By Coleman H.B. No. 1398
76R2554 DLF-D
A BILL TO BE ENTITLED
1-1 AN ACT
1-2 relating to indigent health care.
1-3 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-4 ARTICLE 1. DELIVERY OF INDIGENT HEALTH CARE BY COUNTIES, PUBLIC
1-5 HOSPITALS, AND HOSPITAL DISTRICTS
1-6 SECTION 1.01. Section 61.002, Health and Safety Code, is
1-7 amended to read as follows:
1-8 Sec. 61.002. DEFINITIONS. In this chapter:
1-9 (1) ["AFDC" means the Aid to Families with Dependent
1-10 Children program administered by the Texas Department of Human
1-11 Services under Chapter 31, Human Resources Code.]
1-12 [(2)] "Department" means the Texas Department of
1-13 Health.
1-14 (2) [(3)] "Eligible county resident" means an eligible
1-15 resident of a county who does not reside in the service area of a
1-16 public hospital or hospital district.
1-17 (3) [(4)] "Eligible resident" means a person who meets
1-18 the income and resources requirements established by this chapter
1-19 or by the governmental entity, public hospital, or hospital
1-20 district in whose jurisdiction the person resides.
1-21 (4) [(5)] "Emergency services" has the meaning
1-22 assigned by Chapter 773.
1-23 (5) [(6)] "General revenue levy" means:
1-24 (A) the property taxes imposed by a county that
2-1 are not dedicated to the construction and maintenance of
2-2 farm-to-market roads or to flood control under Article VIII,
2-3 Section 1-a, of the Texas Constitution or that are not dedicated to
2-4 the further maintenance of the public roads under Article VIII,
2-5 Section 9, of the Texas Constitution; and
2-6 (B) the sales and use tax revenue to be received
2-7 by the county during the calendar year in which the state fiscal
2-8 year begins under Chapter 323, Tax Code, as determined under
2-9 Section 26.041(d), Tax Code.
2-10 (6) [(7)] "Governmental entity" includes a county,
2-11 municipality, or other political subdivision of the state, but does
2-12 not include a hospital district or hospital authority.
2-13 (7) [(8)] "Hospital district" means a hospital
2-14 district created under the authority of Article IX, Sections 4-11,
2-15 of the Texas Constitution.
2-16 (8) [(9)] "Mandated provider" means a person who
2-17 provides health care services, is selected by a county, public
2-18 hospital, or hospital district, and agrees to provide health care
2-19 services to eligible residents.
2-20 SECTION 1.02. Subchapter A, Chapter 61, Health and Safety
2-21 Code, is amended by adding Section 61.0055 to read as follows:
2-22 Sec. 61.0055. ADMINISTRATION AND ENFORCEMENT; RULES. The
2-23 department shall administer and enforce this chapter and the board
2-24 may adopt rules as necessary to administer and enforce this
2-25 chapter.
2-26 SECTION 1.03. Sections 61.006 and 61.007, Health and Safety
2-27 Code, are amended to read as follows:
3-1 Sec. 61.006. STANDARDS AND PROCEDURES. (a) The department
3-2 shall establish minimum eligibility standards and application,
3-3 documentation, and verification procedures for counties to use in
3-4 determining eligibility under this chapter.
3-5 (b) The minimum eligibility standards may not be more
3-6 restrictive than [and procedures must be consistent with] the
3-7 eligibility standards [and procedures] used by the Texas Department
3-8 of Human Services to determine eligibility in the Temporary
3-9 Assistance for Needy Families-Medicaid [AFDC-Medicaid] program.
3-10 (c) The department shall also define the services and
3-11 establish the payment standards for the categories of services
3-12 listed in Sections [Section] 61.028(a) and 61.0285. To the extent
3-13 applicable, the department may consider [in accordance with] Texas
3-14 Department of Human Services rules relating to the Temporary
3-15 Assistance for Needy Families-Medicaid [AFDC-Medicaid] program.
