78R6882 KKA-D


By:  Coleman                                                      H.B. No. 1559



A BILL TO BE ENTITLED

AN ACT

relating to a demonstration project to provide certain services and 
medications through the medical assistance program to persons with 
HIV infection or AIDS.
	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:                        
	SECTION 1.  Subchapter B, Chapter 32, Human Resources Code, 
is amended by adding Section 32.057 to read as follows:
	Sec. 32.057.  DEMONSTRATION PROJECT FOR PERSONS WITH HIV 
INFECTION OR AIDS. (a)  In this section, "AIDS" and "HIV" have the  
meanings assigned by Section 81.101, Health and Safety Code.
	(b)  The department shall establish a demonstration project 
to provide a person with HIV infection or AIDS with the following 
services and medications through the medical assistance program:
		(1)  services provided by a physician, physician 
assistant, advanced practice nurse, or other health care provider 
specified by the department;
		(2)  medications not included in the formulary for the 
HIV medication program operated by the department, but determined 
to be necessary for treatment of a condition related to HIV 
infection or AIDS;
		(3)  vaccinations for hepatitis B and pneumonia;                       
		(4)  pap smears, colposcopy, and other diagnostic 
procedures necessary to monitor gynecologic complications 
resulting from HIV infection or AIDS in women;
		(5)  hospitalization;                                                  
		(6)  laboratory and other diagnostic services, 
including periodic testing for CD4+ T-cell counts, viral load 
determination, and phenotype or genotype testing if clinically 
indicated; and
		(7)  other laboratory and radiological testing 
necessary to monitor potential toxicity of therapy.
	(c)  The department shall establish the demonstration 
project in at least two counties with a high prevalence of HIV 
infection and AIDS.  The department shall ensure that the 
demonstration project is financed using funds made available by the 
counties in which the department establishes the demonstration 
project.
	(d)  A person is eligible to participate in the demonstration 
project if the person:
		(1)  has been diagnosed with HIV infection or AIDS by a 
physician;   
		(2)  is under 65 years of age;                                         
		(3)  has a net family income that is at or below 200 
percent of the federal poverty level;
		(4)  is a resident of a county included in the project 
or, subject to guidelines established by the department, is 
receiving medical care for HIV infection or AIDS through a facility 
located in a county included in the project;
		(5)  is not covered by a health benefits plan offering 
adequate coverage, as determined by the department; and
		(6)  is not otherwise eligible for medical assistance 
at the time the person's eligibility for participation in the 
demonstration project is determined.
	(e)  Participation in the demonstration project does not 
entitle a participant to other services provided under the medical 
assistance program.
	(f)  The department shall establish an appropriate 
enrollment limit for the demonstration project and may not allow 
participation in the project to exceed that limit.  Once the limit 
is reached, the department:
		(1)  shall establish a waiting list for enrollment in 
the demonstration project; and
		(2)  may allow eligible persons on the waiting list to 
enroll solely in the HIV medication program operated by the 
department.
	(g)  The department shall ensure that a participant in the 
demonstration project is also enrolled in the HIV medication 
program operated by the department.
	(h)  Notwithstanding any other provision of this section, 
the department shall provide each participant in the project with a 
six-month period of continuous eligibility for participation in the 
project.
	(i)  Not later than December 1 of each even-numbered year, 
the department shall submit a biennial report to the legislature 
regarding the department's progress in establishing and operating 
the demonstration project.
	(j)  Not later than December 1, 2008, the department shall 
evaluate the cost-effectiveness of the demonstration project, 
including whether the services and medications provided offset 
future higher costs for project participants.  If the results of the 
evaluation indicate that the project is cost-effective, the 
department shall incorporate a request for funding for the 
expansion of the project into additional counties or throughout the 
state, as appropriate, in the department's budget request for the 
next state fiscal biennium.
	(k)  This section expires September 1, 2009.                            
	SECTION 2.   The state agency responsible for implementing 
the demonstration project required by Section 32.057, Human 
Resources Code, as added by this Act, shall request and actively 
pursue any necessary waivers or authorizations from the Health Care 
Financing Administration or other appropriate entities to enable 
the agency to implement the demonstration project not later than 
September 1, 2004.  The agency may delay implementing the 
demonstration project until the necessary waivers or 
authorizations are granted.
	SECTION 3.  This Act takes effect immediately if it receives 
a vote of two-thirds of all the members elected to each house, as 
provided by Section 39, Article III, Texas Constitution.  If this 
Act does not receive the vote necessary for immediate effect, this 
Act takes effect September 1, 2003.