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78R11653 KLA/KKA-F
By: Wohlgemuth, Heflin H.B. No. 2292
Substitute the following for H.B. No. 2292:
By: Wohlgemuth C.S.H.B. No. 2292
A BILL TO BE ENTITLED
AN ACT
relating to the provision of health and human services in this
state, including the powers and duties of the Health and Human
Services Commission and other state agencies; providing penalties.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
ARTICLE 1. ORGANIZATION OF THE HEALTH AND HUMAN SERVICES
COMMISSION AND HEALTH AND HUMAN SERVICES AGENCIES
SECTION 1.01. (a) Section 531.001(4), Government Code, as
amended by Chapters 53, 957, and 1420, Acts of the 77th Legislature,
Regular Session, 2001, is reenacted and amended to read as follows:
(4) "Health and human services agencies" includes the:
(A) Interagency Council on Early Childhood
Intervention;
(B) Texas Department on Aging;
(C) Texas Commission on Alcohol and Drug Abuse;
(D) Texas Commission for the Blind;
(E) Texas Commission for the Deaf and Hard of
Hearing;
(F) Texas Department of Health;
(G) Texas Department of Human Services;
(H) Texas Department of Mental Health and Mental
Retardation;
(I) Texas Rehabilitation Commission;
(J) Department of Protective and Regulatory
Services; [and]
(K) Texas Health Care Information Council;
(L) Department of Aging, Community, Disability,
and Long-Term Care Services; and
(M) Department of Health Services.
(b) Effective on the date the agencies listed in Section
1.25 of this article are abolished as provided by that section,
Section 531.001(4), Government Code, as amended by Chapters 53,
957, and 1420, Acts of the 77th Legislature, Regular Session, 2001,
is reenacted and amended to read as follows:
(4) "Health and human services agencies" includes the:
(A) Department of Aging, Community, Disability,
and Long-Term Care Services [Interagency Council on Early Childhood
Intervention];
(B) Department of Health Services [Texas
Department on Aging]; and
(C) [Texas Commission on Alcohol and Drug Abuse;
[(D) Texas Commission for the Blind;
[(E) Texas Commission for the Deaf and Hard of
Hearing;
[(F) Texas Department of Health;
[(G) Texas Department of Human Services;
[(H) Texas Department of Mental Health and Mental
Retardation;
[(I) Texas Rehabilitation Commission;
[(J)] Department of Protective and Regulatory
Services[; and
[(K) Texas Health Care Information Council].
SECTION 1.02. Section 531.004, Government Code, is amended
to read as follows:
Sec. 531.004. SUNSET PROVISION. The Health and Human
Services Commission is subject to Chapter 325 (Texas Sunset Act).
Unless continued in existence as provided by that chapter, the
commission is abolished and this chapter expires September 1, 2009
[2007].
SECTION 1.03. Section 531.0055, Government Code, is amended
to read as follows:
Sec. 531.0055. COMMISSIONER: GENERAL RESPONSIBILITY FOR
[RELATING TO CERTAIN FUNCTIONS OF] HEALTH AND HUMAN SERVICES
AGENCIES. (a) In this section and in Section 531.0056, "agency
director"[:
[(1) "Agency director"] means the [director,]
executive director[, or commissioner] of a health and human
services agency.
[(2) "Policymaking body" means the board or commission
with policymaking authority over a health and human services
agency.]
(b) The commission shall:
(1) supervise the administration and operation of the
Medicaid program, including the administration and operation of the
Medicaid managed care system in accordance with Section 531.021;
(2) perform [supervise] information systems planning
and management for health and human services agencies under Section
531.0273, with:
(A) the provision of information technology
services at health and human services agencies considered to be a
centralized administrative support service either performed by
commission personnel or performed under a contract with the
commission; and
(B) an emphasis on research and implementation on
a demonstration or pilot basis of appropriate and efficient uses of
new and existing technology to improve the operation of health and
human services agencies and delivery of health and human services;
(3) monitor and ensure the effective use of all
federal funds received by a health and human services agency in
accordance with Section 531.028 and the General Appropriations Act;
and
(4) implement Texas Integrated Enrollment Services as
required by Subchapter F, except that notwithstanding Subchapter F,
determining eligibility for benefits under the following programs
is the responsibility of and must be centralized by the commission:
(A) the child health plan program;
(B) the financial assistance program under
Chapter 31, Human Resources Code;
(C) the medical assistance program under Chapter
32, Human Resources Code;
(D) the nutritional assistance programs under
Chapter 33, Human Resources Code;
(E) Supplemental Security Income (SSI) (42
U.S.C. Section 1381 et seq.) and its subsequent amendments, to the
extent permitted by federal law;
(F) long-term care services, as defined by
Section 22.0011, Human Resources Code; and
(G) community-based support services identified
or provided in accordance with Section 531.02481.
(c) The [After implementation of the commission's duties
under Subsection (b), the] commission shall implement the powers
and duties given to the commission under Sections 531.0246,
531.0247, 2155.144, [as added by Chapter 1045, Acts of the 75th
Legislature, Regular Session, 1997,] and 2167.004.
(d) After implementation of the commission's duties under
Subsections (b) and (c), the commission shall implement the powers
and duties given to the commission under Section 531.0248. Nothing
in the priorities established by this section is intended to limit
the authority of the commission to work simultaneously to achieve
the multiple tasks assigned to the commission in this section, when
such an approach is beneficial in the judgment of the commission.
The commission shall plan and implement an efficient and effective
centralized system of administrative support services for health
and human services agencies. The performance of administrative
support services for health and human services agencies is the
responsibility of the commission. The term "administrative support
services" includes, but is not limited to, strategic planning and
evaluation, audit, legal, human resources, information resources,
purchasing, contract management, financial management, and
accounting services.
(e) Notwithstanding any other law, the commissioner shall
adopt rules and policies for the operation of and provision of
health and human services by the health and human services
agencies. In addition, the commissioner, as necessary to perform
the functions described by Subsections (b), (c), and (d) in
implementation of applicable [the] policies established for an
agency by the commissioner [each agency's policymaking body],
shall:
(1) manage and direct the operations of each health
and human services agency; and
(2) supervise and direct the activities of each agency
director.
(f) The operational authority and responsibility of the
commissioner for purposes of Subsection (e) at each health and
human services agency includes authority over and responsibility
for the:
(1) management of the daily operations of the agency,
including the organization and management of the agency and agency
operating procedures;
(2) allocation of resources within the agency,
including use of federal funds received by the agency;
(3) personnel and employment policies;
(4) contracting, purchasing, and related policies,
subject to this chapter and other laws relating to contracting and
purchasing by a state agency;
(5) information resources systems used by the agency;
(6) location of agency facilities; and
(7) coordination of agency activities with activities
of other state agencies, including other health and human services
agencies.
(g) Notwithstanding any other law, the operational
authority and responsibility of the commissioner for purposes of
Subsection (e) at each health and human services agency includes
the authority and responsibility to adopt or approve, subject to
applicable limitations, any rate of payment or similar provision
required by law to be adopted or approved by the agency.
(h) For each health and human services agency, the
commissioner shall implement a program to evaluate and supervise
the daily operations of the agency. The program must include
measurable performance objectives for each agency director and
adequate reporting requirements to permit the commissioner to
perform the duties assigned to the commissioner under this section.
(i) To facilitate the operations of a health and human
services agency in accordance with this section, the commissioner
may delegate a specific power or duty given under Subsection (f) or
(g) to an agency director. The agency director acts on behalf of
the commissioner in performing the delegated function and reports
to the commissioner regarding the delegated function and any matter
affecting agency programs and operations.
(j) The commissioner shall [may] adopt rules to implement
the commissioner's authority under this section.
(k) The commissioner and each agency director shall enter
into a memorandum of understanding in the manner prescribed by
Section 531.0163 that:
(1) clearly defines the responsibilities of the agency
director and the commissioner, including:
(A) the responsibility of the agency director to
report to the governor and to report to and implement policies of
the commissioner; and
(B) the extent to which the agency director acts
as a liaison between the agency and the commission;
(2) establishes the program of evaluation and
supervision of daily operations required by Subsection (h); and
(3) describes each delegation of a power or duty made
under Subsection (i) or other law.
