By: Zaffirini, et al. S.B. No. 1156
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 shall provide for cost-sharing by
1-8 recipients of prescription drug benefits under the medical
1-9 assistance program in a manner that ensures that recipients with
1-10 higher levels of income are required to pay progressively higher
1-11 percentages of the costs of prescription drugs.
1-12 SECTION 2. Section 32.028, Human Resources Code, is amended
1-13 by adding Subsection (g) to read as follows:
1-14 (g) The department in its adoption of reasonable rules and
1-15 standards governing the allocation of any funds appropriated for
1-16 rate increases for physician services and outpatient hospital
1-17 services shall establish a provider reimbursement methodology that
1-18 recognizes and rewards high volume providers, with an emphasis on
1-19 providers located in areas of this state where medical assistance
1-20 payments are particularly vital to the health care delivery system.
1-21 SECTION 3. Subchapter B, Chapter 32, Human Resources Code,
1-22 is amended by adding Section 32.053 to read as follows:
1-23 Sec. 32.053. DEMONSTRATION PROJECT FOR CERTAIN MEDICATIONS
1-24 AND RELATED SERVICES. (a) The department shall establish a
1-25 demonstration project to provide to a person through the medical
2-1 assistance program psychotropic medications and related laboratory
2-2 and medical services necessary to conform to a prescribed medical
2-3 regime for those medications.
2-4 (b) A person is eligible to participate in the demonstration
2-5 project if the person:
2-6 (1) has been diagnosed as having a mental impairment,
2-7 including schizophrenia or bipolar disorder, that is expected to
2-8 cause the person to become a disabled individual, as defined by
2-9 Section 1614(a) of the federal Social Security Act (42 U.S.C.
2-10 Section 1382c(a)), as amended;
2-11 (2) is at least 19 years of age, but not more than 64
2-12 years of age;
2-13 (3) has a net family income that is at or below 200
2-14 percent of the federal poverty level;
2-15 (4) is not covered by a health benefits plan offering
2-16 adequate coverage, as determined by the department; and
2-17 (5) is not otherwise eligible for medical assistance
2-18 at the time the person's eligibility for participation in the
2-19 demonstration project is determined.
2-20 (c) Notwithstanding any other provision of this section, the
2-21 department shall provide each participant in the demonstration
2-22 project with a 12-month period of continuous eligibility for
2-23 participation in the project.
2-24 (d) Participation in the demonstration project does not
2-25 entitle a participant to other services provided under the medical
2-26 assistance program.
3-1 (e) The department shall establish an appropriate enrollment
3-2 limit for the demonstration project and may not allow participation
3-3 in the project to exceed that limit. Once the limit is reached,
3-4 the department shall establish a waiting list for enrollment in the
3-5 demonstration project.
3-6 (f) To the extent permitted by federal law, the department
3-7 may require a participant in the demonstration project to make
3-8 cost-sharing payments for services provided through the project.
3-9 (g) To the maximum extent possible, the department shall use
3-10 existing resources to fund the demonstration project.
3-11 (h) Not later than December 1 of each even-numbered year,
3-12 the department shall submit a biennial report to the legislature
3-13 regarding the department's progress in establishing and operating
3-14 the demonstration project.
3-15 (i) Not later than December 1, 2006, the department shall
3-16 evaluate the cost-effectiveness of the demonstration project,
3-17 including whether the preventive drug treatments and related
3-18 services provided under the project offset future long-term care
3-19 costs for project participants. If the results of the evaluation
3-20 indicate that the project is cost-effective, the department shall
3-21 incorporate a request for funding for the continuation of the
3-22 program in the department's budget request for the next state
3-23 fiscal biennium.
3-24 (j) This section expires September 1, 2009.
3-25 SECTION 4. Subchapter B, Chapter 531, Government Code, is
3-26 amended by adding Sections 531.02101, 531.02102, and 531.02103 to
4-1 read as follows:
4-2 Sec. 531.02101. TRANSFER AUTHORITY RELATING TO
4-3 ADMINISTRATION OF MEDICAID PROGRAM. (a) To the extent that
4-4 reorganization is necessary to achieve the goals of increased
4-5 administrative efficiency, increased accountability, or cost
4-6 savings in the Medicaid program or to otherwise improve the health
4-7 of residents of this state, the commission, subject to Subsection
4-8 (b), may transfer any power, duty, function, program, activity,
4-9 obligation, right, contract, record, employee, property, or
4-10 appropriation or other money relating to administration of the
4-11 Medicaid program from a health and human services agency to the
4-12 commission.
