By Capelo, Oliveira, Chavez, Van de Putte, H.B. No. 1864
76R13531 JRD-F
A BILL TO BE ENTITLED
1-1 AN ACT
1-2 relating to the study and development of outreach and education
1-3 programs for promotoras or community health workers under which
1-4 community residents provide public health education services.
1-5 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-6 ARTICLE 1. PROMOTORA PROGRAM DEVELOPMENT COMMITTEE
1-7 SECTION 1.01. PURPOSE. The purpose of this article is to
1-8 establish a temporary committee that will study certain issues
1-9 related to the development of outreach and education programs for
1-10 promotoras or community health workers and that will advise the
1-11 Texas Department of Health, the governor, and the legislature
1-12 regarding its findings.
1-13 SECTION 1.02. DEFINITIONS. In this article:
1-14 (1) "CHIP" means the children's health insurance
1-15 program as created under Title XXI of the Social Security Act (42
1-16 U.S.C. Section 1397aa et seq.), as amended and as administered by
1-17 this state.
1-18 (2) "Commissioner" means the commissioner of public
1-19 health.
1-20 (3) "Committee" means the Promotora Program
1-21 Development Committee.
1-22 (4) "Department" means the Texas Department of Health.
1-23 (5) "Local pilot project" means a pilot project
1-24 operated in an area of this state under this article for the
1-25 purpose of demonstrating the feasibility and benefits of employing
2-1 promotoras to assist beneficiaries of the Medicaid managed care and
2-2 CHIP programs.
2-3 (6) "Medicaid managed care organization" means a
2-4 managed care organization, as that term is defined by Section
2-5 533.001, Government Code, that is operating a portion of the
2-6 Medicaid managed care program under Chapter 533, Government Code.
2-7 (7) "Promotora" or "community health worker" means a
2-8 person who promotes health within the community in which the person
2-9 resides, without regard to whether the person is compensated, by
2-10 engaging in activities such as providing health education, making
2-11 referrals to health and social services providers, coaching
2-12 families on effective ways to access health services, conducting
2-13 needs assessments, identifying barriers to health care delivery,
2-14 making home visits, providing language services, collecting
2-15 information regarding the outcome of health services provided to
2-16 families, and acting as a liaison between families and health care
2-17 providers.
2-18 SECTION 1.03. COMMITTEE. (a) The department shall
2-19 establish the committee to study the development of a framework for
2-20 a promotora development program and to advise the department, the
2-21 governor, and the legislature regarding its findings and
2-22 recommendations.
2-23 (b) The committee is composed of the following 15 members:
2-24 (1) two representatives designated by the department,
2-25 each of whom must be department employees, one of whom must be
2-26 assigned to the department's bureau of managed care and one of whom
2-27 must be assigned to the department's CHIP bureau;
3-1 (2) one representative of the Texas Higher Education
3-2 Coordinating Board designated by the board;
3-3 (3) one representative of the Texas Tech University
3-4 Health Science Center designated by the university;
3-5 (4) two representatives of The Texas A&M University
3-6 System designated by the system, one of whom must be from the
3-7 Center for Housing and Urban Development in the Texas A&M
3-8 University School of Architecture and one of whom must be from the
3-9 South Texas Center for Rural Public Health;
3-10 (5) two representatives of The University of Texas
3-11 System designated by the system, one of whom must be from the
3-12 system's Valley Border Health Coordination Office and one of whom
3-13 must be from the Health Education Training Centers Alliance of
3-14 Texas;
3-15 (6) one representative of the Texas Association of
3-16 Community Colleges designated by the association;
3-17 (7) two persons who are currently serving as
3-18 promotoras designated by the Texas Association of Community Health
3-19 Centers;
3-20 (8) one representative of the Texas Workforce
3-21 Commission, designated by the commission;
3-22 (9) one representative of the Texas-Mexico Border
3-23 Health Services Delivery Project, designated by The University of
3-24 Texas Health Science Center at Houston; and
3-25 (10) two representatives of the general public who are
3-26 not officers or employees of government designated by the State
3-27 Office of Rural Health of the Center for Rural Health Initiatives.
4-1 (c) Chapter 2110, Government Code, does not apply to the
4-2 committee, except Section 2110.005 does apply.
