1-1     By:  Capelo, et al. (Senate Sponsor - Shapleigh)      H.B. No. 1864
 1-2           (In the Senate - Received from the House May 10, 1999;
 1-3     May 10, 1999, read first time and referred to Committee on Human
 1-4     Services; May 13, 1999, reported favorably by the following vote:
 1-5     Yeas 5, Nays 0; May 13, 1999, sent to printer.)
 1-6                            A BILL TO BE ENTITLED
 1-7                                   AN ACT
 1-8     relating to the study and development of outreach and education
 1-9     programs for promotoras or community health workers under which
1-10     community residents provide public health education services.
1-11           BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-12             ARTICLE 1.  PROMOTORA PROGRAM DEVELOPMENT COMMITTEE
1-13           SECTION 1.01.  PURPOSE.  The purpose of this article is to
1-14     establish a temporary committee that will study certain issues
1-15     related to the development of outreach and education programs for
1-16     promotoras or community health workers and that will advise the
1-17     Texas Department of Health, the governor, and the legislature
1-18     regarding its findings.
1-19           SECTION 1.02.  DEFINITIONS.  In this article:
1-20                 (1)  "CHIP" means the children's health insurance
1-21     program as created under Title XXI of the Social Security Act (42
1-22     U.S.C. Section 1397aa et seq.), as amended and as administered by
1-23     this state.
1-24                 (2)  "Commissioner" means the commissioner of public
1-25     health.
1-26                 (3)  "Committee" means the Promotora Program
1-27     Development Committee.
1-28                 (4)  "Department" means the Texas Department of Health.
1-29                 (5)  "Local pilot project" means a pilot project
1-30     operated in an area of this state under this article for the
1-31     purpose of demonstrating the feasibility and benefits of employing
1-32     promotoras to assist beneficiaries of the Medicaid managed care and
1-33     CHIP programs.
1-34                 (6)  "Medicaid managed care organization" means a
1-35     managed care organization, as that term is defined by Section
1-36     533.001, Government Code, that is operating a portion of the
1-37     Medicaid managed care program under Chapter 533, Government Code.
1-38                 (7)  "Promotora" or "community health worker" means a
1-39     person who promotes health within the community in which the person
1-40     resides, without regard to whether the person is compensated, by
1-41     engaging in activities such as providing health education, making
1-42     referrals to health and social services providers, coaching
1-43     families on effective ways to access health services, conducting
1-44     needs assessments, identifying barriers to health care delivery,
1-45     making home visits, providing language services, collecting
1-46     information regarding the outcome of health services provided to
1-47     families, and acting as a liaison between families and health care
1-48     providers.
1-49           SECTION 1.03.  COMMITTEE.  (a)  The department shall
1-50     establish the committee to study the development of a framework for
1-51     a promotora development program and to advise the department, the
1-52     governor, and the legislature regarding its findings and
1-53     recommendations.
1-54           (b)  The committee is composed of the following 15 members:
1-55                 (1)  two representatives designated by the department,
1-56     each of whom must be department employees, one of whom must be
1-57     assigned to the department's bureau of managed care and one of whom
1-58     must be assigned to the department's CHIP bureau;
1-59                 (2)  one representative of the Texas Higher Education
1-60     Coordinating Board designated by the board;
1-61                 (3)  one representative of the Texas Tech University
1-62     Health Science Center designated by the university;
1-63                 (4)  two representatives of The Texas A&M University
1-64     System designated by the system, one of whom must be from the
 2-1     Center for Housing and Urban Development in the Texas A&M
 2-2     University School of Architecture and one of whom must be from the
 2-3     South Texas Center for Rural Public Health;
 2-4                 (5)  two representatives of The University of Texas
 2-5     System designated by the system, one of whom must be from the
 2-6     system's Valley Border Health Coordination Office and one of whom
 2-7     must be from the Health Education Training Centers Alliance of
 2-8     Texas;
 2-9                 (6)  one representative of the Texas Association of
2-10     Community Colleges designated by the association;
2-11                 (7)  two persons who are currently serving as
2-12     promotoras designated by the Texas Association of Community Health
2-13     Centers;
2-14                 (8)  one representative of the Texas Workforce
2-15     Commission, designated by the commission;
2-16                 (9)  one representative of the Texas-Mexico Border
2-17     Health Services Delivery Project, designated by The University of
2-18     Texas Health Science Center at Houston; and
2-19                 (10)  two representatives of the general public who are
2-20     not officers or employees of government designated by the State
2-21     Office of Rural Health of the Center for Rural Health Initiatives.
