By: Zaffirini S.B. No. 1156
Line and page numbers may not match official copy.
Bill not drafted by TLC or Senate E&E.
A BILL TO BE ENTITLED
1-1 AN ACT
1-2 relating to the financing of, and eligibility for, the state
1-3 Medicaid program; making an appropriation.
1-4 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-5 SECTION 1. Section 32.024, Human Resources Code, is amended
1-6 by adding Subsection (x) to read as follows:
1-7 (x) In its rules and standards governing the vendor drug
1-8 program, the department may not limit benefits for the number of
1-9 medications prescribed to a recipient of prescription drug benefits
1-10 under the medical assistance program.
1-11 SECTION 2. Subchapter B, Chapter 32, Human Resources Code,
1-12 is amended by adding Section 32.02415 to read as follows:
1-13 Sec. 32.02415. EXCLUSION OF ASSETS AND RESOURCES. To the
1-14 extent allowed by federal law, the department may not consider the
1-15 assets and resources of a child under 19 years of age or the assets
1-16 and resources of the child's parents or other caretaker for
1-17 purposes of determining the child's eligibility for medical
1-18 assistance.
1-19 SECTION 3. Section 32.025, Human Resources Code, is amended
1-20 by adding Subsections (d) and (e) to read as follows:
1-21 (d) To the extent allowed by federal law and except as
1-22 otherwise provided by this section, the department shall adopt
1-23 application forms and procedures for a request for medical
2-1 assistance provided to a child under 19 years of age that are
2-2 similar to the application forms and procedures adopted under
2-3 Section 62.103, Health and Safety Code.
2-4 (e) The department shall permit an application requesting
2-5 medical assistance for a child under 19 years of age to be
2-6 conducted by mail instead of through a personal appearance at a
2-7 department office.
2-8 SECTION 4. Section 32.026, Human Resources Code, is amended
2-9 by adding Subsections (d) and (e) to read as follows:
2-10 (d) In adopting rules under this section, the department
2-11 shall ensure, to the extent allowed by federal law, that
2-12 documentation and verification procedures used in determining and
2-13 certifying the eligibility and need for medical assistance of a
2-14 child under 19 years of age are similar to the documentation and
2-15 verification procedures used to determine a child's eligibility for
2-16 coverage under Chapter 62, Health and Safety Code.
2-17 (e) The department shall permit a recertification review of
2-18 the eligibility and need for medical assistance of a child under 19
2-19 years of age to be conducted by telephone or mail instead of
2-20 through a personal appearance at a department office.
2-21 SECTION 5. Subchapter B, Chapter 32, Human Resources Code,
2-22 is amended by adding Section 32.0261 to read as follows:
2-23 Sec. 32.0261. CONTINUOUS ELIGIBILITY. The department shall
2-24 adopt rules in accordance with 42 U.S.C. Section 1396a(e)(12), as
2-25 amended, to provide for a period of continuous eligibility for a
2-26 child under 19 years of age who is determined to be eligible for
3-1 medical assistance under this chapter. The rules shall provide
3-2 that the child remains eligible for medical assistance, without
3-3 additional review by the department and regardless of changes in
3-4 the child's resources or income, until the earlier of:
3-5 (1) the first anniversary of the date on which the
3-6 child's eligibility was determined; or
3-7 (2) the child's 19th birthday.
3-8 SECTION 6. Subchapter B, Chapter 32, Human Resources Code,
3-9 is amended by adding Sections 32.053-32.055 to read as follows:
3-10 Sec. 32.053. DEMONSTRATION PROJECT FOR CERTAIN MEDICATIONS
3-11 AND RELATED SERVICES. (a) The department shall establish a
3-12 five-year demonstration project to provide to a person through the
3-13 medical assistance program psychotropic medications and related
3-14 laboratory and physician services necessary to conform to a
3-15 prescribed medical regime for those medications.
3-16 (b) A person is eligible to participate in the demonstration
3-17 project if the person:
3-18 (1) has been diagnosed with schizophrenia or bipolar
3-19 disorder;
3-20 (2) is at least 19 years of age, but not more than 64
3-21 years of age;
3-22 (3) has a net family income that is at or below 200
3-23 percent of the federal poverty level;
3-24 (4) is not covered by a health benefits plan offering
3-25 adequate coverage, as determined by the department; and
3-26 (5) is not otherwise eligible for medical assistance
4-1 at the time the person's eligibility for participation in the
4-2 demonstration project is determined.
