1-1 By: Hunter, et al. (Senate Sponsor - Zaffirini) H.B. No. 2984
1-2 (In the Senate - Received from the House May 5, 1997;
1-3 May 6, 1997, read first time and referred to Committee on Health
1-4 and Human Services; May 18, 1997, reported favorably, as amended,
1-5 by the following vote: Yeas 8, Nays 0; May 18, 1997, sent to
1-6 printer.)
1-7 COMMITTEE AMENDMENT NO. 1 By: Zaffirini
1-8 Amend H.B. No. 2984 by striking SECTION 3 of the bill and
1-9 substituting the following:
1-10 SECTION 3. This Act takes effect September 1, 1997, but only
1-11 if the 75th Legislature appropriates money to fund the pilot
1-12 program to assist medically fragile children and their families as
1-13 required by Section 35.015, Health and Safety Code, as added by
1-14 this Act. The Texas Board of Health shall select an entity to run
1-15 the pilot program required under Section 35.017, Health and Safety
1-16 Code, as added by this Act, not later than January 1, 1998.
1-17 A BILL TO BE ENTITLED
1-18 AN ACT
1-19 relating to the establishment of a pilot program regarding the
1-20 care, rehabilitation, and education of medically fragile children
1-21 and their families.
1-22 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-23 SECTION 1. Chapter 35, Health and Safety Code, is amended by
1-24 adding Sections 35.014-35.019 to read as follows:
1-25 Sec. 35.014. CARE OF MEDICALLY FRAGILE CHILDREN; POLICY.
1-26 The legislature recognizes the expanding demographics of the
1-27 chronically ill children of this state and that the number of
1-28 children in need of long-term and short-term medical care is
1-29 expected to continue to increase at a potentially great cost to
1-30 this state. The legislature recognizes that care for those
1-31 children provided jointly in private regional and community
1-32 settings is preferred and that significant savings to the state in
1-33 medical care, education, and public assistance can be achieved
1-34 through competent programs that recognize that social and cultural
1-35 needs must be both community-based and family-centered. The
1-36 legislature finds that the issues regarding care for those children
1-37 are complex and varied and that there is a general need to study
1-38 and research these matters and develop a rational legislative and
1-39 executive response to the growing demand for a comprehensive,
1-40 cost-efficient, long-term care system. The policy of this state is
1-41 to develop and maintain a cost-efficient, quality system to provide
1-42 care, continuity, maintenance, rehabilitation, and education for
1-43 chronically ill and disabled children and their families. The
1-44 legislature recognizes that the development of that care poses
1-45 unique challenges for the health care system of this state.
1-46 Therefore, the legislature finds that the state should study and
1-47 research the unique health care, maintenance, education, social,
1-48 and related needs of medically fragile children and their families.
1-49 Sec. 35.015. PILOT PROGRAM. The board shall establish a
1-50 pilot program to study and research the unique health care,
1-51 maintenance, education, social, and related needs of medically
1-52 fragile children and their families in this state. The board shall
1-53 select a nonprofit private entity to operate the pilot program.
1-54 The board may provide the entity that operates the pilot program a
1-55 grant in an amount not to exceed $400,000 during each fiscal year
1-56 to cover the costs of operating the program.
1-57 Sec. 35.016. PROGRAM CRITERIA. The board shall require the
1-58 pilot program study to include:
1-59 (1) specialized case management involving
1-60 24-hour-a-day availability for family support and information
1-61 relating to the specialized needs of medically fragile children,
1-62 including educational assistance, referrals to service providers,
1-63 assistance with educational issues, skilled nursing care, and
1-64 continuity of care in overall coordination with service providers;
2-1 (2) parent mentor programs to educate and assist
2-2 parents of medically fragile children;
2-3 (3) support services for clients, siblings, and
2-4 parents, including individual, group, and family therapy;
2-5 (4) respite services that emphasize family involvement
2-6 and support, including temporary child supervisory services for
2-7 parents of medically fragile children and their healthy siblings;
2-8 (5) a resource library that includes information in
2-9 printed form and computer resources;
2-10 (6) medically supervised day care that recognizes the
2-11 need to reduce or make more efficient the state's financial
2-12 Medicaid support, while ensuring quality of life through
2-13 socialization and inclusion of medically fragile children in a
2-14 healthy and stable environment;
2-15 (7) pediatric home nursing, to recognize long-term
2-16 stability and cost reductions; and
2-17 (8) other criteria that the board finds in the public
2-18 interest.
2-19 Sec. 35.017. SELECTION. In selecting an entity to operate
2-20 the pilot program, the board shall consider the extent to which an
2-21 entity:
2-22 (1) demonstrates the immediate ability to provide the
2-23 services listed in Section 35.016 in a cost-efficient manner;
2-24 (2) is able to provide services on a regional basis,
2-25 including the ability to address the needs of medically fragile
2-26 children and their families in surrounding rural areas; and
2-27 (3) has a demonstrated record showing its ability to
2-28 meet the criteria specified in Section 35.016.
2-29 Sec. 35.018. TERM; REPORT AND REVIEW. (a) The selection of
2-30 an entity to operate the pilot program is effective until the fifth
2-31 anniversary of the selection date.