(l) Notwithstanding any other law, the commissioner
[provision of this section, a policymaking body] has the authority
[provided by law] to adopt policies and rules governing the
delivery of services to persons who are served by each health and
human services [the] agency and the rights and duties of persons who
are served or regulated by each [the] agency. [The commissioner and
each policymaking body shall enter into a memorandum of
understanding that clearly defines:
[(1) the policymaking authority of the policymaking
body; and
[(2) the operational authority of the commissioner.]
SECTION 1.04. Section 531.0056, Government Code, is amended
to read as follows:
Sec. 531.0056. APPOINTMENT [EMPLOYMENT] OF AGENCY DIRECTOR
BY GOVERNOR. (a) The governor shall appoint an agency director for
each health and human services agency. [This section applies only
to an agency director employed by the commissioner.]
(b) The agency director shall serve for a term of one year.
[An agency director employed by the commissioner may be employed
only with the concurrence of the agency's policymaking body and the
approval of the governor.]
(c) In addition to the requirements of [As established in]
Section 531.0055(k)(1), the memorandum of understanding required
by that section must [the commissioner and agency director shall
enter into a memorandum of understanding that] clearly define
[defines] the responsibilities of the agency director [and may
establish terms and conditions of employment in the memorandum of
understanding].
(d) The terms of the memorandum of understanding shall
outline specific performance objectives, as defined [jointly] by
the commissioner [and the policymaking body], to be fulfilled by
the agency director, including the performance objectives outlined
in Section 531.0055(h).
(e) Based upon the performance objectives outlined in the
memorandum of understanding, the commissioner shall perform an
employment evaluation of the agency director.
(f) The commissioner shall submit the evaluation[, along
with any recommendation regarding the employment of the agency
director,] to the [agency's policymaking body and the] governor not
later than January 1 of each even-numbered year.
[(g) The policymaking body shall consider the evaluation in
a meeting of the policymaking body and take necessary action, if
any, not later than 90 days after the date of the receipt of the
evaluation.
[(h) An agency director employed by the commissioner serves
at the pleasure of the commissioner but may be discharged only with
the concurrence of the agency's policymaking body.]
SECTION 1.05. Section 531.008, Government Code, is amended
to read as follows:
Sec. 531.008. DIVISIONS OF COMMISSION. (a) Subject to
Subsection (c), the [The] commissioner may establish divisions
within the commission as necessary for effective administration and
for the discharge of the commission's functions.
(b) Subject to Subsection (c), the [The] commissioner may
allocate and reallocate functions among the commission's
divisions.
(c) The commissioner shall establish the following
divisions and offices within the commission:
(1) the eligibility services division to make
eligibility determinations for services provided through the
commission or a health and human services agency related to:
(A) the child health plan program;
(B) the financial assistance program under
Chapter 31, Human Resources Code;
(C) the medical assistance program under Chapter
32, Human Resources Code;
(D) the nutritional assistance programs under
Chapter 33, Human Resources Code;
(E) Supplemental Security Income (SSI) (42
U.S.C. Section 1381 et seq.) and its subsequent amendments, to the
extent permitted by federal law;
(F) long-term care services, as defined by
Section 22.0011, Human Resources Code; and
(G) community-based support services identified
or provided in accordance with Section 531.02481;
(2) the investigations and enforcement office to
perform fraud investigation and enforcement functions as provided
by Subchapter C and other law;
(3) the office of the ombudsman to:
(A) provide dispute resolution services for the
commission and the health and human services agencies; and
(B) perform consumer protection functions
related to health and human services; and
(4) a purchasing division as provided by Section
531.017.
SECTION 1.06. Subchapter A, Chapter 531, Government Code, is
amended by adding Sections 531.0161, 531.0162, and 531.0163 to read
as follows:
Sec. 531.0161. NEGOTIATED RULEMAKING AND ALTERNATIVE
DISPUTE PROCEDURES. (a) The commission shall develop and
implement a policy, for the commission and each health and human
services agency, to encourage the use of:
(1) negotiated rulemaking procedures under Chapter
2008 for the adoption of commission rules; and
(2) appropriate alternative dispute resolution
procedures under Chapter 2009 to assist in the resolution of
internal and external disputes under the commission's or agency's
jurisdiction.
(b) The procedures relating to alternative dispute
resolution must conform, to the extent possible, to any model
guidelines issued by the State Office of Administrative Hearings
for the use of alternative dispute resolution by state agencies.
Sec. 531.0162. USE OF TECHNOLOGY. (a) The commission shall
develop and implement a policy requiring the executive director and
employees of each health and human services agency to research and
propose appropriate technological solutions to improve the
agency's ability to perform its functions. The technological
solutions must:
(1) ensure that the public is able to easily find
information about a health and human services agency on the
Internet;
(2) ensure that persons who want to use a health and
human services agency's services are able to:
(A) interact with the agency through the
Internet; and
(B) access any service that can be provided
effectively through the Internet; and
(3) be cost-effective and developed through the
commission's planning process.
(b) The commission shall develop and implement a policy
described by Subsection (a) in relation to the commission's
functions.
Sec. 531.0163. MEMORANDUM OF UNDERSTANDING. (a) The
memorandum of understanding under Section 531.0055(k) must be
adopted by the commissioner by rule in accordance with the
procedures prescribed by Subchapter B, Chapter 2001, for adopting
rules, except that the requirements of Section 2001.033(a)(1)(A) or
(C) do not apply with respect to any part of the memorandum of
understanding that:
(1) concerns only internal management or organization
within or among health and human services agencies and does not
affect private rights or procedures; or
(2) relates solely to the internal personnel practices
of health and human services agencies.
(b) The memorandum of understanding may be amended only by
following the procedures prescribed under Subsection (a).
SECTION 1.07. Subchapter B, Chapter 531, Government Code, is
amended by adding Section 531.0224 to read as follows:
Sec. 531.0224. PLANNING AND POLICY DIRECTION OF TEMPORARY
ASSISTANCE FOR NEEDY FAMILIES PROGRAM. The commission shall:
(1) plan and direct the financial assistance program
under Chapter 31, Human Resources Code, including the procurement,
management, and monitoring of contracts necessary to implement the
program;
(2) adopt rules and standards governing the financial
assistance program under Chapter 31, Human Resources Code, in
consultation with the policy councils of the agencies that operate
the program, including rules for determining eligibility for and
the amount and duration of an earned income disregard; and
(3) establish requirements for and define the scope of
the ongoing evaluation of the financial assistance program under
Chapter 31, Human Resources Code.
SECTION 1.08. Chapter 531, Government Code, is amended by
adding Subchapter K to read as follows:
SUBCHAPTER K. HEALTH AND HUMAN SERVICES COUNCIL
Sec. 531.401. DEFINITION. In this subchapter, "council"
means the Health and Human Services Council.
Sec. 531.402. HEALTH AND HUMAN SERVICES COUNCIL. (a) The
Health and Human Services Council is created to assist the
commissioner in developing rules and policies for the commission.
(b) The council is composed of nine members of the public
appointed by the governor. To be eligible for appointment to the
council, a person must have demonstrated an interest in and
knowledge of problems and available services related to the child
health plan program, the financial assistance program under Chapter
31, Human Resources Code, the medical assistance program under
Chapter 32, Human Resources Code, or the nutritional assistance
programs under Chapter 33, Human Resources Code.
(c) The council shall study and make recommendations to the
commissioner regarding the management and operation of the
commission, including policies and rules governing the delivery of
services to persons who are served by the commission and the rights
and duties of persons who are served or regulated by the commission.
(d) Chapter 551 applies to the council.
(e) Chapter 2110 does not apply to the council.
Sec. 531.403. APPOINTMENTS. (a) Appointments to the
council shall be made without regard to the race, color,
disability, sex, religion, age, or national origin of the
appointees.
(b) Appointments to the council shall be made so that each
geographic area of the state is represented on the council.
Sec. 531.404. TRAINING PROGRAM FOR COUNCIL MEMBERS. (a) A
person who is appointed as a member of the council may not vote,
deliberate, or be counted as a member in attendance at a meeting of
the council until the person completes a training program that
complies with this section.
