1-1 By: Brown S.B. No. 371 1-2 (In the Senate - Filed March 8, 1999; March 9, 1999, read 1-3 first time and referred to Committee on Economic Development; 1-4 March 10, 1999, rereferred to Committee on Criminal Justice; 1-5 April 8, 1999, reported adversely, with favorable Committee 1-6 Substitute by the following vote: Yeas 6, Nays 0; April 8, 1999, 1-7 sent to printer.) 1-8 COMMITTEE SUBSTITUTE FOR S.B. No. 371 By: Duncan 1-9 A BILL TO BE ENTITLED 1-10 AN ACT 1-11 relating to the continuation and functions of the Correctional 1-12 Managed Health Care Advisory Committee. 1-13 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: 1-14 SECTION 1. Chapter 501, Government Code, is amended by 1-15 adding Subchapter E to read as follows: 1-16 SUBCHAPTER E. MANAGED HEALTH CARE 1-17 Sec. 501.131. DEFINITION. In this subchapter, "committee" 1-18 means the Correctional Managed Health Care Committee. 1-19 Sec. 501.132. APPLICATION OF SUNSET ACT. The Correctional 1-20 Managed Health Care Committee is subject to Chapter 325 (Texas 1-21 Sunset Act). Unless continued in existence as provided by that 1-22 chapter, the committee is abolished and this subchapter expires 1-23 September 1, 2005. 1-24 Sec. 501.133. COMMITTEE MEMBERSHIP. (a) The committee 1-25 consists of nine members appointed as follows: 1-26 (1) two members employed full-time by the department, 1-27 at least one of whom is a physician, appointed by the executive 1-28 director; 1-29 (2) two members employed full-time by The University 1-30 of Texas Medical Branch at Galveston, at least one of whom is a 1-31 physician, appointed by the president of the medical branch; 1-32 (3) two members employed full-time by the Texas Tech 1-33 University Health Sciences Center, at least one of whom is a 1-34 physician, appointed by the president of the university; and 1-35 (4) three public members appointed by the governor who 1-36 are not affiliated with the department or with any entity with 1-37 which the committee has contracted to provide health care services 1-38 under this chapter, at least two of whom are licensed to practice 1-39 medicine in this state. 1-40 (b) An appointment to the committee shall be made without 1-41 regard to the race, color, disability, sex, religion, age, or 1-42 national origin of the appointee. 1-43 Sec. 501.134. PUBLIC MEMBER ELIGIBILITY. A person may not 1-44 be a public member of the committee if the person or the person's 1-45 spouse: 1-46 (1) is employed by or participates in the management 1-47 of a business entity or other organization regulated by or 1-48 receiving money from the department or the committee; 1-49 (2) owns or controls, directly or indirectly, more 1-50 than a 10 percent interest in a business entity or other 1-51 organization regulated by or receiving money from the department or 1-52 the committee; or 1-53 (3) uses or receives a substantial amount of tangible 1-54 goods, services, or money from the department or the committee 1-55 other than compensation or reimbursement authorized by law for 1-56 committee membership, attendance, or expenses. 1-57 Sec. 501.135. MEMBERSHIP AND EMPLOYEE RESTRICTIONS. (a) In 1-58 this section, "Texas trade association" means a cooperative and 1-59 voluntarily joined association of business or professional 1-60 competitors in this state designed to assist its members and its 1-61 industry or profession in dealing with mutual business or 1-62 professional problems and in promoting their common interest. 1-63 (b) A person may not be a member of the committee and may 1-64 not be a committee employee employed in a "bona fide executive, 2-1 administrative, or professional capacity," as that phrase is used 2-2 for purposes of establishing an exemption to the overtime 2-3 provisions of the federal Fair Labor Standards Act of 1938 (29 2-4 U.S.C. Section 201 et seq.) and its subsequent amendments if: 2-5 (1) the person is an officer, employee, or paid 2-6 consultant of a Texas trade association in the field of health care 2-7 or health care services; or 2-8 (2) the person's spouse is an officer, manager, or 2-9 paid consultant of a Texas trade association in the field of health 2-10 care or health care services. 2-11 (c) A person may not be a member of the committee or act as 2-12 the general counsel to the committee if the person is required to 2-13 register as a lobbyist under Chapter 305 because of the person's 2-14 activities for compensation on behalf of a profession related to 2-15 the operation of the committee. 2-16 Sec. 501.136. TERMS OF OFFICE. Committee members appointed 2-17 by the governor serve staggered six-year terms, with the term of 2-18 one of those members expiring on February 1 of each odd-numbered 2-19 year. Other committee members serve at the will of the appointing 2-20 official or until termination of the member's employment with the 2-21 entity the member represents. 