By Isett H.B. No. 2227
77R2158 CLG-D
A BILL TO BE ENTITLED
1-1 AN ACT
1-2 relating to the establishment of a program of all-inclusive care
1-3 for the elderly (PACE).
1-4 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-5 SECTION 1. Subchapter B, Chapter 32, Human Resources Code, is
1-6 amended by adding Section 32.053 to read as follows:
1-7 Sec. 32.053. PROGRAM OF ALL-INCLUSIVE CARE FOR THE ELDERLY
1-8 (PACE). (a) The department, as a part of the medical assistance
1-9 program, shall develop and implement a program of all-inclusive
1-10 care for the elderly (PACE) in accordance with Section 4802 of the
1-11 Balanced Budget Act of 1997 (Pub. L. No. 105-33), as amended. The
1-12 department shall provide medical assistance to a participant in the
1-13 PACE program in the manner and to the extent authorized by federal
1-14 law.
1-15 (b) The department shall adopt rules as necessary to
1-16 implement this section. In adopting rules, the department shall:
1-17 (1) use the Bienvivir Senior Health Services of El
1-18 Paso initiative as a model for the program; and
1-19 (2) ensure that a person is not required to hold a
1-20 certificate of authority as a health maintenance organization under
1-21 the Texas Health Maintenance Organization Act (Chapter 20A,
1-22 Vernon's Texas Insurance Code) to provide services under the PACE
1-23 program.
1-24 (c) The department may not contract with a person to provide
2-1 services under the PACE program unless the person:
2-2 (1) purchases reinsurance in an amount determined by
2-3 the department that is sufficient to ensure the person's continued
2-4 solvency; or
2-5 (2) has the financial resources sufficient to cover
2-6 expenses in the event of the person's insolvency.
2-7 (d) To demonstrate sufficiency of financial resources for
2-8 purposes of Subsection (c)(2), a person may use cash reserves, a
2-9 letter of credit, a guarantee of a company affiliated with the
2-10 person, or a combination of those arrangements. The amount of a
2-11 person's financial arrangement must be at least equal to the sum
2-12 of:
2-13 (1) the total capitation revenue for one month; and
2-14 (2) the average monthly payment of operating expenses.
2-15 (e) The department, with the cooperation of the Texas
2-16 Department on Aging and area agencies on aging, shall develop and
2-17 implement a coordinated plan to promote PACE program sites
2-18 operating under this section. The department shall adopt policies
2-19 and procedures to ensure that caseworkers and any other appropriate
2-20 department staff discuss the benefits of participating in the PACE
2-21 program with long-term care clients.
2-22 SECTION 2. The state agency administering the program of
2-23 all-inclusive care for the elderly (PACE) implemented under Section
2-24 32.053, Human Resources Code, as added by this Act, shall use its
2-25 best efforts to have in operation six PACE program sites for the
2-26 state fiscal year beginning September 1, 2001, 11 PACE program
2-27 sites for the state fiscal year beginning September 1, 2002, and
3-1 16 PACE program sites for the state fiscal year beginning September
3-2 1, 2003.
3-3 SECTION 3. (a) In this section, "PACE program" means a
3-4 program of all-inclusive care for the elderly (PACE) established in
3-5 accordance with Section 4802 of the Balanced Budget Act of 1997
3-6 (Pub. L. No. 105-33), as amended.
3-7 (b) If before June 1, 2004, the state does not receive
3-8 federal approval for the operation of all PACE program sites for
3-9 which the state has applied solely because the federal limit on the
3-10 number of new PACE program sites allowed nationwide per year has
3-11 been attained, the Health and Human Services Commission and Texas
3-12 Department of Human Services, not later than September 1, 2004,
3-13 shall examine federal laws and regulations regarding PACE programs
3-14 and identify changes to law that would result in an increased
3-15 number of PACE programs in this state.
3-16 (c) Not later than December 1, 2004, the commissioner of
3-17 health and human services shall submit to the legislature a written
3-18 report concerning the results of the examination conducted under
3-19 Subsection (b) of this section. The report must include any
3-20 recommendations for memorializing the Congress of the United States
3-21 to request changes to federal laws or regulations.
3-22 SECTION 4. As soon as practicable after the effective date of
3-23 this Act, the Health and Human Services Commission shall submit an
3-24 amendment to the state's Medicaid plan authorizing the state to
3-25 implement the program of all-inclusive care for the elderly (PACE)
3-26 established under Section 32.053, Human Resources Code, as added by
3-27 this Act. The commission is not required to submit an additional
4-1 amendment to the state's Medicaid plan each time the state agency
4-2 administering the PACE program selects and enters into a proposed
4-3 agreement with a provider to deliver services under the program.
4-4 SECTION 5. If before implementing any provision of this Act,
4-5 a state agency determines that a waiver or authorization from a
4-6 federal agency is necessary for implementation, the state agency
4-7 shall request the waiver or authorization and may delay
4-8 implementing that provision until the waiver or authorization is
4-9 granted.
4-10 SECTION 6. This Act takes effect September 1, 2001.