C.S.H.B. 2292 78(R) BILL ANALYSIS
C.S.H.B. 2292
By: Wohlgemuth
Appropriations
Committee Report (Substituted)
BACKGROUND AND PURPOSE
To achieve the cost savings and revenue necessary to finance certain
health and human services, C.S.H.B. 2292 implements changes in health and
human service policy necessary to ensure that Texas continues to serve its
citizens who are most in need of health and human service assistance.
C.S.H.B. 2292 reorganizes and consolidates the health and human service
agencies, requires additional rebates for drug manufacturers purchasing
drugs under health and human service programs, increases fraud detection
and recovery, reforms the regulatory burden on providers of health and
human services, consolidates certain transportation services and enacts
many other measures that are necessary to deal with the current budget
crisis.
RULEMAKING AUTHORITY
It is the committee's opinion that rulemaking authority is expressly
granted to the Health and Human Services Commissioner in SECTIONS 1.03
(Section 531.0055, Government Code), 1.06 (Section 531.0163, Government
Code), 1.08 (Section 531.409, Government Code), 1.09 (Sections 1001.028,
1001.052, and 1001.075, Health and Safety Code), 1.13 (Sections 161.028,
161.052, and 161.073, Human Resources Code), and 2.20 (Section 531.113,
Government Code) of this bill. Rulemaking authority granted to the Health
and Human Services Commissioner by other law is modified by SECTION 1.03
(Section 531.0055, Government Code) of this bill. Rulemaking authority is
transferred to the Health and Human Services Commissioner in SECTIONS 1.03
(Section 531.0055, Government Code) and 1.11 (Section 40.002, Human
Resources Code) of this bill.
It is the committee's opinion that rulemaking authority is expressly
granted to the Health and Human Services Commission in SECTIONS 1.07
(Section 531.0224, Government Code), 2.04 (Section 531.063, Government
Code), 2.13 (Section 531.074, Government Code), and 2.21 (Section 531.114,
Government Code) of this bill. Rulemaking authority granted to the Health
and Human Services Commission by other law is modified by SECTIONS 2.12
(Section 531.073, Government Code) and 2.73 (Section 32.028, Human
Resources Code) of this bill. Rulemaking authority is transferred to the
Health and Human Services Commission in SECTIONS 1.18 and 2.105 of this
bill.
It is the committee's opinion that rulemaking authority is expressly
granted to the Health and Human Services Commission (or another agency
operating part of the medical assistance program) in SECTIONS 2.76
(Section 32.0321, Human Resources Code) and 2.78 (Section 32.0462, Human
Resources Code) of this bill. Rulemaking authority granted to the Health
and Human Services Commission (or another agency operating part of the
medical assistance program) by other law is modified by SECTIONS 2.70
(Section 32.024, Human Resources Code) and 2.75 (Section 32.032, Human
Resources Code) of this bill.
It is the committee's opinion that rulemaking authority is expressly
granted to the Department of Human Services in SECTIONS 2.48 (Section
242.406, Health and Safety Code), 2.63 (Section 31.0032, Human Resources
Code), 2.66 (Section 31.015, Human Resources Code), and 2.67 (Section
31.032, Human Resources Code) of this bill. Rulemaking authority granted
to the Department of Human Services by other law is modified by SECTIONS
2.63 (Section 31.0033, Human Resources Code) and 2.65 (Section 31.012,
Human Resources Code) of this bill.
It is the committee's opinion that rulemaking authority is expressly
granted to the Interagency Council on Early Childhood Intervention in
SECTION 2.84 (Section 73.0051, Human Resources Code) of this bill.
It is the committee's opinion that rulemaking authority is transferred to
the Texas Education Agency and the Commissioner of Education in SECTION
2.88 of this bill.
It is the committee's opinion that rulemaking authority is expressly
granted to the Secretary of State in SECTION 2.88 of this bill.
SUMMARY ANALYSIS
ARTICLE I
C.S.H.B. 2292 defines existing Health and Human Services Agencies, then
adds certain agencies to the list, and abolishes certain existing
agencies. The sunset provision for the Health and Human Services
Commission is extended. The definition of policymaking body is eliminated,
certain plans and programs are required to be centralized with the
commission, performance of administrative support services is placed with
the commission, the commission is required to adopt rules and policies for
the operation and provision of health and human services by health and
human services agencies, the commissioner is responsible for certain
duties presently under the operational authority of the commissioner, the
agency director is required to act on behalf of and report to the
commissioner in performing a delegated function, new requirements are
added to the required memorandum of understanding related to the
responsibilities of the agency director, and strengthens the commission's
ability to adopt policies and rules governing certain delivery of
services.
C.S.H.B. 2292 requires the governor to appoint an agency director for each
health and human services agency for a term of one year. The substitute
modifies the requirements related to the memorandum of understanding,
eliminates the role of the policymaking body in defining specific
performance objectives, and eliminates the requirement that the agency
director serves at the pleasure of the commissioner and may be discharged
by the commissioner and the policymaking body.
C.S.H.B. 2292 requires the commission to establish an eligibility services
division, investigations and enforcement division, office of ombudsman,
and a purchasing division.
C.S.H.B. 2292 requires the commission to develop and implement policy to
encourage the use of negotiated rulemaking and alternative dispute
resolution, to require the agency directors and employees to research and
propose appropriate technological solutions to improve functions, and to
adopt a memorandum of understanding according to statutory procedure, with
the exception of the internal management, organization, and personnel
practices portions of the memorandum, which this section exempts from
certain statutory requirements.
C.S.H.B. 2292 requires the commission to plan and direct the financial
assistance program, to adopt rules governing the financial assistance
program, and to establish requirements for and define the scope of the
ongoing evaluation of the financial assistance program.
C.S.H.B. 2292 creates the Health and Human Services Council to assist the
commissioner in developing rules and policies for the commission. The
council is composed of nine members, who are appointed by the governor for
staggered six-year terms. The substitute specifies which statutory
provisions apply to the council. In order to vote, deliberate, or be
counted as a member in attendance at a meeting of the council, council
members are required to complete a training program. C.S.H.B. 2292 sets
council terms and restricts the number of consecutive terms that may be
served. It also enables the governor to fill vacancies by appointment and
designate the council's presiding officer; members elect other officers.
