By: Patterson S.B. No. 276
A BILL TO BE ENTITLED
AN ACT
1-1 relating to organizational and health maintenance organization
1-2 requirements for community centers to provide certain services
1-3 under capitation and other at-risk agreements in plans approved by
1-4 the Texas Department of Mental Health and Mental Retardation.
1-5 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-6 SECTION 1. Chapter 534, Health and Safety Code, is amended
1-7 by adding Subchapter C to read as follows:
1-8 SUBCHAPTER C. HEALTH MAINTENANCE ORGANIZATIONS
1-9 Sec. 534.101. HEALTH MAINTENANCE ORGANIZATION CERTIFICATE OF
1-10 AUTHORITY. (a) One or more community centers may create or
1-11 operate a nonprofit corporation pursuant to the laws of this state
1-12 for the purpose of accepting capitated or other at-risk payment
1-13 arrangements for the provision of services designated in a plan
1-14 approved by the department under Subchapter A.
1-15 (b) Before a nonprofit corporation organized or operating
1-16 under Subsection (a) accepts or enters into any capitated or other
1-17 at-risk payment arrangement for services designated in a plan
1-18 approved by the department under Subchapter A, the nonprofit
1-19 corporation must obtain the appropriate certificate of authority
1-20 from the Texas Department of Insurance to operate as a health
1-21 maintenance organization pursuant to the Texas Health Maintenance
1-22 Organization Act (Chapter 20A, Vernon's Texas Insurance Code).
1-23 (c)(1) Prior to submitting any bids, a nonprofit corporation
2-1 operating under this subchapter shall disclose in writing to the
2-2 department those services to be provided by the community center
2-3 through any capitated or other at-risk payment arrangement by the
2-4 nonprofit corporation. The department shall verify that the
2-5 services provided under any capitated or other at-risk payment
2-6 arrangement are within the scope of services approved by the
2-7 department in each community center's plan required under
2-8 Subchapter A.
2-9 (2) The board shall:
2-10 (A) provide for public notice of the nonprofit
2-11 corporation's intent to submit a bid to provide or arrange services
2-12 through a capitated or other at-risk payment arrangement through
2-13 placement as a board agenda item on the next regularly scheduled
2-14 board meeting which allows at least 15 days' public review of the
2-15 plan; and
2-16 (B) provide an opportunity for public comment on
2-17 the services to be provided through such arrangements and on the
2-18 consideration of local input into the plan.
2-19 (3) The nonprofit corporation shall provide:
2-20 (A) public notice prior to such verification and
2-21 disclosure of services to be provided by the community center
2-22 through any capitated or other at-risk payment arrangements by the
2-23 nonprofit corporation;
2-24 (B) an opportunity for public comment on the
2-25 community center services within the capitated or other at-risk
3-1 payment arrangements offered by the nonprofit corporation;
3-2 (C) published summaries of all relevant
3-3 documentation concerning community center services arranged through
3-4 the nonprofit corporation, including summaries of any other similar
3-5 contracts the nonprofit corporation has entered into; and
3-6 (D) public access and review of all relevant
3-7 documentation.
3-8 (d) A nonprofit corporation operating under this subchapter
3-9 shall:
3-10 (1) be subject to the requirements of the open
3-11 meetings law, Chapter 551, Government Code, and the open records
3-12 law, Chapter 552, Government Code;
3-13 (2) solicit public input as to the operations of the
3-14 nonprofit corporation and allow public access to information
3-15 regarding such operations, including services, administration,
3-16 governance, revenues, and expenses, on request unless disclosure is
3-17 expressly prohibited by law or the information is confidential
3-18 under law; and
3-19 (3) publish an annual report detailing the services,
3-20 administration, governance, revenues, and expenses of the nonprofit
3-21 corporation, including the disposition of any excess revenues.
3-22 Sec. 534.102. LAWS AND RULES. A nonprofit corporation
3-23 created or operated pursuant to the authority of this subchapter
3-24 which obtains and holds a valid certificate of authority as a
3-25 health maintenance organization may exercise the powers and
4-1 authority and is subject to the conditions and limitations provided
4-2 by this subchapter, the Texas Health Maintenance Organization Act
4-3 (Chapter 20A, Vernon's Texas Insurance Code), the Texas Non-Profit
4-4 Corporation Act (Article 1396-1.01, et seq., Vernon's Texas Civil
4-5 Statutes), and rules of the Texas Department of Insurance.
4-6 Sec. 534.103. APPLICATION OF LAWS AND RULES. A health
4-7 maintenance organization created and operating under this
4-8 subchapter shall be governed as, and is subject to the same laws
4-9 and rules of the Texas Department of Insurance as, any other health
4-10 maintenance organization of the same type.
4-11 Sec. 534.104. APPLICATION OF SPECIFIC LAWS. (a) A health
4-12 maintenance organization created and operating under this
4-13 subchapter is a governmental unit and a unit of local government,
4-14 as those terms are defined and specified by Chapters 101 and 102,
4-15 Civil Practice and Remedies Code, and a local government as defined
4-16 by Section 791.003, Government Code.
4-17 (b) Nothing in this subchapter precludes one or more
4-18 community centers from forming a nonprofit corporation under
4-19 Section 5.01, Medical Practice Act (Article 4495b, Vernon's Texas
4-20 Civil Statutes), to provide services on a risk-sharing or capitated
4-21 basis as permitted under Article 21.52F, Insurance Code.
4-22 SECTION 2. The Texas Department of Insurance shall adopt
4-23 rules by September 1, 1997, which describe the procedures an entity
4-24 must follow and the standards an entity must meet to obtain a
4-25 certificate of authority as a single health care service plan
5-1 providing behavioral health care services.
5-2 SECTION 3. This Act takes effect September 1, 1997.
5-3 SECTION 4. The importance of this legislation and the
5-4 crowded condition of the calendars in both houses create an
5-5 emergency and an imperative public necessity that the
5-6 constitutional rule requiring bills to be read on three several
5-7 days in each house be suspended, and this rule is hereby suspended.