2-22 Sec. 501.137. PRESIDING OFFICER. The governor shall 2-23 designate a physician member of the committee as presiding officer. 2-24 The presiding officer serves in that capacity at the will of the 2-25 governor. 2-26 Sec. 501.138. GROUNDS FOR REMOVAL. (a) It is a ground for 2-27 removal from the committee that a member: 2-28 (1) does not have at the time of taking office the 2-29 qualifications required by Section 501.133; 2-30 (2) does not maintain during service on the committee 2-31 the qualifications required by Section 501.133; 2-32 (3) is ineligible for membership under Section 501.134 2-33 or 501.135; 2-34 (4) cannot, because of illness or disability, 2-35 discharge the member's duties for a substantial part of the 2-36 member's term; or 2-37 (5) is absent from more than half of the regularly 2-38 scheduled committee meetings that the member is eligible to attend 2-39 during a calendar year without an excuse approved by a majority 2-40 vote of the committee. 2-41 (b) The validity of an action of the committee is not 2-42 affected by the fact that it is taken when a ground for removal of 2-43 a committee member exists. 2-44 (c) If the managed health care administrator has knowledge 2-45 that a potential ground for removal exists, the administrator shall 2-46 notify the presiding officer of the committee of the potential 2-47 ground. The presiding officer shall then notify the governor and 2-48 the attorney general that a potential ground for removal exists. 2-49 If the potential ground for removal involves the presiding officer, 2-50 the managed health care administrator shall notify the next highest 2-51 ranking officer of the committee, who shall then notify the 2-52 governor and the attorney general that a potential ground for 2-53 removal exists. 2-54 Sec. 501.139. MEETINGS. (a) The committee shall meet at 2-55 least once in each quarter of the calendar year and at any other 2-56 time at the call of the presiding officer. 2-57 (b) The committee may hold a meeting by telephone conference 2-58 call or other video or broadcast technology. 2-59 Sec. 501.140. TRAINING. (a) A person who is appointed to 2-60 and qualifies for office as a member of the committee may not vote, 2-61 deliberate, or be counted as a member in attendance at a meeting of 2-62 the committee until the person completes a training program that 2-63 complies with this section. 2-64 (b) The training program must provide the person with 2-65 information regarding: 2-66 (1) the legislation that created the committee; 2-67 (2) the programs operated by the committee; 2-68 (3) the role and functions of the committee; 2-69 (4) the rules of the committee with an emphasis on the 3-1 rules that relate to disciplinary and investigatory authority; 3-2 (5) the current budget for the committee; 3-3 (6) the results of the most recent formal audit of the 3-4 committee; 3-5 (7) the requirements of: 3-6 (A) the open meetings law, Chapter 551; 3-7 (B) the public information law, Chapter 552; 3-8 (C) the administrative procedure law, Chapter 3-9 2001; and 3-10 (D) other laws relating to public officials, 3-11 including conflict-of-interest laws; and 3-12 (8) any applicable ethics policies adopted by the 3-13 committee or the Texas Ethics Commission. 3-14 (c) A person appointed to the committee is entitled to 3-15 reimbursement, as provided by the General Appropriations Act, for 3-16 the travel expenses incurred in attending the training program 3-17 regardless of whether the attendance at the program occurs before 3-18 or after the person qualifies for office. 3-19 Sec. 501.141. COMPENSATION; REIMBURSEMENT. A committee 3-20 member serves without compensation but is entitled to reimbursement 3-21 for actual and necessary expenses incurred in the performance of 3-22 the duties of the committee. 3-23 Sec. 501.142. ADMINISTRATION; PERSONNEL. The committee may 3-24 hire a managed health care administrator, who may employ personnel 3-25 necessary for the administration of the committee's duties. The 3-26 committee shall pay necessary costs for its operation, including 3-27 costs of hiring the managed health care administrator and other 3-28 personnel, from funds appropriated by the legislature to the 3-29 department for correctional health care. 3-30 Sec. 501.143. DIVISION OF RESPONSIBILITIES. The committee 3-31 shall develop and implement policies that clearly separate the 3-32 policy-making responsibilities of the committee and the management 3-33 responsibilities of the managed health care administrator and staff 3-34 of the committee. 