By Hawley H.B. No. 3010
77R9281 T
A BILL TO BE ENTITLED
1-1 AN ACT
1-2 relating to the operation of a statewide rural health care system.
1-3 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-4 SECTION 1. (a) GOALS OF SYSTEM. The statewide rural health
1-5 care system established under Chapter 20C, Insurance Code, is
1-6 designed to protect and enhance the rural health care delivery
1-7 system by (i) establishing a statewide rural health care network;
1-8 (ii) supporting funding to rural communities; (iii) enabling
1-9 administrative simplification for the benefit of rural providers
1-10 that participate in various health benefit plans; and (iv) assuring
1-11 the inclusion of [incorporate] consumer-oriented attributes
1-12 considered important to a successful health care organization.
1-13 These attributes include consideration of patient rights,
1-14 preservation of significant traditional provider
1-15 [physician]-patient relationship, emphasis on prevention and
1-16 wellness, an appropriate credentialing and peer review program, and
1-17 emphasis on quality improvement and disease management [including
1-18 obtaining accreditation.]
1-19 SECTION 2. Article 20C.02, Insurance Code, is amended to read
1-20 as follows:
1-21 Art. 20C.02. DEFINITIONS. Sections (a)(2), (a)(3) and (b)(4)
1-22 shall be amended as follows:
1-23 (2) "Enrollee" means an individual residing in a rural
1-24 area as defined in this Section entitled to receive health care
2-1 services through a health care plan sponsored by, arranged for or
2-2 provided by the system.
2-3 (3) "Health care services" means those services
2-4 provided under a plan of insurance, a health maintenance
2-5 organization, or other entity that provides health benefits
2-6 coverage [has the meaning assigned by Section 2, Texas Health
2-7 Maintenance Organization Act (Article 20A.02, Vernon's Texas
2-8 Insurance Code)].
2-9 (b) In designating rural areas under Subsection (a)(8) of
2-10 this article, the commissioner shall consider any area that is
2-11 delineated as an urbanized area by the federal census bureau and:
2-12 (8) in which emergency or primary care services are
2-13 limited or unavailable in accordance with network access standards
2-14 imposed by the commissioner [under the Texas Health Maintenance
2-15 Organization Act (Chapter 20A, Vernon's Texas Insurance Code)] and
2-16 in which those services would be made materially more accessible by
2-17 allowing access to care in a contiguous area that is eligible to
2-18 participate in the system.
2-19 SECTION 3. Article 20C.03, Insurance Code, is amended to read
2-20 as follows:
2-21 Art. 20C.03. ESTABLISHMENT OF SYSTEM. The state wide rural
2-22 health care system is established to sponsor, arrange for or
2-23 provide health care services that:
2-24 (1) for programs in rural areas offered under Chapter
2-25 62 of the Health and Safety Code or programs offered pursuant to
2-26 Chapter 1377, Article 7, General and Special Laws of the State of
2-27 Texas, 76th Legislature, are not subject to a law that requires (A)
3-1 coverage or the offer of coverage of a health care service or
3-2 benefit; (B) coverage or the offer of coverage for the provision of
3-3 services by a particular health care services provider, or (C) the
3-4 use of a particular policy or contract form or of particular
3-5 language in a policy or contract form, and
3-6 (2) for programs in rural areas offered under Chapter
3-7 32, Human Resources Code or programs offered under any state,
3-8 county or local government sponsored indigent care initiative or as
3-9 part of any federal Medicare + Choice program, are not subject to a
3-10 law the requires coverage or the offer of coverage for the
3-11 provision of services by a particular health care services
3-12 provider.
3-13 SECTION 4. Article 20C.04, Insurance Code, is amended to read
3-14 as follows:
3-15 Art. 20C.04. DESIGNATION AS SYSTEM; QUALIFICATIONS. (a) The
3-16 commissioner shall designate as the system one organization created
3-17 under Article 20C.05 of this code.
3-18 (b) The system is authorized to sponsor, provide or arrange
3-19 for the provision of health care services for enrollees as
3-20 described in Article 20C.03. [Except as provided by Subsection (c)
3-21 of this article, i] If the system seeks to sponsor, arrange[s] or
3-22 provide[s] health care services to enrollees under a private or
3-23 commercial program, the system must meet each requirement imposed
3-24 by current insurance laws unless the commissioner grants by rule an
3-25 exception to such requirements on the basis of distance, network
3-26 adequacy and scope of coverage. [in exchange for a predetermined
3-27 payment per enrollee on a prepaid basis, the system must obtain a
4-1 certificate of authority under, and meet each requirement imposed
4-2 by the Texas Health Maintenance Organization Act (Chapter 20A,
4-3 Vernon's Texas Insurance Code), as if the organization were a
4-4 person under the Act.]