4-3 (d) A member of the committee is not entitled to
4-4 compensation for service on the committee. Reasonable and
4-5 necessary expenses incurred in performing duties as a member of the
4-6 committee by a member of the committee who is an officer or
4-7 employee of state government are reimbursed as expenses incurred in
4-8 the performance of the member's duties as a state officer or
4-9 employee. The two members of the committee who are currently
4-10 serving as promotoras are entitled to reimbursement for reasonable
4-11 travel expenses incurred in performing duties as a member of the
4-12 committee in the manner provided by the General Appropriations Act
4-13 and out of appropriations to the department. Other members of the
4-14 committee are not entitled to reimbursement for expenses.
4-15 (e) The department shall provide staff support to the
4-16 committee.
4-17 (f) The committee shall meet at the call of the presiding
4-18 officer of the committee, at the call of the commissioner, and as
4-19 provided by procedural rules or schedules adopted by the committee.
4-20 (g) The committee shall elect its presiding officer from
4-21 among its members.
4-22 SECTION 1.04. RESPONSIBILITIES OF COMMITTEE. (a) The
4-23 activities of the committee shall include the following:
4-24 (1) reviewing and assessing promotora programs
4-25 currently in operation around the state;
4-26 (2) studying the feasibility of establishing a
4-27 standardized curriculum for promotoras;
5-1 (3) studying the options for certification of
5-2 promotoras and the settings in which certification may be
5-3 appropriate;
5-4 (4) assessing available methods to evaluate the
5-5 success of promotora programs;
5-6 (5) creating, overseeing, and advising local pilot
5-7 projects established under this article, subject to the
5-8 availability of appropriations that may be used for this purpose;
5-9 and
5-10 (6) evaluating the feasibility of seeking a federal
5-11 waiver so that promotora services may be included as a reimbursable
5-12 service provided under the state Medicaid program.
5-13 (b) In conducting its activities, the committee shall
5-14 consult nationally recognized experts in the field of lay community
5-15 health outreach workers.
5-16 (c) Not later than December 31, 2000, the committee shall
5-17 submit a report to the department, the governor, and the presiding
5-18 officer of each house of the legislature that includes the
5-19 committee's findings to date and its recommendations for the
5-20 program.
5-21 SECTION 1.05. MEDICAID/CHIP PROMOTORA PILOT PROJECTS. (a)
5-22 The committee may establish a series of neighborhood-based peer
5-23 health outreach and education pilot projects to demonstrate the
5-24 feasibility and benefits of employing promotoras to assist
5-25 beneficiaries of the Medicaid managed care and CHIP programs.
5-26 (b) The activities of promotoras in any local pilot projects
5-27 shall include:
6-1 (1) educating beneficiaries of the programs on
6-2 appropriate use of health care resources, including the use of any
6-3 available Medicaid or CHIP managed care plan that provides coverage
6-4 to beneficiaries and the effective use of a beneficiary's primary
6-5 care provider;
6-6 (2) promoting regular use of preventive care services
6-7 by beneficiaries of the programs, particularly prenatal care
6-8 services and services available under the Early Periodic Screening,
6-9 Diagnosis, and Treatment Program;
6-10 (3) encouraging beneficiaries of the programs to
6-11 develop a basic family preventive health plan; and
6-12 (4) encouraging and supporting beneficiaries of the
6-13 programs in keeping appointments for health care, following up on
6-14 missed appointments, and complying with the instructions of health
6-15 care providers.
6-16 (c) Subject to the availability of appropriations that may
6-17 be used for this purpose, the commissioner with the advice of the
6-18 committee may provide grants to local pilot projects in not more
6-19 than five areas in the state to provide partial support for the
6-20 operation of the pilot program in that area.
6-21 (d) The commissioner with the advice of the committee may
6-22 adopt rules relating to an application for grants under this
6-23 section and to the use of funds granted to local pilot projects
6-24 under this section.