2-22           (c)  Chapter 2110, Government Code, does not apply to the
2-23     committee, except Section 2110.005 does apply.
2-24           (d)  A member of the committee is not entitled to
2-25     compensation  for service on the committee.  Reasonable and
2-26     necessary expenses incurred in performing duties as a member of the
2-27     committee by a member of the committee who is an officer or
2-28     employee of state government are reimbursed as expenses incurred in
2-29     the performance of the member's duties as a state officer or
2-30     employee. The two members of the committee who are currently
2-31     serving as promotoras are entitled to reimbursement for reasonable
2-32     travel expenses incurred in performing duties as a member of the
2-33     committee in the manner provided by the General Appropriations Act
2-34     and out of appropriations to the department.  Other members of the
2-35     committee are not entitled to reimbursement for expenses.
2-36           (e)  The department shall provide staff support to the
2-37     committee.
2-38           (f)  The committee shall meet at the call of the presiding
2-39     officer of the committee, at the call of the commissioner, and as
2-40     provided by procedural rules or schedules adopted by the committee.
2-41           (g)  The committee shall elect its presiding officer from
2-42     among its members.
2-43           SECTION 1.04.  RESPONSIBILITIES OF COMMITTEE.  (a)  The
2-44     activities of the committee shall include the following:
2-45                 (1)  reviewing and assessing promotora programs
2-46     currently in operation around the state;
2-47                 (2)  studying the feasibility of establishing a
2-48     standardized curriculum for promotoras;
2-49                 (3)  studying the options for certification of
2-50     promotoras and the settings in which certification may be
2-51     appropriate;
2-52                 (4)  assessing available methods to evaluate the
2-53     success of promotora programs;
2-54                 (5)  creating, overseeing, and advising local pilot
2-55     projects established under this article, subject to the
2-56     availability of appropriations that may be used for this purpose;
2-57     and
2-58                 (6)  evaluating the feasibility of seeking a federal
2-59     waiver so that promotora services may be included as a reimbursable
2-60     service provided under the state Medicaid program.
2-61           (b)  In conducting its activities, the committee shall
2-62     consult nationally recognized experts in the field of lay community
2-63     health outreach workers.
2-64           (c)  Not later than December 31, 2000, the committee shall
2-65     submit a report to the department, the governor, and the presiding
2-66     officer of each house of the legislature that includes the
2-67     committee's findings to date and its recommendations for the
2-68     program.
2-69           SECTION 1.05.  MEDICAID/CHIP PROMOTORA PILOT PROJECTS.   (a)
 3-1     The committee may establish a series of neighborhood-based peer
 3-2     health outreach and education pilot projects to demonstrate the
 3-3     feasibility and benefits of employing promotoras to assist
 3-4     beneficiaries of the Medicaid managed care and CHIP programs.
 3-5           (b)  The activities of promotoras in any local pilot projects
 3-6     shall include:
 3-7                 (1)  educating beneficiaries of the programs on
 3-8     appropriate use of health care resources, including the use of any
 3-9     available Medicaid or CHIP managed care plan that provides coverage
3-10     to beneficiaries and the effective use of  a beneficiary's primary
3-11     care provider;
3-12                 (2)  promoting regular use of preventive care services
3-13     by beneficiaries of the programs, particularly prenatal care
3-14     services and services available under the Early Periodic Screening,
3-15     Diagnosis, and Treatment Program;
3-16                 (3)  encouraging beneficiaries of the programs to
3-17     develop a basic family preventive health plan; and
3-18                 (4)  encouraging and supporting beneficiaries of the
3-19     programs in keeping appointments for health care, following up on
3-20     missed appointments, and complying with the instructions of health
3-21     care providers.
3-22           (c)  Subject to the availability of appropriations that may
3-23     be used for this purpose, the commissioner with the advice of the
3-24     committee may provide grants to local pilot projects in not more
3-25     than five areas in the state to provide partial support for the
3-26     operation of the pilot program in that area.
3-27           (d)  The commissioner with the advice of the committee may
3-28     adopt rules relating to an application for grants under this
3-29     section and to the use of funds granted to local pilot projects
3-30     under this section.
