committee
5-10 and may include other persons or entities the executive committee
5-11 decides to appoint. The persons or entities appointed to the
5-12 governing board by the executive committee may include:
5-13 (A) representatives of clients of the
5-14 intergovernmental initiative;
5-15 (B) representatives of children's hospitals;
5-16 (C) physicians and other health care providers;
5-17 (D) representatives of nonprofit and for-profit
5-18 hospitals; and
5-19 (E) representatives of licensed managed care
5-20 organizations.
5-21 (3) If more than one entity forms an intergovernmental
5-22 initiative, the entities shall share governance of the executive
5-23 committee of the intergovernmental initiative in proportion to the
5-24 amount of resources they make available for matching under the
5-25 matching funds agreement.
5-26 (4) Representation on the governing board and the
5-27 manner in which votes are apportioned among members of the
5-28 governing board who are not members of the executive committee must
5-29 be based primarily on the relative level of Medicaid and charity
5-30 care services, as defined by Section 311.031, Health and Safety
5-31 Code, provided by those nonexecutive committee members of the
5-32 governing board over the previous two years. The executive
5-33 committee must have at least 51 percent of the voting rights on the
5-34 governing board. The votes of the executive committee must be
5-35 apportioned in the manner described by Subdivision (3) of this
5-36 subsection.
5-37 (5) The executive committee of an intergovernmental
5-38 initiative has exclusive authority to manage the public funds of
5-39 the intergovernmental initiative, including the authority to spend
5-40 those funds. The governing board of an intergovernmental
5-41 initiative shall address health care delivery system issues for the
5-42 intergovernmental initiative, including the preparation and
5-43 negotiation of the proposed health care delivery plan for the
5-44 intergovernmental initiative under Subsection (i) of this section.
5-45 (6) If an intergovernmental initiative formed under
5-46 this section includes a hospital district whose tax rate is set by
5-47 the commissioners court of a county in the hospital district, the
5-48 commissioners court of that county must also agree to the structure
5-49 of governance of the intergovernmental initiative.
5-50 (f) An intergovernmental initiative formed under this
5-51 section shall:
5-52 (1) administer the health care delivery system
5-53 developed under Section 16A of this article in the geographical
5-54 area described by the plan agreement of the intergovernmental
5-55 initiative under this section subject to standards and oversight
5-56 contained in:
5-57 (A) applicable state and federal statutes and
5-58 rules;
5-59 (B) federal waivers or other authorizations
5-60 required to implement the health care delivery system; and
5-61 (C) the plan agreement executed under this
5-62 section by the entities forming the intergovernmental initiative;
5-63 (2) perform the functions in administering the health
5-64 care delivery system that are prescribed by the plan agreement
5-65 executed by the entities forming the intergovernmental initiative
5-66 and the appropriate operating agency; and
5-67 (3) make supplemental payments as necessary to satisfy
5-68 the requirement in Section 16A(h) of this article and Subsection
5-69 (l)(8) of this section that the entities receive payments at least
5-70 equal to the resources the entities made available to the
6-1 commission.
6-2 (g) An intergovernmental initiative formed under this
6-3 section may contract with any public or private entity to perform
6-4 any of the intergovernmental initiative's powers or duties. The
6-5 entities that form the intergovernmental initiative may contract,
6-6 collaborate, or enter into a joint venture with other entities as
6-7 necessary or appropriate to form or carry out the functions of or
6-8 provide services to the intergovernmental initiative.
6-9 (h) Not later than the 60th day after the date on which the
6-10 commission submits to the federal government an application for a
6-11 waiver or other authorization required to implement the health care
6-12 delivery system developed under Section 16A of this article, the
6-13 entities listed in Sections 16A(d) and (e) of this article that
6-14 intend to form an intergovernmental initiative shall submit to the
6-15 commission a letter of intent to form the intergovernmental
6-16 initiative. The letter of intent must include any information
6-17 required by the commission, including at a minimum the names and
6-18 addresses of the entities that intend to participate in the
6-19 intergovernmental initiative and the geographical area to be served
6-20 by the intergovernmental initiative. The letter of intent is not
6-21 binding on the entities or the commission and only serves to inform
6-22 the commission of the areas of the state that intend to be part of
6-23 an intergovernmental initiative.