6-25 (e) Subject to the requirements of federal law or
6-26 regulations, the commissioner may authorize a local pilot project
6-27 to:
7-1 (1) obtain confidential information from:
7-2 (A) the department;
7-3 (B) the Texas Department of Human Services;
7-4 (C) the Health and Human Services Commission;
7-5 (D) any contractor implementing a part of the
7-6 state Medicaid program, including a Medicaid managed care
7-7 organization; or
7-8 (E) a health care provider providing services to
7-9 Medicaid recipients; and
7-10 (2) use the information obtained under Subdivision (1)
7-11 of this subsection to conduct the local pilot project in the area.
7-12 (f) Information that may be obtained by a local pilot
7-13 project under Subsection (e) of this section is limited to the
7-14 information that the commissioner with the advice of the committee
7-15 determines is necessary to achieve the purposes of the local pilot
7-16 project. The information obtained may include a Medicaid
7-17 recipient's:
7-18 (1) name, address, and telephone number;
7-19 (2) date of birth;
7-20 (3) Medicaid managed care plan and primary care
7-21 provider; and
7-22 (4) appointment scheduling information.
7-23 (g) Confidential information obtained by a local pilot
7-24 project may be used by the local pilot project only for the
7-25 purposes for which it was obtained and may not be released by the
7-26 local pilot project to any person other than the person who is the
7-27 subject of the information. The commissioner may adopt rules that
8-1 impose additional restrictions on the use of the information.
8-2 SECTION 1.06. FUNDING. The department shall pay for the
8-3 costs of all activities authorized or required under this article
8-4 out of money appropriated to the department that may be used for
8-5 that purpose.
8-6 SECTION 1.07. EXPIRATION. The committee is abolished and
8-7 this article expires September 1, 2001.
8-8 ARTICLE 2. VOLUNTARY TRAINING AND REGULATION PROGRAM
8-9 SECTION 2.01. AMENDMENT. Subtitle B, Title 2, Health and
8-10 Safety Code, is amended by adding Chapter 46 to read as follows:
8-11 CHAPTER 46. TRAINING AND REGULATION OF PROMOTORAS
8-12 Sec. 46.001. DEFINITION. In this chapter, "promotora" means
8-13 a person who, with or without compensation, provides a bilingual
8-14 liaison between health care providers and patients through
8-15 activities that include assisting in case conferences, providing
8-16 patient education, making referrals to health and social services,
8-17 conducting needs assessments, distributing surveys to identify
8-18 barriers to health care delivery, making home visits, and providing
8-19 language services.
8-20 Sec. 46.002. PROMOTORA TRAINING PROGRAM. (a) The
8-21 department shall establish and operate a program designed to train
8-22 and educate persons who act as promotoras. In establishing the
8-23 training program, the department, to the extent possible, shall use
8-24 as a resource the uniform curriculum for training and educating
8-25 promotoras developed by the Health Education Training Centers
8-26 Alliance of Texas.
8-27 (b) Participation in a training and education program
9-1 established under this section is voluntary.
9-2 Sec. 46.003. CERTIFICATION PROGRAM FOR PROMOTORAS. (a) The
9-3 department shall establish and operate a certification program for
9-4 persons who act as promotoras. In establishing the program, the
9-5 board shall adopt rules that provide minimum standards and
9-6 guidelines, including participation in the training and education
9-7 program under Section 46.002, for issuance of a certificate to a
9-8 person under this section.
9-9 (b) Receipt of a certificate issued under this section may
9-10 not be a requirement for a person to act as a promotora.
9-11 SECTION 2.02. PROGRAM ESTABLISHMENT; ADOPTION OF RULES. The
9-12 Texas Department of Health shall establish the promotora training
9-13 and certification program required by Chapter 46, Health and Safety
9-14 Code, as added by this article, not later than January 1, 2000.
9-15 The Texas Board of Health shall adopt rules as necessary under
9-16 Chapter 46, Health and Safety Code, as added by this article, not
9-17 later than December 1, 1999.
9-18 ARTICLE 3. EFFECTIVE DATE; EMERGENCY
9-19 SECTION 3.01. EFFECTIVE DATE. This Act takes effect
9-20 September 1, 1999.
9-21 SECTION 3.02. EMERGENCY. The importance of this legislation
9-22 and the crowded condition of the calendars in both houses create an
9-23 emergency and an imperative public necessity that the
9-24 constitutional rule requiring bills to be read on three several
9-25 days in each house be suspended, and this rule is hereby suspended.