The substitute sets meetings at least quarterly, or at the discretion of
the presiding officer, and meetings may be held in different areas of the
state. Members may not receive compensation, but are entitled to
reimbursement for travel expenses. The commissioner, in conjunction with
the council, is responsible for preparing certain information for the
public. C.S.H.B. 2292 requires the commissioner to develop and implement
methods for notifying the public of where to direct complaints. Policies
must also be implemented that provide the public opportunity to appear
before the council. The commissioner and council are required to
implement policies that clearly delineate the responsibilities of the
commissioner.
C.S.H.B. 2292 creates the Department of Health Services; provides for
definitions; applies sunset provision, establishes a Health Services
Council of nine members appointed by governor. The committee substitute
specifies which chapters are and are not applicable; requires that each
geographical region of the state be represented; establishes council
member qualifications; specifies duties; requires council member training;
establishes staggered six year terms; requires governor to designate
presiding officer and fill vacancies; allows council to elect other
officers as needed; allows reimbursement of council member expenses;
provides for a complaint system; requires commission to adopt policies to
provide public opportunity for input to the council; requires the
commissioner to implement policies with advice of the council; requires
the executive director to file report annually with governor, presiding
officer of each house of the legislature, and the commissioner a complete
and detailed written report accounting for all funds disbursed by the
department during the preceding fiscal year; requires the agency central
office be maintained in Austin, allows for other offices as necessary;
requires the governor to appoint an executive director of the department;
provides that executive director serves for a term of one year; requires
the executive director to serve as the chief administrative officer
subject to the control of the commissioner; allows the department to
employ individuals to administer functions under this chapter; provides
for the distribution of information related to standards of conduct;
requires development of a merit pay system by the executive director
subject to rules adopted by the commissioner; requires a career ladder;
requires, subject to rules adopted by the commissioner, the executive
director to maintain an equal opportunity policy; provides for policies
regarding complaints; requires employees be provided information about the
benefits and participation in the state employee incentive program; allows
rulemaking to administer this chapter; establishes certain powers and
duties for the department related to health care, mental health, and
substance abuse.
C.S.H.B. 2292 defines "commissioner" as the health and human service
commissioner and "council" as the protective and regulatory council in the
enabling statute for the Department of Protective and Regulatory Services.
C.S.H.B. 2292 requires certain conforming changes, and requires the
Department of Protective and Regulatory Services to license, register, and
enforce regulations applicable to child-care facilities and child-care
administrators; implement programs to prevent family violence and provide
services to victims of family violence; perform all licensing and
enforcement activities related to long-term care facilities, including
licensing and enforcement activities. It also allows the commissioner
rather than department to adopt certain policies and rules.
C.S.H.B. 2292 creates the protective and regulatory council to assist the
commissioner in developing rules and policies for the Department of
Protective and Regulatory Services; provides for the composition and
appointment of the council; requires that each geographical region of the
state be represented. The committee substitute specifies which chapters
are and are not applicable; requires council member training; establishes
staggered six-year terms; requires the governor to designate the presiding
officer and fill vacancies; allows the council to elect other officers as
needed; allows reimbursement of council member expenses; provides that
executive director is appointed by the governor and serves for a term of
one year and requires the executive director to serve as the chief
administrative officer subject to the control of the commissioner.
C.S.H.B. 2292 creates the Department of Aging, Community, Disability, and
Long-Term Care Services; provides for definitions; applies sunset
provision, establishes an Aging, Community, Disability, and Long-Term Care
Council of nine members appointed by governor; and requires that each
geographical region of the state be represented. The substitute specifies
which chapters are and are not applicable; establishes council member
qualifications and specifies duties, requires council member training;
establishes staggered six-year terms; requires governor to designate
presiding officer and fill vacancies; allows council to elect other
officers as needed; allows reimbursement of council member expenses;
provides for a complaint system; requires commission to adopt policies to
provide public opportunity for input to the council; requires the
commissioner to implement policies with advice of the council; requires
the executive director to file annually with governor, presiding officer
of each house of the legislature, and the commissioner a report accounting
for all funds disbursed by the department during the preceding fiscal
year; requires that the agency central office be maintained in Austin;
allows for other offices as necessary; requires the governor to appoint an
executive director of the department; provides that the executive director
serves for a term of one year; requires the executive director to serve as
the chief administrative officer subject to the control of the
commissioner; allows the department to employ individuals to administer
functions under this chapter; provides for the distribution of information
related to standards of conduct; requires development of a merit pay
system by the executive director subject to rules adopted by the
commissioner; requires a career ladder; requires, subject to rules adopted
by the commissioner, the executive director to maintain an equal
opportunity policy; provides for policies regarding complaints; requires
employees be provided information about the benefits and participation in
the state employee incentive program; allows rulemaking to administer this
chapter; and establishes certain powers and duties for the department.
C.S.H.B. 2292 requires the governor to appoint executive directors for the
Department of Health Services; Department of Aging, Community, Disability,
and Long-Term Care Services; and Department of Protective and Regulatory
Services.
C.S.H.B. 2292 requires the appointment of council members by the governor
for the Health Services; Protective and Regulatory; and Aging, Community,
Disability, and Long-Term Care Councils.
C.S.H.B. 2292 limits the activities of an agency created under this
article, before the date specified in the transition plan, to preparing to
assume powers, duties, functions, programs, and activities specified under
this article.
C.S.H.B. 2292 requires that the presiding officer of each council created
under this article shall call an initial meeting as soon as possible after
the council members are appointed.
C.S.H.B. 2292 transfers various powers, duties, functions, programs, and
activities currently under health and human services agencies to the
revised Health and Human Services Commission (administrative support
services for all health and human services agencies, duties of Department
of Human Services related to eligibility determination for long-term care
and community-based support services; TANF, food stamps, any duties of an
agency being abolished relating to Medicaid and CHIP, duties of the Texas
Rehabilitation Commission relating to determination of SSI eligibility,
and all rulemaking and policymaking authority for health and human
services agencies).
