By Tillery H.B. No. 1248
77R5196 DLF-D
A BILL TO BE ENTITLED
1-1 AN ACT
1-2 relating to a public school prescription drug benefit plan.
1-3 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-4 ARTICLE 1. PUBLIC SCHOOL PRESCRIPTION DRUG BENEFIT PLAN
1-5 SECTION 1.01. Subchapter E, Chapter 3, Insurance Code, is
1-6 amended by adding Article 3.50-4B to read as follows:
1-7 Art. 3.50-4B. PUBLIC SCHOOL PRESCRIPTION DRUG BENEFIT PLAN
1-8 Sec. 1. DEFINITIONS. In this article:
1-9 (1) "Active employee," "dependent," and "retiree" have
1-10 the meanings assigned by Section 2, Article 3.50-4 of this code.
1-11 (2) "Plan" means the public school prescription drug
1-12 benefit plan established under this article.
1-13 (3) "Plan participant" means an active employee,
1-14 dependent, or retiree who participates in the plan.
1-15 Sec. 2. ADMINISTRATION. (a) The Employees Retirement
1-16 System of Texas and the Teacher Retirement System of Texas shall
1-17 jointly administer the public school prescription drug benefit plan
1-18 established under this article.
1-19 (b) The Employees Retirement System of Texas has primary
1-20 responsibility for developing the plan, contracting for the plan,
1-21 and managing the operations of the plan.
1-22 (c) The Teacher Retirement System of Texas has primary
1-23 responsibility for providing plan-related services to plan
1-24 participants.
2-1 Sec. 3. POWERS AND DUTIES OF BOARDS OF TRUSTEES; RULES. (a)
2-2 The board of trustees of the Employees Retirement System of Texas
2-3 and the board of trustees of the Teacher Retirement System of Texas
2-4 jointly have the powers with regard to the plan that are equivalent
2-5 to the powers that the board of trustees of the Employees
2-6 Retirement System of Texas has in administering the Texas Employees
2-7 Uniform Group Insurance Benefits Act (Article 3.50-2, Vernon's
2-8 Texas Insurance Code).
2-9 (b) The powers granted by Subsection (a) of this section
2-10 include the power to adjudicate claims, expel participants from the
2-11 plan for cause, and adopt rules to administer this article,
2-12 including rules governing which active employees participate in the
2-13 plan as full-time active employees and which active employees
2-14 participate in the plan as part-time active employees.
2-15 Sec. 4. SEPARATION OF AUTHORITY; MEMORANDUM OF
2-16 UNDERSTANDING. The board of trustees of the Employees Retirement
2-17 System of Texas and the board of trustees of the Teacher Retirement
2-18 System of Texas shall enter into a memorandum of understanding
2-19 governing each system's powers and duties under this article.
2-20 Sec. 5. PRESCRIPTION DRUG BENEFIT PLAN. (a) The Employees
2-21 Retirement System of Texas shall develop and implement a
2-22 prescription drug benefit plan to provide prescription drug
2-23 benefits for:
2-24 (1) active employees;
2-25 (2) retirees; and
2-26 (3) the dependents of active employees and retirees.
2-27 (b) Each full-time active employee and each retiree
3-1 participate in the program unless participation is specifically
3-2 waived or the employee or retiree is expelled from the program. A
3-3 retiree, dependent, or part-time active employee may enroll in the
3-4 program in accordance with rules adopted to administer the program.
3-5 (c) The plan must provide benefits at least equivalent to
3-6 the comparable benefits provided under the basic coverage offered
3-7 as part of the uniform group insurance program for state employees
3-8 under the Texas Employees Uniform Group Insurance Benefits Act
3-9 (Article 3.50-2, Vernon's Texas Insurance Code).
