1-1 By: Fraser, Madla S.B. No. 1394
1-2 (In the Senate - Filed March 8, 2001; March 13, 2001, read
1-3 first time and referred to Committee on Health and Human Services;
1-4 April 10, 2001, reported adversely, with favorable Committee
1-5 Substitute by the following vote: Yeas 7, Nays 0; April 10, 2001,
1-6 sent to printer.)
1-7 COMMITTEE SUBSTITUTE FOR S.B. No. 1394 By: Nelson
1-8 A BILL TO BE ENTITLED
1-9 AN ACT
1-10 relating to the operation of a statewide rural health care system.
1-11 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-12 SECTION 1. Subsection (a), Section 1, Chapter 757, Acts of
1-13 the 76th Legislature, Regular Session, 1999, is amended to read as
1-14 follows:
1-15 (a) GOALS OF SYSTEM. The statewide rural health care system
1-16 established under Chapter 20C, Insurance Code, is designed to
1-17 protect and enhance the rural health care delivery system by
1-18 establishing a statewide rural health care network, supporting
1-19 funding to rural communities, enabling administrative
1-20 simplification for the benefit of rural providers that participate
1-21 in various health care plans, and ensuring the inclusion of
1-22 [incorporate] consumer-oriented attributes considered important to
1-23 a successful health care organization. These attributes include
1-24 consideration of patient rights, preservation of patient rights,
1-25 preservation of the provider-patient [physician-patient]
1-26 relationship, emphasis on prevention and wellness, an appropriate
1-27 credentialing and peer review program, and emphasis on quality
1-28 improvement and disease management[, including obtaining
1-29 accreditation].
1-30 SECTION 2. Article 20C.02, Insurance Code, is amended to
1-31 read as follows:
1-32 Art. 20C.02. DEFINITIONS. (a) In this chapter:
1-33 (1) "Board" means the board of directors of the
1-34 system.
1-35 (2) "Enrollee" means an individual who is:
1-36 (A) residing in a rural area; and
1-37 (B) entitled to receive health care services
1-38 through a health care plan sponsored by, arranged for, or provided
1-39 by the system.
1-40 (3) "Health care services" has the meaning assigned by
1-41 Section 2, Texas Health Maintenance Organization Act (Article
1-42 20A.02, Vernon's Texas Insurance Code).
1-43 (4) "Health care provider" means a physician,
1-44 facility, practitioner, or other person or organization who, under
1-45 a license or grant of authority issued by this state, provides care
1-46 or supplies to individuals under a health benefit plan. The term
1-47 does not include a hospital provider.
1-48 (5) "Hospital provider" means a county hospital,
1-49 county hospital authority, hospital district, municipal hospital,
1-50 or municipal hospital authority.
1-51 (6) [(5)] "Local health care provider" means:
1-52 (A) a person licensed, registered, or certified
1-53 as a health care practitioner in this state who resides in or
1-54 practices in a rural area in which the person provides health care
1-55 services; or
1-56 (B) a general or specialty hospital that is not
1-57 a hospital provider under this chapter.
1-58 (7) [(6)] "Participating provider" means a hospital
1-59 provider that participates in the system.
1-60 (8) [(7)] "Person" means an individual, professional
1-61 association, professional corporation, partnership, limited
1-62 liability corporation, limited liability partnership, or nonprofit
1-63 corporation, including a nonprofit corporation certified under
1-64 Section 162.001, Occupations Code [created under Section 5.01(a),
2-1 Medical Practice Act (Article 4495b, Vernon's Texas Civil
2-2 Statutes)].
2-3 (9) [(8)] "Rural area" means:
2-4 (A) a county with a population of 50,000 or
2-5 less;
2-6 (B) an area that is not delineated as an
2-7 urbanized area by the federal census bureau; or
2-8 (C) any other area designated as rural by rules
2-9 adopted by the commissioner, subject to Subsection (b) of this
2-10 article.
2-11 (10) [(9)] "System" means the statewide rural health
2-12 care system established by this chapter.
2-13 (11) [(10)] "Territorial jurisdiction" means the
2-14 geographical area in which a participating provider is obligated by
2-15 law to provide health care services.
2-16 (b) In designating rural areas under Subsection (a)(9)
2-17 [(a)(8)] of this article, the commissioner shall consider any area
2-18 that is delineated as an urbanized area by the federal census
2-19 bureau and:
2-20 (1) is contiguous with and not more than 10 miles away
2-21 from a rural area described by Subsection (a)(9)(A) [(a)(8)(A)] or
2-22 (B) of this section;
2-23 (2) is sparsely populated, compared to areas within a
2-24 10-mile radius that are delineated as urbanized areas by the
2-25 federal census bureau;
2-26 (3) has not increased in population in any single
2-27 calendar year in the seven years before the commissioner makes the
2-28 designation; and
2-29 (4) in which emergency or primary care services are
2-30 limited or unavailable in accordance with network access standards
2-31 imposed by the commissioner [under the Texas Health Maintenance
2-32 Organization Act (Chapter 20A, Vernon's Texas Insurance Code)] and
2-33 in which those services would be made materially more accessible by
2-34 allowing access to care in a contiguous area that is eligible to
2-35 participate in the system.