4-13 (b) A transfer authorized by Subsection (a) may not take
4-14 effect unless approved by the Medicaid legislative oversight
4-15 committee created under Section 531.02102.
4-16 (c) The commission must notify the Legislative Budget Board
4-17 and the governor's office of budget and planning not later than the
4-18 30th day before the effective date of a transfer authorized by
4-19 Subsection (a).
4-20 Sec. 531.02102. MEDICAID LEGISLATIVE OVERSIGHT COMMITTEE.
4-21 (a) The Medicaid legislative oversight committee is composed of:
4-22 (1) three members of the senate appointed by the
4-23 lieutenant governor; and
4-24 (2) three members of the house of representatives
4-25 appointed by the speaker of the house of representatives.
4-26 (b) A member of the Medicaid legislative oversight committee
5-1 serves at the pleasure of the appointing official.
5-2 (c) The lieutenant governor and speaker of the house of
5-3 representatives shall appoint the presiding officer of the Medicaid
5-4 legislative oversight committee on an alternating basis. The
5-5 presiding officer shall serve a two-year term expiring February 1
5-6 of each odd-numbered year.
5-7 (d) The Medicaid legislative oversight committee shall:
5-8 (1) meet not more than quarterly at the call of the
5-9 presiding officer; and
5-10 (2) review and approve or reject any transfer proposed
5-11 by the commission of a power, duty, function, program, activity,
5-12 obligation, right, contract, record, employee, property, or
5-13 appropriation or other money relating to administration of the
5-14 Medicaid program from a health and human services agency to the
5-15 commission.
5-16 (e) The Medicaid legislative oversight committee may use
5-17 staff of standing committees in the senate and house of
5-18 representatives with appropriate jurisdiction, the Department of
5-19 Information Resources, the state auditor, the Texas Legislative
5-20 Council, and the Legislative Budget Board in carrying out its
5-21 responsibilities.
5-22 Sec. 531.02103. MEDICAID PROGRAM: STRATEGIES FOR IMPROVING
5-23 BUDGET CERTAINTY AND COST SAVINGS. To achieve administrative
5-24 efficiency and cost savings in the Medicaid program, the commission
5-25 shall develop and implement strategies to improve management of the
5-26 cost, quality, and use of services provided under the program. The
6-1 strategies developed and implemented under this section may
6-2 include:
6-3 (1) imposition of copayments for services provided
6-4 under the program; and
6-5 (2) use of procurement initiatives such as selective
6-6 contracting as a mechanism for obtaining provider services under
6-7 the program.
6-8 SECTION 5. Subsection (d), Section 531.0214, Government
6-9 Code, is amended to read as follows:
6-10 (d) The commission shall develop the database system in a
6-11 manner that will enable a complete analysis of the use of
6-12 prescription medications[, including information relating to:]
6-13 [(1) Medicaid clients for whom more than three
6-14 medications have been prescribed; and]
6-15 [(2) the medical effect denial of Medicaid coverage
6-16 for more than three medications has had on Medicaid clients].
6-17 SECTION 6. Subsection (a), Section 531.026, Government Code,
6-18 is amended to read as follows:
6-19 (a) The commission shall prepare and submit to the
6-20 lieutenant governor, the speaker of the house of representatives,
6-21 the comptroller, the Legislative Budget Board, [and] the governor's
6-22 office of budget and planning, each member of the appropriations
6-23 committees of the senate and house of representatives, and each
6-24 member of the standing committees of the senate and house of
6-25 representatives with responsibility for oversight of health and
6-26 human services issues [governor] a consolidated health and human
7-1 services budget recommendation not later than October 15 of each
7-2 even-numbered year.
7-3 SECTION 7. Subchapter B, Chapter 531, Government Code, is
7-4 amended by adding Section 531.0261 to read as follows:
7-5 Sec. 531.0261. CONSOLIDATED MEDICAID APPROPRIATIONS REQUEST.
7-6 (a) The commission shall include in the consolidated budget
7-7 recommendation required by Section 531.026 a consolidated Medicaid
7-8 appropriations request for the subsequent fiscal biennium.
