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