SRC-JBJ C.S.H.B. 1194 76(R)BILL ANALYSIS


Senate Research CenterC.S.H.B. 1194
76R11093 AJA-DBy: Turner, Bob (Fraser)
Economic Development
5/12/1999
Committee Report (Substituted)


DIGEST 

The 75th Texas Legislature enacted legislation creating the statewide rural
health care system.  This system provided rural communities an alternative
to urban-based health maintenance organizations now operating in rural
Texas.  To improve the implementation of the system, changes could be made
as to the designation of rural areas and the regulation of care on a
prepaid basis.  C.S.H.B. 1194 would amend regulation of a statewide rural
health care system. 

PURPOSE

As proposed, C.S.H.B. 1194 amends regulation of a statewide rural health
care system. 

RULEMAKING AUTHORITY

This bill does not grant any additional rulemaking authority to a state
officer, institution, or agency. 

SECTION BY SECTION ANALYSIS

SECTION 1. (a) GOALS OF SYSTEM.  Designates the statewide rural health care
system to incorporate consumer-oriented attributes considered imported to a
successful health care organization.  Specifies the attributes of a
successful health care organization. 

(b)  PATIENT RIGHTS POLICIES.  Sets forth patient-focused considerations
that the statewide rural health care system (system) is intended to
incorporate. 

(c)  PATIENT-PHYSICIAN RELATIONSHIP.  Sets forth assurances the system
intends to preserve regarding significant, traditional, and ethical
relationships between a patient and the patient's health care provider. 

(d)  PUBLIC HEALTH AND PREVENTION.  Intends the system to use incentives to
promote healthy communities and individuals by using a public health model
that focuses on certain health aspects. 

(e)  CREDENTIALS AND PEER REVIEW.  Intends the system to focus on processes
for obtaining credentials and performing peer review that consider the
rural communities and that track processes required under federal and state
law, to ensure that enrollees receive quality health care.  Intends local
physicians and hospitals to retain responsibility for these purposes that
are not intended to exclude otherwise qualified practitioners from
participation. 

(f)  QUALITY IMPROVEMENT AND MANAGEMENT.  Intends the system to utilize
standard guidelines established by the National Committee on Quality
Assurance and other recognized accrediting organizations to ensure that the
program achieves certain objectives and to emphasize establishing certain
benchmarks. 

SECTION 2.  Amends Article 20C.02, Insurance Code, to redefine "rural
area." Requires the commissioner of insurance (commissioner) to consider
certain criteria of an urbanized areas in designating rural areas. 

SECTION 3.  Amends Article 20C.03, Insurance Code, to provide that the
system is established to  provide health care services, rather than to
provide health care services on a prepaid basis, to enrollees who reside in
rural areas. 

SECTION 4.  Amends Article 20C.04, Insurance Code, to require the system to
obtain a certificate of authority, if the system arranges for or provides
health care services to enrollees in exchange for a predetermined payment
per enrollee on a prepaid basis.  Deletes a requirement that makes a system
eligible for designation.  Authorizes the commissioner to provide, by rule,
exceptions to the application of provisions of Chapter 20A, V.T.I.S. (Texas
Health Maintenance Organization Act), relating to mileage, distance, and
network adequacy and scope.  Makes conforming changes. 

SECTION 5.  Amends Article 20C.07(a), Insurance Code, to provide that
members of the statewide rural health care system (board) serve terms that
expire December 1 of each even-numbered year, rather than February 1 of
each odd-numbered year. 

SECTION 6.  Amends Article 20C.08(f), Insurance Code, to authorize, rather
than require, the board to appoint an advisory committee to represent
certain health care services.  Sets forth meeting requirements for the
board.  Deletes composition requirements of the board. 

SECTION 7.  Amends Article 20C.14, Insurance Code, as follows:

Art. 20C.14.  New heading:  MANDATED PROVIDER.  Provides that the system
operates under certificate of authority of the Texas Health Maintenance
Organization Act in regards to certain Medicaid reimbursements.  Deletes
provisions that make this article inapplicable to certain contracts.  Makes
conforming changes. 

SECTION 8. Effective date: September 1, 1999.
  Makes application of this Act prospective.

SECTION 9.Emergency clause.