3-16 (d) The department may establish application, documentation,
3-17 and verification procedures that are different from and less
3-18 restrictive than the procedures used to determine eligibility in
3-19 the Temporary Assistance for Needy Families-Medicaid program. The
3-20 [(b) The department may simplify the AFDC-Medicaid standards and
3-21 procedures used by the Texas Department of Human Services as
3-22 necessary to provide efficient county administration. In
3-23 establishing simplified standards and procedures for county
3-24 administration, the] department may not adopt a standard or
3-25 procedure that is more restrictive than the Temporary Assistance
3-26 for Needy Families-Medicaid program [AFDC-Medicaid standards] or
3-27 procedures.
4-1 (e) [(c)] The department shall ensure that each person who
4-2 meets the basic income and resources requirements for Temporary
4-3 Assistance for Needy Families program [AFDC] payments but who is
4-4 categorically ineligible for Temporary Assistance for Needy
4-5 Families [AFDC] will be eligible for assistance under Subchapter
4-6 B. Except as provided by Subsection (f) and Section 61.023(b), the
4-7 [The] department by rule shall also provide that a person who
4-8 receives or is eligible to receive Temporary Assistance for Needy
4-9 Families, Supplemental Security Income [AFDC, SSI], or Medicaid
4-10 benefits is not eligible for assistance under Subchapter B even if
4-11 the person has exhausted a part or all of that person's [AFDC, SSI,
4-12 or Medicaid] benefits.
4-13 (f) The department shall ensure that each person who is
4-14 entitled to receive federal Social Security Disability Income
4-15 payments but who is ineligible for Medicare because of a waiting
4-16 period applicable under federal law will be eligible for assistance
4-17 under Subchapter B during the period the person is ineligible for
4-18 Medicare. This subsection applies without regard to whether the
4-19 individual would otherwise meet the basic income and resources
4-20 requirements for the Temporary Assistance for Needy Families or
4-21 Medicaid program.
4-22 (g) [(d)] The department shall notify each county and public
4-23 hospital of any change to department rules [AFDC or Medicaid
4-24 guidelines] that affect the provision of services under this
4-25 chapter [and shall amend the rules adopted under this chapter to
4-26 reflect the changes made in the AFDC or Medicaid programs].
4-27 (h) [(e)] Notwithstanding Subsection (a), (b), or (c) or any
5-1 other provision of law, the department shall permit payment to a
5-2 licensed dentist for services provided under Sections 61.028(a)(1),
5-3 (a)(4), and (a)(6) [61.028(a)(3) and (a)(5) to the extent that
5-4 these services are required by Section 61.028(a)(5)] if the
5-5 dentist can provide those services within the scope of the
5-6 dentist's license.
5-7 (i) [(f)] Notwithstanding Subsection (a), (b), or (c), the
5-8 department shall permit payment to a licensed podiatrist for
5-9 services provided under Sections 61.028(a)(1), (a)(4), and (a)(6)
5-10 [61.028(a)(3) and (a)(5) to the extent that the services are
5-11 required by Section 61.028(a)(5)], if the podiatrist can provide
5-12 the services within the scope of the podiatrist's license.
5-13 Sec. 61.007. INFORMATION PROVIDED BY APPLICANT. The
5-14 department by rule shall require each applicant to provide at least
5-15 the following information:
5-16 (1) the applicant's full name and address;
5-17 (2) the applicant's social security number, if
5-18 available;
5-19 (3) the number of persons in the applicant's
5-20 household, excluding persons receiving Temporary Assistance for
5-21 Needy Families, Supplemental Security Income [AFDC, SSI], or
5-22 Medicaid benefits;
5-23 (4) the applicant's county of residence;
5-24 (5) the existence of insurance coverage or other
5-25 hospital or health care benefits for which the applicant is
5-26 eligible;
5-27 (6) any transfer of title to real property that the
6-1 applicant has made in the preceding 24 months;
6-2 (7) the applicant's annual household income, excluding
6-3 the income of any household member receiving Temporary Assistance
6-4 for Needy Families, Supplemental Security Income [AFDC, SSI], or
6-5 Medicaid benefits; and
6-6 (8) the amount of the applicant's liquid assets and
6-7 the equity value of the applicant's car and real property.