(b) The training program must provide the person with
information regarding:
(1) the legislation that created the commission and
the council;
(2) the programs operated by the commission;
(3) the role and functions of the commission and the
council, including detailed information regarding the advisory
responsibilities of the council;
(4) the rules of the commissioner applicable to the
commission, with an emphasis on the rules that relate to
disciplinary and investigatory authority;
(5) the current budget for the commission;
(6) the results of the most recent formal audit of the
commission;
(7) the requirements of:
(A) the open meetings law, Chapter 551;
(B) the public information law, Chapter 552;
(C) the administrative procedure law, Chapter
2001; and
(D) other laws relating to public officials,
including conflict-of-interest laws; and
(8) any applicable ethics policies adopted by the
commissioner or the Texas Ethics Commission.
Sec. 531.405. TERMS. (a) Council members serve for
staggered six-year terms with the terms of three members expiring
February 1 of each odd-numbered year.
(b) A member of the council may not serve more than two
consecutive full terms as a council member.
Sec. 531.406. VACANCY. The governor by appointment shall
fill the unexpired term of a vacancy on the council.
Sec. 531.407. PRESIDING OFFICER; OTHER OFFICERS; MEETINGS.
(a) The governor shall designate a member of the council as the
presiding officer to serve in that capacity at the pleasure of the
governor.
(b) The members of the council shall elect any other
necessary officers.
(c) The council shall meet quarterly and at other times at
the call of the presiding officer. The council may hold meetings in
different areas of the state.
Sec. 531.408. REIMBURSEMENT FOR EXPENSES. A council member
may not receive compensation for service as a member of the council
but is entitled to reimbursement for travel expenses incurred by
the member while conducting the business of the council as provided
by the General Appropriations Act.
Sec. 531.409. PUBLIC INTEREST INFORMATION AND COMPLAINTS.
(a) The commissioner, with the advice of the council, shall prepare
information of public interest describing the functions of the
commission and the procedures by which complaints are filed with
and resolved by the commission. The commission shall make the
information available to the public and appropriate state
governmental entities.
(b) The commissioner by rule shall establish methods by
which consumers and service recipients are notified of the name,
mailing address, and telephone number of the commission for
directing complaints to the commission.
Sec. 531.410. PUBLIC ACCESS AND TESTIMONY. The
commissioner shall develop and implement policies that provide the
public with a reasonable opportunity to appear before the council
or commissioner and to speak on any issue under the jurisdiction of
the commission.
Sec. 531.411. POLICYMAKING AND MANAGEMENT
RESPONSIBILITIES. The commissioner, with the advice of the
council, shall develop and the commission shall implement policies
that clearly delineate the policymaking responsibilities of the
commissioner from the management responsibilities of the
commission and the staff of the commission.
SECTION 1.09. The Health and Safety Code is amended by
adding Title 12 to read as follows:
TITLE 12. HEALTH AND MENTAL HEALTH
CHAPTER 1001. DEPARTMENT OF HEALTH SERVICES
SUBCHAPTER A. GENERAL PROVISIONS
Sec. 1001.001. DEFINITIONS. In this chapter:
(1) "Commission" means the Health and Human Services
Commission.
(2) "Commissioner" means the commissioner of health
and human services.
(3) "Council" means the Health Services Council.
(4) "Department" means the Department of Health
Services.
(5) "Executive director" means the executive director
of the department.
Sec. 1001.002. AGENCY. The department is an agency of the
state.
Sec. 1001.003. SUNSET PROVISION. The department is subject
to Chapter 325, Government Code (Texas Sunset Act). Unless
continued in existence as provided by that chapter, the department
is abolished and this chapter expires September 1, 2009.
[Sections 1001.004-1001.020 reserved for expansion]
SUBCHAPTER B. ADMINISTRATIVE PROVISIONS
Sec. 1001.021. HEALTH SERVICES COUNCIL. (a) The Health
Services Council is created to assist the commissioner in
developing rules and policies for the department.
(b) The council is composed of nine members of the public
appointed by the governor. To be eligible for appointment to the
council, a person must have demonstrated an interest in and
knowledge of problems and available services related to public
health, mental health, substance abuse, deafness, or hard of
hearing conditions.
(c) The council shall study and make recommendations to the
commissioner regarding the management and operation of the
department, including policies and rules governing the delivery of
services to persons who are served by the department and the rights
and duties of persons who are served or regulated by the department.
(d) Chapter 551, Government Code, applies to the council.
(e) Chapter 2110, Government Code, does not apply to the
council.
Sec. 1001.022. APPOINTMENTS. (a) Appointments to the
council shall be made without regard to the race, color,
disability, sex, religion, age, or national origin of the
appointees.
(b) Appointments to the council shall be made so that each
geographic area of the state is represented on the council.
Sec. 1001.023. TRAINING PROGRAM FOR COUNCIL MEMBERS. (a) A
person who is appointed as a member of the council may not vote,
deliberate, or be counted as a member in attendance at a meeting of
the council until the person completes a training program that
complies with this section.
(b) The training program must provide the person with
information regarding:
(1) the legislation that created the department and
the council;
(2) the programs operated by the department;
(3) the role and functions of the department and the
council, including detailed information regarding:
(A) the division of authority and of
responsibility between the executive director and the
commissioner; and
(B) the advisory responsibilities of the
council;
(4) the rules of the commissioner applicable to the
department, with an emphasis on the rules that relate to
disciplinary and investigatory authority;
(5) the current budget for the department;
(6) the results of the most recent formal audit of the
department;
(7) the requirements of:
(A) the open meetings law, Chapter 551,
Government Code;
(B) the public information law, Chapter 552,
Government Code;
(C) the administrative procedure law, Chapter
2001, Government Code; and
(D) other laws relating to public officials,
including conflict-of-interest laws; and
(8) any applicable ethics policies adopted by the
commissioner or the Texas Ethics Commission.
Sec. 1001.024. TERMS. (a) Council members serve for
staggered six-year terms with the terms of three members expiring
February 1 of each odd-numbered year.
(b) A member of the council may not serve more than two
consecutive full terms as a council member.
Sec. 1001.025. VACANCY. The governor by appointment shall
fill the unexpired term of a vacancy on the council.
Sec. 1001.026. PRESIDING OFFICER; OTHER OFFICERS;
MEETINGS. (a) The governor shall designate a member of the council
as the presiding officer to serve in that capacity at the pleasure
of the governor.
(b) The members of the council shall elect any other
necessary officers.
(c) The council shall meet quarterly and at other times at
the call of the presiding officer. The council may hold meetings in
different areas of the state.
Sec. 1001.027. REIMBURSEMENT FOR EXPENSES. A council
member may not receive compensation for service as a member of the
council but is entitled to reimbursement for travel expenses
incurred by the member while conducting the business of the council
as provided by the General Appropriations Act.
Sec. 1001.028. PUBLIC INTEREST INFORMATION AND COMPLAINTS.
(a) The commissioner, with the advice of the council, shall prepare
information of public interest describing the functions of the
department and the procedures by which complaints are filed with
and resolved by the department. The commission shall make the
information available to the public and appropriate state
governmental entities.
(b) The commissioner by rule shall establish methods by
which consumers and service recipients are notified of the name,
mailing address, and telephone number of the department for
directing complaints to the department.
Sec. 1001.029. PUBLIC ACCESS AND TESTIMONY. The
commissioner shall develop and implement policies that provide the
public with a reasonable opportunity to appear before the council
or commissioner and to speak on any issue under the jurisdiction of
the department.
Sec. 1001.030. POLICYMAKING AND MANAGEMENT
RESPONSIBILITIES. The commissioner, with the advice of the
council, shall develop and the department shall implement policies
that clearly delineate the policymaking responsibilities of the
commissioner from the management responsibilities of the
commission, the executive director, and the staff of the
department.
Sec. 1001.031. ANNUAL REPORT. (a) The executive director
shall file annually with the governor, the presiding officer of
each house of the legislature, and the commissioner a complete and
detailed written report accounting for all funds received and
disbursed by the department during the preceding fiscal year.
(b) The annual report must be in the form and be reported in
the time provided by the General Appropriations Act.
Sec. 1001.032. OFFICES. The department shall maintain its
central office in Austin. The department may maintain offices in
other areas of the state as necessary.
