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.