4-3 (c) A participant in the demonstration project is not
4-4 subject to the monthly three-prescription limit under the medical
4-5 assistance program.
4-6 (d) Participation in the demonstration project does not
4-7 entitle a participant to other services provided under the medical
4-8 assistance program.
4-9 (e) Not later than December 1 of each even-numbered year,
4-10 the department shall submit a biennial report to the legislature
4-11 regarding the department's progress in establishing and operating
4-12 the demonstration project.
4-13 (f) Not later than December 1, 2006, the department shall
4-14 evaluate the cost-effectiveness of the demonstration project,
4-15 including whether the preventive drug treatments and related
4-16 services provided under the project offset future long-term care
4-17 costs for project participants. If the results of the evaluation
4-18 indicate that the project is cost-effective, the department shall
4-19 incorporate a request for funding for the continuation of the
4-20 program in the department's budget request for the next state
4-21 fiscal biennium.
4-22 (g) This section expires September 1, 2007.
4-23 Sec. 32.054. DEMONSTRATION PROJECT FOR PERSONS WITH HIV
4-24 INFECTION OR AIDS. (a) In this section, "AIDS" and "HIV" have the
4-25 meanings assigned by Section 81.101, Health and Safety Code.
4-26 (b) The department shall establish a demonstration project
5-1 to provide a person with HIV infection or AIDS with the following
5-2 services and medications through the medical assistance program:
5-3 (1) services provided by a physician, physician
5-4 assistant, advanced practice nurse, or other health care provider
5-5 specified by the department;
5-6 (2) anti-retroviral drug treatments;
5-7 (3) other medications determined to be necessary for
5-8 treatment of a condition related to HIV infection or AIDS;
5-9 (4) vaccinations for hepatitis B and pneumonia;
5-10 (5) pap smears, colposcopy, and other diagnostic
5-11 procedures necessary to monitor gynecologic complications resulting
5-12 from HIV infection or AIDS in women;
5-13 (6) laboratory and other diagnostic services,
5-14 including periodic testing for CD4+ T-cell counts, viral load
5-15 determination, and phenotype or genotype testing if clinically
5-16 indicated; and
5-17 (7) other laboratory and radiological testing
5-18 necessary to monitor potential toxicity of therapy.
5-19 (c) The department shall establish the demonstration project
5-20 in at least two counties with a high prevalence of HIV infection
5-21 and AIDS. The department may request financial participation from
5-22 the counties in which the department establishes the demonstration
5-23 project.
5-24 (d) A person is eligible to participate in the demonstration
5-25 project if the person:
5-26 (1) has been diagnosed with HIV infection or AIDS by a
6-1 physician;
6-2 (2) is under 65 years of age;
6-3 (3) has a net family income that is at or below 200
6-4 percent of the federal poverty level;
6-5 (4) is a resident of a county included in the project
6-6 or, subject to guidelines established by the department, is
6-7 receiving medical care for HIV infection or AIDS through a facility
6-8 located in a county included in the project;
6-9 (5) is not covered by a health benefits plan offering
6-10 adequate coverage, as determined by the department; and
6-11 (6) is not otherwise eligible for medical assistance
6-12 at the time the person's eligibility for participation in the
6-13 demonstration project is determined.
6-14 (e) Participation in the demonstration project does not
6-15 entitle a participant to other services provided under the medical
6-16 assistance program.
6-17 (f) A participant in the demonstration project is not
6-18 subject to the monthly three-prescription limit under the medical
6-19 assistance program.
6-20 (g) Not later than December 1 of each even-numbered year,
6-21 the department shall submit a biennial report to the legislature
6-22 regarding the department's progress in establishing and operating
6-23 the demonstration project.
6-24 (h) Not later than December 1, 2006, the department shall
6-25 evaluate the cost-effectiveness of the demonstration project,
6-26 including whether the services and medications provided offset
7-1 future higher costs for project participants. If the results of
7-2 the evaluation indicate that the project is cost-effective, the
7-3 department shall incorporate a request for funding for the
7-4 expansion of the project into additional counties or throughout the
7-5 state, as appropriate, in the department's budget request for the
7-6 next state fiscal biennium.
7-7 (i) This section expires September 1, 2007.