6-24 (i) Within the time specified by the appropriate operating
6-25 agency after approval of any waiver or federal authorization
6-26 required to implement the health care delivery system developed
6-27 under Section 16A of this article, the entities that have submitted
6-28 a letter of intent to form an intergovernmental initiative under
6-29 this section shall submit to the appropriate operating agency a
6-30 proposed health care delivery plan that contains the information
6-31 required by the operating agency. The proposed health care
6-32 delivery plan is not binding on the entities or the operating
6-33 agency but only serves as the basis for negotiation of a final,
6-34 binding plan agreement between the entities and the operating
6-35 agency. The operating agency by rule shall set a reasonable date
6-36 by which the entities must submit and negotiate the proposed health
6-37 care delivery plan. The date must be based on the schedule
6-38 developed for phasing in the health care delivery system statewide.
6-39 (j) The commission or the commission's designated
6-40 representative must approve the plan agreement, the structure of
6-41 the governing board, and the service area of an intergovernmental
6-42 initiative before the intergovernmental initiative can administer
6-43 the health care delivery system in accordance with the plan
6-44 agreement.
6-45 (k) The appropriate operating agency shall implement the
6-46 health care delivery system in accordance with an approved waiver
6-47 in a geographical area for which the commission does not receive a
6-48 letter of intent and that is not covered by a plan agreement that
6-49 has become final and binding by the date specified by the operating
6-50 agency under Subsection (i) of this section.
6-51 (l) The appropriate operating agency by rule shall develop a
6-52 model plan agreement to establish the minimum requirements for a
6-53 health care delivery plan under a plan agreement developed and
6-54 implemented by an intergovernmental initiative under this section.
6-55 In adopting rules under this section, the operating agency shall
6-56 ensure that an intergovernmental initiative:
6-57 (1) seeks public input regarding the development and
6-58 provisions of the health care delivery plan of the
6-59 intergovernmental initiative;
6-60 (2) to the extent payments to the intergovernmental
6-61 initiative are made on a capitated basis, receives payments that
6-62 reflect the geographic, risk-adjusted cost of providing care to
6-63 persons eligible for Medicaid;
6-64 (3) develops a sufficient provider network to ensure
6-65 adequate access to quality health care services consistent with the
6-66 applicable waiver and any standards prescribed by the federal
6-67 Health Care Financing Administration, commission, or operating
6-68 agency, including standards relating to travel time and distance
6-69 that are designed to ensure access by patients to providers in
6-70 their own communities;
7-1 (4) develops and administers policies regarding
7-2 financial management, quality assurance, utilization review, and
7-3 patient access by the intergovernmental initiative, and the plans
7-4 or providers with which the intergovernmental initiative contracts,
7-5 in accordance with standards consistent with the applicable waiver
7-6 and any standards prescribed by the federal Health Care Financing
7-7 Administration, commission, or operating agency;
7-8 (5) includes in the plan agreement of the
7-9 intergovernmental initiative provisions relating to participation
7-10 of public and private health care plans and providers in the health
7-11 care delivery system in accordance with standards established by
7-12 the operating agency, including provisions relating to:
7-13 (A) a methodology within a region for selection
7-14 of participating health care plans and providers, which methodology
7-15 shall provide added weight for additional services of value to the
7-16 state such as trauma, Level I emergency services, neonatal
7-17 intensive care, medical education, or other specialty services; and
7-18 (B) a methodology within a region for
7-19 establishing capitation rates and provider payment rates, which
7-20 rates may be supplemented in exchange for the provision of
7-21 specified additional services;
7-22 (6) maintains adequate stop-loss coverage of the
7-23 intergovernmental initiative or any health care plans under
7-24 contract with the intergovernmental initiative, including
7-25 provisions to ensure that adequate stop-loss coverage is available;
7-26 (7) in accordance with any waiver application approval
7-27 or other federal authorization to implement the health care
7-28 delivery system, includes in the plan agreement adequate
7-29 provisions, as appropriate to the area served by the
7-30 intergovernmental initiative, for phasing in implementation of the
7-31 health care delivery system, which may include provisions that
7-32 include methods, such as reserve funds, for phasing
7-33 disproportionate share funds into the Medicaid program;
7-34 (8) includes in the plan agreement adequate provisions
7-35 to ensure that the amount of resources spent by each participating
7-36 entity listed in Section 16A(d)(1), (d)(2), (d)(3), (d)(7), (d)(8),
7-37 or (e) of this article for Medicaid health care services provided
7-38 to persons who are eligible for Medicaid as a result of the
7-39 expanded eligibility criteria developed under Section 16A(a)(4)(B)
7-40 of this article is at least equal to the amount of resources made
7-41 available to the commission by the entity;
7-42 (9) provides notice to health care providers of the
7-43 procedures used by the intergovernmental initiative or any health
7-44 care plans under contract with the intergovernmental initiative to
7-45 solicit bids for the delivery of services by health care providers;
7-46 (10) includes in the plan agreement grievance and
7-47 appeal procedures for persons who are denied services or have a
7-48 complaint regarding the quality of services under the health care
7-49 delivery plan; and
7-50 (11) includes in the plan agreement appeal procedures
7-51 for health care providers who are denied participation in the
7-52 health care delivery plan.
