By Van de Putte S.B. No. 1152
77R5921 DLF-D
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. OBJECTIVE OF TEX RX PLAN. The Tex Rx plan
1-9 provides prescription drug benefits to individuals who are eligible
1-10 for the plan under Section 65.101.
1-11 Sec. 65.002. DEFINITIONS. In this chapter:
1-12 (1) "Net family income" means the amount of income
1-13 established for a family after reduction for offsets for expenses
1-14 such as child care and work-related expenses, in accordance with
1-15 standards applicable under the Medicaid plan.
1-16 (2) "Plan" means the Tex Rx plan operated under this
1-17 chapter.
1-18 Sec. 65.003. NOT AN ENTITLEMENT. This chapter does not
1-19 establish an entitlement to assistance in obtaining prescription
1-20 drug benefits.
1-21 (Sections 65.004-65.050 reserved for expansion
1-22 SUBCHAPTER B. ADMINISTRATION OF PLAN
1-23 Sec. 65.051. DUTIES OF DEPARTMENT. (a) The department shall
1-24 develop and implement the Tex Rx plan to provide prescription drug
2-1 benefits for eligible individuals.
2-2 (b) The board shall make policy for the plan, including
2-3 policy related to eligibility for coverage under the plan and to
2-4 prescription drug benefits provided under the plan.
2-5 (c) The board shall adopt rules as necessary to implement
2-6 this chapter. In adopting rules under this section, the board
2-7 shall consider any requirements imposed under a federal program
2-8 that provides federal matching money for prescription drug
2-9 benefits.
2-10 Sec. 65.052. VENDOR DRUG PROGRAM. The department may
2-11 consolidate or coordinate the administration of the plan provided
2-12 under this chapter with the Medicaid vendor drug program.
2-13 Sec. 65.053. DISCOUNTS AND MANUFACTURER REBATES. The
2-14 department may negotiate discounts for prescription drugs and
2-15 accept prescription drug manufacturer's rebates for the benefit of
2-16 enrollees in the plan.
2-17 Sec. 65.054. IMPLEMENTATION OF CONTRACTS. (a) The
2-18 department may enter into contracts relating to the purchase and
2-19 distribution of prescription drugs under the plan.
2-20 (b) For any contract entered into under Subsection (a), the
2-21 board shall:
2-22 (1) retain all policymaking authority over the plan;
2-23 (2) procure the contract through a competitive
2-24 procurement process in compliance with applicable state laws;
2-25 (3) monitor the person with whom the department
2-26 contracts, through reporting requirements and other means, to
2-27 ensure performance under the contract and quality delivery of
3-1 services;
3-2 (4) monitor the quality of services delivered to
3-3 enrollees; and
3-4 (5) provide payment under the contracts.
3-5 Sec. 65.055. ADMINISTRATION OF ENROLLMENT. The department
3-6 shall:
3-7 (1) accept applications for enrollment under the plan
3-8 and implement the plan eligibility screening and enrollment
3-9 procedures;
3-10 (2) resolve grievances relating to eligibility
3-11 determinations; and
3-12 (3) coordinate the plan with Medicare and the Medicaid
3-13 plan, as necessary.
3-14 Sec. 65.056. COMMUNITY OUTREACH CAMPAIGN; TOLL-FREE HOTLINE.
3-15 (a) The department may conduct a community outreach and education
3-16 campaign to provide information relating to the availability of the
3-17 plan.
3-18 (b) The community outreach campaign may include a toll-free
3-19 telephone number through which individuals may obtain information
3-20 about the plan.
3-21 (c) The department may contract with community-based
3-22 organizations or coalitions of community-based organizations to
3-23 implement the community outreach campaign and may promote and
3-24 encourage voluntary efforts to implement the community outreach
3-25 campaign.
3-26 Sec. 65.057. REGIONAL ADVISORY COMMITTEES. The board may
3-27 appoint regional advisory committees to provide recommendations on
4-1 the implementation and operation of the plan.
4-2 Sec. 65.058. FRAUD PREVENTION. (a) The board shall adopt
4-3 and implement rules for the prevention and detection of fraud in
4-4 the plan.