[Sections 1001.033-1001.050 reserved for expansion]
SUBCHAPTER C. PERSONNEL
Sec. 1001.051. EXECUTIVE DIRECTOR. (a) The governor shall
appoint an executive director of the department. The executive
director is to be selected according to education, training,
experience, and demonstrated ability.
(b) The executive director serves for a term of one year.
(c) Subject to the commissioner's control, the executive
director shall act as the department's chief administrative officer
and as a liaison between the department and commission.
(d) The executive director shall administer this chapter
under operational policies established by the commissioner and in
accordance with the memorandum of understanding under Section
531.0055(k), Government Code, between the executive director and
the commissioner, as adopted by rule.
Sec. 1001.052. PERSONNEL. (a) The department may employ,
compensate, and prescribe the duties of personnel necessary and
suitable to administer this chapter.
(b) The commissioner shall prepare and by rule adopt
personnel standards.
(c) A personnel position may be filled only by an individual
selected and appointed on a nonpartisan merit basis.
(d) The commissioner, with the advice of the council, shall
develop and the department shall implement policies that clearly
define the responsibilities of the staff of the department.
Sec. 1001.053. INFORMATION ABOUT QUALIFICATIONS AND
STANDARDS OF CONDUCT. The executive director or the executive
director's designee shall provide to department employees, as often
as necessary, information regarding the requirements for
employment under this chapter or rules adopted by the commissioner,
including information regarding a person's responsibilities under
applicable laws relating to standards of conduct for state
employees.
Sec. 1001.054. MERIT PAY. Subject to rules adopted by the
commissioner, the executive director or the executive director's
designee shall develop a system of annual performance evaluations.
All merit pay for department employees must be given under the
system established under this section or under rules adopted by the
commissioner.
Sec. 1001.055. CAREER LADDER. The executive director or
the executive director's designee shall develop an intra-agency
career ladder program. The program must require intra-agency
postings of all nonentry-level positions concurrently with any
public posting.
Sec. 1001.056. EQUAL EMPLOYMENT OPPORTUNITY POLICY. (a)
Subject to rules adopted by the commissioner, the executive
director or the executive director's designee shall prepare and
maintain a written policy statement that implements a program of
equal employment opportunity to ensure that all personnel decisions
are made without regard to race, color, disability, sex, religion,
age, or national origin.
(b) Unless the following are included in a policy statement
adopted by the commissioner that is applicable to the department,
the policy statement must include:
(1) personnel policies, including policies relating
to recruitment, evaluation, selection, training, and promotion of
personnel, that show the intent of the department to avoid the
unlawful employment practices described by Chapter 21, Labor Code;
and
(2) an analysis of the extent to which the composition
of the department's personnel is in accordance with state and
federal law and a description of reasonable methods to achieve
compliance with state and federal law.
(c) The policy statement must be:
(1) updated annually;
(2) reviewed by the state Commission on Human Rights
for compliance with Subsection (b)(1); and
(3) filed with the governor's office.
Sec. 1001.057. STATE EMPLOYEE INCENTIVE PROGRAM. The
executive director or the executive director's designee shall
provide to department employees information and training on the
benefits and methods of participation in the state employee
incentive program.
[Sections 1001.058-1001.070 reserved for expansion]
SUBCHAPTER D. POWERS AND DUTIES OF DEPARTMENT
Sec. 1001.071. GENERAL POWERS AND DUTIES OF DEPARTMENT
RELATED TO HEALTH CARE. The department is responsible for
administering human services programs regarding the public health,
including:
(1) implementing the state's health care delivery
programs;
(2) administering state health facilities, hospitals,
and health care systems;
(3) developing and providing health care services, as
directed by law;
(4) providing for the prevention and control of
communicable diseases;
(5) providing public education on health-related
matters, as directed by law;
(6) compiling and reporting health-related
information, as directed by law;
(7) acting as the lead agency for implementation of
state policies regarding the human immunodeficiency virus and
acquired immunodeficiency syndrome and administering programs
related to the human immunodeficiency virus and acquired
immunodeficiency syndrome;
(8) administering state programs related to cancer,
including the Texas Cancer Plan;
(9) investigating the causes of injuries and methods
of prevention;
(10) administering a grant program to provide
appropriated money to counties, municipalities, public health
districts, and other political subdivisions for their use to
provide or pay for essential public health services;
(11) administering the registration of vital
statistics;
(12) licensing, inspecting, and enforcing regulations
regarding health facilities, other than long-term care facilities
regulated by the Department of Protective and Regulatory Services;
(13) implementing established standards and
procedures for the management and control of sanitation and for
health protection measures;
(14) enforcing regulations regarding radioactive
materials;
(15) enforcing regulations regarding food, bottled
and vended drinking water, drugs, cosmetics, and health devices;
(16) enforcing regulations regarding food service
establishments, retail food stores, mobile food units, and roadside
food vendors;
(17) enforcing regulations controlling hazardous
substances in households and workplaces; and
(18) administering services focused on individuals
who are deaf or hard of hearing.
Sec. 1001.072. GENERAL POWERS AND DUTIES OF DEPARTMENT
RELATED TO MENTAL HEALTH. The department is responsible for
administering human services programs regarding mental health,
including:
(1) administering and coordinating mental health
services at the local and state level;
(2) operating the state's mental health facilities;
and
(3) inspecting, licensing, and enforcing regulations
regarding mental health facilities, other than long-term care
facilities regulated by the Department of Protective and Regulatory
Services.
Sec. 1001.073. GENERAL POWERS AND DUTIES OF DEPARTMENT
RELATED TO SUBSTANCE ABUSE. The department is responsible for
administering human services programs regarding substance abuse,
including:
(1) administering and coordinating substance abuse
prevention and treatment programs at the state and local level;
(2) inspecting, licensing, and enforcing regulations
regarding substance abuse treatment facilities; and
(3) providing public education on substance abuse
issues, as directed by law.
Sec. 1001.074. INFORMATION REGARDING COMPLAINTS. (a) The
department shall maintain a file on each written complaint filed
with the department. The file must include:
(1) the name of the person who filed the complaint;
(2) the date the complaint is received by the
department;
(3) the subject matter of the complaint;
(4) the name of each person contacted in relation to
the complaint;
(5) a summary of the results of the review or
investigation of the complaint; and
(6) an explanation of the reason the file was closed,
if the department closed the file without taking action other than
to investigate the complaint.
(b) The department shall provide to the person filing the
complaint and to each person who is a subject of the complaint a
copy of the commissioner's and the department's policies and
procedures relating to complaint investigation and resolution.
(c) The department, at least quarterly until final
disposition of the complaint, shall notify the person filing the
complaint and each person who is a subject of the complaint of the
status of the investigation unless the notice would jeopardize an
undercover investigation.
Sec. 1001.075. RULES. The commissioner may adopt rules
reasonably necessary for the department to administer this chapter,
consistent with the memorandum of understanding under Section
531.0055(k), Government Code, between the executive director and
the commissioner, as adopted by rule.
SECTION 1.10. Section 40.001, Human Resources Code, is
amended by adding Subdivisions (2-a) and (2-b) to read as follows:
(2-a) "Commissioner" means the commissioner of health
and human services.
(2-b) "Council" means the Protective and Regulatory
Council.
SECTION 1.11. Section 40.002, Human Resources Code, is
amended to read as follows:
Sec. 40.002. DEPARTMENT OF PROTECTIVE AND REGULATORY
SERVICES; GENERAL DUTIES OF DEPARTMENT [RESPONSIBILITY]. (a) The
Department of Protective and Regulatory Services is composed of the
council [board], the executive director, an administrative staff,
and other officers and employees necessary to efficiently carry out
the purposes of this chapter.
(b) Notwithstanding any other law, the [The] department
shall [is the state agency with primary responsibility for]:
(1) provide [providing] protective services for
children and elderly and disabled persons, including
investigations of alleged abuse, neglect, or exploitation in
facilities of the Texas Department of Mental Health and Mental
Retardation or its successor agency;
(2) provide [providing] family support and family
preservation services that [which] respect the fundamental right of
parents to control the education and upbringing of their children;
(3) license, register, and enforce regulations
applicable to [regulating] child-care facilities and child-care
administrators; [and]
(4) implement [implementing] and manage [managing]
programs intended to provide early intervention or prevent at-risk
behaviors that lead to child abuse, delinquency, running away,
truancy, and dropping out of school;
(5) implement programs intended to prevent family
violence and provide services to victims of family violence; and
(6) perform all licensing and enforcement activities
and functions related to long-term care facilities, including
licensing and enforcement activities related to convalescent and
nursing homes and related institutions under Chapter 242, Health
and Safety Code.
