1-1 AN ACT
1-2 relating to the operation of a statewide rural health care system.
1-3 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-4 SECTION 1. Subsection (a), Section 1, Chapter 757, Acts of
1-5 the 76th Legislature, Regular Session, 1999, is amended to read as
1-6 follows:
1-7 (a) GOALS OF SYSTEM. The statewide rural health care system
1-8 established under Chapter 20C, Insurance Code, is designed to
1-9 protect and enhance the rural health care delivery system by
1-10 establishing a statewide rural health care network, supporting
1-11 funding to rural communities, enabling administrative
1-12 simplification for the benefit of rural providers that participate
1-13 in various health care plans, and ensuring the inclusion of
1-14 [incorporate] consumer-oriented attributes considered important to
1-15 a successful health care organization. These attributes include
1-16 consideration of patient rights, preservation of patient rights,
1-17 preservation of the provider-patient [physician-patient]
1-18 relationship, emphasis on prevention and wellness, an appropriate
1-19 credentialing and peer review program, and emphasis on quality
1-20 improvement and disease management[, including obtaining
1-21 accreditation].
1-22 SECTION 2. Article 20C.02, Insurance Code, is amended to
1-23 read as follows:
1-24 Art. 20C.02. DEFINITIONS. (a) In this chapter:
1-25 (1) "Board" means the board of directors of the
2-1 system.
2-2 (2) "Enrollee" means an individual who is:
2-3 (A) residing in a rural area; and
2-4 (B) entitled to receive health care services
2-5 through a health care plan sponsored by, arranged for, or provided
2-6 by the system.
2-7 (3) "Health care services" has the meaning assigned by
2-8 Section 2, Texas Health Maintenance Organization Act (Article
2-9 20A.02, Vernon's Texas Insurance Code).
2-10 (4) "Health care provider" means a physician,
2-11 facility, practitioner, or other person or organization who, under
2-12 a license or grant of authority issued by this state, provides care
2-13 or supplies to individuals under a health benefit plan. The term
2-14 does not include a hospital provider.
2-15 (5) "Hospital provider" means a county hospital,
2-16 county hospital authority, hospital district, municipal hospital,
2-17 or municipal hospital authority.
2-18 (6) [(5)] "Local health care provider" means:
2-19 (A) a person licensed, registered, or certified
2-20 as a health care practitioner in this state who resides in or
2-21 practices in a rural area in which the person provides health care
2-22 services; or
2-23 (B) a general or specialty hospital that is not
2-24 a hospital provider under this chapter.
2-25 (7) [(6)] "Participating provider" means a hospital
2-26 provider that participates in the system.
3-1 (8) [(7)] "Person" means an individual, professional
3-2 association, professional corporation, partnership, limited
3-3 liability corporation, limited liability partnership, or nonprofit
3-4 corporation, including a nonprofit corporation certified under
3-5 Section 162.001, Occupations Code [created under Section 5.01(a),
3-6 Medical Practice Act (Article 4495b, Vernon's Texas Civil
3-7 Statutes)].
3-8 (9) [(8)] "Rural area" means:
3-9 (A) a county with a population of 50,000 or
3-10 less;
3-11 (B) an area that is not delineated as an
3-12 urbanized area by the federal census bureau; or
3-13 (C) any other area designated as rural by rules
3-14 adopted by the commissioner, subject to Subsection (b) of this
3-15 article.
3-16 (10) [(9)] "System" means the statewide rural health
3-17 care system established by this chapter.
3-18 (11) [(10)] "Territorial jurisdiction" means the
3-19 geographical area in which a participating provider is obligated by
3-20 law to provide health care services.
3-21 (b) In designating rural areas under Subsection (a)(9)
3-22 [(a)(8)] of this article, the commissioner shall consider any area
3-23 that is delineated as an urbanized area by the federal census
3-24 bureau and:
3-25 (1) is contiguous with and not more than 10 miles away
3-26 from a rural area described by Subsection (a)(9)(A) [(a)(8)(A)] or
4-1 (B) of this section;
4-2 (2) is sparsely populated, compared to areas within a
4-3 10-mile radius that are delineated as urbanized areas by the
4-4 federal census bureau;
4-5 (3) has not increased in population in any single
4-6 calendar year in the seven years before the commissioner makes the
4-7 designation; and
4-8 (4) in which emergency or primary care services are
4-9 limited or unavailable in accordance with network access standards
4-10 imposed by the commissioner [under the Texas Health Maintenance
4-11 Organization Act (Chapter 20A, Vernon's Texas Insurance Code)] and
4-12 in which those services would be made materially more accessible by
4-13 allowing access to care in a contiguous area that is eligible to
4-14 participate in the system.
