1-1 By: Zaffirini, et al. S.B. No. 1156
1-2 (In the Senate - Filed March 6, 2001; March 7, 2001, read
1-3 first time and referred to Committee on Finance; April 17, 2001,
1-4 reported adversely, with favorable Committee Substitute by the
1-5 following vote: Yeas 12, Nays 0; April 17, 2001, sent to printer.)
1-6 COMMITTEE SUBSTITUTE FOR S.B. No. 1156 By: Zaffirini
1-7 A BILL TO BE ENTITLED
1-8 AN ACT
1-9 relating to the state Medicaid program.
1-10 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-11 SECTION 1. Section 32.024, Human Resources Code, is amended
1-12 by adding Subsection (x) to read as follows:
1-13 (x) In its rules and standards governing the vendor drug
1-14 program, the department shall provide for cost-sharing by
1-15 recipients of prescription drug benefits under the medical
1-16 assistance program in a manner that ensures that recipients with
1-17 higher levels of income are required to pay progressively higher
1-18 percentages of the costs of prescription drugs.
1-19 SECTION 2. Subchapter B, Chapter 32, Human Resources Code,
1-20 is amended by adding Section 32.053 to read as follows:
1-21 Sec. 32.053. DEMONSTRATION PROJECT FOR CERTAIN MEDICATIONS
1-22 AND RELATED SERVICES. (a) The department shall establish a
1-23 demonstration project to provide to a person through the medical
1-24 assistance program psychotropic medications and related laboratory
1-25 and medical services necessary to conform to a prescribed medical
1-26 regime for those medications.
1-27 (b) A person is eligible to participate in the demonstration
1-28 project if the person:
1-29 (1) has been diagnosed as having a mental impairment,
1-30 including schizophrenia or bipolar disorder, that is expected to
1-31 cause the person to become a disabled individual, as defined by
1-32 Section 1614(a) of the federal Social Security Act (42 U.S.C.
1-33 Section 1382c(a)), as amended;
1-34 (2) is at least 19 years of age, but not more than 64
1-35 years of age;
1-36 (3) has a net family income that is at or below 200
1-37 percent of the federal poverty level;
1-38 (4) is not covered by a health benefits plan offering
1-39 adequate coverage, as determined by the department; and
1-40 (5) is not otherwise eligible for medical assistance
1-41 at the time the person's eligibility for participation in the
1-42 demonstration project is determined.
1-43 (c) Notwithstanding any other provision of this section, the
1-44 department shall provide each participant in the demonstration
1-45 project with a 12-month period of continuous eligibility for
1-46 participation in the project.
1-47 (d) Participation in the demonstration project does not
1-48 entitle a participant to other services provided under the medical
1-49 assistance program.
1-50 (e) The department shall establish an appropriate enrollment
1-51 limit for the demonstration project and may not allow participation
1-52 in the project to exceed that limit. Once the limit is reached,
1-53 the department shall establish a waiting list for enrollment in the
1-54 demonstration project.
1-55 (f) To the extent permitted by federal law, the department
1-56 may require a participant in the demonstration project to make
1-57 cost-sharing payments for services provided through the project.
1-58 (g) To the maximum extent possible, the department shall use
1-59 existing resources to fund the demonstration project.
1-60 (h) Not later than December 1 of each even-numbered year,
1-61 the department shall submit a biennial report to the legislature
1-62 regarding the department's progress in establishing and operating
1-63 the demonstration project.
1-64 (i) Not later than December 1, 2006, the department shall
2-1 evaluate the cost-effectiveness of the demonstration project,
2-2 including whether the preventive drug treatments and related
2-3 services provided under the project offset future long-term care
2-4 costs for project participants. If the results of the evaluation
2-5 indicate that the project is cost-effective, the department shall
2-6 incorporate a request for funding for the continuation of the
2-7 program in the department's budget request for the next state
2-8 fiscal biennium.
2-9 (j) This section expires September 1, 2009.