(c) The department is the state agency designated to
cooperate with the federal government in the administration of
programs under:
(1) Parts B and E, Title IV, federal Social Security
Act (42 U.S.C. Sections 620 et seq. and 670 et seq.); and
(2) other federal law for which the department has
administrative responsibility.
(d) The department shall cooperate with the United States
Department of Health and Human Services and other federal and state
agencies in a reasonable manner and in conformity with the
provisions of federal law and this subtitle to the extent necessary
to qualify for federal assistance in the delivery of services.
(e) If the department determines that a provision of state
law governing the department conflicts with a provision of federal
law, the commissioner [department] may adopt policies and rules
necessary to allow the state to receive and spend federal matching
funds to the fullest extent possible in accordance with the federal
statutes, this subtitle, and the state constitution and within the
limits of appropriated funds.
SECTION 1.12. Sections 40.021, 40.022, 40.0226, 40.024,
40.025, 40.026, and 40.027, Human Resources Code, are amended to
read as follows:
Sec. 40.021. [BOARD OF] PROTECTIVE AND REGULATORY COUNCIL
[SERVICES]. (a) The Protective and Regulatory Council is created
to assist the commissioner in developing rules and policies for the
department [board is composed of six members appointed by the
governor with the advice and consent of the senate. The governor
shall designate one member to be the presiding officer of the board
to serve in that capacity at the pleasure of the governor].
(b) The council is composed of nine members of the public
appointed by the governor. To be eligible for appointment to the
council, a person must have demonstrated an interest in and
knowledge of problems and available services related to the
functions of the department. [Four members of the board must have a
demonstrated interest in the services provided by the department,
and two members must represent the public.]
(c) The council shall study and make recommendations to the
commissioner regarding the management and operation of the
department, including policies and rules governing the delivery of
services to persons who are served by the department and the rights
and duties of persons who are served or regulated by the department.
(d) Chapter 551, Government Code, applies to the council.
(e) Chapter 2110, Government Code, does not apply to the
council [board shall be appointed without regard to race, color,
disability, sex, religion, age, or national origin].
Sec. 40.022. APPOINTMENTS [RESTRICTIONS ON BOARD
APPOINTMENT OR MEMBERSHIP]. (a) Appointments to the council shall
be made without regard to the race, color, disability, sex,
religion, age, or national origin of the appointees. [A person is
not eligible for appointment as a member of the board if the person
or the person's spouse:
[(1) is a person who is employed by or participates in
the management of a business entity or other organization regulated
by the department or receiving funds from the department;
[(2) owns or controls, directly or indirectly, more
than a 10 percent interest in a business entity or other
organization that is regulated by the department or that receives
funds from the department;
[(3) uses or receives a substantial amount of tangible
goods, services, or money from the department, other than
compensation or reimbursement authorized by law for board
membership, attendance, or expenses, or as a client or a parent or
guardian of a client receiving services from the department; or
[(4) is an employee, officer, or paid consultant of a
trade association in a field under the jurisdiction of the
department.]
(b) Appointments to the council shall be made so that each
geographic area of the state is represented on the council. [In
addition to the requirements of Subsection (a), a person is not
eligible for appointment as a public member of the board if the
person or the person's spouse is registered, certified, or licensed
by an occupational regulatory agency in a field under the
jurisdiction of the department.]
Sec. 40.0226. [BOARD MEMBER] TRAINING PROGRAM FOR COUNCIL
MEMBERS. (a) A person who is appointed as a member of the council
may not vote, deliberate, or be counted as a member in attendance at
a meeting of the council until the person completes a training
program that complies with [Before a member of the board may assume
the member's duties and before the member may be confirmed by the
senate, the member must complete at least one course of the training
program established under] this section.
(b) The [A] training program must [established under this
section shall] provide information to the member regarding:
(1) the [enabling] legislation that created the
department and the council [board];
(2) the programs operated by the department;
(3) the role and functions of the department and the
council, including detailed information regarding:
(A) the division of authority and of
responsibility between the executive director and the
commissioner; and
(B) the advisory responsibilities of the
council;
(4) the rules of the commissioner applicable to the
department, with an emphasis on the rules that relate to
disciplinary and investigatory authority;
(5) the current budget for the department;
(6) the results of the most recent formal audit of the
department;
(7) the requirements of the:
(A) open meetings law, Chapter 551, Government
Code;
(B) public information [open records] law,
Chapter 552, Government Code; and
(C) administrative procedure law, Chapter 2001,
Government Code;
(8) the requirements of the conflict-of-interest laws
and other laws relating to public officials; and
(9) any applicable ethics policies adopted by the
commissioner [board] or the Texas Ethics Commission.
Sec. 40.024. [BOARD] TERMS; VACANCY. (a) Members of the
council [board] serve for staggered six-year terms, with the terms
of three [two] members expiring February 1 of each odd-numbered
year.
(b) A member of the council may not serve more than two
consecutive full terms as a council member.
(c) The governor by appointment shall fill the unexpired
term of a vacancy on the council.
Sec. 40.025. REIMBURSEMENT FOR EXPENSES [BOARD PER DIEM].
A council member may not receive compensation for service as a
member of the council but is entitled to reimbursement for travel
expenses incurred by the member while conducting the business of
the council as provided [While performing their duties, board
members are entitled to a per diem as prescribed] by the General
Appropriations Act.
Sec. 40.026. PRESIDING OFFICER; OTHER OFFICERS; [BOARD]
MEETINGS[; QUORUM]. (a) The governor shall designate a member of
the council as the presiding officer to serve in that capacity at
the pleasure of the governor [board shall meet at least quarterly
and at the call of the presiding officer].
(b) The members of the council shall elect any other
necessary officers [Four members of the board constitute a quorum].
(c) The council shall meet quarterly and at other times at
the call of the presiding officer. The council may hold meetings in
different areas of the state.
Sec. 40.027. EXECUTIVE DIRECTOR. (a) The governor
[commissioner of health and human services] shall appoint an
[employ the] executive director, who is to be selected according to
education, training, experience, and demonstrated ability [in
accordance with Section 531.0056, Government Code].
(b) The executive director serves for a term of one year.
(c) Subject to the commissioner's control, the executive
director shall act as the department's chief administrative officer
and as a liaison between the department and commission.
(d) The executive director shall administer this chapter
and other laws relating to the department under operational
policies established [is the executive head of the department. The
executive director shall perform the duties assigned] by the
commissioner and in accordance with the memorandum of understanding
under Section 531.0055(k), Government Code, between the executive
director and the commissioner, as adopted by rule [of health and
human services and state law].
SECTION 1.13. The Human Resources Code is amended by adding
Title 11 to read as follows:
TITLE 11. COMMUNITY-BASED AND LONG-TERM CARE SERVICES
CHAPTER 161. DEPARTMENT OF AGING, COMMUNITY, DISABILITY, AND
LONG-TERM CARE SERVICES
SUBCHAPTER A. GENERAL PROVISIONS
Sec. 161.001. DEFINITIONS. In this chapter:
(1) "Commission" means the Health and Human Services
Commission.
(2) "Commissioner" means the commissioner of health
and human services.
(3) "Council" means the Aging, Community, Disability,
and Long-Term Care Council.
(4) "Department" means the Department of Aging,
Community, Disability, and Long-Term Care Services.
(5) "Executive director" means the executive director
of the department.
Sec. 161.002. AGENCY. The department is an agency of the
state.
Sec. 161.003. SUNSET PROVISION. The department is subject
to Chapter 325, Government Code (Texas Sunset Act). Unless
continued in existence as provided by that chapter, the department
is abolished and this chapter expires September 1, 2009.
[Sections 161.004-161.020 reserved for expansion]
SUBCHAPTER B. ADMINISTRATIVE PROVISIONS
Sec. 161.021. AGING, COMMUNITY, DISABILITY, AND LONG-TERM
CARE COUNCIL. (a) The Aging, Community, Disability, and Long-Term
Care Council is created to assist the commissioner in developing
rules and policies for the department.