7-9 (b) The commission shall:
7-10 (1) develop the consolidated Medicaid appropriations
7-11 request with input from the Legislative Budget Board and the
7-12 governor's office of budget and planning to ensure that relevant
7-13 information for acute and long-term care Medicaid programs relating
7-14 to caseloads, costs, measures, rates, waivers, and eligibility is
7-15 reflected; and
7-16 (2) to assist in the legislative appropriations
7-17 process, revise the consolidated Medicaid appropriations request
7-18 each time that revised caseload and cost estimates relating to the
7-19 Medicaid program are prepared.
7-20 SECTION 8. Subchapter B, Chapter 531, Government Code, is
7-21 amended by adding Section 531.0272 to read as follows:
7-22 Sec. 531.0272. COMPREHENSIVE MEDICAID OPERATING BUDGET;
7-23 QUARTERLY EXPENDITURE REPORTS. (a) The commission shall prepare a
7-24 comprehensive Medicaid operating budget at the beginning of each
7-25 fiscal year, with input as appropriate from each health and human
7-26 services agency that receives legislative appropriations relating
8-1 to the Medicaid program.
8-2 (b) The commission shall monitor all Medicaid expenditures
8-3 by the commission and health and human services agencies and submit
8-4 quarterly Medicaid expenditure reports to the lieutenant governor,
8-5 the speaker of the house of representatives, the comptroller, the
8-6 Legislative Budget Board, the governor's office of budget and
8-7 planning, each member of the appropriations committees of the
8-8 senate and house of representatives, and each member of the
8-9 standing committees of the senate and house of representatives with
8-10 responsibility for oversight of health and human services issues.
8-11 (c) The commission shall prepare the comprehensive Medicaid
8-12 operating budget and quarterly Medicaid expenditure reports with
8-13 input from the Legislative Budget Board and the governor's office
8-14 of budget and planning to ensure that the information described by
8-15 Section 531.0261(b)(1) is reflected.
8-16 SECTION 9. Subchapter B, Chapter 531, Government Code, is
8-17 amended by adding Section 531.055 to read as follows:
8-18 Sec. 531.055. MEDICAID REIMBURSEMENT RATES REPORT. Not
8-19 later than December 1 of each even-numbered year, the commission
8-20 shall prepare and deliver to the governor, lieutenant governor,
8-21 speaker of the house of representatives, and each member of the
8-22 legislature a report that:
8-23 (1) identifies the Medicaid reimbursement rates for
8-24 each county in this state; and
8-25 (2) compares the state's Medicaid reimbursement rates
8-26 to the Medicaid reimbursement rates of the top 15 industrial states
9-1 as ranked by the United States Department of Commerce Bureau of
9-2 Economic Analysis based on gross state product.
9-3 SECTION 10. Subchapter A, Chapter 533, Government Code, is
9-4 amended by adding Sections 533.0055 and 533.016 to read as follows:
9-5 Sec. 533.0055. EVALUATION OF REPORTING REQUIREMENTS AND
9-6 INSPECTION PROCEDURES. (a) The commission shall:
9-7 (1) evaluate on-site inspection procedures of managed
9-8 care organizations contracting with the commission under this
9-9 chapter and evaluate methods to streamline those procedures to
9-10 assist the commission in determining necessary and effective
9-11 quality control measures and required data;
9-12 (2) evaluate methods to streamline reporting
9-13 requirements for managed care organizations contracting with the
9-14 commission under this chapter, including:
9-15 (A) combining information required to be
9-16 reported into a quarterly management report;
9-17 (B) eliminating unnecessary or duplicative
9-18 reporting requirements; and
9-19 (C) requiring managed care organizations to use
9-20 uniform forms developed by the commission for referrals for
9-21 services and credentialing of health care providers providing
9-22 health care services to recipients; and
9-23 (3) require managed care organizations contracting
9-24 with the commission under this chapter to evaluate reporting
9-25 requirements for health care providers to identify methods of
9-26 reducing the administrative burden placed on the providers,
10-1 including:
10-2 (A) reducing the complexity of forms health care
10-3 providers are required to complete; and
10-4 (B) eliminating unnecessary or duplicative
10-5 reporting requirements.