3-31           (e)  Subject to the requirements of federal law or
3-32     regulations, the commissioner may authorize a local pilot project
3-33     to:
3-34                 (1)  obtain confidential information from:
3-35                       (A)  the department;
3-36                       (B)  the Texas Department of Human Services;
3-37                       (C)  the Health and Human Services Commission;
3-38                       (D)  any contractor implementing a part of the
3-39     state Medicaid program, including a Medicaid managed care
3-40     organization; or
3-41                       (E)  a health care provider providing services to
3-42     Medicaid recipients; and
3-43                 (2)  use the information obtained under Subdivision (1)
3-44     of this subsection to conduct the local pilot project in the area.
3-45           (f)  Information that may be obtained by a local pilot
3-46     project under Subsection (e) of this section is limited to the
3-47     information that the commissioner with the advice of the committee
3-48     determines is necessary to achieve the purposes of the local pilot
3-49     project.  The information obtained may include a Medicaid
3-50     recipient's:
3-51                 (1)  name, address, and telephone number;
3-52                 (2)  date of birth;
3-53                 (3)  Medicaid managed care plan and primary care
3-54     provider; and
3-55                 (4)  appointment scheduling information.
3-56           (g)  Confidential information obtained by a local pilot
3-57     project may be used by the local pilot project only for the
3-58     purposes for which it was obtained and may not be released by the
3-59     local pilot project to any person other than the person who is the
3-60     subject of the information.  The commissioner may adopt rules that
3-61     impose additional restrictions on the use of the information.
3-62           SECTION 1.06.  FUNDING.  The department shall pay for the
3-63     costs of all activities authorized or required under this article
3-64     out of money appropriated to the department that may be used for
3-65     that purpose.
3-66           SECTION 1.07.  EXPIRATION.  The committee is abolished and
3-67     this article expires September 1, 2001.
3-68            ARTICLE 2.  VOLUNTARY TRAINING AND REGULATION PROGRAM
3-69           SECTION 2.01.  AMENDMENT.  Subtitle B, Title 2, Health and
 4-1     Safety Code, is amended by adding Chapter 46 to read as follows:
 4-2             CHAPTER 46.  TRAINING AND REGULATION OF PROMOTORAS
 4-3           Sec. 46.001.  DEFINITION.  In this chapter, "promotora" means
 4-4     a person who, with or without compensation, provides a bilingual
 4-5     liaison between health care providers and patients through
 4-6     activities that include assisting in case conferences, providing
 4-7     patient education, making referrals to health and social services,
 4-8     conducting needs assessments, distributing surveys to identify
 4-9     barriers to health care delivery, making home visits, and providing
4-10     language services.
4-11           Sec. 46.002.  PROMOTORA TRAINING PROGRAM.  (a)  The
4-12     department shall establish and operate a program designed to train
4-13     and educate persons who act as promotoras.  In establishing the
4-14     training program, the department, to the extent possible, shall use
4-15     as a resource the uniform curriculum for training and educating
4-16     promotoras developed by the Health Education Training Centers
4-17     Alliance of Texas.
4-18           (b)  Participation in a training and education program
4-19     established under this section is voluntary.
4-20           Sec. 46.003.  CERTIFICATION PROGRAM FOR PROMOTORAS.  (a)  The
4-21     department shall establish and operate a certification program for
4-22     persons who act as promotoras.  In establishing the program, the
4-23     board shall adopt rules that provide minimum standards and
4-24     guidelines, including participation in the training and education
4-25     program under Section 46.002, for issuance of a certificate to a
4-26     person under this section.
4-27           (b)  Receipt of a certificate issued under this section may
4-28     not be a requirement for a person to act as a promotora.
4-29           SECTION 2.02.  PROGRAM ESTABLISHMENT; ADOPTION OF RULES.  The
4-30     Texas Department of Health shall establish the  promotora training
4-31     and certification program required by Chapter 46, Health and Safety
4-32     Code, as added by this article, not later than January 1, 2000.
4-33     The Texas Board of Health shall adopt rules as necessary under
4-34     Chapter 46, Health and Safety Code, as added by this article, not
4-35     later than December 1, 1999.
4-36                    ARTICLE 3. EFFECTIVE DATE; EMERGENCY
4-37           SECTION 3.01.  EFFECTIVE DATE.  This Act takes effect
4-38     September 1, 1999.
4-39           SECTION 3.02.  EMERGENCY.  The importance of this legislation
4-40     and the crowded condition of the calendars in both houses create an
4-41     emergency and an imperative public necessity that the
4-42     constitutional rule requiring bills to be read on three several
4-43     days in each house be suspended, and this rule is hereby suspended.
4-44                                  * * * * *