(b) The council is composed of nine members of the public
appointed by the governor. To be eligible for appointment to the
council, a person must have demonstrated an interest in and
knowledge of problems and available services related to the aging
and persons with disabilities, including persons who are blind or
visually impaired.
(c) The council shall study and make recommendations to the
commissioner regarding the management and operation of the
department, including policies and rules governing the delivery of
services to persons who are served by the department and the rights
and duties of persons who are served or regulated by the department.
(d) Chapter 551, Government Code, applies to the council.
(e) Chapter 2110, Government Code, does not apply to the
council.
Sec. 161.022. APPOINTMENTS. (a) Appointments to the
council shall be made without regard to the race, color,
disability, sex, religion, age, or national origin of the
appointees.
(b) Appointments to the council shall be made so that each
geographic area of the state is represented on the council.
Sec. 161.023. TRAINING PROGRAM FOR COUNCIL MEMBERS. (a) A
person who is appointed as a member of the council may not vote,
deliberate, or be counted as a member in attendance at a meeting of
the council until the person completes a training program that
complies with this section.
(b) The training program must provide the person with
information regarding:
(1) the legislation that created the department and
the council;
(2) the programs operated by the department;
(3) the role and functions of the department and the
council, including detailed information regarding:
(A) the division of authority and of
responsibility between the executive director and the
commissioner; and
(B) the advisory responsibilities of the
council;
(4) the rules of the commissioner applicable to the
department, with an emphasis on the rules that relate to
disciplinary and investigatory authority;
(5) the current budget for the department;
(6) the results of the most recent formal audit of the
department;
(7) the requirements of:
(A) the open meetings law, Chapter 551,
Government Code;
(B) the public information law, Chapter 552,
Government Code;
(C) the administrative procedure law, Chapter
2001, Government Code; and
(D) other laws relating to public officials,
including conflict-of-interest laws; and
(8) any applicable ethics policies adopted by the
commissioner or the Texas Ethics Commission.
Sec. 161.024. TERMS. (a) Council members serve for
staggered six-year terms with the terms of three members expiring
February 1 of each odd-numbered year.
(b) A member of the council may not serve more than two
consecutive full terms as a council member.
Sec. 161.025. VACANCY. The governor by appointment shall
fill the unexpired term of a vacancy on the council.
Sec. 161.026. PRESIDING OFFICER; OTHER OFFICERS; MEETINGS.
(a) The governor shall designate a member of the council as the
presiding officer to serve in that capacity at the pleasure of the
governor.
(b) The members of the council shall elect any other
necessary officers.
(c) The council shall meet quarterly and at other times at
the call of the presiding officer. The council may hold meetings in
different areas of the state.
Sec. 161.027. REIMBURSEMENT FOR EXPENSES. A council member
may not receive compensation for service as a member of the council
but is entitled to reimbursement for travel expenses incurred by
the member while conducting the business of the council as provided
by the General Appropriations Act.
Sec. 161.028. PUBLIC INTEREST INFORMATION AND COMPLAINTS.
(a) The commissioner, with the advice of the council, shall prepare
information of public interest describing the functions of the
department and the procedures by which complaints are filed with
and resolved by the department. The commission shall make the
information available to the public and appropriate state
governmental entities.
(b) The commissioner by rule shall establish methods by
which consumers and service recipients are notified of the name,
mailing address, and telephone number of the department for
directing complaints to the department.
Sec. 161.029. PUBLIC ACCESS AND TESTIMONY. The
commissioner shall develop and implement policies that provide the
public with a reasonable opportunity to appear before the council
or commissioner and to speak on any issue under the jurisdiction of
the department.
Sec. 161.030. POLICYMAKING AND MANAGEMENT
RESPONSIBILITIES. The commissioner, with the advice of the
council, shall develop and the department shall implement policies
that clearly delineate the policymaking responsibilities of the
commissioner from the management responsibilities of the
commission, the executive director, and the staff of the
department.
Sec. 161.031. ANNUAL REPORT. (a) The executive director
shall file annually with the governor, the presiding officer of
each house of the legislature, and the commissioner a complete and
detailed written report accounting for all funds received and
disbursed by the department during the preceding fiscal year.
(b) The annual report must be in the form and be reported in
the time provided by the General Appropriations Act.
Sec. 161.032. OFFICES. The department shall maintain its
central office in Austin. The department may maintain offices in
other areas of the state as necessary.
[Sections 161.033-161.050 reserved for expansion]
SUBCHAPTER C. PERSONNEL
Sec. 161.051. EXECUTIVE DIRECTOR. (a) The governor shall
appoint an executive director of the department. The executive
director is to be selected according to education, training,
experience, and demonstrated ability.
(b) The executive director serves for a term of one year.
(c) Subject to the commissioner's control, the executive
director shall act as the department's chief administrative officer
and as a liaison between the department and commission.
(d) The executive director shall administer this chapter
under operational policies established by the commissioner and in
accordance with the memorandum of understanding under Section
531.0055(k), Government Code, between the executive director and
the commissioner, as adopted by rule.
Sec. 161.052. PERSONNEL. (a) The department may employ,
compensate, and prescribe the duties of personnel necessary and
suitable to administer this chapter.
(b) The commissioner shall prepare and by rule adopt
personnel standards.
(c) A personnel position may be filled only by an individual
selected and appointed on a nonpartisan merit basis.
(d) The commissioner, with the advice of the council, shall
develop and the department shall implement policies that clearly
define the responsibilities of the staff of the department.
Sec. 161.053. INFORMATION ABOUT QUALIFICATIONS AND
STANDARDS OF CONDUCT. The executive director or the executive
director's designee shall provide to department employees, as often
as necessary, information regarding the requirements for
employment under this chapter or rules adopted by the commissioner,
including information regarding a person's responsibilities under
applicable laws relating to standards of conduct for state
employees.
Sec. 161.054. MERIT PAY. Subject to rules adopted by the
commissioner, the executive director or the executive director's
designee shall develop a system of annual performance evaluations.
All merit pay for department employees must be given under the
system established under this section or under rules adopted by the
commissioner.
Sec. 161.055. CAREER LADDER. The executive director or the
executive director's designee shall develop an intra-agency career
ladder program. The program must require intra-agency postings of
all nonentry-level positions concurrently with any public posting.
Sec. 161.056. EQUAL EMPLOYMENT OPPORTUNITY POLICY. (a)
Subject to rules adopted by the commissioner, the executive
director or the executive director's designee shall prepare and
maintain a written policy statement that implements a program of
equal employment opportunity to ensure that all personnel decisions
are made without regard to race, color, disability, sex, religion,
age, or national origin.
(b) Unless the following are included in a policy statement
adopted by the commissioner that is applicable to the department,
the policy statement must include:
(1) personnel policies, including policies relating
to recruitment, evaluation, selection, training, and promotion of
personnel, that show the intent of the department to avoid the
unlawful employment practices described by Chapter 21, Labor Code;
and
(2) an analysis of the extent to which the composition
of the department's personnel is in accordance with state and
federal law and a description of reasonable methods to achieve
compliance with state and federal law.
(c) The policy statement must be:
(1) updated annually;
(2) reviewed by the state Commission on Human Rights
for compliance with Subsection (b)(1); and
(3) filed with the governor's office.
Sec. 161.057. STATE EMPLOYEE INCENTIVE PROGRAM. The
executive director or the executive director's designee shall
provide to department employees information and training on the
benefits and methods of participation in the state employee
incentive program.