6-8 SECTION 1.04. Section 61.023(b), Health and Safety Code, is
6-9 amended to read as follows:
6-10 (b) A county may use a less restrictive standard of
6-11 eligibility for residents than prescribed by Subsection (a) and may
6-12 credit the services provided to all persons who are eligible
6-13 residents under that standard toward eligibility for state
6-14 assistance under this subchapter.
6-15 SECTION 1.05. Section 61.025(d), Health and Safety Code, is
6-16 amended to read as follows:
6-17 (d) Expenditures made by the county under Subsection (b) may
6-18 be credited toward eligibility for state assistance under this
6-19 subchapter if the person who received the health care services
6-20 meets the eligibility standards established under Section 61.023
6-21 [Sections 61.006 and 61.008] and would have been eligible for
6-22 assistance under the county program if the person had not resided
6-23 in a public hospital's service area.
6-24 SECTION 1.06. Section 61.028, Health and Safety Code, is
6-25 amended to read as follows:
6-26 Sec. 61.028. MANDATORY HEALTH CARE SERVICES. (a) A county
6-27 shall, in accordance with department rules adopted under Section
7-1 61.006, provide:
7-2 (1) primary and preventative services designed to meet
7-3 the needs of the community, including:
7-4 (A) immunizations;
7-5 (B) medical screening services;
7-6 (C) dental care;
7-7 (D) annual physical examinations; and
7-8 (E) any other appropriate primary or
7-9 preventative health care service required by department rule;
7-10 (2) inpatient and outpatient hospital services;
7-11 (3) [(2)] rural health clinics;
7-12 (4) [(3)] laboratory and X-ray services;
7-13 (5) [(4)] family planning services;
7-14 (6) [(5)] physician services;
7-15 (7) [(6)] payment for not more than three prescription
7-16 drugs a month; and
7-17 (8) [(7)] skilled nursing facility services,
7-18 regardless of the patient's age.
7-19 (b) The county may provide additional health care services,
7-20 but may not credit the assistance toward eligibility for state
7-21 assistance, except as provided by Sections 61.0285 and 61.0286.
7-22 SECTION 1.07. Subchapter B, Chapter 61, Health and Safety
7-23 Code, is amended by adding Sections 61.0285 and 61.0286 to read as
7-24 follows:
7-25 Sec. 61.0285. OPTIONAL HEALTH CARE SERVICES. (a) In
7-26 addition to mandatory services provided under Section 61.028, a
7-27 county may, in accordance with department rules adopted under
8-1 Section 61.006, provide other medically necessary services or
8-2 supplies that the county determines to be cost-effective,
8-3 including:
8-4 (1) ambulatory surgical center services;
8-5 (2) diabetic and colostomy medical supplies and
8-6 equipment;
8-7 (3) durable medical equipment;
8-8 (4) home and community health care services;
8-9 (5) medical social worker services;
8-10 (6) psychological counseling services;
8-11 (7) services provided by advanced nurse practitioners,
8-12 physician's assistants, and other licensed persons who are not
8-13 physicians;
8-14 (8) vision care, including eyeglasses; and
8-15 (9) any other appropriate health care service
8-16 identified by board rule that may be determined to be
8-17 cost-effective.
8-18 (b) If the services are approved by the department under
8-19 Section 61.006, the county may credit the services toward
8-20 eligibility for state assistance under this subchapter. A county
8-21 may provide health care services that are not specified in
8-22 Subsection (a), or may provide the services specified in Subsection
8-23 (a) without department approval, but may not credit the services
8-24 toward eligibility for state assistance.
8-25 Sec. 61.0286. PREMIUM PAYMENTS FOR HEALTH BENEFIT PLAN
8-26 COVERAGE. (a) A county may credit a payment for the purchase of
8-27 insurance or other health benefit plan coverage made by the county
9-1 on behalf of an eligible resident under Section 157.006, Local
9-2 Government Code, or Section 61.029(a) toward eligibility for state
9-3 assistance under this subchapter if the county determines that the
9-4 purchase of the coverage is cost-effective.
9-5 (b) A county that elects to provide health benefit plan
9-6 coverage under this section may require an eligible resident to
9-7 contribute to the premium cost, on an income-based sliding scale,
9-8 in accordance with Section 61.005.