3-35 Sec. 501.144. QUALIFICATIONS AND STANDARDS OF CONDUCT 3-36 INFORMATION. The managed health care administrator or the 3-37 administrator's designee shall provide to members of the committee 3-38 and to committee employees, as often as necessary, information 3-39 regarding the requirements for office or employment under this 3-40 subchapter, including information regarding a person's 3-41 responsibilities under applicable laws relating to standards of 3-42 conduct for state officers or employees. 3-43 Sec. 501.145. EQUAL EMPLOYMENT OPPORTUNITY POLICY. (a) The 3-44 managed health care administrator or the administrator's designee 3-45 shall prepare and maintain a written policy statement that 3-46 implements a program of equal employment opportunity to ensure that 3-47 all personnel decisions are made without regard to race, color, 3-48 disability, sex, religion, age, or national origin. 3-49 (b) The policy statement must include: 3-50 (1) personnel policies, including policies relating to 3-51 recruitment, evaluation, selection, training, and promotion of 3-52 personnel, that show the intent of the committee to avoid the 3-53 unlawful employment practices described by Chapter 21, Labor Code; 3-54 and 3-55 (2) an analysis of the extent to which the composition 3-56 of the committee's personnel is in accordance with state and 3-57 federal law and a description of reasonable methods to achieve 3-58 compliance with state and federal law. 3-59 (c) The policy statement must: 3-60 (1) be updated annually; 3-61 (2) be reviewed by the state Commission on Human 3-62 Rights for compliance with Subsection (b)(1); and 3-63 (3) be filed with the governor's office. 3-64 Sec. 501.146. MANAGED HEALTH CARE PLAN. (a) The committee 3-65 shall develop a managed health care plan for all persons confined 3-66 by the department that includes: 3-67 (1) the establishment of a managed health care 3-68 provider network of physicians and hospitals that will serve the 3-69 department as the exclusive health care provider for persons 4-1 confined in institutions operated by the department; 4-2 (2) cost containment studies; 4-3 (3) care case management and utilization management 4-4 studies performed for the department; and 4-5 (4) concerning the establishment of criteria for 4-6 hospitals, home health, or hospice providers, a provision requiring 4-7 the managed health care plan to accept certification by the 4-8 Medicare program under Title XVIII, Social Security Act (42 U.S.C. 4-9 Section 1395 et seq.), and its subsequent amendments as an 4-10 alternative to accreditation by the Joint Commission on 4-11 Accreditation of Healthcare Organizations. 4-12 (b) To implement the managed health care plan, The 4-13 University of Texas Medical Branch at Galveston and the Texas Tech 4-14 University Health Sciences Center, for employees who are entitled 4-15 to retain salary and benefits applicable to employees of the Texas 4-16 Department of Criminal Justice under Section 9.01, Chapter 238, 4-17 Acts of the 73rd Legislature, Regular Session, 1993, may 4-18 administer, offer, and report through their payroll systems 4-19 participation by those employees in the Texas employees uniform 4-20 group insurance benefits program and the Employees Retirement 4-21 System of Texas. 4-22 Sec. 501.147. COMMITTEE AUTHORITY TO CONTRACT. (a) The 4-23 committee may enter into a contract on behalf of the department to 4-24 fully implement the managed health care plan under this subchapter. 4-25 (b) The committee may, in addition to providing services to 4-26 the department, contract with other governmental entities for 4-27 similar health care services and integrate those services into the 4-28 managed health care provider network. 4-29 (c) In contracting for implementation of the managed health 4-30 care plan, the committee, to the extent possible, shall integrate 4-31 the managed health care provider network with the public medical 4-32 schools of this state and the component and affiliated hospitals of 4-33 those medical schools. 4-34 (d) For services that the public medical schools and their 4-35 components and affiliates cannot provide, the committee shall 4-36 initiate a competitive bidding process for contracts with other 4-37 providers for medical care to persons confined by the department. 4-38 Sec. 501.148. GENERAL POWERS AND DUTIES OF COMMITTEE. 4-39 (a) The committee shall: 4-40 (1) develop the contracts for health care services in 4-41 consultation with the department and the health care providers; 4-42 (2) determine a capitation rate reflecting the true 4-43 cost of correctional health care, including necessary catastrophic 4-44 reserves; 4-45 (3) monitor and develop reports on general quality of 4-46 care issues; 4-47 (4) act as an independent third party in the 4-48 allocation of money to inmate health care providers; 4-49 (5) act as an independent third party for the purpose 4-50 of dispute resolution in the event of a disagreement between the 4-51 department and the health care providers; and 4-52 (6) enforce compliance with contract provisions, 4-53 including requiring corrective action if care does not meet 4-54 expectations as determined by quality of care monitoring 4-55 activities. 