2-10 SECTION 3. Subchapter B, Chapter 531, Government Code, is
2-11 amended by adding Sections 531.02101 and 531.02102 to read as
2-12 follows:
2-13 Sec. 531.02101. TRANSFER AUTHORITY RELATING TO
2-14 ADMINISTRATION OF MEDICAID PROGRAM. (a) To the extent that
2-15 reorganization is necessary to achieve the goals of increased
2-16 administrative efficiency, increased accountability, or cost
2-17 savings in the Medicaid program or to otherwise improve the health
2-18 of residents of this state, the commission, subject to Subsection
2-19 (b), may transfer any power, duty, function, program, activity,
2-20 obligation, right, contract, record, employee, property, or
2-21 appropriation or other money relating to administration of the
2-22 Medicaid program from a health and human services agency to the
2-23 commission.
2-24 (b) A transfer authorized by Subsection (a) may not take
2-25 effect unless approved by the Medicaid legislative oversight
2-26 committee created under Section 531.02102.
2-27 (c) The commission must notify the Legislative Budget Board
2-28 and the governor's office of budget and planning not later than the
2-29 30th day before the effective date of a transfer authorized by
2-30 Subsection (a).
2-31 Sec. 531.02102. MEDICAID LEGISLATIVE OVERSIGHT COMMITTEE.
2-32 (a) The Medicaid legislative oversight committee is composed of:
2-33 (1) three members of the senate appointed by the
2-34 lieutenant governor; and
2-35 (2) three members of the house of representatives
2-36 appointed by the speaker of the house of representatives.
2-37 (b) A member of the Medicaid legislative oversight committee
2-38 serves at the pleasure of the appointing official.
2-39 (c) The lieutenant governor and speaker of the house of
2-40 representatives shall appoint the presiding officer of the Medicaid
2-41 legislative oversight committee on an alternating basis. The
2-42 presiding officer shall serve a two-year term expiring February 1
2-43 of each odd-numbered year.
2-44 (d) The Medicaid legislative oversight committee shall:
2-45 (1) meet not more than quarterly at the call of the
2-46 presiding officer; and
2-47 (2) review and approve or reject any transfer proposed
2-48 by the commission of a power, duty, function, program, activity,
2-49 obligation, right, contract, record, employee, property, or
2-50 appropriation or other money relating to administration of the
2-51 Medicaid program from a health and human services agency to the
2-52 commission.
2-53 (e) The Medicaid legislative oversight committee may use
2-54 staff of standing committees in the senate and house of
2-55 representatives with appropriate jurisdiction, the Department of
2-56 Information Resources, the state auditor, the Texas Legislative
2-57 Council, and the Legislative Budget Board in carrying out its
2-58 responsibilities.
2-59 SECTION 4. Subsection (d), Section 531.0214, Government
2-60 Code, is amended to read as follows:
2-61 (d) The commission shall develop the database system in a
2-62 manner that will enable a complete analysis of the use of
2-63 prescription medications[, including information relating to:]
2-64 [(1) Medicaid clients for whom more than three
2-65 medications have been prescribed; and]
2-66 [(2) the medical effect denial of Medicaid coverage
2-67 for more than three medications has had on Medicaid clients].
2-68 SECTION 5. Subsection (a), Section 531.026, Government Code,
2-69 is amended to read as follows:
3-1 (a) The commission shall prepare and submit to the
3-2 lieutenant governor, the speaker of the house of representatives,
3-3 the comptroller, the Legislative Budget Board, [and] the governor's
3-4 office of budget and planning, each member of the appropriations
3-5 committees of the senate and house of representatives, and each
3-6 member of the standing committees of the senate and house of
3-7 representatives with responsibility for oversight of health and
3-8 human services issues [governor] a consolidated health and human
3-9 services budget recommendation not later than October 15 of each
3-10 even-numbered year.
3-11 SECTION 6. Subchapter B, Chapter 531, Government Code, is
3-12 amended by adding Section 531.0261 to read as follows:
3-13 Sec. 531.0261. CONSOLIDATED MEDICAID APPROPRIATIONS REQUEST.
