1-1     By:  Van de Putte                                     S.B. No. 1152
 1-2           (In the Senate - Filed March 6, 2001; March 8, 2001, read
 1-3     first time and referred to Committee on Health and Human Services;
 1-4     May 11, 2001, reported adversely, with favorable Committee
 1-5     Substitute by the following vote:  Yeas 7, Nays 0; May 11, 2001,
 1-6     sent to printer.)
 1-7     COMMITTEE SUBSTITUTE FOR S.B. No. 1152                  By:  Nelson
 1-8                            A BILL TO BE ENTITLED
 1-9                                   AN ACT
1-10     relating to establishing the Tex Rx plan.
1-11           BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-12           SECTION 1.  Subtitle C, Title 2, Health and Safety Code, is
1-13     amended by adding Chapter 65 to read as follows:
1-14                          CHAPTER 65.  TEX RX PLAN
1-15                      SUBCHAPTER A.  GENERAL PROVISIONS
1-16           Sec. 65.001.  PURPOSE; IMPLEMENTATION.  This chapter is
1-17     enacted to permit development of a Tex Rx plan to provide
1-18     prescription drug benefits to individuals in anticipation of
1-19     federal legislation authorizing the granting of federal money to
1-20     assist states in providing such plans.  Until federal and state
1-21     resources are available for implementation of the plan, the Texas
1-22     Department of Health may not implement the plan developed under
1-23     this chapter.
1-24           Sec. 65.002.  DEFINITIONS.  In this chapter:
1-25                 (1)  "Net family income" means the amount of income
1-26     established for a family after reduction for offsets for expenses
1-27     such as child-care and work-related expenses, in accordance with
1-28     standards applicable under the Medicaid plan.
1-29                 (2)  "Plan" means the Tex Rx plan operated under this
1-30     chapter.
1-31           Sec. 65.003.  NOT AN ENTITLEMENT.  This chapter does not
1-32     establish an entitlement to assistance in obtaining prescription
1-33     drug benefits.
1-34               (Sections 65.004-65.050 reserved for expansion
1-35                    SUBCHAPTER B.  ADMINISTRATION OF PLAN
1-36           Sec. 65.051.  DUTIES OF DEPARTMENT.  (a)  The department
1-37     shall develop and, subject to available funds, implement the Tex Rx
1-38     plan to provide prescription drug benefits for eligible
1-39     individuals.
1-40           (b)  The board shall make policy for the plan, including
1-41     policy related to eligibility for coverage under the plan and to
1-42     prescription drug benefits provided under the plan.
1-43           (c)  The board shall adopt rules as necessary to implement
1-44     this chapter.  In adopting rules under this section, the board
1-45     shall consider any requirements imposed under a federal program
1-46     that provides federal matching money for prescription drug
1-47     benefits.
1-48           Sec. 65.052.  COORDINATION WITH OTHER PROGRAMS.  The
1-49     department may consolidate or coordinate the administration of the
1-50     plan provided under this chapter with other similar programs
1-51     provided under state or federal law, including, if appropriate, the
1-52     Medicaid vendor drug program.
1-53           Sec. 65.053.  MANUFACTURER REBATES.  (a)  Unless prohibited
1-54     by the federal program that provides federal matching money for
1-55     prescription drug benefits, the department shall obtain
1-56     prescription drug manufacturer rebates for the benefit of enrollees
1-57     in the plan.
1-58           (b)  Money obtained from the rebates required under this
1-59     section may be appropriated only for the administration and
1-60     operation of the plan.
1-61           Sec. 65.054.  IMPLEMENTATION OF CONTRACTS.  (a)  The
1-62     department may enter into contracts relating to the purchase and
1-63     distribution of prescription drugs under the plan.