C.S.H.B. 2292 transfers various powers, duties, functions, programs, and
activities currently under health and human services agencies to the new
Department of Health Services (current duties of the Texas Department of
Health, mental health services currently provided by the Department of
Mental Health and Mental Retardation, and all current duties of the Texas
Commission on Alcohol and Drug Abuse, Texas Cancer Council, Commission for
the Deaf and Hard of Hearing, Interagency Council on Early Childhood
Intervention, and Texas Health Care Information Council).
C.S.H.B. 2292 transfers various powers, duties, functions, programs, and
activities currently under health and human services agencies to the
revised Department of Protective and Regulatory Services; (current duties
of the Department of Protective and Regulatory Services, duties and
functions related to licensing of long-term care facilities, and duties of
the Department of Human Services related to family violence prevention and
victim services).
C.S.H.B. 2292 transfers various powers, duties, functions, programs, and
activities currently under health and human services agencies to the new
Department of Aging, Community, Disability, and Long-Term Care Services
(current duties of the Department on Aging, current duties of the
Department of Human Services related to providing long-term care and
community-based support services, current duties of Texas Rehabilitation
Commission (except for determination of SSI eligibility), current duties
of the Texas Commission for the Blind, and current duties of the
Department of Mental Health and Mental Retardation related to providing
mental retardation services, including state school administration and
community residential services).
C.S.H.B. 2292 creates a transition council to facilitate the transfer of
powers, duties, functions, programs, and activities among the state health
and human services agencies and commission. It also specifies the makeup
of the council and designates the presiding officer.
C.S.H.B. 2292 requires creation of a transition plan to guide the
transition of powers, duties, functions, programs, and activities to the
Health and Human Services Commission, the Department of Health Services,
Department of Protective Regulatory Services, and the Department of Aging,
Community, Disability, and Long-Term Care Services. The plan must include
a schedule and be submitted to the governor and the legislative budget
board by December 1, 2003.
C.S.H.B. 2292 provides that former law governs for actions brought or
proceeding commenced before the effective date of a transfer prescribed
under this article.
C.S.H.B. 2292 abolishes the Interagency Council for Early Childhood
Intervention, Texas Cancer Council, Commission for the Blind, Commission
for the Deaf and Hard of Hearing, Commission on Alcohol and Drug Abuse,
Department of Health, Department of Mental Health and Mental Retardation,
Department on Aging, Texas Health Care Information Council, and Texas
Rehabilitation Commission; provides that abolition or transfer does not
impair an act done, any obligation, right, order, permit, certificate,
rule, criterion, standard, or requirement existing, or any penalty accrued
under former law and that law remains in effect for any action concerning
those matters.
C.S.H.B. 2292 repeals certain sections of the Government Code, certain
sections of the Human Resources Code, and certain Acts of the 76th
Legislature.
ARTICLE II
C.S.H.B. 2292 defines "child health plan program;" requires the commission
to create a purchasing division for all health and human services
agencies; requires the commission to obtain Medicaid reimbursement from
Medicare fiscal intermediaries for clients eligible for Medicaid and
Medicare, and requires the commission to request waivers as appropriate.
C.S.H.B. 2292 requires the commission to establish a call center to
establish eligibility and allows the commission to contract with a private
entity, if cost-effective.
C.S.H.B. 2292 requires the commission to consolidate and coordinate health
insurance premium payment reimbursement programs for CHIP and Medicaid and
allows the commission to contract with a private entity if cost-effective.
C.S.H.B. 2292 requires the commission to appoint a public assistance
health benefit review and design committee and allows the commission to
consider committee recommendations.
C.S.H.B. 2292 requires the commission to periodically review all purchases
made under the vendor drug program.
C.S.H.B. 2292 requires the commission to negotiate for supplemental
rebates for prescription drugs, provides for contracting and reporting
procedures and establishes confidentiality of information.
C.S.H.B. 2292 requires adoption of preferred drug list (PDL) for certain
programs, establishes procedures for implementation, establishes prior
authorization for drugs not on the PDL, and allows the commission to
implement applicable procedures.
C.S.H.B. 2292 creates a Pharmaceutical and Therapeutics Committee and sets
procedures for implementation.
C.S.H.B. 2292 allows the commission to implement prior authorization for
high cost medical services and to contract with qualified providers for
that function.
C.S.H.B. 2292 expands the commission's responsibility to investigate fraud
to abuse and requires the commission to develop and implement a cross
reference system with list of fugitive felons. The substitute provides
requirements related to: seizure of assets; referral of cases to the
Attorney General, U.S. Attorney, or local prosecutors; development of a
fraud reduction pilot program; expansion of the Medicaid and Public
Assistance Fraud Oversight Task Force; fraud and abuse prevention by
managed care organizations; and the commission's authority with regard to
TANF fraud.
C.S.H.B. 2292 requires medical assistance to be provided in the most
cost-effective model of managed care and allows exceptions if a managed
care model is determined by the commissioner to not be cost-effective.
C.S.H.B. 2292 specifies method of calculation for Medicaid experience
rebate or profit sharing.
C.S.H.B. 2292 expands the scope of the Permanent Fund for Tobacco
Education and Enforcement.
C.S.H.B. 2292 expands the scope of the Permanent Fund for Children and
Public Health to the Interagency Council on Early Childhood Intervention.
C.S.H.B. 2292 expands the scope of the Rural Health Facility Capital
Improvement Permanent Fund and the Community Hospital Capital Improvements
Fund.
C.S.H.B. 2292 reduces from $40 million to $25 million the amount of
unclaimed lottery funds per biennium distributed to the state-owned
multi-categorical teaching hospital account.
C.S.H.B. 2292 allows TDH to charge a fee for issuing or renewing certain
licenses and creates a renewal period of three years.
C.S.H.B. 2292 removes references to the Texas Healthy Kids Corporation.