3-14 (a) The commission shall include in the consolidated budget
3-15 recommendation required by Section 531.026 a consolidated Medicaid
3-16 appropriations request for the subsequent fiscal biennium.
3-17 (b) The commission shall:
3-18 (1) develop the consolidated Medicaid appropriations
3-19 request with input from the Legislative Budget Board and the
3-20 governor's office of budget and planning to ensure that relevant
3-21 information for acute and long-term care Medicaid programs relating
3-22 to caseloads, costs, measures, rates, waivers, and eligibility is
3-23 reflected; and
3-24 (2) to assist in the legislative appropriations
3-25 process, revise the consolidated Medicaid appropriations request
3-26 each time that revised caseload and cost estimates relating to the
3-27 Medicaid program are prepared.
3-28 SECTION 7. Subchapter B, Chapter 531, Government Code, is
3-29 amended by adding Section 531.0272 to read as follows:
3-30 Sec. 531.0272. COMPREHENSIVE MEDICAID OPERATING BUDGET;
3-31 QUARTERLY EXPENDITURE REPORTS. (a) The commission shall prepare a
3-32 comprehensive Medicaid operating budget at the beginning of each
3-33 fiscal year, with input as appropriate from each health and human
3-34 services agency that receives legislative appropriations relating
3-35 to the Medicaid program.
3-36 (b) The commission shall monitor all Medicaid expenditures
3-37 by the commission and health and human services agencies and submit
3-38 quarterly Medicaid expenditure reports to the lieutenant governor,
3-39 the speaker of the house of representatives, the comptroller, the
3-40 Legislative Budget Board, the governor's office of budget and
3-41 planning, each member of the appropriations committees of the
3-42 senate and house of representatives, and each member of the
3-43 standing committees of the senate and house of representatives with
3-44 responsibility for oversight of health and human services issues.
3-45 (c) The commission shall prepare the comprehensive Medicaid
3-46 operating budget and quarterly Medicaid expenditure reports with
3-47 input from the Legislative Budget Board and the governor's office
3-48 of budget and planning to ensure that the information described by
3-49 Section 531.0261(b)(1) is reflected.
3-50 SECTION 8. Subchapter A, Chapter 533, Government Code, is
3-51 amended by adding Sections 533.0055 and 533.016 to read as follows:
3-52 Sec. 533.0055. EVALUATION OF REPORTING REQUIREMENTS AND
3-53 INSPECTION PROCEDURES. (a) The commission shall:
3-54 (1) evaluate on-site inspection procedures of managed
3-55 care organizations contracting with the commission under this
3-56 chapter and evaluate methods to streamline those procedures to
3-57 assist the commission in determining necessary and effective
3-58 quality control measures and required data;
3-59 (2) evaluate methods to streamline reporting
3-60 requirements for managed care organizations contracting with the
3-61 commission under this chapter, including:
3-62 (A) combining information required to be
3-63 reported into a quarterly management report;
3-64 (B) eliminating unnecessary or duplicative
3-65 reporting requirements; and
3-66 (C) requiring managed care organizations to use
3-67 uniform forms developed by the commission for referrals for
3-68 services and credentialing of health care providers providing
3-69 health care services to recipients; and
4-1 (3) require managed care organizations contracting
4-2 with the commission under this chapter to evaluate reporting
4-3 requirements for health care providers to identify methods of
4-4 reducing the administrative burden placed on the providers,
4-5 including:
4-6 (A) reducing the complexity of forms health care
4-7 providers are required to complete; and
4-8 (B) eliminating unnecessary or duplicative
4-9 reporting requirements.
4-10 (b) The commission shall submit a report to the legislature
4-11 regarding the evaluation of and methods for streamlining on-site
4-12 inspection procedures and reporting requirements for managed care
4-13 organizations and health care providers providing health care
4-14 services to recipients. The report must include recommendations on
4-15 which methods should be implemented and a schedule for
4-16 implementation.
4-17 (c) This section expires September 1, 2002.