9-9 SECTION 1.08. Section 61.034(a), Health and Safety Code, is
9-10 amended to read as follows:
9-11 (a) A county is not liable for the cost of a [mandatory]
9-12 health care service provided under Section 61.028 or 61.0285 that
9-13 is in excess of the payment standards for that service established
9-14 by the department under Section 61.006.
9-15 SECTION 1.09. Section 61.036(b), Health and Safety Code, is
9-16 amended to read as follows:
9-17 (b) Except as provided by Section 61.023(b), a [A] county
9-18 may not credit an expenditure for an applicant toward eligibility
9-19 for state assistance if the applicant does not meet the
9-20 department's eligibility standards.
9-21 SECTION 1.10. Sections 61.037, 61.038, and 61.039, Health
9-22 and Safety Code, are amended to read as follows:
9-23 Sec. 61.037. COUNTY ELIGIBILITY FOR STATE ASSISTANCE. (a)
9-24 The department may distribute funds as provided by this subchapter
9-25 to eligible counties to assist the counties in providing
9-26 [mandatory] health care services under Sections 61.028, 61.0285,
9-27 and 61.0286, to their eligible county residents.
10-1 (b) Except as provided by Subsection (c), (d), or (e), to be
10-2 eligible for state assistance, a county must:
10-3 (1) spend in a state fiscal year at least eight [10]
10-4 percent of the county general revenue levy for that year to provide
10-5 [mandatory] health care services described by Subsection (a) to its
10-6 eligible county residents who qualify for assistance under Section
10-7 61.023 [61.006]; and
10-8 (2) notify the department, not later than the seventh
10-9 day after the date on which the county reaches the expenditure
10-10 level, that the county has spent at least six [eight] percent of
10-11 the applicable county general revenue levy for that year to provide
10-12 [mandatory] health care services described by Subsection (a) to its
10-13 eligible county residents who qualify for assistance under Section
10-14 61.023 [61.006].
10-15 (c) If a county and health care provider signed a contract
10-16 on or before January 1, 1985, under which the provider agrees to
10-17 furnish a certain level of health care services to indigent
10-18 persons, the value of services furnished in a state fiscal year
10-19 under the contract is included as part of the computation of a
10-20 county expenditure under this section if the value of services does
10-21 not exceed the payment rate established by the department under
10-22 Section 61.006.
10-23 (d) If a hospital district is located in part but not all of
10-24 a county, that county's appraisal district shall determine the
10-25 taxable value of the property located inside the county but outside
10-26 the hospital district. In determining eligibility for state
10-27 assistance, that county shall consider only the county general
11-1 revenue levy resulting from the property located outside the
11-2 hospital district. A county is eligible for state assistance if:
11-3 (1) the county spends in a state fiscal year at least
11-4 eight [10] percent of the county general revenue levy for that year
11-5 resulting from the property located outside the hospital district
11-6 to provide [mandatory] health care services described by Subsection
11-7 (a) to its eligible county residents who qualify for assistance
11-8 under Section 61.023 [61.006]; and
11-9 (2) the county complies with the other requirements of
11-10 this subchapter.
11-11 (e) A county that provides [mandatory] health care services
11-12 described by Subsection (a) to its eligible residents through a
11-13 hospital established by a board of managers jointly appointed by a
11-14 county and a municipality under Section 265.011 is eligible for
11-15 state assistance if:
11-16 (1) the county spends in a state fiscal year at least
11-17 eight [10] percent of the county general revenue levy for the year
11-18 to provide the [mandatory] health care services to its eligible
11-19 county residents who qualify for assistance under Section 61.023
11-20 [61.006]; and
11-21 (2) the county complies with the requirements of this
11-22 subchapter.
11-23 (f) If a county anticipates that it will reach the eight
11-24 [10] percent expenditure level, the county must notify the
11-25 department as soon as possible before the anticipated date on which
11-26 the county will reach the level.
11-27 (g) The county must give the department all necessary
12-1 information so that the department can determine if the county
12-2 meets the requirements of Subsection (b), (d), or (e).