1-64           (b)  For any contract entered into under Subsection (a), the
 2-1     board shall:
 2-2                 (1)  retain all policy-making authority over the plan;
 2-3                 (2)  procure the contract through a competitive
 2-4     procurement process in compliance with applicable state laws;
 2-5                 (3)  monitor the person with whom the department
 2-6     contracts, through reporting requirements and other means, to
 2-7     ensure performance under the contract and quality delivery of
 2-8     services;
 2-9                 (4)  require the person with whom the department
2-10     contracts to comply with Subchapter E;
2-11                 (5)  monitor the quality of services delivered to
2-12     enrollees; and
2-13                 (6)  provide payment under the contracts.
2-14           Sec. 65.055.  ADMINISTRATION OF ENROLLMENT.  The department
2-15     shall:
2-16                 (1)  accept applications for enrollment under the plan
2-17     and implement the plan eligibility screening and enrollment
2-18     procedures;
2-19                 (2)  resolve grievances relating to eligibility
2-20     determinations; and
2-21                 (3)  coordinate the plan with Medicare and the Medicaid
2-22     plan, as necessary.
2-23           Sec. 65.056.  COMMUNITY OUTREACH CAMPAIGN; TOLL-FREE HOTLINE.
2-24     (a)  The department may conduct a community outreach and education
2-25     campaign to provide information relating to the availability of the
2-26     plan.
2-27           (b)  The community outreach campaign may include a toll-free
2-28     telephone number through which individuals may obtain information
2-29     about the plan.
2-30           (c)  The department may contract with community-based
2-31     organizations or coalitions of community-based organizations to
2-32     implement the community outreach campaign and may promote and
2-33     encourage voluntary efforts to implement the community outreach
2-34     campaign.
2-35           Sec. 65.057.  REGIONAL ADVISORY COMMITTEES.  The board may
2-36     appoint regional advisory committees to provide recommendations on
2-37     the implementation and operation of the plan.
2-38           Sec. 65.058.  FRAUD PREVENTION.  (a)  The board shall adopt
2-39     and implement rules for the prevention and detection of fraud in
2-40     the plan.
2-41           (b)  The rules may authorize the exclusion from the plan,
2-42     after notice to the individual and an opportunity for a hearing, of
2-43     an individual who commits fraud.
2-44               (Sections 65.059-65.100 reserved for expansion
2-45                         SUBCHAPTER C.  ELIGIBILITY
2-46           Sec. 65.101.  ELIGIBILITY.  An individual is eligible to
2-47     participate in the plan if the individual is a resident of this
2-48     state and:
2-49                 (1)  is not eligible for medical assistance under the
2-50     state Medicaid program;
2-51                 (2)  is eligible to participate in the Medicare
2-52     program;
2-53                 (3)  is not covered and has not been covered by a
2-54     Medicare supplement policy that provides benefits for prescription
2-55     drugs, except as provided by Section 65.102; and
2-56                 (4)  has a net family income that is at or below 200
2-57     percent of the federal poverty level.
2-58           Sec. 65.102. ELIGIBILITY OF CERTAIN INDIVIDUALS.  The board
2-59     by rule shall authorize the enrollment of individuals who, at any
2-60     time, are covered by a Medicare supplement policy that provides
2-61     prescription drug benefits and who, because of changed
2-62     circumstances, become unable to continue to pay premiums for the
2-63     policy or to pay applicable cost-sharing amounts.
2-64           Sec. 65.103.  APPLICATION FORM AND PROCEDURES.  (a)  The
2-65     department shall adopt an application form and application
2-66     procedures for requesting enrollment in the plan under this
2-67     chapter.
2-68           (b)  To the extent possible, the application form shall be
2-69     made available in languages other than English.
 3-1           (c)  The department may permit application to be made by
 3-2     mail, by telephone, or through the Internet.
 3-3           Sec. 65.104.  ELIGIBILITY SCREENING AND ENROLLMENT.  (a)  The
 3-4     department shall develop eligibility screening and enrollment
 3-5     procedures for the plan.
 3-6           (b)  A determination of whether an individual is eligible to
 3-7     participate in the plan and the enrollment of an eligible
 3-8     individual must be completed not later than the 30th day after the
 3-9     date the individual submits a complete application.
3-10           (c)  The department may establish enrollment periods for the
3-11     plan.