4-18 Sec. 533.016. INTERAGENCY SHARING OF INFORMATION. The
4-19 commission shall require a health and human services agency
4-20 implementing the Medicaid managed care program to provide to each
4-21 other health and human services agency implementing the Medicaid
4-22 managed care program information reported to that agency by a
4-23 managed care organization or health care provider providing
4-24 services to recipients.
4-25 SECTION 9. On January 1, 2002, or on an earlier date
4-26 specified by the Health and Human Services Commission:
4-27 (1) all powers, duties, functions, programs,
4-28 activities, obligations, rights, contracts, records, employees,
4-29 property, and appropriations and other money of the Texas
4-30 Department of Health that are determined by the commissioner of
4-31 health and human services to be essential to the administration of
4-32 the Medicaid program are transferred to the Health and Human
4-33 Services Commission;
4-34 (2) a rule or form adopted by the Texas Department of
4-35 Health that relates to a transferred component of the Medicaid
4-36 program is a rule or form of the Health and Human Services
4-37 Commission and remains in effect until altered by the commission;
4-38 (3) a reference in law or an administrative rule to
4-39 the Texas Department of Health that relates to a transferred
4-40 component of the Medicaid program means the Health and Human
4-41 Services Commission;
4-42 (4) a license, permit, or certification in effect that
4-43 was issued by the Texas Department of Health that relates to a
4-44 transferred component of the Medicaid program is continued in
4-45 effect as a license, permit, or certification of the Health and
4-46 Human Services Commission; and
4-47 (5) a complaint, investigation, or other proceeding
4-48 pending before the Texas Department of Health that relates to a
4-49 transferred component of the Medicaid program is transferred
4-50 without change in status to the Health and Human Services
4-51 Commission.
4-52 SECTION 10. The state agency responsible for implementing
4-53 the demonstration project required by Section 32.053, Human
4-54 Resources Code, as added by this Act, shall request and actively
4-55 pursue any necessary waivers or authorizations from the Health Care
4-56 Financing Administration or other appropriate entities to enable
4-57 the agency to implement the demonstration project not later than
4-58 September 1, 2002. The agency may delay implementing the
4-59 demonstration project until the necessary waivers or authorizations
4-60 are granted.
4-61 SECTION 11. The Health and Human Services Commission shall
4-62 submit the report required by Subsection (b), Section 533.0055,
4-63 Government Code, as added by this Act, not later than November 1,
4-64 2002.
4-65 SECTION 12. As soon as possible after the effective date of
4-66 this Act, the lieutenant governor and speaker of the house of
4-67 representatives shall appoint the members of the Medicaid
4-68 legislative oversight committee created by Section 531.02102,
4-69 Government Code, as added by this Act. The lieutenant governor
5-1 shall appoint the initial presiding officer of the committee.
5-2 SECTION 13. (a) Subject to Subsection (b) of this section,
5-3 if before implementing any provision of this Act a state agency
5-4 determines that a waiver or authorization from a federal agency is
5-5 necessary for implementation of that provision, the agency affected
5-6 by the provision shall request the waiver or authorization and may
5-7 delay implementing that provision until the waiver or authorization
5-8 is granted.
5-9 (b) Implementation of Section 32.053, Human Resources Code,
5-10 as added by this Act, is governed by Section 10 of this Act.
5-11 SECTION 14. (a) Except as provided by Subsection (b) of
5-12 this section, this Act takes effect September 1, 2001, and applies
5-13 to a person receiving medical assistance on or after that date
5-14 regardless of the date on which the person began receiving that
5-15 medical assistance.
5-16 (b) Sections 2, 8, and 10 of this Act take effect
5-17 immediately if this Act receives a vote of two-thirds of all the
5-18 members elected to each house, as provided by Section 39, Article
5-19 III, Texas Constitution. If this Act does not receive the vote
5-20 necessary for immediate effect, Sections 2, 8, and 10 of this Act
5-21 take effect September 1, 2001.
5-22 * * * * *