By Coleman H.B. No. 2541
77R8155 KKA-D
A BILL TO BE ENTITLED
1-1 AN ACT
1-2 relating to the state Medicaid program.
1-3 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-4 SECTION 1. Section 32.024, Human Resources Code, is amended
1-5 by adding Subsection (x) to read as follows:
1-6 (x) In its rules and standards governing the vendor drug
1-7 program, the department may not limit benefits for the number of
1-8 medications prescribed to a recipient of prescription drug benefits
1-9 under the medical assistance program.
1-10 SECTION 2. Subchapter B, Chapter 32, Human Resources Code, is
1-11 amended by adding Section 32.02415 to read as follows:
1-12 Sec. 32.02415. EXCLUSION OF ASSETS AND RESOURCES. To the
1-13 extent allowed by federal law, the department may not consider the
1-14 assets and resources of a child under 19 years of age or the assets
1-15 and resources of the child's parents or other caretaker for
1-16 purposes of determining the child's eligibility for medical
1-17 assistance.
1-18 SECTION 3. Section 32.025, Human Resources Code, is amended
1-19 by adding Subsections (d) and (e) to read as follows:
1-20 (d) To the extent allowed by federal law and except as
1-21 otherwise provided by this section, the department shall adopt
1-22 application forms and procedures for a request for medical
1-23 assistance provided to a child under 19 years of age that are
1-24 similar to the application forms and procedures adopted under
2-1 Section 62.103, Health and Safety Code.
2-2 (e) The department shall permit an application requesting
2-3 medical assistance for a child under 19 years of age to be
2-4 conducted by mail instead of through a personal appearance at a
2-5 department office.
2-6 SECTION 4. Section 32.026, Human Resources Code, is amended
2-7 by adding Subsections (d) and (e) to read as follows:
2-8 (d) In adopting rules under this section, the department
2-9 shall ensure, to the extent allowed by federal law, that
2-10 documentation and verification procedures used in determining and
2-11 certifying the eligibility and need for medical assistance of a
2-12 child under 19 years of age are similar to the documentation and
2-13 verification procedures used to determine a child's eligibility for
2-14 coverage under Chapter 62, Health and Safety Code.
2-15 (e) The department shall permit a recertification review of
2-16 the eligibility and need for medical assistance of a child under 19
2-17 years of age to be conducted by telephone or mail instead of
2-18 through a personal appearance at a department office.
2-19 SECTION 5. Subchapter B, Chapter 32, Human Resources Code, is
2-20 amended by adding Section 32.0261 to read as follows:
2-21 Sec. 32.0261. CONTINUOUS ELIGIBILITY. The department shall
2-22 adopt rules in accordance with 42 U.S.C. Section 1396a(e)(12), as
2-23 amended, to provide for a period of continuous eligibility for a
2-24 child under 19 years of age who is determined to be eligible for
2-25 medical assistance under this chapter. The rules shall provide
2-26 that the child remains eligible for medical assistance, without
2-27 additional review by the department and regardless of changes in
3-1 the child's resources or income, until the earlier of:
3-2 (1) the first anniversary of the date on which the
3-3 child's eligibility was determined; or
3-4 (2) the child's 19th birthday.
3-5 SECTION 6. Subchapter B, Chapter 32, Human Resources Code, is
3-6 amended by adding Sections 32.053-32.055 to read as follows:
3-7 Sec. 32.053. DEMONSTRATION PROJECT FOR CERTAIN MEDICATIONS
3-8 AND RELATED SERVICES. (a) The department shall establish a
3-9 five-year demonstration project to provide to a person through the
3-10 medical assistance program psychotropic medications and related
3-11 laboratory and physician services necessary to conform to a
3-12 prescribed medical regime for those medications.
3-13 (b) A person is eligible to participate in the demonstration
3-14 project if the person:
3-15 (1) has been diagnosed with schizophrenia or bipolar
3-16 disorder;
3-17 (2) is at least 19 years of age, but not more than 64
3-18 years of age;
3-19 (3) has a net family income that is at or below 200
3-20 percent of the federal poverty level;
3-21 (4) is not covered by a health benefits plan offering
3-22 adequate coverage, as determined by the department; and
3-23 (5) is not otherwise eligible for medical assistance
3-24 at the time the person's eligibility for participation in the
3-25 demonstration project is determined.
3-26 (c) A participant in the demonstration project is not
3-27 subject to the monthly three-prescription limit under the medical
4-1 assistance program.