3-12               (Sections 65.105-65.150 reserved for expansion
3-13               SUBCHAPTER D.  BENEFITS FOR PRESCRIPTION DRUGS
3-14           Sec. 65.151.  PLAN BENEFITS.  The plan shall provide benefits
3-15     for prescription drug benefits as required by any federal program
3-16     that provides federal matching money for prescription drug
3-17     benefits.  In developing the benefits, the department may consider,
3-18     if appropriate, the benefits provided under the Medicaid vendor
3-19     drug program.
3-20           Sec. 65.152.  COST SHARING.  The department may require an
3-21     enrollee in the plan to pay a copayment or similar charge for
3-22     prescription drugs provided under the plan.
3-23               (Sections 65.153-65.200 reserved for expansion
3-24                          SUBCHAPTER E.  PHARMACIES
3-25           Sec. 65.201.  PARTICIPATION CRITERIA.  (a)  The department
3-26     shall determine the terms and conditions with which a pharmacy must
3-27     comply to participate in the plan.
3-28           (b)  The department, and any person with whom the department
3-29     contracts under Section 65.054, shall allow any pharmacy to
3-30     participate as a pharmacy in the plan if the pharmacy agrees to
3-31     comply with the terms and conditions established under Subsection
3-32     (a).
3-33           Sec. 65.202.  REIMBURSEMENT RATES.  The department shall
3-34     determine the reimbursement rates for participating pharmacies
3-35     under the plan.  In determining the reimbursement rates, the
3-36     department may consider, if appropriate, the reimbursement rates
3-37     provided under the Medicaid vendor drug program.
3-38           Sec. 65.203.  SOURCE OR METHOD OF DISTRIBUTION.  The
3-39     department, and any person with whom the department contracts under
3-40     Section 65.054, may not vary the amount of enrollee cost-sharing
3-41     amounts required under Section 65.152 based on:
3-42                 (1)  the source from which the prescription drugs are
3-43     dispensed; or
3-44                 (2)  the method of distribution of the prescription
3-45     drugs.
3-46           Sec. 65.204.  MEDICATION THERAPY MANAGEMENT.  (a)  In this
3-47     section, "medication therapy management services" means services
3-48     that enhance the patient's understanding of the appropriate use of
3-49     medications, increase the patient's adherence to prescription
3-50     medication regimes, and reduce the risk of potential adverse events
3-51     associated with medications.
3-52           (b)  The department, or any person with whom the department
3-53     contracts under Section 65.054, shall reimburse pharmacies for
3-54     providing medication therapy management services to patients.
3-55           SECTION 2.  The heading of Subtitle C, Title 2, Health and
3-56     Safety Code, is amended to read as follows:
3-57      SUBTITLE C.  INDIGENT HEALTH CARE AND PUBLIC HEALTH CARE PROGRAMS
3-58           SECTION 3.  (a)  The Texas Department of Health shall develop
3-59     a preliminary plan for implementation of the Tex Rx plan
3-60     established under Chapter 65, Health and Safety Code, as added by
3-61     this Act.  The department may not implement the Tex Rx plan until
3-62     state and federal matching money becomes available for the plan.
3-63           (b)  The Texas Department of Health shall monitor federal
3-64     legislation that would authorize the granting of federal money for
3-65     plans similar to the Tex Rx plan described by Chapter 65, Health
3-66     and Safety Code, as added by this Act, and shall determine the
3-67     actions required to implement Chapter 65, Health and Safety Code,
3-68     as added by this Act, in coordination with any federal legislation
3-69     that is enacted.  The department shall report its determinations,
 4-1     as appropriate, to the governor, the lieutenant governor, the
 4-2     speaker of the house of representatives, the Health and Human
 4-3     Services Commission, and the Legislative Budget Board.
 4-4           SECTION 4.  This Act takes effect immediately if it receives
 4-5     a vote of two-thirds of all the members elected to each house, as
 4-6     provided by Section 39, Article III, Texas Constitution.  If this
 4-7     Act does not receive the vote necessary for immediate effect, this
 4-8     Act takes effect September 1, 2001.
 4-9                                  * * * * *