4-56 (b) The committee shall evaluate and recommend to the board 4-57 sites for new medical facilities that appropriately support the 4-58 managed health care provider network. 4-59 (c) The committee may contract with an individual for 4-60 financial consulting services and may make use of financial 4-61 monitoring of the managed health care plan to assist the committee 4-62 in determining an accurate capitation rate. 4-63 (d) The committee may contract with an individual for 4-64 actuarial consulting services to assist the committee in 4-65 determining trends in the health of the inmate population and the 4-66 impact of those trends on future financial needs. 4-67 Sec. 501.149. QUALITY OF CARE MONITORING BY THE DEPARTMENT 4-68 AND HEALTH CARE PROVIDERS. (a) The committee shall establish a 4-69 procedure for monitoring the quality of care delivered by the 5-1 health care providers. Under the procedure, the department's 5-2 monitoring activities must be limited to investigating medical 5-3 grievances, ensuring access to medical care, and conducting 5-4 periodic operational reviews of medical care provided at its units. 5-5 (b) The department and the medical care providers shall 5-6 cooperate in monitoring quality of care. The clinical and 5-7 professional resources of the health care providers shall be used 5-8 to the greatest extent feasible for clinical oversight of quality 5-9 of care issues. 5-10 (c) The department and the medical care providers shall 5-11 communicate the results of their monitoring activities to the 5-12 committee. 5-13 Sec. 501.150. COMPLAINTS. (a) The committee shall maintain 5-14 a file on each written complaint filed with the committee. The 5-15 file must include: 5-16 (1) the name of the person who filed the complaint; 5-17 (2) the date the complaint is received by the 5-18 committee; 5-19 (3) the subject matter of the complaint; 5-20 (4) the name of each person contacted in relation to 5-21 the complaint; 5-22 (5) a summary of the results of the review or 5-23 investigation of the complaint; and 5-24 (6) an explanation of the reason the file was closed, 5-25 if the committee closed the file without taking action other than 5-26 to investigate the complaint. 5-27 (b) The committee shall provide to the person filing the 5-28 complaint and to each person who is a subject of the complaint a 5-29 copy of the committee's policies and procedures relating to 5-30 complaint investigation and resolution. 5-31 (c) The committee, at least quarterly until final 5-32 disposition of the complaint, shall notify the person filing the 5-33 complaint and each person who is a subject of the complaint of the 5-34 status of the investigation unless the notice would jeopardize an 5-35 undercover investigation. 5-36 Sec. 501.151. PUBLIC PARTICIPATION. The committee shall 5-37 develop and implement policies that provide the public with a 5-38 reasonable opportunity to appear before the committee and to speak 5-39 on any issue under the jurisdiction of the committee. 5-40 SECTION 2. Section 501.059, Government Code, is repealed. 5-41 SECTION 3. The name of the Correctional Managed Health Care 5-42 Advisory Committee is changed to the Correctional Managed Health 5-43 Care Committee. The change in the name of the Correctional Managed 5-44 Health Care Advisory Committee does not affect the validity of any 5-45 action taken by the committee before, on, or after the effective 5-46 date of this Act. A reference in law to the Correctional Managed 5-47 Health Care Advisory Committee means the Correctional Managed 5-48 Health Care Committee. 5-49 SECTION 4. The governor shall make initial gubernatorial 5-50 appointments to the Correctional Managed Health Care Committee to 5-51 accomplish the membership required by Section 501.133, Government 5-52 Code, as added by this Act, not later than January 1, 2000, and 5-53 shall designate one member for a term expiring January 31, 2001, 5-54 one member for a term expiring January 31, 2003, and one member for 5-55 a term expiring January 31, 2005. 5-56 SECTION 5. This Act takes effect September 1, 1999. 5-57 SECTION 6. The importance of this legislation and the 5-58 crowded condition of the calendars in both houses create an 5-59 emergency and an imperative public necessity that the 5-60 constitutional rule requiring bills to be read on three several 5-61 days in each house be suspended, and this rule is hereby suspended. 5-62 * * * * *