4-5 (b) The rules may authorize the exclusion from the plan of
4-6 an individual who commits fraud after notice to the individual and
4-7 an opportunity for a hearing.
4-8 (Sections 65.059-65.100 reserved for expansion
4-9 SUBCHAPTER C. ELIGIBILITY
4-10 Sec. 65.101. ELIGIBILITY. An individual is eligible to
4-11 participate in the plan if the individual is a resident of this
4-12 state and:
4-13 (1) is not eligible for medical assistance under the
4-14 state Medicaid program;
4-15 (2) is eligible to participate in the Medicare
4-16 program;
4-17 (3) is not covered and has not been covered by a
4-18 Medicare supplement policy that provides benefits for prescription
4-19 drugs, except as provided by Section 65.102; and
4-20 (4) has a net family income that is at or below 200
4-21 percent of the federal poverty level.
4-22 Sec. 65.102. ELIGIBILITY OF CERTAIN INDIVIDUALS. The board
4-23 by rule shall authorize the enrollment of individuals who, at any
4-24 time, are covered by a Medicare supplement policy that provides
4-25 prescription drug benefits and who, because of changed
4-26 circumstances, become unable to continue to pay premiums for the
4-27 policy or to pay applicable cost-sharing amounts.
5-1 Sec. 65.103. APPLICATION FORM AND PROCEDURES. (a) The
5-2 department shall adopt an application form and application
5-3 procedures for requesting enrollment in the plan under this
5-4 chapter.
5-5 (b) To the extent possible, the application form shall be
5-6 made available in languages other than English.
5-7 (c) The department may permit application to be made by
5-8 mail, telephone, or through the Internet.
5-9 Sec. 65.104. ELIGIBILITY SCREENING AND ENROLLMENT. (a) The
5-10 department shall develop eligibility screening and enrollment
5-11 procedures for the plan.
5-12 (b) A determination of whether an individual is eligible to
5-13 participate in the plan and the enrollment of an eligible
5-14 individual must be completed not later than the 30th day after the
5-15 date the individual submits a complete application.
5-16 (c) The department may establish enrollment periods for the
5-17 plan.
5-18 (Sections 65.105-65.150 reserved for expansion
5-19 SUBCHAPTER D. BENEFITS FOR PRESCRIPTION DRUGS
5-20 Sec. 65.151. PLAN BENEFITS. The plan shall provide benefits
5-21 equivalent to the benefits provided under the Medicaid vendor drug
5-22 program.
5-23 Sec. 65.152. COST SHARING. The department may require an
5-24 enrollee in the plan to pay a copayment or similar charge for
5-25 prescription drugs provided under the plan.
5-26 SECTION 2. The heading of Subtitle C, Title 2, Health and
5-27 Safety Code, is amended to read as follows:
6-1 SUBTITLE C. INDIGENT HEALTH CARE AND PUBLIC HEALTH CARE PROGRAMS
6-2 SECTION 3. (a) The Texas Department of Health shall develop
6-3 the Tex Rx plan established under Chapter 65, Health and Safety
6-4 Code, as added by this Act, as soon as practicable after the
6-5 effective date of this Act. The department may not implement the
6-6 plan before federal matching money becomes available for the plan.
6-7 (b) At the request of the Texas Department of Health, the
6-8 Health and Human Services Commission shall request from the
6-9 appropriate federal agency an appropriate waiver or authorization
6-10 to permit operation of the plan required by Chapter 65, Health and
6-11 Safety Code, as added by this Act, using federal matching dollars.
6-12 (c) In anticipation of federal legislation authorizing the
6-13 granting of federal money for plans similar to the plan required by
6-14 Chapter 65, Health and Safety Code, as added by this Act, it is the
6-15 intention of the legislature that the Texas Department of Health
6-16 develop the plan without regard to whether the granting of the
6-17 waiver or authorization requested under Subsection (b) of this
6-18 section is delayed or denied.
6-19 SECTION 4. This Act takes effect immediately if it receives
6-20 a vote of two-thirds of all the members elected to each house, as
6-21 provided by Section 39, Article III, Texas Constitution. If this
6-22 Act does not receive the vote necessary for immediate effect, this
6-23 Act takes effect September 1, 2001.