76R10430 AJA-F
By Turner of Coleman, Glaze, Cook H.B. No. 1194
Substitute the following for H.B. No. 1194:
By Lewis of Tarrant C.S.H.B. No. 1194
A BILL TO BE ENTITLED
1-1 AN ACT
1-2 relating to the operation of a statewide rural health care system.
1-3 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-4 SECTION 1. Article 20C.02, Insurance Code, is amended to
1-5 read as follows:
1-6 Art. 20C.02. DEFINITIONS. (a) In this chapter:
1-7 (1) "Board" means the board of directors of the
1-8 system.
1-9 (2) "Enrollee" means an individual entitled to receive
1-10 health care services through a health care plan arranged for or
1-11 provided by the system.
1-12 (3) "Health care services" has the meaning assigned by
1-13 Section 2, Texas Health Maintenance Organization Act (Article
1-14 20A.02, Vernon's Texas Insurance Code).
1-15 (4) "Hospital provider" means a county hospital,
1-16 county hospital authority, hospital district, municipal hospital,
1-17 or municipal hospital authority.
1-18 (5) "Local health care provider" means:
1-19 (A) a person licensed, registered, or certified
1-20 as a health care practitioner in this state who resides in or
1-21 practices in a rural area in which the person provides health care
1-22 services; or
1-23 (B) a general or specialty hospital that is not
1-24 a hospital provider under this chapter.
2-1 (6) "Participating provider" means a hospital provider
2-2 that participates in the system.
2-3 (7) "Person" means an individual, professional
2-4 association, professional corporation, partnership, limited
2-5 liability corporation, limited liability partnership, or nonprofit
2-6 corporation, including a nonprofit corporation created under
2-7 Section 5.01(a), Medical Practice Act (Article 4495b, Vernon's
2-8 Texas Civil Statutes).
2-9 (8) "Rural area" means:
2-10 (A) a county with a population of 50,000 or
2-11 less;
2-12 (B) an area that is not delineated as an
2-13 urbanized area by the federal census bureau; or
2-14 (C) any other area designated as rural by rules
2-15 adopted by the commissioner, subject to Subsection (b) of this
2-16 article.
2-17 (9) "System" means the statewide rural health care
2-18 system established by this chapter.
2-19 (10) "Territorial jurisdiction" means the geographical
2-20 area in which a participating provider is obligated by law to
2-21 provide health care services.
2-22 (b) In designating rural areas under Subsection (a)(8) of
2-23 this article, the commissioner shall consider any area:
2-24 (1) in which appropriate emergency, acute, specialty,
2-25 or primary care services are limited or unavailable and could be
2-26 made more accessible through contracting with the system or a
2-27 participating community health network; or
3-1 (2) the demographics of which indicate a high
3-2 population of aged, at-risk, or low-income persons, including
3-3 persons with serious mental illness or serious emotional
3-4 disturbance, whose needs would be better served by allowing access
3-5 to care in a contiguous area that is eligible to participate in the
3-6 system.
3-7 SECTION 2. Article 20C.03, Insurance Code, is amended to
3-8 read as follows:
3-9 Art. 20C.03. ESTABLISHMENT OF SYSTEM. The statewide rural
3-10 health care system is established to arrange for or provide health
3-11 care services [on a prepaid basis] to enrollees who reside in rural
3-12 areas.
3-13 SECTION 3. Article 20C.04, Insurance Code, is amended to
3-14 read as follows:
3-15 Art. 20C.04. DESIGNATION AS SYSTEM; QUALIFICATIONS. (a)
3-16 The commissioner shall designate as the system one organization
3-17 created under Article 20C.05 of this code.
3-18 (b) Except as provided by Subsection (c)[(b)] of this
3-19 article, if the system arranges for or provides health care
3-20 services to enrollees in exchange for a predetermined payment per
3-21 enrollee on a prepaid basis, the system must obtain a certificate
3-22 of authority under, and [to be eligible for designation as the
3-23 system, the organization must] meet each requirement imposed by,
3-24 the Texas Health Maintenance Organization Act (Chapter 20A,
3-25 Vernon's Texas Insurance Code), as if the organization were a
3-26 person under the Act.
3-27 (c) If the system seeks a certificate of authority under the
4-1 Texas Health Maintenance Organization Act (Chapter 20A, Vernon's
4-2 Texas Insurance Code), the commissioner by rule may provide
4-3 exceptions to the application of provisions of the Texas Health
4-4 Maintenance Organization Act (Chapter 20A, Vernon's Texas Insurance
4-5 Code) relating to mileage, distance, and network adequacy and
4-6 scope.
4-7 (d) If the system seeks a certificate of authority under the
4-8 Texas Health Maintenance Organization Act (Chapter 20A, Vernon's
4-9 Texas Insurance Code), the [(b) The] system shall meet all reserve
4-10 requirements required by the commissioner under the Texas Health
4-11 Maintenance Organization Act (Chapter 20A, Vernon's Texas Insurance
4-12 Code). The system may fulfill the requirements of this subsection
4-13 through the purchase of reinsurance from insurance companies
4-14 approved for that purpose by the commissioner.