[Sections 161.058-161.070 reserved for expansion]
SUBCHAPTER D. POWERS AND DUTIES OF DEPARTMENT
Sec. 161.071. GENERAL POWERS AND DUTIES OF DEPARTMENT. The
department is responsible for administering human services
programs for the aging and disabled, including:
(1) administering and coordinating programs to
provide community-based care and support services to promote
independent living for populations that would otherwise be
institutionalized;
(2) providing institutional care services, including
services through convalescent and nursing homes and related
institutions under Chapter 242, Health and Safety Code;
(3) providing and coordinating programs and services
for persons with disabilities, including programs for the
treatment, rehabilitation, or benefit of:
(A) persons with developmental disabilities or
mental retardation;
(B) persons who are blind or visually impaired;
and
(C) persons with other disabilities;
(4) operating state facilities for the housing,
treatment, rehabilitation, or benefit of persons with
disabilities, including state schools for persons with mental
retardation; and
(5) serving as the state unit on aging required by the
federal Older Americans Act of 1965 (42 U.S.C. Section 3001 et seq.)
and its subsequent amendments, including performing the general
functions under Section 101.022 to ensure:
(A) implementation of the federal Older
Americans Act of 1965 (42 U.S.C. Section 3001 et seq.) and its
subsequent amendments, including implementation of services and
volunteer opportunities under that Act for older residents of this
state through area agencies on aging;
(B) advocacy for residents of nursing facilities
through the office of the state long-term care ombudsman;
(C) fostering of the state and community
infrastructure and capacity to serve older residents of this state;
and
(D) availability of a comprehensive resource for
state government and the public on trends related to and services
and programs for an aging population.
Sec. 161.072. INFORMATION REGARDING COMPLAINTS. (a) The
department shall maintain a file on each written complaint filed
with the department. The file must include:
(1) the name of the person who filed the complaint;
(2) the date the complaint is received by the
department;
(3) the subject matter of the complaint;
(4) the name of each person contacted in relation to
the complaint;
(5) a summary of the results of the review or
investigation of the complaint; and
(6) an explanation of the reason the file was closed,
if the department closed the file without taking action other than
to investigate the complaint.
(b) The department shall provide to the person filing the
complaint and to each person who is a subject of the complaint a
copy of the commissioner's and the department's policies and
procedures relating to complaint investigation and resolution.
(c) The department, at least quarterly until final
disposition of the complaint, shall notify the person filing the
complaint and each person who is a subject of the complaint of the
status of the investigation unless the notice would jeopardize an
undercover investigation.
Sec. 161.073. RULES. The commissioner may adopt rules
reasonably necessary for the department to administer this chapter,
consistent with the memorandum of understanding under Section
531.0055(k), Government Code, between the executive director and
the commissioner, as adopted by rule.
SECTION 1.14. APPOINTMENT OF EXECUTIVE DIRECTORS. As soon
as possible, the governor shall appoint the executive directors of:
(1) the Department of Health Services in accordance
with Chapter 1001, Health and Safety Code, as added by this article;
(2) the Department of Protective and Regulatory
Services in accordance with Chapter 40, Human Resources Code, as
amended by this article; and
(3) the Department of Aging, Community, Disability,
and Long-Term Care Services in accordance with Chapter 161, Human
Resources Code, as added by this article.
SECTION 1.15. APPOINTMENTS OF COUNCIL MEMBERS. (a) As soon
as possible, the governor shall appoint the members of the Health
Services Council in accordance with Chapter 1001, Health and Safety
Code, as added by this article. In making the initial appointments,
the governor shall designate three members for terms expiring
February 1, 2005, three members for terms expiring February 1,
2007, and three members for terms expiring February 1, 2009.
(b) As soon as possible, the governor shall appoint the
members of the Protective and Regulatory Council in accordance with
Chapter 40, Human Resources Code, as amended by this article. In
making the initial appointments, the governor shall designate three
members for terms expiring February 1, 2005, three members for
terms expiring February 1, 2007, and three members for terms
expiring February 1, 2009.
(c) As soon as possible, the governor shall appoint the
members of the Aging, Community, Disability, and Long-Term Care
Council in accordance with Chapter 161, Human Resources Code, as
added by this article. In making the initial appointments, the
governor shall designate three members for terms expiring February
1, 2005, three members for terms expiring February 1, 2007, and
three members for terms expiring February 1, 2009.
SECTION 1.16. LIMITATION ON ACTIVITIES. A state agency
created under this article may, before the date specified in the
transition plan required under Section 1.23 of this article,
perform only those powers, duties, functions, programs, and
activities that relate to preparing for the transfer of powers,
duties, functions, programs, and activities to that agency in
accordance with this article. A state agency created under this
article may not operate all or any part of a health and human
services program before the date specified in the transition plan
required under Section 1.23 of this article.
SECTION 1.17. INITIAL COUNCIL MEETINGS. The presiding
officer of the council for each state agency created under this
article and the presiding officer of the Protective and Regulatory
Council shall call the initial meeting of the council as soon as
possible after the council members are appointed.
SECTION 1.18. TRANSFERS TO THE HEALTH AND HUMAN SERVICES
COMMISSION. (a) On the date specified in the transition plan
required under Section 1.23 of this article, the following powers,
duties, functions, programs, and activities, other than those
related to licensing and enforcement of regulations regarding
long-term care facilities, are transferred to the Health and Human
Services Commission:
(1) all powers, duties, functions, programs, and
activities related to administrative support services, such as
strategic planning and evaluation, audit, legal, human resources,
information resources, accounting, purchasing, financial
management, and contract management services, of a state agency or
entity abolished by Section 1.25 of this article;
(2) all powers, duties, functions, programs, and
activities of the Texas Department of Human Services related to:
(A) determining eligibility for long-term care
services and community-based support services;
(B) the financial assistance program under
Chapter 31, Human Resources Code; and
(C) the nutritional assistance programs under
Chapter 33, Human Resources Code;
(3) all powers, duties, functions, programs, and
activities related to the following programs administered by a
state agency or entity abolished by Section 1.25 of this article:
(A) the state child health plan program under
Chapters 62 and 63, Health and Safety Code; and
(B) the medical assistance program under Chapter
32, Human Resources Code;
(4) all powers, duties, functions, programs, and
activities of the Texas Rehabilitation Commission relating to
determining eligibility for Supplemental Security Income (SSI) (42
U.S.C. Section 1381 et seq.) and its subsequent amendments; and
(5) all rulemaking and policymaking authority for the
provision of health and human services in this state.
(b) On the date specified by Subsection (a) of this section:
(1) all obligations and contracts of a state agency or
entity abolished by Section 1.25 of this article that are related to
a power, duty, function, program, or activity transferred under
Subsection (a) of this section are transferred to the Health and
Human Services Commission;
(2) all property and records in the custody of a state
agency or entity abolished by Section 1.25 of this article that are
related to a power, duty, function, program, or activity
transferred under Subsection (a) of this section and all funds
appropriated by the legislature for the power, duty, function,
program, or activity shall be transferred to the Health and Human
Services Commission; and
(3) all complaints, investigations, or contested
cases that are pending before a state agency or entity abolished by
Section 1.25 of this article or the governing body of the agency or
entity and that are related to a power, duty, function, program, or
activity transferred under Subsection (a) of this section are
transferred without change in status to the Health and Human
Services Commission.
(c) A rule or form adopted by a state agency or entity
abolished by Section 1.25 of this article that relates to a power,
duty, function, program, or activity transferred under Subsection
(a) of this section is a rule or form of the Health and Human
Services Commission and remains in effect until altered by the
commission.
(d) A reference in law to a state agency or entity abolished
by Section 1.25 of this article, or to the governing body of the
agency or entity, that relates to a power, duty, function, program,
or activity transferred under Subsection (a) of this section means
the Health and Human Services Commission.
(e) A license, permit, or certification in effect that was
issued by a state agency or entity abolished by Section 1.25 of this
article and that relates to a power, duty, function, program, or
activity transferred under Subsection (a) of this section is
continued in effect as a license, permit, or certification of the
Health and Human Services Commission.
SECTION 1.19. TRANSFERS TO THE DEPARTMENT OF HEALTH
SERVICES. (a) On the date specified in the transition plan
required under Section 1.23 of this article, the following powers,
duties, functions, programs, and activities, other than those
related to rulemaking or policymaking, licensing and enforcement of
regulations regarding long-term care facilities, or administrative
support services such as strategic planning and evaluation, audit,
legal, human resources, information resources, accounting,
purchasing, financial management, and contract management
services, are transferred to the Department of Health Services:
(1) except as provided by Section 1.18 of this
article, all powers, duties, functions, programs, and activities of
the Texas Department of Health;
(2) all powers, duties, functions, programs, and
activities of the Texas Department of Mental Health and Mental
Retardation relating to providing mental health services;
(3) all powers, duties, functions, programs, and
activities of the Texas Commission on Alcohol and Drug Abuse;
(4) all powers, duties, functions, programs, and
activities of the Texas Cancer Council;
(5) all powers, duties, functions, programs, and
activities of the Texas Commission for the Deaf and Hard of Hearing;
(6) all powers, duties, functions, programs, and
activities of the Interagency Council on Early Childhood
Intervention; and
(7) all powers, duties, functions, programs, and
activities of the Texas Health Care Information Council.
