By: Van de Putte S.B. No. 1152
A BILL TO BE ENTITLED
1-1 AN ACT
1-2 relating to establishing the Tex Rx plan.
1-3 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-4 SECTION 1. Subtitle C, Title 2, Health and Safety Code, is
1-5 amended by adding Chapter 65 to read as follows:
1-6 CHAPTER 65. TEX RX PLAN
1-7 SUBCHAPTER A. GENERAL PROVISIONS
1-8 Sec. 65.001. PURPOSE; IMPLEMENTATION. This chapter is
1-9 enacted to permit development of a Tex Rx plan to provide
1-10 prescription drug benefits to individuals in anticipation of
1-11 federal legislation authorizing the granting of federal money to
1-12 assist states in providing such plans. Until federal and state
1-13 resources are available for implementation of the plan, the Texas
1-14 Department of Health may not implement the plan developed under
1-15 this chapter.
1-16 Sec. 65.002. DEFINITIONS. In this chapter:
1-17 (1) "Net family income" means the amount of income
1-18 established for a family after reduction for offsets for expenses
1-19 such as child-care and work-related expenses, in accordance with
1-20 standards applicable under the Medicaid plan.
1-21 (2) "Plan" means the Tex Rx plan operated under this
1-22 chapter.
1-23 Sec. 65.003. NOT AN ENTITLEMENT. This chapter does not
1-24 establish an entitlement to assistance in obtaining prescription
1-25 drug benefits.
2-1 (Sections 65.004-65.050 reserved for expansion
2-2 SUBCHAPTER B. ADMINISTRATION OF PLAN
2-3 Sec. 65.051. DUTIES OF DEPARTMENT. (a) The department
2-4 shall develop and, subject to available funds, implement the Tex Rx
2-5 plan to provide prescription drug benefits for eligible
2-6 individuals.
2-7 (b) The board shall make policy for the plan, including
2-8 policy related to eligibility for coverage under the plan and to
2-9 prescription drug benefits provided under the plan.
2-10 (c) The board shall adopt rules as necessary to implement
2-11 this chapter. In adopting rules under this section, the board
2-12 shall consider any requirements imposed under a federal program
2-13 that provides federal matching money for prescription drug
2-14 benefits.
2-15 Sec. 65.052. COORDINATION WITH OTHER PROGRAMS. The
2-16 department may consolidate or coordinate the administration of the
2-17 plan provided under this chapter with other similar programs
2-18 provided under state or federal law, including, if appropriate, the
2-19 Medicaid vendor drug program.
2-20 Sec. 65.053. MANUFACTURER REBATES. (a) Unless prohibited
2-21 by the federal program that provides federal matching money for
2-22 prescription drug benefits, the department shall obtain
2-23 prescription drug manufacturer rebates for the benefit of enrollees
2-24 in the plan.
2-25 (b) Money obtained from the rebates required under this
2-26 section may be appropriated only for the administration and
3-1 operation of the plan.
3-2 Sec. 65.054. IMPLEMENTATION OF CONTRACTS. (a) The
3-3 department may enter into contracts relating to the purchase and
3-4 distribution of prescription drugs under the plan.
3-5 (b) For any contract entered into under Subsection (a), the
3-6 board shall:
3-7 (1) retain all policy-making authority over the plan;
3-8 (2) procure the contract through a competitive
3-9 procurement process in compliance with applicable state laws;
3-10 (3) monitor the person with whom the department
3-11 contracts, through reporting requirements and other means, to
3-12 ensure performance under the contract and quality delivery of
3-13 services;
3-14 (4) require the person with whom the department
3-15 contracts to comply with Subchapter E;
3-16 (5) monitor the quality of services delivered to
3-17 enrollees; and
3-18 (6) provide payment under the contracts.
3-19 Sec. 65.055. ADMINISTRATION OF ENROLLMENT. The department
3-20 shall:
3-21 (1) accept applications for enrollment under the plan
3-22 and implement the plan eligibility screening and enrollment
3-23 procedures;
3-24 (2) resolve grievances relating to eligibility
3-25 determinations; and
3-26 (3) coordinate the plan with Medicare and the Medicaid
4-1 plan, as necessary.
4-2 Sec. 65.056. COMMUNITY OUTREACH CAMPAIGN; TOLL-FREE HOTLINE.
4-3 (a) The department may conduct a community outreach and education
4-4 campaign to provide information relating to the availability of the
4-5 plan.
4-6 (b) The community outreach campaign may include a toll-free
4-7 telephone number through which individuals may obtain information
4-8 about the plan.
4-9 (c) The department may contract with community-based
4-10 organizations or coalitions of community-based organizations to
4-11 implement the community outreach campaign and may promote and
4-12 encourage voluntary efforts to implement the community outreach
4-13 campaign.
4-14 Sec. 65.057. REGIONAL ADVISORY COMMITTEES. The board may
4-15 appoint regional advisory committees to provide recommendations on
4-16 the implementation and operation of the plan.
4-17 Sec. 65.058. FRAUD PREVENTION. (a) The board shall adopt
4-18 and implement rules for the prevention and detection of fraud in
4-19 the plan.
4-20 (b) The rules may authorize the exclusion from the plan,
4-21 after notice to the individual and an opportunity for a hearing, of
4-22 an individual who commits fraud.