4-2 (d) Participation in the demonstration project does not
4-3 entitle a participant to other services provided under the medical
4-4 assistance program.
4-5 (e) Not later than December 1 of each even-numbered year,
4-6 the department shall submit a biennial report to the legislature
4-7 regarding the department's progress in establishing and operating
4-8 the demonstration project.
4-9 (f) Not later than December 1, 2006, the department shall
4-10 evaluate the cost-effectiveness of the demonstration project,
4-11 including whether the preventive drug treatments and related
4-12 services provided under the project offset future long-term care
4-13 costs for project participants. If the results of the evaluation
4-14 indicate that the project is cost-effective, the department shall
4-15 incorporate a request for funding for the continuation of the
4-16 program in the department's budget request for the next state
4-17 fiscal biennium.
4-18 (g) This section expires September 1, 2007.
4-19 Sec. 32.054. DEMONSTRATION PROJECT FOR PERSONS WITH HIV
4-20 INFECTION OR AIDS. (a) In this section, "AIDS" and "HIV" have the
4-21 meanings assigned by Section 81.101, Health and Safety Code.
4-22 (b) The department shall establish a demonstration project
4-23 to provide a person with HIV infection or AIDS with the following
4-24 services and medications through the medical assistance program:
4-25 (1) services provided by a physician, physician
4-26 assistant, advanced practice nurse, or other health care provider
4-27 specified by the department;
5-1 (2) anti-retroviral drug treatments;
5-2 (3) other medications determined to be necessary for
5-3 treatment of a condition related to HIV infection or AIDS;
5-4 (4) vaccinations for hepatitis B and pneumonia;
5-5 (5) pap smears, colposcopy, and other diagnostic
5-6 procedures necessary to monitor gynecologic complications resulting
5-7 from HIV infection or AIDS in women;
5-8 (6) laboratory and other diagnostic services,
5-9 including periodic testing for CD4+ T-cell counts, viral load
5-10 determination, and phenotype or genotype testing if clinically
5-11 indicated; and
5-12 (7) other laboratory and radiological testing
5-13 necessary to monitor potential toxicity of therapy.
5-14 (c) The department shall establish the demonstration project
5-15 in at least two counties with a high prevalence of HIV infection
5-16 and AIDS. The department may request financial participation from
5-17 the counties in which the department establishes the demonstration
5-18 project.
5-19 (d) A person is eligible to participate in the demonstration
5-20 project if the person:
5-21 (1) has been diagnosed with HIV infection or AIDS by a
5-22 physician;
5-23 (2) is under 65 years of age;
5-24 (3) has a net family income that is at or below 200
5-25 percent of the federal poverty level;
5-26 (4) is a resident of a county included in the project
5-27 or, subject to guidelines established by the department, is
6-1 receiving medical care for HIV infection or AIDS through a facility
6-2 located in a county included in the project;
6-3 (5) is not covered by a health benefits plan offering
6-4 adequate coverage, as determined by the department; and
6-5 (6) is not otherwise eligible for medical assistance
6-6 at the time the person's eligibility for participation in the
6-7 demonstration project is determined.
6-8 (e) Participation in the demonstration project does not
6-9 entitle a participant to other services provided under the medical
6-10 assistance program.
6-11 (f) A participant in the demonstration project is not
6-12 subject to the monthly three-prescription limit under the medical
6-13 assistance program.
6-14 (g) Not later than December 1 of each even-numbered year,
6-15 the department shall submit a biennial report to the legislature
6-16 regarding the department's progress in establishing and operating
6-17 the demonstration project.
6-18 (h) Not later than December 1, 2006, the department shall
6-19 evaluate the cost-effectiveness of the demonstration project,
6-20 including whether the services and medications provided offset
6-21 future higher costs for project participants. If the results of
6-22 the evaluation indicate that the project is cost-effective, the
6-23 department shall incorporate a request for funding for the
6-24 expansion of the project into additional counties or throughout the
6-25 state, as appropriate, in the department's budget request for the
6-26 next state fiscal biennium.
6-27 (i) This section expires September 1, 2007.