C.S.H.B. 2292 requires third party billing vendors to enroll in CHIP under
the same requirements and restrictions as a CHIP provider, including
completion of a contract that emphasizes the prevention of fraud and
abuse.
C.S.H.B. 2292 changes CHIP income eligibility from 200% to 150% of the
federal poverty level, provides additional enrollment guidelines, changes
the eligibility period for coverage, addresses coverage of qualified
aliens, addresses development of CHIP benefits, and applies CHIP
requirements to SKIP enrollees.
C.S.H.B. 2292 allows for certain determinations of cost-sharing provisions.
C.S.H.B. 2292 removes, modifies, and adds certain CHIP requirements.
C.S.H.B. 2292 specifies certain requirements involving nursing home
violations and restricts the State from imposing more than one monetary
penalty for the same nursing home care violation.
C.S.H.B. 2292 requires the State to implement a grant program designed to
encourage quality nursing home environments.
C.S.H.B. 2292 eliminates specific requirements for administering
medications in nursing facilities but continues the general requirement
that nursing facilities establish drug administration procedures and
eliminates specific security requirements related to the storage of
poisons and medications in nursing homes.
C.S.H.B. 2292 adds TDMHMR-owned facilities to the group of facilities
subject to the quality assurance fee and changes the methods for
calculating and reporting the number of patient days that would be subject
to the quality assurance fee.
C.S.H.B. 2292 expands authorized purposes for use of the quality assurance
fund subject to legislative appropriations.
C.S.H.B. 2292 eliminates TCADA's requirement to provide a toll-free number
for compulsive gambling.
C.S.H.B. 2292 requires local mental authorities to use disease management
practices for adults with bipolar disorder, schizophrenia, or clinically
severe depression.
C.S.H.B. 2292 requires termination of a contract with an ICF-MR if a
vendor hold on Medicaid payments to the facility has been imposed three
times during an 18-month period.
C.S.H.B. 2292 states that proceeds from the disposal of TDMHMR's surplus
real property, if it occurs before September 1, 2005, do not have to be
deposited in the Capital Trust Fund.
C.S.H.B. 2292 establishes a Mental Health Community Services Trust Fund
and a Mental Retardation Community Services Trust Fund.
C.S.H.B. 2292 allows DHS to use information obtained from a third party to
verify the assets and resources of a person in determining the person's
eligibility and need for medical assistance, financial assistance, or
nutritional assistance.
C.S.H.B. 2292 adds a requirement to the TANF personal responsibility
agreement that each recipient must claim the federal earned income tax
credit on the recipient's federal income tax return and requires that
caretakers also sign a personal responsibility agreement.
C.S.H.B. 2292 institutes a Payment of Assistance After Performance method
for TANF recipients and requires a person determined to be eligible for
TANF to cooperate with the requirements of the personal responsibility
agreement for one month before the person receives a TANF payment. An
eligible person cannot receive a check if the person did not cooperate
with the responsibility agreement during the previous month. The
substitute also requires the department to immediately notify the
caretaker relative, second parent, or payee if a monthly payment will not
be made due to failure to cooperate with the agreement. A person is not
prohibited from receiving Medicaid, child care services, or other social
or support services for failure to cooperate.
C.S.H.B. 2292 allows the disregard of income earned by the new spouse of a
person receiving TANF for the first six months of marriage, as long as the
combined income of the recipient and a new spouse does not exceed 200% of
the federal poverty level.
C.S.H.B. 2292 removes the phased-in provisions relating to exemption from
the work requirements for persons receiving financial assistance.
C.S.H.B. 2292 creates health, abstinence and marital development programs
for TANF cash recipients and provides for additional assistance of not
more than $20 for the recipient's participation, up to a maximum payment
of $60 a month.
C.S.H.B. 2292 requires all TANF applicants to apply for the earned income
tax credit and claim the credit on their federal income tax return.
C.S.H.B. 2292 allows for more input into the development of nursing home
standards by the nursing facilities, requires DHS to have in each contract
specific performance measures by which the department may evaluate the
extent to which a nursing facility is meeting standards, allows DHS to
terminate the contract if a facility is not meeting the standards, and
requires DHS to submit a report regarding nursing facilities every
even-numbered year.
C.S.H.B. 2292 directs the department to provide medical assistance through
Medicaid managed care system.
C.S.H.B. 2292 prohibits the exclusion of Medicaid nursing home residents
from receiving Medicaid transportation services, based on their nursing
facility status and allows the commission to limit Medicaid prescription
drug benefits under certain circumstances.
C.S.H.B. 2292 allows for recertification for medical assistance of a child
under 19 by a phone interview or a combination of a phone interview and
mail correspondence.
C.S.H.B. 2292 delays the implementation of 12-month continuous
eligibility until June 1, 2004.
C.S.H.B. 2292 removes the current spending requirement on nursing
facilities not participating in enhanced rates and requires that
non-participating facilities receive the same base rate as participants.
The substitute also allows for an incentive program for increased direct
care staffing only to the extent that appropriated funds were available
after funds were allocated according to the commission's base rate
reimbursement methodology.
C.S.H.B. 2292 authorizes prepayment reviews and postpayment holds on
claims for Medicaid reimbursement and grants the commission additional
authority to prevent fraudulent, abusive, wasteful, or erroneous payments.
C.S.H.B. 2292 requires medical assistance providers to file a surety bond
if the state identifies irregularities related to the provider's services.
C.S.H.B. 2292 directs a provider, to extent allowable by federal law, to
seek reimbursement from third party coverage or insurance before billing
the medical assistance program.
C.S.H.B. 2292 allows the commission to adopt rules for the purchase and
distribution of over-the-counter medications and medical supplies
previously provided via prescription, if the commission determines it is
more cost-effective to do so.
C.S.H.B. 2292, with regard to nursing home residents eligible for both
Medicare and Medicaid, allows the state to pay Medicare deductibles and
coinsurance up to the Medicaid reimbursement rate. If the Medicare
reimbursement rate exceeds the Medicaid rate, the Medicaid program is
prohibited from paying Medicare deductibles and coinsurance.