7-8 Sec. 32.055. DEMONSTRATION PROJECT FOR WOMEN'S HEALTH CARE
7-9 SERVICES. (a) The department shall establish a five-year
7-10 demonstration project through the medical assistance program to
7-11 expand access to preventive health and family planning services for
7-12 women. A woman eligible under Subsection (b) to participate in the
7-13 demonstration project may receive preventive health and family
7-14 planning services including:
7-15 (1) medical history;
7-16 (2) physical examinations;
7-17 (3) counseling and education on contraceptive methods;
7-18 (4) provision of contraceptives;
7-19 (5) health screenings, including screening for:
7-20 (A) diabetes;
7-21 (B) cervical cancer;
7-22 (C) breast cancer;
7-23 (D) sexually transmitted diseases;
7-24 (E) hypertension;
7-25 (F) cholesterol; and
7-26 (G) tuberculosis;
8-1 (6) risk assessment; and
8-2 (7) referral of medical problems to appropriate
8-3 providers.
8-4 (b) A woman is eligible to participate in the demonstration
8-5 project if the woman:
8-6 (1) is of childbearing age, as determined by the
8-7 department;
8-8 (2) has a net family income that is at or below 185
8-9 percent of the federal poverty level; and
8-10 (3) is not otherwise eligible for the medical
8-11 assistance program.
8-12 (c) The department shall compile a list of potential funding
8-13 sources a client can use to help pay for treatment for health
8-14 problems:
8-15 (1) identified using services provided to the client
8-16 under the demonstration project; and
8-17 (2) for which the client is not eligible to receive
8-18 treatment under the medical assistance program.
8-19 (d) Not later than December 1 of each even-numbered year,
8-20 the department shall submit a report to the legislature regarding
8-21 the department's progress in establishing and operating the
8-22 demonstration project.
8-23 (e) This section expires September 1, 2007.
8-24 SECTION 7. Subchapter B, Chapter 32, Human Resources Code,
8-25 is amended by adding Section 32.056 to read as follows:
8-26 Sec. 32.056. DEMONSTRATION PROJECT FOR MEDICAL ASSISTANCE
9-1 BUY-IN PROGRAM FOR CERTAIN RECIPIENTS WITH DISABILITIES. (a) The
9-2 department shall establish a demonstration project to implement in
9-3 five sites a medical assistance buy-in program in accordance with
9-4 the Ticket to Work and Work Incentives Improvement Act of 1999
9-5 (Pub. L. No. 106-170), as amended, to provide medical assistance
9-6 to:
9-7 (1) a person who:
9-8 (A) is at least 16 years of age, but is not more
9-9 than 64 years of age; and
9-10 (B) has earned income that exceeds the limit
9-11 established by federal law for eligibility for Supplemental
9-12 Security Income (SSI) (42 U.S.C. Section 1381 et seq.), as amended,
9-13 but is otherwise eligible for those benefits; and
9-14 (2) an employed individual with a medically improved
9-15 disability, as defined by 42 U.S.C. Section 1396d(v)(1), as
9-16 amended.
9-17 (b) In establishing the demonstration project, the
9-18 department may:
9-19 (1) establish income, assets, and resource limitations
9-20 for eligibility for participation in the demonstration project; and
9-21 (2) require a participant in the demonstration project
9-22 to pay premiums and other cost-sharing charges in accordance with
9-23 42 U.S.C. Section 1396o(g)(1), as amended.
9-24 (c) The department shall require a participant in the
9-25 project to pay premiums to the extent required by 42 U.S.C. Section
9-26 1396o(g)(2), as amended.
10-1 (d) Not later than December 1, 2002, the department shall
10-2 evaluate the effectiveness of the demonstration project in
10-3 providing health care services to employed persons with
10-4 disabilities. If the results of the evaluation indicate that the
10-5 project is effective, the department shall incorporate a request
10-6 for funding for the continuation or expansion of the program in the
10-7 department's budget request for the next state fiscal biennium.
10-8 (e) This section expires September 1, 2003.
10-9 SECTION 8. Section 531.0214(d), Government Code, is amended
10-10 to read as follows:
10-11 (d) The commission shall develop the database system in a
10-12 manner that will enable a complete analysis of the use of
10-13 prescription medications[, including information relating to:]
10-14 [(1) Medicaid clients for whom more than three
10-15 medications have been prescribed; and]
10-16 [(2) the medical effect denial of Medicaid coverage
10-17 for more than three medications has had on Medicaid clients].