12-3 Sec. 61.038. DISTRIBUTION OF ASSISTANCE FUNDS. (a) If the
12-4 department determines that a county is eligible for assistance, the
12-5 department shall distribute funds appropriated to the department
12-6 from the indigent health care assistance fund or any other
12-7 available fund to the county to assist the county in providing
12-8 [mandatory] health care services under Sections 61.028, 61.0285,
12-9 and 61.0286 to its eligible county residents who qualify for
12-10 assistance under Section 61.023 [61.006].
12-11 (b) State funds provided under this section to a county must
12-12 be equal to at least 90 [80] percent of the actual payment for the
12-13 [mandatory] health care services for the county's eligible
12-14 residents during the remainder of the state fiscal year after the
12-15 eight [10] percent expenditure level is reached.
12-16 Sec. 61.039. FAILURE TO PROVIDE STATE ASSISTANCE. If the
12-17 department fails to provide assistance to an eligible county as
12-18 prescribed by Section 61.038, the county is not liable for payments
12-19 for health care services provided to its eligible county residents
12-20 after the county reaches the eight [10] percent expenditure level.
12-21 SECTION 1.11. Subchapter B, Chapter 61, Health and Safety
12-22 Code, is amended by adding Section 61.0395 to read as follows:
12-23 Sec. 61.0395. ADDITIONAL STATE ASSISTANCE FOR OUT-OF-COUNTY
12-24 TERTIARY CARE. (a) In addition to state assistance distributed
12-25 under Section 61.038, the department shall distribute assistance to
12-26 a county that is otherwise eligible for state assistance under this
12-27 subchapter and that provides a significant amount of tertiary care
13-1 to eligible residents in a facility located outside of the
13-2 boundaries of the county.
13-3 (b) The board shall adopt rules governing the determination
13-4 of whether a county is eligible for additional state assistance
13-5 under this section and the allocation of money appropriated for
13-6 the purposes of this section.
13-7 SECTION 1.12. Sections 61.041(a) and (b), Health and Safety
13-8 Code, are amended to read as follows:
13-9 (a) The department shall establish monthly reporting
13-10 requirements for all counties required to provide indigent health
13-11 care under this chapter, including counties [a county] seeking
13-12 state assistance under this chapter and shall establish procedures
13-13 necessary to determine if a [the] county is eligible for state
13-14 assistance.
13-15 (b) The department shall establish requirements relating to:
13-16 (1) documentation required to verify the eligibility
13-17 of residents to whom the county provides assistance; and
13-18 (2) county expenditures for [mandatory] health care
13-19 services under Sections 61.028 and 61.0285 and for health benefit
13-20 plan coverage under Section 61.0286.
13-21 SECTION 1.13. Subchapter B, Chapter 61, Health and Safety
13-22 Code, is amended by adding Section 61.0415 to read as follows:
13-23 Sec. 61.0415. PERFORMANCE STANDARDS FOR PRIMARY AND
13-24 PREVENTATIVE CARE. (a) The department, in consultation with the
13-25 Legislative Budget Board, shall:
13-26 (1) develop objective performance standards to measure
13-27 the level of services provided by a county under Section
14-1 61.028(a)(1); and
14-2 (2) establish performance goals for these services.
14-3 (b) To the extent that money appropriated for state
14-4 assistance under this subchapter is available for this purpose, the
14-5 department may provide grants to counties that meet or exceed
14-6 performance goals established under Subsection (a)(2).
14-7 SECTION 1.14. Section 61.054(a), Health and Safety Code, is
14-8 amended to read as follows:
14-9 (a) A public hospital shall provide the mandatory health
14-10 care [inpatient and outpatient hospital] services a county is
14-11 required to provide under Section 61.028 [61.028(a)(1)].
14-12 SECTION 1.15. Section 61.055, Health and Safety Code, is
14-13 amended to read as follows:
14-14 Sec. 61.055. SERVICES PROVIDED BY HOSPITAL DISTRICTS. A
14-15 hospital district shall provide the mandatory health care services
14-16 a county is required to provide under Section 61.028, together with
14-17 any other services required under the Texas Constitution and the
14-18 statute creating the district.