C.S.H.B. 2292 establishes the nursing facility quality assurance team to
make recommendations for promoting high-quality care for nursing home
residents and requires DHS to implement these recommendations no later
than September 1, 2004.
C.S.H.B. 2292 redesignates the "Frail and Elderly program" as the
"Community Attendant Services program."
C.S.H.B. 2292 requires third party billing vendors to enroll in the
Medicaid program under the same requirements and restrictions as a
Medicaid provider, including completion of a contract that emphasizes the
prevention of fraud and abuse.
C.S.H.B. 2292 establishes cost-sharing requirements for Medicaid
recipients.
C.S.H.B. 2292 allows for the establishment of a system of payments on a
sliding scale fee schedule by families of children receiving services
through the Interagency Council on Early Childhood Development.
C.S.H.B. 2292 allows the Texas Commission for the Blind to provide
prevention and transition services to blind disabled individuals eligible
for vocational rehabilitation services, subject to the availability of
funds generated though optional fees assessed on drivers' licenses and
personal identification cards.
C.S.H.B. 2292 repeals the authority for the Texas Rehabilitation
Commission to operate an extended rehabilitation services program and
moves the transitional planning program into vocational rehabilitation
services.
C.S.H.B. 2292, allows money in the comprehensive rehabilitation fund to be
used for general governmental purposes if the comptroller certifies that
appropriations exceed available revenue for the current biennium, if the
revenue estimate for the next biennium is less than the revenue estimate
for the current biennium, or if LBB determines that a fiscal emergency
exists.
C.S.H.B. 2292 transfers the Communities in Schools program from the
Department of Protective and Regulatory Services to the Texas Education
Agency.
C.S.H.B. 2292 eliminates the current exemption from the premium tax for
Medicaid HMOs.
C.S.H.B. 2292 requires group health plans to enroll persons who lose
Medicaid or CHIP eligibility without subjecting them to open enrollment
restrictions.
C.S.H.B. 2292 requires an issuer of a health benefit plan to offer
coverage for therapies for children with developmental delays.
C.S.H.B. 2292 requires certain health and human services agencies that
provide transportation services to contract with TxDOT to provide those
services.
C.S.H.B. 2292 allows the Telecommunications Infrastructure Fund Board to
award grants from the qualifying entities account in the
Telecommunications Infrastructure Fund to the commission for technology
initiatives.
C.S.H.B. 2292 requires the Medicaid and Public Assistance Fraud Oversight
Task Force and other agencies to conduct a study of the procedures and
documentation requirement used to establish identity for the Medicaid
program and other health and human services programs.
C.S.H.B. 2292 requires the transfer of medical transportation services
from TDH to the commission by September 1, 2004.
C.S.H.B. 2292 requires the commission to consolidate the post-payment
third-party recovery divisions for TDH, vendor drug and the Medicaid
claims administrator with the Medicaid TPR functions.
C.S.H.B. 2292 abolishes certain advisory committees.
C.S.H.B. 2292 requires the commission to request waivers necessary to
allow families enrolled in Medicaid to opt into the child health plan
program.
C.S.H.B. 2292 requires the commission to submit a state plan amendment
requesting federal matching funds for the employers' share of required
premiums for CHIP-eligible children and Medicaid eligible clients enrolled
in a group health plan.
C.S.H.B. 2292 repeals Sections 62.055(b) and (c), 62.056, 62.057,
252.206(d), and 252.207(b), Health and Safety Code.
C.S.H.B. 2292 repeals Section 32.0315, Human Resources Code.
C.S.H.B. 2292 provides that in the event of any conflict between a
provision of this Act and another Act passed during the 78th Legislature,
Regular Session, that becomes law, this act prevails and controls,
regardless of the relative dates of enactment.
C.S.H.B.2292 allows an agency to delay implementation of any provision
that requires a waiver or other federal authorization until the waiver or
authorization is granted.
EFFECTIVE DATES
ARTICLE I
September 1, 2003, except that the Department of Health Services and the
Department of Aging, Community, Disability, and Long-Term Care Services
are created on the date the governor appoints the executive director of
the respective agency.
ARTICLE II
September 1, 2003, except that Section 62.0582, Health and Safety Code, as
added by this Act, and Section 32.063, Human Resources Code, as added by
this Act, take effect January 1, 2004.
COMPARISON OF ORIGINAL TO SUBSTITUTE
ARTICLE I
C.S.H.B. 2292 modifies the original to add Article I relating to the
consolidation of health and human services agencies.
ARTICLE II
C.S.H.B. 2292 adds new language to authorize the commission to establish a
purchasing division for all health and human services agencies and directs
the purchasing division to improve efficiencies and increase cost
reductions.
C.S.H.B. 2292 modifies the original by adding language that requires the
commission to request and actively pursue any necessary waivers from a
federal agency or other appropriate entity to enable the commission to
combine Medicaid and Medicare services for persons who are eligible for
both programs when cost-effective for the state.
C.S.H.B. 2292 adds new language to require the commission to establish a
call center for determination and certification of eligibility and need
for services and to contract with a private entity for the operation of a
call center required by this section, unless not cost-effective to do so.
C.S.H.B. 2292 adds new language to require the commission to develop and
implement a plan to consolidate and coordinate the administration of the
health insurance premium payment reimbursement programs by January 1,
2004, and, if cost-effective, to contract with a private entity to assist
in the development and implementation.
C.S.H.B. 2292 adds new language to require the commission to establish a
public health assistance health benefit review and design committee. The
substitute also adds new language to set forth the committee guidelines
and to require the committee to review and provide recommendations
regarding benefits coverage provided under the income-based care programs
administered by the commission or a health and human services agency.
C.S.H.B. 2292 adds new language to require the commission to take into
consideration recommendations made by the public assistance health benefit
review and design committee with respect to health benefits coverage for a
program administered by the commission or a health and human services
agency.
C.S.H.B. 2292 adds new language to require the commission to periodically
review all purchases made under the vendor drug program to determine the
cost-effectiveness of including a component for prescription drug benefits
in any capitation rate paid by the state and to consider the value of any
prescription drug rebates.