4-15 SECTION 4. Article 20C.07(a), Insurance Code, is amended to
4-16 read as follows:
4-17 (a) The members of the board serve staggered six-year terms,
4-18 with the terms of six members expiring December 1 of each
4-19 even-numbered year [February 1 of each odd-numbered year].
4-20 SECTION 5. Article 20C.08(f), Insurance Code, is amended to
4-21 read as follows:
4-22 (f) The board may [shall] appoint an advisory committee to
4-23 represent health care services, including representatives of rural,
4-24 urban, and educational groups and organizations. The advisory
4-25 committee shall meet at the will of the board and advise the board
4-26 on any matters as directed by the board [composed of:]
4-27 [(1) hospital administrators who represent nonprofit
5-1 and investor-owned facilities;]
5-2 [(2) representatives of hospital districts located in
5-3 urban areas;]
5-4 [(3) representatives of health care teaching
5-5 facilities;]
5-6 [(4) representatives of health care specialty
5-7 facilities;]
5-8 [(5) representatives of medical residency programs in
5-9 family practice; and]
5-10 [(6) representatives of rural health clinics,
5-11 federally qualified health centers, and ambulatory surgical
5-12 centers].
5-13 SECTION 6. Article 20C.14, Insurance Code, is amended to
5-14 read as follows:
5-15 Art. 20C.14. MANDATED PROVIDER[; EXCEPTION]. (a) To the
5-16 extent consistent with federal law, the state shall award to the
5-17 system at least one of any state managed care contracts awarded to
5-18 provide health care services to beneficiaries of the Texas Medical
5-19 Assistance Program under Chapter 32, Human Resources Code, in the
5-20 rural areas within the territorial jurisdiction of the
5-21 participating providers.
5-22 (b) [This article does not apply to a contract that expands
5-23 coverage of the Texas Medical Assistance Program under Chapter 32,
5-24 Human Resources Code, to certain children that is implemented
5-25 during the 1997-1998 state fiscal biennium, except that the system
5-26 shall receive a subcontract from the funding entity to provide
5-27 services to those children if the system elects to receive a
6-1 subcontract not later than November 1, 1997, the system provides
6-2 the state share of matching funds for the entire population covered
6-3 by the subcontract, and the subcontract does not cover an area that
6-4 is included in the statutory territorial jurisdiction of a hospital
6-5 district. If the system elects not to receive a subcontract or to
6-6 provide the state share of matching funds, then any entity that is
6-7 selected by the state Medicaid contracting entity to provide health
6-8 care to those children shall use local health care providers and
6-9 hospital providers in establishing its provider network.]
6-10 [(c)] As a requirement of participation in any state
6-11 contract, the system must satisfactorily address the qualifications
6-12 for arranging to provide health care services to beneficiaries of
6-13 certain governmental health care programs as delineated in the
6-14 contractor's request for proposal, including:
6-15 (1) readiness reviews and adequacy of credentialing,
6-16 medical management, quality assurance, claims payment, information
6-17 management, provider and patient education, and complaint and
6-18 grievance procedures; and
6-19 (2) adequacy of physician and provider networks,
6-20 including such factors as diversity, geographic accessibility,
6-21 inclusion of physicians and other providers that have furnished a
6-22 significant amount of Medicaid or charity care to beneficiaries,
6-23 and tertiary and subspecialty services.
6-24 (c) To the extent the system operates under a certificate of
6-25 authority issued under the Texas Health Maintenance Organization
6-26 Act (Chapter 20A, Vernon's Texas Insurance Code), the [(d) The]
6-27 system shall be reimbursed by the Medicaid contracting agency at
7-1 the state-defined capitation rate for each service area in which
7-2 the system operates.
7-3 (d) [(e)] It is not a condition of participation for the
7-4 system to accept from the Medicaid contracting agency a capitation
7-5 rate which is lower than the state-defined capitation rate for each
7-6 service area in which the system operates.
7-7 (e) [(f)] The state retains the right to cancel a contract
7-8 awarded under this article if the system is sold or dissolved.
7-9 SECTION 7. (a) This Act takes effect September 1, 1999.
7-10 (b) The term of a member of the board of directors of the
7-11 statewide rural health care system appointed before the effective
7-12 date of this Act expires December 1 of the year before the year the
7-13 term was to expire under Chapter 20C, Insurance Code, as that
7-14 chapter existed before amendment by this Act.
7-15 SECTION 8. The importance of this legislation and the
7-16 crowded condition of the calendars in both houses create an
7-17 emergency and an imperative public necessity that the
7-18 constitutional rule requiring bills to be read on three several
7-19 days in each house be suspended, and this rule is hereby suspended.