14-19 SECTION 1.16. Section 157.006, Local Government Code, is
14-20 amended to read as follows:
14-21 Sec. 157.006. PAYMENTS FOR CERTAIN HEALTH BENEFIT PLAN
14-22 [INSURANCE] COVERAGE. (a) A hospital district created under
14-23 Article IX of the Texas Constitution or a county may purchase and
14-24 pay the premiums for a conversion policy or other health benefit
14-25 plan [insurance] coverage for a person, without regard to whether
14-26 the person is eligible for benefits under Chapter 32, Human
14-27 Resources Code, if the person:
15-1 (1) [who] is diagnosed as having HIV or AIDS, as [or]
15-2 defined by Section 81.101, Health and Safety Code, or other
15-3 terminal or chronic illness, [who] is unemployed, and has an
15-4 [whose] income level [is] less than 200 percent of the federal
15-5 poverty level, based on the federal Office of Management and Budget
15-6 poverty index in effect at the time coverage is provided; or
15-7 (2) is otherwise an eligible resident of the hospital
15-8 district or county under Chapter 61, Health and Safety Code [, even
15-9 though that person may be eligible for benefits under Chapter 32,
15-10 Human Resources Code, or a medical assistance program of the county
15-11 or hospital district].
15-12 (b) Health benefit plan [insurance] coverage for which
15-13 premiums may be paid under this section includes coverage purchased
15-14 from an insurance company authorized to do business in this state,
15-15 a group hospital services corporation operating under Chapter 20,
15-16 Insurance Code, a health maintenance organization operating under
15-17 the Texas Health Maintenance Organization Act (Chapter 20A,
15-18 Vernon's Texas Insurance Code), or an insurance pool created by the
15-19 federal or state government or a political subdivision of the
15-20 state.
15-21 (c) The county or hospital district may provide for payment
15-22 of premiums from unencumbered money available to it for that
15-23 purpose.
15-24 (d) A county or hospital by order may adopt necessary rules,
15-25 criteria, and plans and may enter into necessary contracts to carry
15-26 out this section.
15-27 SECTION 1.17. Section 531.204(b), Government Code, is
16-1 amended to read as follows:
16-2 (b) The report must include:
16-3 (1) identification of significant problems in the
16-4 Texas Integrated Enrollment Services, with recommendations for
16-5 action by the commissioner;
16-6 (2) the status of the effectiveness of the Texas
16-7 Integrated Enrollment Services in providing necessary services to
16-8 the people of this state, with recommendations for any necessary
16-9 research;
16-10 (3) an analysis of the feasibility of including
16-11 indigent health care programs provided by counties, public
16-12 hospitals, and hospital districts in the Texas Integrated
16-13 Enrollment Services, a schedule for inclusion of these programs,
16-14 and a statement of how the Texas Integrated Enrollment Services may
16-15 be structured to address the wide variation in information systems
16-16 used by counties, public hospitals, and hospital districts; and
16-17 (4) [(3)] recommendations for legislative action.
16-18 SECTION 1.18. (a) The change in law made by this article to
16-19 Chapter 61, Health and Safety Code, applies only to:
16-20 (1) health care services under Chapter 61, Health and
16-21 Safety Code, as amended by this article, that are delivered on or
16-22 after January 1, 2000; and
16-23 (2) state assistance under Chapter 61, Health and
16-24 Safety Code, as amended by this article, for the services described
16-25 by Subdivision (1) of this subsection.
16-26 (b) Health care services under Chapter 61, Health and Safety
16-27 Code, as amended by this article, that are delivered before January
17-1 1, 2000, and state assistance for those services are governed by
17-2 the law as it existed immediately before that date and that law is
17-3 continued in effect for this purpose.
17-4 ARTICLE 2. FEDERAL AUTHORIZATION FOR STATE MEDICAID PROGRAM
17-5 SECTION 2.01. FEDERAL AUTHORIZATION. It is the intent of
17-6 the 76th Legislature that:
17-7 (1) the Health and Human Services Commission or an
17-8 appropriate health and human services agency continue to pursue the
17-9 waiver or other authorization described by Section 4, Chapter 444,
17-10 Acts of the 74th Legislature, Regular Session, 1995; and
17-11 (2) the waiver or other authorization apply to
17-12 expansion of Medicaid eligibility, as described by Section 532.102,
17-13 Government Code, for both children and their families and other
17-14 adults.