4-5 [(c) If the system seeks a certificate of authority under
4-6 the Texas Health Maintenance Organization Act (Chapter 20A,
4-7 Vernon's Texas Insurance Code), the commissioner by rule may
4-8 provide exceptions to the application of provisions of the Texas
4-9 Health Maintenance Organization Act (Chapter 20A, Vernon's Texas
4-10 Insurance Code) relating to mileage, distance, and network adequacy
4-11 and scope.]
4-12 [(d) If the system seeks a certificate of authority under
4-13 the Texas Health Maintenance Organization Act (Chapter 20A,
4-14 Vernon's Texas Insurance Code), the system shall meet all reserve
4-15 requirements required by the commissioner under the Texas Health
4-16 Maintenance Organization Act (Chapter 20A, Vernon's Texas Insurance
4-17 Code). The system may fulfill the requirements of this subsection
4-18 through the purchase of reinsurance from insurance companies
4-19 approved for that purpose by the commissioner.]
4-20 SECTION 5. Article 20C.06, Insurance Code, is amended as
4-21 follows:
4-22 20C.06 BOARD. (a) The system is governed by a board of
4-23 directors composed of 18 members. Notwithstanding the Texas
4-24 Non-Profit Corporation Act (Article 1396-1.01 et seq., Vernon's
4-25 Texas Civil Statutes), the board of directors is selected as
4-26 provided by this chapter.
4-27 (b) [The participating providers shall appoint as
5-1 representatives of the participating providers s] Six directors
5-2 shall be selected in the manner provided by Article 20C.10 of this
5-3 code.
5-4 (c) [The governor shall appoint s] Six directors shall be
5-5 selected from persons residing in the territorial jurisdictions of
5-6 the participating providers, including two each who:
5-7 (1) [two persons who] represent employers;
5-8 (2) [two persons who] are local government officials;
5-9 and
5-10 (3) [two persons who] are consumers of health care
5-11 services.
5-12 (d) In addition to the directors appointed under Subsection
5-13 (c) of this article, [the governor shall appoint] six directors
5-14 shall be appointed from among licensed physicians who reside and
5-15 practice in the territorial jurisdictions of the participating
5-16 providers. At least three of the physicians appointed under this
5-17 subsection must perform as their professional practice the general
5-18 practice of medicine.
5-19 (e) Directors appointed under Subsection (c) or (d) of this
5-20 article shall be appointed in such a manner as to represent the
5-21 territorial jurisdictions of all participating providers.
5-22 ARTICLE 6. Article 20C.08, Insurance Code, shall be amended
5-23 as follows:
5-24 ARTICLE 20C.08. ADMINISTRATION BY BOARD; COMMITTEES.
5-25 (d) On a majority vote, the board may:
5-26 (1) contract for administrative, management or support
5-27 services; [or]
6-1 (2) hire an executive director, contract with
6-2 consultants, attorneys and other professionals, and [other staff as
6-3 necessary to implement the duties of the system]
6-4 (3) retain such other staff as necessary to implement
6-5 the duties of the system.
6-6 SECTION 7. Article 20C.14, Insurance Code, is amended to read
6-7 as follows:
6-8 Art. 20C.14. MANDATED PROVIDER. (a) to the extent
6-9 consistent with federal law, the state shall award to the system at
6-10 least one of any state managed care contracts awarded to provide
6-11 health care services to beneficiaries of the Texas Medical
6-12 Assistance Program under Chapter 32, Human Resources Code, in the
6-13 rural areas within the territorial jurisdiction of the
6-14 participating providers. Notwithstanding any other law, the
6-15 commissioner of health and human services may include the system in
6-16 any voluntary pilot or demonstration program which seeks to
6-17 evaluate the use of an insured model for beneficiaries of the Texas
6-18 Medical Assistance Program in a rural area that is not currently
6-19 included in an existing Medicaid managed care pilot program area
6-20 and that incorporates the principles of prevention, disease
6-21 management and studies the use of Promotora's as described in H.B.
6-22 1864, 76th Session."