7-53 (m) The plan agreement for an intergovernmental initiative
7-54 must be completed before the appropriate operating agency
7-55 implements an approved waiver within the area covered by the
7-56 intergovernmental initiative. If an approved waiver is terminated,
7-57 both the intergovernmental initiative and the operating agency may
7-58 terminate the plan agreement. If the waiver is modified in a way
7-59 that affects the provision of services in the area covered by the
7-60 plan agreement, the intergovernmental initiative or the appropriate
7-61 operating agency may renegotiate the plan agreement.
7-62 (n) If an intergovernmental initiative formed under this
7-63 section includes a hospital district whose tax rate is set by the
7-64 commissioners court of a county in the hospital district, the
7-65 intergovernmental initiative shall file the plan agreement with the
7-66 commissioners court. The plan agreement is considered approved by
7-67 the commissioners court on the 30th day after the date on which the
7-68 intergovernmental initiative files the agreement unless the
7-69 commissioners court adopts a resolution rejecting the plan
7-70 agreement. The commissioners court may adopt a resolution to
8-1 delegate the authority to reject the plan agreement to the board of
8-2 directors of the hospital district.
8-3 (o) To the extent of conflict between this section and
8-4 another provision of state law relating to the state Medicaid
8-5 program, this section prevails.
8-6 (p) This section expires September 1, 2001.
8-7 SECTION 2. Section 1, Article 4413(502), Revised Statutes,
8-8 is amended by adding Subdivision (3) to read as follows:
8-9 (3) "Operating agency" means a health and human
8-10 services agency that administers a part of the state Medicaid
8-11 program.
8-12 SECTION 3. Chapter 285, Health and Safety Code, is amended
8-13 by adding Subchapter H to read as follows:
8-14 SUBCHAPTER H. CONTRACTS, COLLABORATIONS, AND JOINT VENTURES
8-15 Sec. 285.091. HOSPITAL DISTRICT CONTRACTS, COLLABORATIONS,
8-16 AND JOINT VENTURES. A hospital district created under general or
8-17 special law may contract, collaborate, or enter into a joint
8-18 venture with any public or private entity as necessary to form or
8-19 carry out the functions of or provide services to an
8-20 intergovernmental initiative under Section 16B, Article 4413(502),
8-21 Revised Statutes.
8-22 SECTION 4. The Health and Human Services Commission or a
8-23 health and human services agency that administers a part of the
8-24 state Medicaid program may not implement Sections 16A and 16B,
8-25 Article 4413(502), Revised Statutes, as added by this Act, unless
8-26 the commission has obtained a waiver or other authorization from
8-27 all necessary federal agencies to implement those provisions. Not
8-28 later than July 31, 1995, the commission shall submit to the
8-29 federal government the waiver or other authorizations required to
8-30 develop or implement the health care delivery system.
8-31 SECTION 5. (a) If a federal waiver or other authorization
8-32 is not obtained from all necessary federal agencies to implement
8-33 the health care delivery system developed under Section 16A,
8-34 Article 4413(502), Revised Statutes, as added by this Act, the
8-35 Texas Department of Health shall continue to establish additional
8-36 Medicaid managed care pilot programs statewide to decrease the cost
8-37 to the state of providing Medicaid services while improving access
8-38 to health care services for Medicaid recipients. The Texas
8-39 Department of Health shall begin the process of establishing
8-40 additional Medicaid managed care pilot programs not later than the
8-41 date on which the Health and Human Services Commission submits the
8-42 waiver application to the federal government.
8-43 (b) The Texas Department of Health may contract with public
8-44 or private entities as necessary for the department to perform its
8-45 functions under this section.
8-46 SECTION 6. The importance of this legislation and the
8-47 crowded condition of the calendars in both houses create an
8-48 emergency and an imperative public necessity that the
8-49 constitutional rule requiring bills to be read on three several
8-50 days in each house be suspended, and this rule is hereby suspended,
8-51 and that this Act take effect and be in force from and after its
8-52 passage, and it is so enacted.
8-53 * * * * *