17-15 ARTICLE 3. THRESHOLD FOR STATE ASSISTANCE TO COUNTIES
17-16 SECTION 3.01. STUDY. The Texas Department of Health shall:
17-17 (1) study the threshold for eligibility for state
17-18 assistance to a county established under Section 61.037, Health and
17-19 Safety Code; and
17-20 (2) develop a threshold to replace the threshold
17-21 established under Section 61.037, Health and Safety Code, that is
17-22 stated as a formula and that reflects:
17-23 (A) a county's fiscal capacity;
17-24 (B) a county's health care resources; and
17-25 (C) the relevant characteristics of the county's
17-26 residents, including the percentage of the county's residents
17-27 living below the federal poverty level.
18-1 SECTION 3.02. WORK GROUP. (a) In developing the
18-2 eligibility threshold under Section 3.01 of this article, the Texas
18-3 Department of Health shall consult with:
18-4 (1) the Legislative Budget Board;
18-5 (2) the comptroller; and
18-6 (3) the legislative committees of the house of
18-7 representatives and senate that have legislative oversight over the
18-8 department.
18-9 (b) The Texas Department of Health shall form a work group
18-10 composed of representatives of the entities described by Subsection
18-11 (a) of this section and may request the cooperation of other
18-12 persons.
18-13 SECTION 3.03. REPORT. Not later than December 1, 2000, the
18-14 Texas Department of Health shall submit a written report of the
18-15 study conducted under this article to the governor, lieutenant
18-16 governor, and speaker of the house of representatives. The report
18-17 must include the recommendations of the work group established
18-18 under Subsection 3.02 of this article, together with the proposed
18-19 eligibility threshold described by Section 3.01(2) of this article.
18-20 SECTION 3.04. EXPIRATION. This article expires August 31,
18-21 2001.
18-22 ARTICLE 4. PILOT PROGRAM FOR REGIONAL HEALTH CARE
18-23 DELIVERY SYSTEM
18-24 SECTION 4.01. DEFINITIONS. In this article:
18-25 (1) "Commissioner" means the commissioner of health
18-26 and human services.
18-27 (2) "Fund" means the regional health care delivery
19-1 system trust fund established under this article.
19-2 (3) "Hospital district" has the meaning assigned by
19-3 Section 61.002, Health and Safety Code.
19-4 (4) "Pilot program" means the regional health care
19-5 delivery system pilot program established under this article.
19-6 (5) "Public hospital" means an entity that is a public
19-7 hospital for purposes of Chapter 61, Health and Safety Code.
19-8 (6) "Regional advisory committee" means a Medicaid
19-9 managed care advisory committee for a region appointed under
19-10 Section 533.021, Government Code.
19-11 SECTION 4.02. PILOT PROGRAM. (a) Not later than January 1,
19-12 2000, the commissioner shall establish a regional health care
19-13 delivery system pilot program in one region of this state.
19-14 (b) The pilot program must be established in a region for
19-15 which a regional advisory committee has been appointed. The
19-16 commissioner may not establish the pilot program in a region unless
19-17 the governing body of each public hospital, hospital district, and
19-18 county in the region approves the establishment of the pilot
19-19 program.
19-20 (c) During the pilot program, a county located in the region
19-21 selected for the pilot program may not receive state assistance
19-22 under Chapter 61, Health and Safety Code.
19-23 SECTION 4.03. REGIONAL HEALTH CARE DELIVERY SYSTEM TRUST
19-24 FUND. (a) The regional health care delivery system trust fund is
19-25 a trust fund with the comptroller.
19-26 (b) The fund is composed of money contributed to the fund
19-27 under this article. The money in the fund is not a part of the
20-1 general funds of this state. The money in the fund may be used only
20-2 to provide health care services through a regional health care
20-3 delivery system under this article.
20-4 (c) The comptroller shall pay money from the fund on a
20-5 warrant supported by a voucher signed by the commissioner or by
20-6 another person designated by the commissioner.