7-1 Sec. 32.055. DEMONSTRATION PROJECT FOR WOMEN'S HEALTH CARE
7-2 SERVICES. (a) The department shall establish a five-year
7-3 demonstration project through the medical assistance program to
7-4 expand access to preventive health and family planning services for
7-5 women. A woman eligible under Subsection (b) to participate in the
7-6 demonstration project may receive preventive health and family
7-7 planning services including:
7-8 (1) medical history;
7-9 (2) physical examinations;
7-10 (3) counseling and education on contraceptive methods;
7-11 (4) provision of contraceptives;
7-12 (5) health screenings, including screening for:
7-13 (A) diabetes;
7-14 (B) cervical cancer;
7-15 (C) breast cancer;
7-16 (D) sexually transmitted diseases;
7-17 (E) hypertension;
7-18 (F) cholesterol; and
7-19 (G) tuberculosis;
7-20 (6) risk assessment; and
7-21 (7) referral of medical problems to appropriate
7-22 providers.
7-23 (b) A woman is eligible to participate in the demonstration
7-24 project if the woman:
7-25 (1) is of childbearing age, as determined by the
7-26 department;
7-27 (2) has a net family income that is at or below 185
8-1 percent of the federal poverty level; and
8-2 (3) is not otherwise eligible for the medical
8-3 assistance program.
8-4 (c) The department shall compile a list of potential funding
8-5 sources a client can use to help pay for treatment for health
8-6 problems:
8-7 (1) identified using services provided to the client
8-8 under the demonstration project; and
8-9 (2) for which the client is not eligible to receive
8-10 treatment under the medical assistance program.
8-11 (d) Not later than December 1 of each even-numbered year,
8-12 the department shall submit a report to the legislature regarding
8-13 the department's progress in establishing and operating the
8-14 demonstration project.
8-15 (e) This section expires September 1, 2007.
8-16 SECTION 7. Subchapter B, Chapter 32, Human Resources Code,
8-17 is amended by adding Section 32.056 to read as follows:
8-18 Sec. 32.056. DEMONSTRATION PROJECT FOR MEDICAL ASSISTANCE
8-19 BUY-IN PROGRAM FOR CERTAIN RECIPIENTS WITH DISABILITIES. (a) The
8-20 department shall establish a demonstration project to implement in
8-21 five sites a medical assistance buy-in program in accordance with
8-22 the Ticket to Work and Work Incentives Improvement Act of 1999
8-23 (Pub. L. No. 106-170), as amended, to provide medical assistance
8-24 to:
8-25 (1) a person who:
8-26 (A) is at least 16 years of age, but is not more
8-27 than 64 years of age; and
9-1 (B) has earned income that exceeds the limit
9-2 established by federal law for eligibility for Supplemental
9-3 Security Income (SSI) (42 U.S.C. Section 1381 et seq.), as amended,
9-4 but is otherwise eligible for those benefits; and
9-5 (2) an employed individual with a medically improved
9-6 disability, as defined by 42 U.S.C. Section 1396d(v)(1), as
9-7 amended.
9-8 (b) In establishing the demonstration project, the
9-9 department may:
9-10 (1) establish income, assets, and resource limitations
9-11 for eligibility for participation in the demonstration project; and
9-12 (2) require a participant in the demonstration project
9-13 to pay premiums and other cost-sharing charges in accordance with
9-14 42 U.S.C. Section 1396o(g)(1), as amended.
9-15 (c) The department shall require a participant in the
9-16 project to pay premiums to the extent required by 42 U.S.C. Section
9-17 1396o(g)(2), as amended.
9-18 (d) Not later than December 1, 2002, the department shall
9-19 evaluate the effectiveness of the demonstration project in
9-20 providing health care services to employed persons with
9-21 disabilities. If the results of the evaluation indicate that the
9-22 project is effective, the department shall incorporate a request
9-23 for funding for the continuation or expansion of the program in the
9-24 department's budget request for the next state fiscal biennium.
9-25 (e) This section expires September 1, 2003.
9-26 SECTION 8. Section 531.0214(d), Government Code, is amended
9-27 to read as follows:
10-1 (d) The commission shall develop the database system in a
10-2 manner that will enable a complete analysis of the use of
10-3 prescription medications[, including information relating to:]
10-4 [(1) Medicaid clients for whom more than three
10-5 medications have been prescribed; and]
10-6 [(2) the medical effect denial of Medicaid coverage
10-7 for more than three medications has had on Medicaid clients].