C.S.H.B. 2292 modifies original by authorizing the commission to contract
with private entity to negotiate with manufacturers and labelers for
supplemental rebates on its behalf. The substitute also adds new language
to allow voluntary negotiations with a manufacturer or labeler to provide
supplemental rebates under any state program administered by the
commission. The substitute also adds new language to require the
commission to provide a yearly written report on the state prescription
drug benefit programs to the governor and legislature.
C.S.H.B. 2292 modifies the original by extending the confidentiality
provisions to cover prescription drug rebate negotiations as well as
supplemental medical assistance rebate negotiations and agreements. The
substitute also adds new language to extend the confidentiality provisions
to information from the above reference negotiations and agreements that
is obtained or maintained in connection with the Medicaid vendor drug
program, the child health plan program, the kidney health care program, or
the children with special health care needs program.
C.S.H.B. 2292 modifies the original by expressly requiring the adoption of
preferred drug lists occurs in a manner that complies with applicable
state and federal law. The substitute also adds new language to require
that the lists contain only drugs provided by a manufacturer or labeler
that has reached an agreement with the commission on supplemental rebates.
The substitute also adds new language to require distribution of current
copies of the lists to all appropriate providers before changes go into
effect. The substitute also adds new language to allow manufacturers and
labelers to submit written evidence supporting the inclusion of a drug on
the lists before a supplemental rebate agreement is reached with the
commission. The substitute modifies language to provide for use of the
Medicaid Fair Hearing Process to appeal a denial of prior authorization of
a covered drug or dosage, rather than to appeal a preferred drug list
decision.
C.S.H.B. 2292 modifies the original by setting forth requirements for the
procedures the commission is required to establish for prior
authorization. The substitute also adds new language to require the
commission to ensure that a prescription prescribed to a recipient under a
program administered by the commission, or for a person who becomes
eligible, shall not be subject to any requirement for prior authorization
unless the recipient has exhausted the prescription or a time period
prescribed by the commission has expired. The substitute also adds new
language to require the commission to implement procedures to ensure that
the aforementioned recipients receive continuity of care in relation to
certain prescriptions identified by the commission and to allow the
commission to contract with a private entity to administer the required
prior authorization requirements.
C.S.H.B. 2292 modifies the original by amending guidelines on the
composition and activities of the committee, changing the composition of
the committee to six physicians and five pharmacists, rather than five
physicians, five pharmacists, and one public member. The substitute
requires the governor to appoint a physician to chair the committee,
rather than allowing the committee to elect a chair. The substitute also
requires the committee to meet monthly, rather than quarterly, during the
first six months.
C.S.H.B. 2292 adds new language to authorize the commission to require
prior authorization for high-cost medical services and procedures and to
contract with qualified service providers or organizations to perform
these functions.
C.S.H.B. 2292 adds new language to increase the commission's
responsibility to investigate to include abuse and to authorize the
commission to obtain any information or technology necessary to enable it
to meet its responsibility. The substitute also adds new language to
establish the commission's office of investigations and enforcement as a
law enforcement agency for the purposes of obtaining information relevant
to the office's duties from a law enforcement agency, prosecutor, or
governmental entity and to authorize the office to issue a subpoena under
certain circumstances to compel the attendance and testimony of a witness
or production of records.
C.S.H.B. 2292 adds new language to authorize the seizure of assets by the
commission if the listed criteria are met and to provide for a hearing at
which a seizure may be contested. The substitute also adds new language
to prohibit disposal of seized assets until fraud or abuse is established
and the commission's entitlement to the assets is confirmed in accordance
with due process.
C.S.H.B. 2292 adds new language to set forth certain provisions that must
be included in the memorandum of understanding between the commission and
the office of the attorney general. The substitute also adds new language
to require the office of the attorney general to submit a yearly report to
the governor, legislature, and comptroller, specifically addressing the
activities of the attorney general's Medicaid fraud control unit and civil
Medicaid fraud section. The substitute also adds new language to
authorize the referral of a case of suspected fraud or abuse to a United
States Attorney. The substitute also requires that the above-referenced
memorandum of understanding be amended by December 1, 2003.
C.S.H.B. 2292 adds new language to require the commission to implement a
pilot program in one or more counties in Texas to reduce Medicaid provider
fraud and third-party and recipient fraud and to set forth guidelines and
requirements for the design of the project. The substitute also adds new
language to authorize the commission to extend the program to other
counties if it is found to be cost-effective. The substitute also adds
new language to require that implementation of the program begin by
January 1, 2004 and that evaluation reports on the program be sent to the
governor, lieutenant governor, and speaker of the house by February 1,
2005.
C.S.H.B. 2292 adds new language to require placement of a representative
of the Texas Department of Health, appointed by the commissioner of public
health, to serve on the Medicaid and Public Assistance Fraud Oversight
Task Force.
C.S.H.B. 2292 adds new language to require each managed care organization
providing services under government programs to adopt a plan and engage in
activities to prevent or reduce fraud or abuse, including the
establishment of special investigative units.
C.S.H.B. 2292 adds new language to set forth the guidelines and provides
consequences for prohibited actions, such as misrepresentation of facts,
in establishing or maintaining eligibility for financial assistance.
C.S.H.B. 2292 adds new language to require the commission to develop and
implement a system to cross-reference certain data with the list of
fugitive felons maintained by the federal government.
C.S.H.B. 2292 adds specific language outlining the manner in which the
commission must provide medical assistance through the most cost-effective
model of Medicaid managed care.
C.S.H.B. 2292 adds new language to require the commissioner to ensure that
any experience rebate or profit sharing for Medicaid managed care
organizations is calculated by treating taxes as allowable expenses.
C.S.H.B. 2292 adds new language to expand the scope of the Permanent Fund
for Tobacco Education and Enforcement to include essential public health
services administered by TDH.
C.S.H.B. 2292 adds new language to expand the scope of the Permanent Fund
for Children and Public Health to provide intervention services for
children who have or have a high probability of developmental disabilities
and their families through the Interagency Council on Early Childhood
Intervention.