4-23 (Sections 65.059-65.100 reserved for expansion
4-24 SUBCHAPTER C. ELIGIBILITY
4-25 Sec. 65.101. ELIGIBILITY. An individual is eligible to
4-26 participate in the plan if the individual is a resident of this
5-1 state and:
5-2 (1) is not eligible for medical assistance under the
5-3 state Medicaid program;
5-4 (2) is eligible to participate in the Medicare
5-5 program;
5-6 (3) is not covered and has not been covered by a
5-7 Medicare supplement policy that provides benefits for prescription
5-8 drugs, except as provided by Section 65.102; and
5-9 (4) has a net family income that is at or below 200
5-10 percent of the federal poverty level.
5-11 Sec. 65.102. ELIGIBILITY OF CERTAIN INDIVIDUALS. The board
5-12 by rule shall authorize the enrollment of individuals who, at any
5-13 time, are covered by a Medicare supplement policy that provides
5-14 prescription drug benefits and who, because of changed
5-15 circumstances, become unable to continue to pay premiums for the
5-16 policy or to pay applicable cost-sharing amounts.
5-17 Sec. 65.103. APPLICATION FORM AND PROCEDURES. (a) The
5-18 department shall adopt an application form and application
5-19 procedures for requesting enrollment in the plan under this
5-20 chapter.
5-21 (b) To the extent possible, the application form shall be
5-22 made available in languages other than English.
5-23 (c) The department may permit application to be made by
5-24 mail, by telephone, or through the Internet.
5-25 Sec. 65.104. ELIGIBILITY SCREENING AND ENROLLMENT. (a) The
5-26 department shall develop eligibility screening and enrollment
6-1 procedures for the plan.
6-2 (b) A determination of whether an individual is eligible to
6-3 participate in the plan and the enrollment of an eligible
6-4 individual must be completed not later than the 30th day after the
6-5 date the individual submits a complete application.
6-6 (c) The department may establish enrollment periods for the
6-7 plan.
6-8 (Sections 65.105-65.150 reserved for expansion
6-9 SUBCHAPTER D. BENEFITS FOR PRESCRIPTION DRUGS
6-10 Sec. 65.151. PLAN BENEFITS. The plan shall provide benefits
6-11 for prescription drug benefits as required by any federal program
6-12 that provides federal matching money for prescription drug
6-13 benefits. In developing the benefits, the department may consider,
6-14 if appropriate, the benefits provided under the Medicaid vendor
6-15 drug program.
6-16 Sec. 65.152. COST SHARING. The department may require an
6-17 enrollee in the plan to pay a copayment or similar charge for
6-18 prescription drugs provided under the plan.
6-19 (Sections 65.153-65.200 reserved for expansion
6-20 SUBCHAPTER E. PHARMACIES
6-21 Sec. 65.201. PARTICIPATION CRITERIA. (a) The department
6-22 shall determine the terms and conditions with which a pharmacy must
6-23 comply to participate in the plan.
6-24 (b) The department, and any person with whom the department
6-25 contracts under Section 65.054, shall allow any pharmacy to
6-26 participate as a pharmacy in the plan if the pharmacy agrees to
7-1 comply with the terms and conditions established under Subsection
7-2 (a).
7-3 Sec. 65.202. REIMBURSEMENT RATES. The department shall
7-4 determine the reimbursement rates for participating pharmacies
7-5 under the plan. In determining the reimbursement rates, the
7-6 department may consider, if appropriate, the reimbursement rates
7-7 provided under the Medicaid vendor drug program.
7-8 Sec. 65.203. SOURCE OR METHOD OF DISTRIBUTION. The
7-9 department, and any person with whom the department contracts under
7-10 Section 65.054, may not vary the amount of enrollee cost-sharing
7-11 amounts required under Section 65.152 based on:
7-12 (1) the source from which the prescription drugs are
7-13 dispensed; or
7-14 (2) the method of distribution of the prescription
7-15 drugs.
7-16 Sec. 65.204. MEDICATION THERAPY MANAGEMENT. (a) In this
7-17 section, "medication therapy management services" means services
7-18 that enhance the patient's understanding of the appropriate use of
7-19 medications, increase the patient's adherence to prescription
7-20 medication regimes, and reduce the risk of potential adverse events
7-21 associated with medications.
7-22 (b) The department, or any person with whom the department
7-23 contracts under Section 65.054, shall reimburse pharmacies for
7-24 providing medication therapy management services to patients.
7-25 SECTION 2. The heading of Subtitle C, Title 2, Health and
7-26 Safety Code, is amended to read as follows:
8-1 SUBTITLE C. INDIGENT HEALTH CARE AND PUBLIC HEALTH CARE PROGRAMS
8-2 SECTION 3. (a) The Texas Department of Health shall develop
8-3 a preliminary plan for implementation of the Tex Rx plan
8-4 established under Chapter 65, Health and Safety Code, as added by
8-5 this Act. The department may not implement the Tex Rx plan until
8-6 state and federal matching money becomes available for the plan.
8-7 (b) The Texas Department of Health shall monitor federal
8-8 legislation that would authorize the granting of federal money for
8-9 plans similar to the Tex Rx plan described by Chapter 65, Health
8-10 and Safety Code, as added by this Act, and shall determine the
8-11 actions required to implement Chapter 65, Health and Safety Code,
8-12 as added by this Act, in coordination with any federal legislation
8-13 that is enacted. The department shall report its determinations, as
8-14 appropriate, to the governor, the lieutenant governor, the speaker
8-15 of the house of representatives, the Health and Human Services
8-16 Commission, and the Legislative Budget Board.
8-17 SECTION 4. This Act takes effect immediately if it receives
8-18 a vote of two-thirds of all the members elected to each house, as
8-19 provided by Section 39, Article III, Texas Constitution. If this
8-20 Act does not receive the vote necessary for immediate effect, this
8-21 Act takes effect September 1, 2001.