3-10 (d) The plan must be subject to copayment, coinsurance, or
3-11 deductible provisions at least as favorable to plan participants as
3-12 the comparable provisions applicable to benefits provided under the
3-13 basic coverage offered as part of the uniform group insurance
3-14 program for state employees under the Texas Employees Uniform Group
3-15 Insurance Benefits Act (Article 3.50-2, Vernon's Texas Insurance
3-16 Code).
3-17 Sec. 6. FUND. (a) The public school prescription drug
3-18 benefit plan fund is created as a trust fund with the state
3-19 comptroller.
3-20 (b) The board of trustees of the Employees Retirement System
3-21 of Texas, as a trustee on behalf of members of the system, shall
3-22 administer the fund.
3-23 (c) Contributions of the state, school districts, and plan
3-24 participants made under Sections 7, 8, and 9 of this article shall
3-25 be credited to the fund.
3-26 (d) The fund is available only to pay for coverage or
3-27 benefits provided under the plan and to pay the expenses of
4-1 administering the plan.
4-2 Sec. 7. STATE CONTRIBUTION. (a) The state shall contribute
4-3 the full cost of the plan coverage for each full-time active
4-4 employee or retiree who participates in the plan. The state shall
4-5 contribute one-half of the cost of the plan coverage for each
4-6 part-time active employee or dependent who participates in the
4-7 plan.
4-8 (b) Not later than November 1 preceding each regular session
4-9 of the legislature, the Employees Retirement System of Texas shall
4-10 certify to the Legislative Budget Board and the budget division of
4-11 the governor's office for information and review the amount
4-12 necessary to pay the contributions of the state to the fund
4-13 established under Section 6 of this article for the plan provided
4-14 under this article during the following biennium.
4-15 (c) The governor shall include the amount in the budget that
4-16 the governor submits to the legislature.
4-17 Sec. 8. SCHOOL DISTRICT CONTRIBUTIONS. The school district
4-18 that employs a plan participant, or employs or employed the active
4-19 employee with respect to whom the plan participant is a dependent,
4-20 may contribute all or part of the cost of the plan that exceeds the
4-21 amount of state contributions under Section 7 of this article.
4-22 Sec. 9. PARTICIPANT CONTRIBUTIONS. The plan participants
4-23 shall contribute the cost of the plan that exceeds the total amount
4-24 of state contributions under Section 7 of this article and
4-25 applicable school district contributions under Section 8 of this
4-26 article.
4-27 ARTICLE 2. CONFORMING AMENDMENTS
5-1 SECTION 2.01. Section 8(b), Article 3.50-4, Insurance Code,
5-2 is amended to read as follows:
5-3 (b) The coverages provided under the plan or plans may
5-4 include but are not limited to life insurance, accidental death and
5-5 dismemberment, hospital care and benefits, surgical care and
5-6 treatment, medical care and treatment, dental care, eye care,
5-7 obstetrical benefits, long-term care, [prescribed drugs,
5-8 medicines,] and prosthetic devices, and other supplemental
5-9 benefits, supplies, and services as provided by this article,
5-10 protection against loss of salary, and other coverages considered
5-11 advisable. The coverages may not provide benefits for prescription
5-12 drugs.