2-32 (b) The board shall monitor and review the pilot program and
2-33 deliver a report on the program to the Sunset Advisory Commission
2-34 on or before February 1, 2000. In its report, the board shall:
2-35 (1) address the medical, social, educational, and
2-36 cultural benefits of the program to the state's medically fragile
2-37 children and their families;
2-38 (2) review the overall cost savings to the state of
2-39 the program, including intangible savings and benefits involving
2-40 any general welfare reform measures such as the return of parents
2-41 of medically fragile children to the workplace and cost savings at
2-42 the local level to affected activities of counties, municipalities,
2-43 educational institutions, and other governmental entities; and
2-44 (3) provide recommendations regarding the future of
2-45 the program, including its continuation, modification, expansion
2-46 through replicability, or limitation.
2-47 (c) The Sunset Advisory Commission shall review the report
2-48 submitted by the board and include any appropriate recommendations
2-49 regarding the pilot program in its report to the 77th Legislature.
2-50 Sec. 35.019. RULES. The board may adopt rules to implement
2-51 this section and to obtain the necessary reports and records to
2-52 fulfill its monitoring and reporting requirement to the Sunset
2-53 Advisory Commission and the legislature.
2-54 SECTION 2. Section 35.002, Health and Safety Code, is
2-55 amended by adding a new Subdivision (9) and renumbering
2-56 Subdivisions (9)-(16) as Subdivisions (10)-(17) to read as follows:
2-57 (9) "Medically fragile child" means a person younger
2-58 than 21 years of age who is:
2-59 (A) chronically ill or disabled and requires
2-60 indefinite skilled nursing care to maintain the person's existence
2-61 in the person's home;
2-62 (B) temporarily ill or disabled because of
2-63 premature birth, accident, or trauma and has experienced a
2-64 temporary lifestyle change requiring skilled nursing care;
2-65 (C) suffering from uncontrollable seizures,
2-66 diabetes, asthma, or other chronic illness; or
2-67 (D) chronically dependent on medical devices to
2-68 perform vital bodily functions.
2-69 (10) [(9)] "Other benefit" means a benefit, other than
3-1 a benefit provided under this chapter, to which a person is
3-2 entitled for payment of the costs of services provided under the
3-3 program, including benefits available from:
3-4 (A) an insurance policy, group health plan,
3-5 health maintenance organization, or prepaid medical or dental care
3-6 plan;
3-7 (B) Title XVIII or Title XIX of the Social
3-8 Security Act (42 U.S.C. Sections 1395 et seq. and 1396 et seq.);
3-9 (C) the Veterans Administration;
3-10 (D) the Civilian Health and Medical Program of
3-11 the Uniformed Services;
3-12 (E) workers' compensation or any other
3-13 compulsory employers' insurance program;
3-14 (F) a public program created by federal or state
3-15 law or the ordinances or rules of a municipality or other political
3-16 subdivision of the state, excluding benefits created by the
3-17 establishment of a municipal or county hospital, a joint
3-18 municipal-county hospital, a county hospital authority, a hospital
3-19 district, or the facilities of a publicly supported medical school;
3-20 or
3-21 (G) a cause of action for the cost of care,
3-22 including medical care, dental care, facility care, and medical
3-23 supplies, required for a person applying for or receiving services
3-24 from the department, or a settlement or judgment based on the cause
3-25 of action, if the expenses are related to the need for services
3-26 provided under this chapter.
3-27 (11) [(10)] "Physician" means a person licensed by the
3-28 Texas State Board of Medical Examiners to practice medicine in this
3-29 state.
3-30 (12) [(11)] "Program" means the chronically ill and
3-31 disabled children's services program.
3-32 (13) [(12)] "Provider" means a person who delivers
3-33 services purchased by the department for the purposes of this
3-34 chapter.
3-35 (14) [(13)] "Rehabilitation services" means the
3-36 process of the physical restoration of a body function destroyed or
3-37 impaired by congenital defect, disease, or injury, and includes:
3-38 (A) facility care, medical and dental care,
3-39 optometric care, and occupational and physical therapy;
3-40 (B) the provision of braces, artificial
3-41 appliances, durable medical equipment, and other medical supplies;
3-42 and
3-43 (C) other types of care specified by the board
3-44 in the program rules.
3-45 (15) [(14)] "Services" means the care, activities, and
3-46 supplies provided under this chapter or program rules, including
3-47 medical care, dental care, facility care, medical supplies,
3-48 occupational and physical therapy, and other care specified by
3-49 program rules.
3-50 (16) [(15)] "Specialty center" means a facility and
3-51 staff that meets minimum standards established under the program
3-52 and is designated by the board for program use in the comprehensive
3-53 diagnostic and treatment services for a specific medical condition.
3-54 (17) [(16)] "Support" means to contribute money or
3-55 services necessary for a person's maintenance, including food,
3-56 clothing, shelter, transportation, and health care.
3-57 SECTION 3. This Act takes effect September 1, 1997. The
3-58 Texas Board of Health shall select an entity to run the pilot
3-59 program to assist medically fragile children and their families as
3-60 required under Section 35.017, Health and Safety Code, as added by
3-61 this Act, not later than January 1, 1998.
3-62 SECTION 4. The importance of this legislation and the
3-63 crowded condition of the calendars in both houses create an
3-64 emergency and an imperative public necessity that the
3-65 constitutional rule requiring bills to be read on three several
3-66 days in each house be suspended, and this rule is hereby suspended.
3-67 * * * * *