2-36 SECTION 3. Article 20C.03, Insurance Code, is amended to
2-37 read as follows:
2-38 Art. 20C.03. ESTABLISHMENT OF SYSTEM. The statewide rural
2-39 health care system is established to sponsor, arrange for, or
2-40 provide health care services for programs in rural areas that are
2-41 not subject to:
2-42 (1) a law requiring coverage or the offer of coverage
2-43 for services by a particular health care provider under:
2-44 (A) Chapter 62, Health and Safety Code;
2-45 (B) Chapter 32, Human Resources Code;
2-46 (C) any state, county, or local government
2-47 sponsored indigent care initiative; or
2-48 (D) any federal Medicare Plus Choice program; or
2-49 (2) Article 3.51-6 under any state, county, or local
2-50 government sponsored uninsured or indigent care initiative [to
2-51 enrollees who reside in rural areas].
2-52 SECTION 4. Subsection (b), Article 20C.04, Insurance Code,
2-53 is amended to read as follows:
2-54 (b) The system is authorized to sponsor, provide, or arrange
2-55 for the provision of health care services for enrollees as
2-56 described in Article 20C.03. If [Except as provided by Subsection
2-57 (c) of this article, if] the system seeks to sponsor, arrange
2-58 [arranges] for, or provide [provides] health care services to
2-59 enrollees in exchange for a predetermined payment per enrollee on a
2-60 prepaid basis, the system must comply with:
2-61 (1) all requirements under this code imposed on health
2-62 plans, including health maintenance organizations, except the
2-63 requirements the commissioner determines are not applicable to the
2-64 system under this chapter relating to mileage, distance, network
2-65 adequacy, and scope of coverage; and
2-66 (2) any additional requirements the commissioner
2-67 determines are necessary to ensure enrollee access to health care
2-68 providers and health care services [obtain a certificate of
2-69 authority under, and meet each requirement imposed by, the Texas
3-1 Health Maintenance Organization Act (Chapter 20A, Vernon's Texas
3-2 Insurance Code), as if the organization were a person under the
3-3 Act].
3-4 SECTION 5. Subsections (b), (c), and (d), Article 20C.06,
3-5 Insurance Code, are amended to read as follows:
3-6 (b) The participating providers shall appoint [as
3-7 representatives of the participating providers] six directors
3-8 [selected] in the manner provided by Article 20C.10 of this code.
3-9 (c) Six [The governor shall appoint six] directors shall be
3-10 appointed in accordance with the system's bylaws from persons
3-11 residing in the territorial jurisdictions of the participating
3-12 providers, including two persons to represent each of the
3-13 following:
3-14 (1) [two persons who represent] employers;
3-15 (2) [two persons who are] local government officials;
3-16 and
3-17 (3) [two persons who are] consumers of health care
3-18 services.
3-19 (d) In addition to the directors appointed under Subsection
3-20 (c) of this article, [the governor shall appoint] six directors
3-21 shall be appointed in accordance with the system's bylaws from
3-22 among licensed physicians who reside and practice in the
3-23 territorial jurisdictions of the participating providers. At least
3-24 three of the physicians appointed under this subsection must
3-25 perform as their professional practice the general practice of
3-26 medicine.
3-27 SECTION 6. Subsection (d), Article 20C.08, Insurance Code,
3-28 is amended to read as follows:
3-29 (d) On a majority vote, the board may:
3-30 (1) contract for administrative, management, or
3-31 support services; [or]
3-32 (2) hire an executive director;
3-33 (3) contract with[,] consultants, attorneys and other
3-34 professionals; [,] and
3-35 (4) retain other staff as necessary to implement the
3-36 duties of the system.
3-37 SECTION 7. Subsection (a), Article 20C.14, Insurance Code,
3-38 is amended to read as follows:
3-39 (a) To the extent consistent with federal law, the state
3-40 shall award to the system at least one of any state managed care
3-41 contracts awarded to provide health care services to beneficiaries
3-42 of the Texas Medical Assistance Program under Chapter 32, Human
3-43 Resources Code, in the rural areas within the territorial
3-44 jurisdiction of the participating providers. Notwithstanding any
3-45 other law, the commissioner of health and human services may use
3-46 the system for:
3-47 (1) a voluntary pilot or demonstration program that:
3-48 (A) evaluates the use of an insured model for
3-49 beneficiaries of a medical assistance program in a rural area not
3-50 currently included in an existing Medicaid managed care pilot
3-51 program area; and
3-52 (B) incorporates the principles of prevention
3-53 and disease management; and
3-54 (2) a study of the use of promotoras as defined by
3-55 Section 46.001, Health and Safety Code, as added by Chapter 857,
3-56 Acts of the 76th Legislature, Regular Session, 1999.
3-57 SECTION 8. Sections (c) and (d), Article 20C.04, Insurance
3-58 Code, are repealed.
3-59 SECTION 9. This Act takes effect September 1, 2001.
3-60 * * * * *