C.S.H.B. 2292 adds new language to expand the scope of the Permanent Fund
for Rural Health Facility Capital Improvement for the promotion,
construction, or operation of federally qualified health centers in rural
areas of the state based on medically underserved need.
C.S.H.B. 2292 adds new language to expand the scope of the Community
Hospital Capital Improvement Fund for the promotion, construction, or
operation of federally qualified health centers in urban areas of the
state based on medically underserved need.
C.S.H.B. 2292 adds new language to reduce from $40 million to $25 million
the amount of unclaimed lottery funds per biennium distributed to
state-owned multi-categorical teaching hospital account.
C.S.H.B. 2292 adds new language to require TDH to charge a fee for issuing
or renewing a license to recover all direct and indirect costs associated
with administering and enforcing the applicable licensing program. The
substitute also adds new language to require such licenses to be issues
for a period of three years.
C.S.H.B. 2292 adds new language to remove references to the Texas Healthy
Kids Corporation.
C.S.H.B. 2292 adds new language to require third party billing vendors for
CHIP to contract with the commission under the same requirements and
restrictions emphasizing fraud and abuse as a health care provider before
submitting a claim.
C.S.H.B. 2292 modifies the original by requiring the commissioner to
suspend enrollment in CHIP if enrollment exceeds the number authorized in
the General Appropriations Act.
C.S.H.B. 2292 adds new language to require children of school district
employees to meet the same requirements as any other child enrolled in the
child health plan.
C.S.H.B. 2292 adds new language to change the eligibility period for
coverage under the child health plan from 12 months to a period not to
exceed 180 days.
C.S.H.B. 2292 adds new language to make it permissive, rather than
mandatory, for the commission to cover a child who is a qualified alien.
C.S.H.B. 2292 modifies the original by keeping existing language that
requires the child health plan, when first implemented, to be actuarially
equivalent to the basic plan offered to active state employees. The
substitute also adds new language to require the commission to seek input
from the Public Assistance Benefit Review and Design Committee in
developing CHIP benefits and to allow the commission to limit CHIP
prescription benefits if cost-effective.
C.S.H.B. 2292 adds new language to allow CHIP cost-sharing provisions to
be determined based on the maximum amount allowed by federal law and
applied to income levels in a manner that minimizes administrative costs.
C.S.H.B. 2292 adds new language to remove the requirement that the 90-day
waiting period apply only to CHIP applicants who were covered by a health
benefits plan during the 90 days prior to application for coverage and to
add a new exception to the 90-day waiting period for a child who has
access to group health insurance and is required to participate in the
health insurance premium payment reimbursement program.
C.S.H.B. 2292 adds new language to restrict the number of health plans in
each service area to no more than two, unless the commissioner determines
it is more cost-effective to grant an exception to this limit.
C.S.H.B. 2292 adds new language to require the commissioner to ensure that
any experience rebate or profit sharing for CHIP managed care
organizations is calculated by treating taxes as allowable expenses.
C.S.H.B. 2292 adds new language to require that a suit for a temporary
restraining order or other injunctive relief relating to nursing home
violations to be brought in the county in which the alleged violation
occurred.
C.S.H.B. 2292 adds new language to change the description of factors that
must be considered when trying a person who has allegedly threatened the
health and safety of a nursing home resident.
C.S.H.B. 2292 adds new language to prohibit the State from imposing more
than one monetary penalty for the same nursing home care violation.
C.S.H.B. 2292 adds new language to eliminate specific requirements for
medication administration in nursing facilities and to eliminate specific
security requirements related to the storage of poisons and medications in
nursing homes.
C.S.H.B. 2292 adds new language to expand the quality assurance fee to
facilities owned by TDMHMR.
C.S.H.B. 2292 adds new language to change the method for calculating and
reporting the number of patient days that would be subject to the quality
assurance fee.
C.S.H.B. 2292 adds new language to expand the authorized purposes for use
of the quality assurance fund.
C.S.H.B. 2292 adds new language to eliminates TCADA's requirement to
provide and maintain a toll-free "800" number to provide counseling and
referral services for compulsive gambling.
C.S.H.B. 2292 adds new language to require local mental health
authorities to use strategies for disease management practices for adults
with bipolar disorder, schizophrenia or severe depression and children
with serious emotional illnesses. The substitute also adds new language
to require TDMHMR to study and report to the governor, lieutenant
governor, and the speaker of the house on the implementation of jail
diversion measures and the effect of regional funding disparities.
C.S.H.B. 2292 adds new language regarding guidelines, terminations, and
sanctions on ICF-MR program provider contracts.
C.S.H.B. 2292 adds new language to allow the proceeds from the disposal of
TDMHMR's surplus real property to be appropriated for any governmental
purpose.
C.S.H.B. 2292 adds new language to establish a Mental Health Community
Services Trust Fund and a Mental Retardation Community Services Trust
Fund.
C.S.H.B. 2292 adds new language to allow the DHS to obtain and use
information from a third party to verify assets and resources of a person
applying for medical, financial, or nutritional assistance.
C.S.H.B. 2292 adds new language to amend the TANF personal responsibility
agreement to include a requirement that each recipient claim the federal
earned income tax credit.
C.S.H.B. 2292 adds new language to amend guidelines for TANF eligibility
and cooperation with personal responsibility agreements by instituting a
Payment of Assistance after Performance method for TANF recipients.
C.S.H.B. 2292 adds new language to allow the disregard of income earned by
the new spouse of a person receiving TANF for the first six months of
marriage, as long as their combined income does not exceed 200% of the
federal poverty level.
C.S.H.B. 2292 adds new language to remove phased-in provisions relating to
exemption from the work requirements for persons receiving financial
assistance.
C.S.H.B. 2292 adds new language to create health, abstinence and marital
development programs and additional assistance for TANF cash recipients.
C.S.H.B. 2292 adds new language that requires all TANF applicants to apply
for the Earned Income Tax Credit and claim the credit on their federal
income tax return.