20-7 (d) During the pilot program, each public hospital, hospital
20-8 district, and county in the region selected for participation shall
20-9 contribute to the fund the revenue or other money designated for
20-10 the provision of indigent health care in the jurisdiction of the
20-11 public hospital, hospital district, or county. The amount paid
20-12 under this subsection may not be less than the amount used for
20-13 indigent health care by the public hospital, hospital district, or
20-14 county in the preceding calendar year.
20-15 (e) The state may contribute money to the fund, including
20-16 amounts that would otherwise be provided as state assistance to a
20-17 county participating in the pilot program in accordance with
20-18 Chapter 61, Health and Safety Code. Subject to appropriation, the
20-19 state may contribute money to the fund at a higher matching rate
20-20 than the rate otherwise provided for state assistance in accordance
20-21 with Section 61.038, Health and Safety Code.
20-22 (f) Not later than the 30th day after the date the pilot
20-23 program terminates, the comptroller shall return any money
20-24 remaining in the fund on that date to the entities that contributed
20-25 the money to the fund, in proportion to their total contributions.
20-26 The comptroller shall transfer the money to be returned to the
20-27 state under this subsection to the general revenue fund.
21-1 SECTION 4.04. REGIONAL HEALTH CARE DELIVERY SYSTEM. (a)
21-2 The regional advisory committee for the region participating in the
21-3 pilot program shall develop a regional health care delivery system.
21-4 (b) The regional health care delivery system must provide at
21-5 a minimum the mandatory health care services required by Section
21-6 61.028, Health and Safety Code, in each public hospital, hospital
21-7 district, and county participating in the pilot program. In each
21-8 public hospital, hospital district, and county, the system must
21-9 provide health care services at least comparable to the services
21-10 provided in the preceeding calendar year in that public hospital,
21-11 hospital district, and county.
21-12 (c) On approval of the regional health care delivery system
21-13 by the commissioner, the commissioner, in consultation with the
21-14 regional advisory committee, shall implement the system in the
21-15 region.
21-16 SECTION 4.05. RULES. The commissioner may adopt rules as
21-17 necessary to implement the pilot program.
21-18 SECTION 4.06. DELEGATION OF POWER OR DUTIES. The
21-19 commissioner may delegate any power or duty of the commissioner
21-20 under this article to the Texas Department of Health or to the
21-21 commissioner of public health.
21-22 SECTION 4.07. REPORT. (a) Not later than January 1, 2001,
21-23 the commissioner shall submit a written report relating to the
21-24 pilot program to the governor, lieutenant governor, and speaker of
21-25 the house of representatives.
21-26 (b) The report must include:
21-27 (1) an analysis of:
22-1 (A) the quality of health care services provided
22-2 under the regional health care delivery system operated under this
22-3 article; and
22-4 (B) the cost-effectiveness of providing health
22-5 care services through the regional health care delivery system
22-6 operated under this article; and
22-7 (2) recommendations for legislation for implementing
22-8 regional health care delivery systems in other regions of this
22-9 state, including recommendations relating to:
22-10 (A) the structure of a regional entity to
22-11 administer each regional health care delivery system;
22-12 (B) the manner in which state assistance money
22-13 may most effectively be distributed to support each regional health
22-14 care delivery system; and
22-15 (C) any other matter necessary to implement
22-16 effective and efficient regional health care delivery systems in
22-17 other regions of the state.
22-18 SECTION 4.08. EXPIRATION; TERMINATION OF PILOT PROGRAM.
22-19 This section expires and the pilot program is terminated August 31,
22-20 2001.
22-21 ARTICLE 5. EFFECTIVE DATE; EMERGENCY
22-22 SECTION 5.01. EFFECTIVE DATE. This Act takes effect
22-23 September 1, 1999.
22-24 SECTION 5.02. EMERGENCY. The importance of this legislation
22-25 and the crowded condition of the calendars in both houses create an
22-26 emergency and an imperative public necessity that the
22-27 constitutional rule requiring bills to be read on three several
23-1 days in each house be suspended, and this rule is hereby suspended.