10-6 (b) The commission shall submit a report to the legislature
10-7 regarding the evaluation of and methods for streamlining on-site
10-8 inspection procedures and reporting requirements for managed care
10-9 organizations and health care providers providing health care
10-10 services to recipients. The report must include recommendations on
10-11 which methods should be implemented and a schedule for
10-12 implementation.
10-13 (c) This section expires September 1, 2002.
10-14 Sec. 533.016. INTERAGENCY SHARING OF INFORMATION. The
10-15 commission shall require a health and human services agency
10-16 implementing the Medicaid managed care program to provide to each
10-17 other health and human services agency implementing the Medicaid
10-18 managed care program information reported to that agency by a
10-19 managed care organization or health care provider providing
10-20 services to recipients.
10-21 SECTION 11. On January 1, 2002, or on an earlier date
10-22 specified by the Health and Human Services Commission:
10-23 (1) all powers, duties, functions, programs,
10-24 activities, obligations, rights, contracts, records, employees,
10-25 property, and appropriations and other money of the Texas
10-26 Department of Health that are determined by the commissioner of
11-1 health and human services to be essential to the administration of
11-2 the Medicaid program are transferred to the Health and Human
11-3 Services Commission;
11-4 (2) a rule or form adopted by the Texas Department of
11-5 Health that relates to a transferred component of the Medicaid
11-6 program is a rule or form of the Health and Human Services
11-7 Commission and remains in effect until altered by the commission;
11-8 (3) a reference in law or an administrative rule to
11-9 the Texas Department of Health that relates to a transferred
11-10 component of the Medicaid program means the Health and Human
11-11 Services Commission;
11-12 (4) a license, permit, or certification in effect that
11-13 was issued by the Texas Department of Health that relates to a
11-14 transferred component of the Medicaid program is continued in
11-15 effect as a license, permit, or certification of the Health and
11-16 Human Services Commission; and
11-17 (5) a complaint, investigation, or other proceeding
11-18 pending before the Texas Department of Health that relates to a
11-19 transferred component of the Medicaid program is transferred
11-20 without change in status to the Health and Human Services
11-21 Commission.
11-22 SECTION 12. The state agency responsible for implementing
11-23 the demonstration project required by Section 32.053, Human
11-24 Resources Code, as added by this Act, shall request and actively
11-25 pursue any necessary waivers or authorizations from the Health Care
11-26 Financing Administration or other appropriate entities to enable
12-1 the agency to implement the demonstration project not later than
12-2 September 1, 2002. The agency may delay implementing the
12-3 demonstration project until the necessary waivers or authorizations
12-4 are granted.
12-5 SECTION 13. The Health and Human Services Commission shall
12-6 submit the report required by Subsection (b), Section 533.0055,
12-7 Government Code, as added by this Act, not later than November 1,
12-8 2002.
12-9 SECTION 14. As soon as possible after the effective date of
12-10 this Act, the lieutenant governor and speaker of the house of
12-11 representatives shall appoint the members of the Medicaid
12-12 legislative oversight committee created by Section 531.02102,
12-13 Government Code, as added by this Act. The lieutenant governor
12-14 shall appoint the initial presiding officer of the committee.
12-15 SECTION 15. (a) Subject to Subsection (b) of this section,
12-16 if before implementing any provision of this Act a state agency
12-17 determines that a waiver or authorization from a federal agency is
12-18 necessary for implementation of that provision, the agency affected
12-19 by the provision shall request the waiver or authorization and may
12-20 delay implementing that provision until the waiver or authorization
12-21 is granted.
12-22 (b) Implementation of Section 32.053, Human Resources Code,
12-23 as added by this Act, is governed by Section 12 of this Act.
12-24 SECTION 16. (a) Except as provided by Subsection (b) of
12-25 this section, this Act takes effect September 1, 2001, and applies
12-26 to a person receiving medical assistance on or after that date
13-1 regardless of the date on which the person began receiving that
13-2 medical assistance.
13-3 (b) Sections 3, 10, and 12 of this Act take effect
13-4 immediately if this Act receives a vote of two-thirds of all the
13-5 members elected to each house, as provided by Section 39, Article
13-6 III, Texas Constitution. If this Act does not receive the vote
13-7 necessary for immediate effect, Sections 3, 10, and 12 of this Act
13-8 take effect September 1, 2001.