4-15 SECTION 3. Article 20C.03, Insurance Code, is amended to
4-16 read as follows:
4-17 Art. 20C.03. ESTABLISHMENT OF SYSTEM. The statewide rural
4-18 health care system is established to sponsor, arrange for, or
4-19 provide health care services for programs in rural areas that are
4-20 not subject to:
4-21 (1) a law requiring coverage or the offer of coverage
4-22 for services by a particular health care provider under:
4-23 (A) Chapter 62, Health and Safety Code;
4-24 (B) Chapter 32, Human Resources Code;
4-25 (C) any state, county, or local government
4-26 sponsored indigent care initiative; or
5-1 (D) any federal Medicare Plus Choice program; or
5-2 (2) Article 3.51-6 under any state, county, or local
5-3 government sponsored uninsured or indigent care initiative [to
5-4 enrollees who reside in rural areas].
5-5 SECTION 4. Subsection (b), Article 20C.04, Insurance Code,
5-6 is amended to read as follows:
5-7 (b) The system is authorized to sponsor, provide, or arrange
5-8 for the provision of health care services for enrollees as
5-9 described in Article 20C.03. If [Except as provided by Subsection
5-10 (c) of this article, if] the system seeks to sponsor, arrange
5-11 [arranges] for, or provide [provides] health care services to
5-12 enrollees in exchange for a predetermined payment per enrollee on a
5-13 prepaid basis, the system must comply with:
5-14 (1) all requirements under this code imposed on health
5-15 plans, including health maintenance organizations, except the
5-16 requirements the commissioner determines are not applicable to the
5-17 system under this chapter relating to mileage, distance, network
5-18 adequacy, and scope of coverage; and
5-19 (2) any additional requirements the commissioner
5-20 determines are necessary to ensure enrollee access to health care
5-21 providers and health care services [obtain a certificate of
5-22 authority under, and meet each requirement imposed by, the Texas
5-23 Health Maintenance Organization Act (Chapter 20A, Vernon's Texas
5-24 Insurance Code), as if the organization were a person under the
5-25 Act].
5-26 SECTION 5. Subsections (b), (c), and (d), Article 20C.06,
6-1 Insurance Code, are amended to read as follows:
6-2 (b) The participating providers shall appoint [as
6-3 representatives of the participating providers] six directors
6-4 [selected] in the manner provided by Article 20C.10 of this code.
6-5 (c) Six [The governor shall appoint six] directors shall be
6-6 appointed in accordance with the system's bylaws from persons
6-7 residing in the territorial jurisdictions of the participating
6-8 providers, including two persons to represent each of the
6-9 following:
6-10 (1) [two persons who represent] employers;
6-11 (2) [two persons who are] local government officials;
6-12 and
6-13 (3) [two persons who are] consumers of health care
6-14 services.
6-15 (d) In addition to the directors appointed under Subsection
6-16 (c) of this article, [the governor shall appoint] six directors
6-17 shall be appointed in accordance with the system's bylaws from
6-18 among licensed physicians who reside and practice in the
6-19 territorial jurisdictions of the participating providers. At least
6-20 three of the physicians appointed under this subsection must
6-21 perform as their professional practice the general practice of
6-22 medicine.
6-23 SECTION 6. Subsection (d), Article 20C.08, Insurance Code,
6-24 is amended to read as follows:
6-25 (d) On a majority vote, the board may:
6-26 (1) contract for administrative, management, or
7-1 support services; [or]
7-2 (2) hire an executive director;
7-3 (3) contract with[,] consultants, attorneys and other
7-4 professionals; [,] and
7-5 (4) retain other staff as necessary to implement the
7-6 duties of the system.
7-7 SECTION 7. Subsection (a), Article 20C.14, Insurance Code,
7-8 is amended to read as follows:
7-9 (a) To the extent consistent with federal law, the state
7-10 shall award to the system at least one of any state managed care
7-11 contracts awarded to provide health care services to beneficiaries
7-12 of the Texas Medical Assistance Program under Chapter 32, Human
7-13 Resources Code, in the rural areas within the territorial
7-14 jurisdiction of the participating providers. Notwithstanding any
7-15 other law, the commissioner of health and human services may use
7-16 the system for:
7-17 (1) a voluntary pilot or demonstration program that:
7-18 (A) evaluates the use of an insured model for
7-19 beneficiaries of a medical assistance program in a rural area not
7-20 currently included in an existing Medicaid managed care pilot
7-21 program area; and
7-22 (B) incorporates the principles of prevention
7-23 and disease management; and
7-24 (2) a study of the use of promotoras as defined by
7-25 Section 46.001, Health and Safety Code, as added by Chapter 857,
7-26 Acts of the 76th Legislature, Regular Session, 1999.
8-1 SECTION 8. Sections (c) and (d), Article 20C.04, Insurance
8-2 Code, are repealed.
8-3 SECTION 9. This Act takes effect September 1, 2001.
_______________________________ _______________________________
President of the Senate Speaker of the House
I hereby certify that S.B. No. 1394 passed the Senate on
April 20, 2001, by the following vote: Yeas 30, Nays 0, one
present, not voting.
_______________________________
Secretary of the Senate
I hereby certify that S.B. No. 1394 passed the House on
May 17, 2001, by a non-record vote.
_______________________________
Chief Clerk of the House
Approved:
_______________________________
Date
_______________________________
Governor