5-13 SECTION 2.02. Section 22.004, Education Code, is amended by
5-14 amending Subsections (a) and (d) and adding Subsection (h) to read
5-15 as follows:
5-16 (a) Each district shall make available to its employees
5-17 group health coverage provided by a risk pool established by one or
5-18 more school districts under Chapter 172, Local Government Code, or
5-19 under a policy of insurance or group contract issued by an insurer,
5-20 a company subject to Chapter 20, Insurance Code, or a health
5-21 maintenance organization under the Texas Health Maintenance
5-22 Organization Act (Chapter 20A, Vernon's Texas Insurance Code). The
5-23 coverage must meet the substantive coverage requirements of Article
5-24 3.51-6, Insurance Code, and any other law applicable to group
5-25 health insurance policies or contracts issued in this state. The
5-26 coverage must include major medical treatment but may exclude
5-27 experimental procedures. In this subsection, "major medical
6-1 treatment" means a medical, surgical, or diagnostic procedure for
6-2 illness or injury. The coverage may include managed care or
6-3 preventive care and, except as provided by Subsection (h), must be
6-4 comparable to the basic health coverage provided under the Texas
6-5 Employees Uniform Group Insurance Benefits Act (Article 3.50-2,
6-6 Vernon's Texas Insurance Code). The board of trustees of the
6-7 Teacher Retirement System of Texas shall adopt rules to determine
6-8 whether a school district's group health coverage is comparable to
6-9 the basic health coverage specified by this subsection. The rules
6-10 must provide for consideration of the following factors concerning
6-11 the district's coverage in determining whether the district's
6-12 coverage is comparable to the basic health coverage specified by
6-13 this subsection:
6-14 (1) the deductible amount for service provided inside
6-15 and outside of the network;
6-16 (2) the coinsurance percentages for service provided
6-17 inside and outside of the network;
6-18 (3) the maximum amount of coinsurance payments a
6-19 covered person is required to pay;
6-20 (4) the amount of the copayment for an office visit;
6-21 (5) the schedule of benefits and the scope of
6-22 coverage;
6-23 (6) the lifetime maximum benefit amount; and
6-24 (7) verification that the coverage is issued by a
6-25 provider licensed to do business in this state by the Texas
6-26 Department of Insurance or is provided by a risk pool authorized
6-27 under Chapter 172, Local Government Code, or that a district is
7-1 capable of covering the assumed liabilities in the case of coverage
7-2 provided through district self-insurance.
7-3 (d) Based on the criteria prescribed by Subsection (a) and
7-4 except as provided by Subsection (h), the executive director of the
7-5 Teacher Retirement System of Texas shall certify whether a
7-6 district's coverage is comparable to the basic health coverage
7-7 provided under the Texas Employees Uniform Group Insurance Benefits
7-8 Act (Article 3.50-2, Vernon's Texas Insurance Code). If the
7-9 executive director of the Teacher Retirement System of Texas
7-10 determines that the group health coverage offered by a district is
7-11 not comparable, the executive director shall report that
7-12 information to the district and to the Legislative Budget Board.
7-13 The executive director shall submit a report to the legislature not
7-14 later than September 1 of each even-numbered year describing the
7-15 status of each district's group health coverage program based on
7-16 the information contained in the report required by Subsection (c)
7-17 and the certification required by this subsection.
7-18 (h) Group health coverage made available under this section
7-19 may not provide benefits for prescription drugs.
7-20 SECTION 2.03. Section 22.005, Education Code, is amended by
7-21 adding Subsection (d) to read as follows:
7-22 (d) A health care plan established under this section may
7-23 not provide benefits for prescription drugs.
7-24 SECTION 2.04. Article 26.036, Insurance Code, is amended by
7-25 adding Subsection (c) to read as follows:
7-26 (c) Notwithstanding any other provision of this chapter, a
7-27 small employer health benefit plan provided to an independent
8-1 school district under this chapter may not provide benefits for
8-2 prescription drugs.
8-3 ARTICLE 3. TRANSITION; EFFECTIVE DATE
8-4 SECTION 3.01. (a) During the 2001-2002 school year, the
8-5 Employees Retirement System of Texas and the Teacher Retirement
8-6 System of Texas shall develop the public school prescription drug
8-7 benefit plan required by Article 3.50-4B, Insurance Code, as added
8-8 by this Act. The systems may employ persons as necessary to
8-9 implement this subsection.
8-10 (b) Coverage under the public school prescription drug
8-11 benefit plan required by Article 3.50-4B, Insurance Code, as added
8-12 by this Act, shall begin with the 2002-2003 school year, but not
8-13 later than September 1, 2002.
8-14 SECTION 3.02. (a) Except as provided by Subsection (b) of
8-15 this section, this Act takes effect September 1, 2001.
8-16 (b) Article 2 of this Act takes effect September 1, 2002.