10-8 SECTION 9. Subchapter A, Chapter 533, Government Code, is
10-9 amended by adding Sections 533.0055 and 533.016 to read as follows:
10-10 Sec. 533.0055. EVALUATION OF REPORTING REQUIREMENTS AND
10-11 INSPECTION PROCEDURES. (a) The commission shall:
10-12 (1) evaluate on-site inspection procedures of managed
10-13 care organizations contracting with the commission under this
10-14 chapter and evaluate methods to streamline those procedures to
10-15 assist the commission in determining necessary and effective
10-16 quality control measures and required data;
10-17 (2) evaluate methods to streamline reporting
10-18 requirements for managed care organizations contracting with the
10-19 commission under this chapter, including:
10-20 (A) combining information required to be
10-21 reported into a quarterly management report;
10-22 (B) eliminating unnecessary or duplicative
10-23 reporting requirements; and
10-24 (C) requiring managed care organizations to use
10-25 uniform forms developed by the commission for referrals for
10-26 services and credentialing of health care providers providing
10-27 health care services to recipients; and
11-1 (3) require managed care organizations contracting
11-2 with the commission under this chapter to evaluate reporting
11-3 requirements for health care providers to identify methods of
11-4 reducing the administrative burden placed on the providers,
11-5 including:
11-6 (A) reducing the complexity of forms health care
11-7 providers are required to complete; and
11-8 (B) eliminating unnecessary or duplicative
11-9 reporting requirements.
11-10 (b) The commission shall submit a report to the legislature
11-11 regarding the evaluation of and methods for streamlining on-site
11-12 inspection procedures and reporting requirements for managed care
11-13 organizations and health care providers providing health care
11-14 services to recipients. The report must include recommendations on
11-15 which methods should be implemented and a schedule for
11-16 implementation.
11-17 (c) This section expires September 1, 2002.
11-18 Sec. 533.016. INTERAGENCY SHARING OF INFORMATION. The
11-19 commission shall require a health and human services agency
11-20 implementing the Medicaid managed care program to provide to each
11-21 other health and human services agency implementing the Medicaid
11-22 managed care program information reported to that agency by a
11-23 managed care organization or health care provider providing
11-24 services to recipients.
11-25 SECTION 10. The Health and Human Services Commission or the
11-26 appropriate state agency operating part of the medical assistance
11-27 program under Chapter 32, Human Resources Code, shall adopt rules
12-1 required by Section 32.0261, Human Resources Code, as added by this
12-2 Act, not later than October 1, 2001. The rules must provide for a
12-3 period of continuous eligibility in accordance with that section
12-4 for a child whose initial or continued eligibility is determined on
12-5 or after the effective date of the rules.
12-6 SECTION 11. The state agencies responsible for implementing
12-7 the demonstration projects required by Sections 32.053-32.055,
12-8 Human Resources Code, as added by this Act, shall request and
12-9 actively pursue any necessary waivers or authorizations from the
12-10 Health Care Financing Administration or other appropriate entities
12-11 to enable the agencies to implement the demonstration projects not
12-12 later than September 1, 2002. The agencies may delay implementing
12-13 the demonstration projects until the necessary waivers or
12-14 authorizations are granted.
12-15 SECTION 12. The Health and Human Services Commission shall
12-16 submit the report required by Section 533.0055(b), Government Code,
12-17 as added by this Act, not later than November 1, 2002.
12-18 SECTION 13. (a) Subject to Subsection (b) of this section,
12-19 if before implementing any provision of this Act a state agency
12-20 determines that a waiver or authorization from a federal agency is
12-21 necessary for implementation of that provision, the agency affected
12-22 by the provision shall request the waiver or authorization and may
12-23 delay implementing that provision until the waiver or authorization
12-24 is granted.
12-25 (b) Implementation of Sections 32.053-32.055, Human
12-26 Resources Code, as added by this Act, is governed by Section 11 of
12-27 this Act.
13-1 SECTION 14. (a) Except as provided by Subsection (b) of this
13-2 section, this Act takes effect September 1, 2001, and applies to a
13-3 person receiving medical assistance on or after that date
13-4 regardless of the date on which the person began receiving that
13-5 medical assistance.
13-6 (b) Sections 6, 9, and 11 of this Act take effect
13-7 immediately if this Act receives a vote of two-thirds of all the
13-8 members elected to each house, as provided by Section 39, Article
13-9 III, Texas Constitution. If this Act does not receive the vote
13-10 necessary for immediate effect, Sections 6, 9, and 11 of this Act
13-11 take effect September 1, 2001.