C.S.H.B. 2292 adds new language to require consideration of the Nursing
Facility Quality Assurance Team's recommendations in establishing care
standards and to expand the scope of the long-term care facility report to
the Legislature.
C.S.H.B. 2292 adds new language to prohibit the exclusion of Medicaid
nursing home recipients from receiving Medicaid transportation services
based on their nursing facility status.
C.S.H.B. 2292 adds new language to limit prescription drug benefits to the
extent allowed, if it is determined to be cost effective.
C.S.H.B. 2292 adds new language to allow for recertification for services
via telephone or a combination of telephone and correspondence.
C.S.H.B. 2292 adds new language to delay the implementation of 12-month
continuous eligibility.
C.S.H.B. 2292 adds new language to remove the current spending requirement
on nursing facilities not participating in enhanced rates and to require
that non-participating facilities receive the same base rate as
participants. The substitute also adds language that would allow for an
incentive program for increased direct care staffing only to the extent
that appropriated funds were available after funds were allocated
according to the commission's base rate reimbursement methodology.
C.S.H.B. 2292 adds new language to grant additional authority to prevent
and detect fraud in the Medicaid program through the use of prepayment
reviews and postpayment holds.
C.S.H.B. 2292 adds new language to allow the commission to establish
procedures for purchase and distribution of over-the-counter medications
and medical supplies, if the commission determines it is more cost
effective, and to require the commission to report on cost savings to
certain legislative committees.
C.S.H.B. 2292 modifies the original by limiting the prohibition on payment
of Medicare deductibles and coinsurance by the state when payment exceeds
the Medicaid reimbursement rate.
C.S.H.B. 2292 adds new language to establish the Nursing Facility Quality
Assurance Team to make recommendations for promoting high-quality care for
nursing home residents and to require DHS to implement the recommendations
of the team.
C.S.H.B. 2292 adds new language to redesignate the "Frail and Elderly
program" as the "Community Attendant Services program."
C.S.H.B. 2292 adds new language to establish and evaluate the impact of
cost sharing requirements for Medicaid recipients.
C.S.H.B. 2292 adds new language that allows the establishment of a system
of payments on a sliding fee schedule by families of children receiving
services through ECI.
C.S.H.B. 2292 adds new language to allow the Texas Commission for the
Blind to provide prevention and transition services to blind disabled
individuals if funds generated through optional fees are available.
C.S.H.B. 2292 adds new language to repeal authority for the Texas
Rehabilitation Commission to operate an extended rehabilitation services
program and to move the transitional planning program into vocational
rehabilitation services.
C.S.H.B. 2292 adds new language to allow money in the comprehensive
rehabilitation fund to be used for general governmental purposes if the
comptroller certifies that appropriations exceed available revenue for the
current biennium, if the revenue estimate for the next biennium is less
than the revenue estimate for the current biennium, or if the LBB
determines that a fiscal emergency exists.
C.S.H.B. 2292 adds new language to transfer the Communities in Schools
program from the Department of Protective and Regulatory Services to the
Texas Education Agency.
C.S.H.B. 2292 adds new language to eliminate the current exemption from
the premium tax for Medicaid HMOs.
C.S.H.B. 2292 adds new language to require group health plans to enroll
people who lose Medicaid or CHIP eligibility without subjecting them to
open enrollment restrictions; however, this does not apply to self-funded
ERISA plans.
C.S.H.B. 2292 adds new language to require an issuer of a health benefit
plan to offer coverage for therapies for children with developmental
delays.
C.S.H.B. 2292 adds new language to require certain health and human
services agencies that provide transportation services to contract with
TxDOT to provide those services and removes provisions requiring the
commission to contract with a single statewide or appropriate number of
regional transportation brokers for providing medical transportation
services.
C.S.H.B. 2292 adds new language to apply any requirements and restrictions
relating to income eligibility, continuous coverage, and enrollment in
CHIP to children enrolled under SKIP.
C.S.H.B. 2292 adds new language to require the Medicaid and Public
Assistance Fraud Oversight Task Force and other agencies to conduct a
study of the procedures and documentation requirements used to establish
identity for the Medicaid program and other health and human services
programs and to report to the Legislature on the findings.
C.S.H.B. 2292 adds new language to abolish advisory committees unless
required by federal law or related to licensing or regulation of entities
providing health and human services or the implementation of a duty as
determined by the commissioner.
C.S.H.B. 2292 modifies the original to amend the date by which the
commission must request waivers necessary to allow families enrolled in
Medicaid to opt into CHIP.
C.S.H.B. 2292 adds new language to require the commission to submit a
state plan amendment requesting federal matching funds for the employers'
share of required premiums for CHIP-eligible children enrolled in a group
health plan.
C.S.H.B. 2292 adds new language to require the commission to submit a
state plan amendment requesting federal matching funds for the employers'
share of required premiums for Medicaid-eligible clients enrolled in a
group health plan.
C.S.H.B. 2292 adds new language to repeal Section 62.055(b) and (c),
Health and Safety Code; Section 62.056, Health and Safety Code; Section
62.057, Health and Safety Code; Section 252.206(d), Health and Safety
Code; and Section 252.207(b), Health and Safety Code.
C.S.H.B. 2292 adds new language to provide that in the event of any
conflict between a provision of this Act and another Act passed during the
78th Legislature, Regular Session, that becomes law, this Act prevails and
controls, regardless of the relative dates of enactment.
C.S.H.B. 2292 removes the provision in the original which eliminated
transitional TANF benefits.
C.S.H.B. 2292 removes the provision in the original which defined
"pharmacy benefit manager" and directed the commission to contract with a
pharmacy benefit manager to administer prescription benefits for Medicaid
and CHIP.
C.S.H.B. 2292 removes the provision in the original which directed the
commission to contract with providers of disease management services for
Medicaid recipients and set forth guidelines for such contracts.
C.S.H.B. 2292 removes the provision in the original which repealed
Sections 31.0035, 32.0255, 32.027, and 32.028, Human Resources Code.
C.S.H.B. 2292 removes the provision in the original which set forth a
January 1, 2004, effective date for providing medical assistance through
managed care.