10-18 SECTION 9. Subchapter A, Chapter 533, Government Code, is
10-19 amended by adding Sections 533.0055 and 533.016 to read as follows:
10-20 Sec. 533.0055. EVALUATION OF REPORTING REQUIREMENTS AND
10-21 INSPECTION PROCEDURES. (a) The commission shall:
10-22 (1) evaluate on-site inspection procedures of managed
10-23 care organizations contracting with the commission under this
10-24 chapter and evaluate methods to streamline those procedures to
10-25 assist the commission in determining necessary and effective
10-26 quality control measures and required data;
11-1 (2) evaluate methods to streamline reporting
11-2 requirements for managed care organizations contracting with the
11-3 commission under this chapter, including:
11-4 (A) combining information required to be
11-5 reported into a quarterly management report;
11-6 (B) eliminating unnecessary or duplicative
11-7 reporting requirements; and
11-8 (C) requiring managed care organizations to use
11-9 uniform forms developed by the commission for referrals for
11-10 services and credentialing of health care providers providing
11-11 health care services to recipients; and
11-12 (3) require managed care organizations contracting
11-13 with the commission under this chapter to evaluate reporting
11-14 requirements for health care providers to identify methods of
11-15 reducing the administrative burden placed on the providers,
11-16 including:
11-17 (A) reducing the complexity of forms health care
11-18 providers are required to complete; and
11-19 (B) eliminating unnecessary or duplicative
11-20 reporting requirements.
11-21 (b) The commission shall submit a report to the legislature
11-22 regarding the evaluation of and methods for streamlining on-site
11-23 inspection procedures and reporting requirements for managed care
11-24 organizations and health care providers providing health care
11-25 services to recipients. The report must include recommendations on
11-26 which methods should be implemented and a schedule for
12-1 implementation.
12-2 (c) This section expires September 1,2002.
12-3 Sec. 533.016. INTERAGENCY SHARING OF INFORMATION. The
12-4 commission shall require a health and human services agency
12-5 implementing the Medicaid managed care program to provide to each
12-6 other health and human services agency implementing the Medicaid
12-7 managed care program information reported to that agency by a
12-8 managed care organization or health care provider providing
12-9 services to recipients.
12-10 SECTION 10. The sum of __________ is hereby appropriated to
12-11 the Health and Human Services Commission for the implementation of
12-12 this Act.
12-13 SECTION 11. The Health and Human Services Commission or the
12-14 appropriate state agency operating part of the medical assistance
12-15 program under Chapter 32, Human Resources Code, shall adopt rules
12-16 required by Section 32.0261, Human Resources Code, as added by this
12-17 Act, not later than October 1, 2001. The rules must provide for a
12-18 period of continuous eligibility in accordance with that section
12-19 for a child whose initial or continued eligibility is determined on
12-20 or after the effective date of the rules.
12-21 SECTION 12. The state agencies responsible for implementing
12-22 the demonstration projects required by Sections 32.053-32.055,
12-23 Human Resources Code, as added by this Act, shall request and
12-24 actively pursue any necessary waivers or authorizations from the
12-25 Health Care Financing Administration or other appropriate entities
12-26 to enable the agencies to implement the demonstration projects not
13-1 later than September 1, 2002. The agencies may delay implementing
13-2 the demonstration projects until the necessary waivers or
13-3 authorizations are granted.
13-4 SECTION 13. The Health and Human Services Commission shall
13-5 submit the report required by Section 533.0055(b), Government Code,
13-6 as added by this Act, not later than November 1, 2002.
13-7 SECTION 14. (a) Subject to Subsection (b) of this section,
13-8 if before implementing any provision of this Act a state agency
13-9 determines that a waiver or authorization from a federal agency is
13-10 necessary for implementation of that provision, the agency affected
13-11 by the provision shall request the waiver or authorization and may
13-12 delay implementing that provision until the waiver or authorization
13-13 is granted.
13-14 (b) Implementation of Sections 32.053-32.055, Human
13-15 Resources Code, as added by this Act, is governed by Section 12 of
13-16 this Act.
13-17 SECTION 15. (a) Except as provided by Subsection (b) of
13-18 this section, this Act takes effect September 1, 2001, and applies
13-19 to a person receiving medical assistance on or after that date
13-20 regardless of the date on which the person began receiving that
13-21 medical assistance.
13-22 (b) Sections 6, 9, and 12 of this Act take effect
13-23 immediately if this Act receives a vote of two-thirds of all the
13-24 members elected to each house, as provided by Section 39, Article
13-25 III, Texas Constitution. If this Act does not receive the vote
13-26 necessary for immediate effect, Sections 6, 9, and 12 of this Act
14-1 take effect September 1, 2001.