(b) On the date specified by Subsection (a) of this section:
(1) all obligations and contracts of an entity listed
in Subsection (a) of this section that are related to a power, duty,
function, program, or activity transferred under that subsection
are transferred to the Department of Health Services;
(2) all property and records in the custody of an
entity listed in Subsection (a) of this section that are related to
a power, duty, function, program, or activity transferred under
that subsection and all funds appropriated by the legislature for
the power, duty, function, program, or activity shall be
transferred to the Department of Health Services; and
(3) all complaints, investigations, or contested
cases that are pending before an entity or the governing body of an
entity listed in Subsection (a) of this section and that are related
to a power, duty, function, program, or activity transferred under
that subsection are transferred without change in status to the
Department of Health Services.
(c) A rule or form adopted by an entity listed in Subsection
(a) of this section that relates to a power, duty, function,
program, or activity transferred under that subsection is a rule or
form of the Department of Health Services and remains in effect
until altered by the commissioner of health and human services.
(d) A reference in law to an entity listed in Subsection (a)
of this section that relates to a power, duty, function, program, or
activity transferred under that subsection means the Department of
Health Services. A reference in law to the governing body of an
entity listed in Subsection (a) of this section means the Health and
Human Services Commission or the commissioner of health and human
services.
(e) A license, permit, or certification in effect that was
issued by an entity listed in Subsection (a) of this section and
that relates to a power, duty, function, program, or activity
transferred under that subsection is continued in effect as a
license, permit, or certification of the Department of Health
Services.
SECTION 1.20. TRANSFERS TO THE DEPARTMENT OF PROTECTIVE AND
REGULATORY SERVICES. (a) On the date specified in the transition
plan required under Section 1.23 of this article, the following
powers, duties, functions, programs, and activities, other than
those related to rulemaking or policymaking or administrative
support services such as strategic planning and evaluation, audit,
legal, human resources, information resources, accounting,
purchasing, financial management, and contract management
services, are transferred to the Department of Protective and
Regulatory Services:
(1) except as provided by Sections 1.18 and 1.21 of
this article, all powers, duties, functions, programs, and
activities of the Texas Department of Human Services, including
those related to preventing family violence and providing services
to victims of family violence; and
(2) all powers, duties, functions, programs, and
activities of a state agency or entity abolished by Section 1.25 of
this article related to licensing and enforcing regulations
applicable to long-term care facilities.
(b) On the date specified by Subsection (a) of this section:
(1) all obligations and contracts of an entity listed
in Subsection (a) of this section that are related to a power, duty,
function, program, or activity transferred under that subsection
are transferred to the Department of Protective and Regulatory
Services;
(2) all property and records in the custody of an
entity listed in Subsection (a) of this section that are related to
a power, duty, function, program, or activity transferred under
that subsection and all funds appropriated by the legislature for
the power, duty, function, program, or activity shall be
transferred to the Department of Protective and Regulatory
Services; and
(3) all complaints, investigations, or contested
cases that are pending before an entity or the governing body of an
entity listed in Subsection (a) of this section and that are related
to a power, duty, function, program, or activity transferred under
that subsection are transferred without change in status to the
Department of Protective and Regulatory Services.
(c) A rule or form adopted by an entity listed in Subsection
(a) of this section that relates to a power, duty, function,
program, or activity transferred under that subsection is a rule or
form of the Department of Protective and Regulatory Services and
remains in effect until altered by the commissioner of health and
human services.
(d) A reference in law to an entity listed in Subsection (a)
of this section that relates to a power, duty, function, program, or
activity transferred under that subsection means the Department of
Protective and Regulatory Services. A reference in law to the
governing body of an entity listed in Subsection (a) of this section
means the Health and Human Services Commission or the commissioner
of health and human services.
(e) A license, permit, or certification in effect that was
issued by an entity listed in Subsection (a) of this section and
that relates to a power, duty, function, program, or activity
transferred under that subsection is continued in effect as a
license, permit, or certification of the Department of Protective
and Regulatory Services.
SECTION 1.21. TRANSFERS TO THE DEPARTMENT OF AGING,
COMMUNITY, DISABILITY, AND LONG-TERM CARE SERVICES. (a) On the
date specified in the transition plan required under Section 1.23
of this article, the following powers, duties, functions, programs,
and activities, other than those related to rulemaking or
policymaking, licensing and enforcement of regulations regarding
long-term care facilities, or administrative support services such
as strategic planning and evaluation, audit, legal, human
resources, information resources, accounting, purchasing,
financial management, and contract management services, are
transferred to the Department of Aging, Community, Disability, and
Long-Term Care Services:
(1) all powers, duties, functions, programs, and
activities of the Texas Department on Aging;
(2) except as provided by Section 1.18 of this
article, from the Texas Department of Human Services, all powers,
duties, functions, programs, and activities related to providing
long-term care services and community-based support and services;
(3) except as provided by Section 1.18 of this
article, all powers, duties, functions, programs, and activities of
the Texas Rehabilitation Commission;
(4) all powers, duties, functions, programs, and
activities of the Texas Commission for the Blind; and
(5) all powers, duties, functions, programs, and
activities of the Texas Department of Mental Health and Mental
Retardation related to providing mental retardation services,
including state school administration and services and community
residential services.
(b) On the date specified by Subsection (a) of this section:
(1) all obligations and contracts of an entity listed
in Subsection (a) of this section that are related to a power, duty,
function, program, or activity transferred under that subsection
are transferred to the Department of Aging, Community, Disability,
and Long-Term Care Services;
(2) all property and records in the custody of an
entity listed in Subsection (a) of this section that are related to
a power, duty, function, program, or activity transferred under
that subsection and all funds appropriated by the legislature for
the power, duty, function, program, or activity shall be
transferred to the Department of Aging, Community, Disability, and
Long-Term Care Services; and
(3) all complaints, investigations, or contested
cases that are pending before an entity or the governing body of an
entity listed in Subsection (a) of this section and that are related
to a power, duty, function, program, or activity transferred under
that subsection are transferred without change in status to the
Department of Aging, Community, Disability, and Long-Term Care
Services.
(c) A rule or form adopted by an entity listed in Subsection
(a) of this section that relates to a power, duty, function,
program, or activity transferred under that subsection is a rule or
form of the Department of Aging, Community, Disability, and
Long-Term Care Services and remains in effect until altered by the
commissioner of health and human services.
(d) A reference in law to an entity listed in Subsection (a)
of this section that relates to a power, duty, function, program, or
activity transferred under that subsection means the Department of
Aging, Community, Disability, and Long-Term Care Services. A
reference in law to the governing body of an entity listed in
Subsection (a) of this section means the Health and Human Services
Commission or the commissioner of health and human services.
(e) A license, permit, or certification in effect that was
issued by an entity listed in Subsection (a) of this section and
that relates to a power, duty, function, program, or activity
transferred under that subsection is continued in effect as a
license, permit, or certification of the Department of Aging,
Community, Disability, and Long-Term Care Services.
SECTION 1.22. FACILITATION OF TRANSFERS BY HEALTH AND HUMAN
SERVICES TRANSITION COUNCIL. (a) The Health and Human Services
Transition Council is created to facilitate the transfer of powers,
duties, functions, programs, and activities among the state's
health and human services agencies and the Health and Human
Services Commission as provided by this article with a minimal
negative effect on the delivery of those services in this state.
(b) The council is composed of 10 members, as follows:
(1) the commissioner of health and human services;
(2) two members of the senate, appointed by the
lieutenant governor not later than October 1, 2003;
(3) two members of the house of representatives,
appointed by the speaker of the house of representatives not later
than October 1, 2003; and
(4) five members of the public, appointed by the
governor not later than October 1, 2003.
(c) The commissioner of health and human services serves as
presiding officer. The members of the council shall elect any other
necessary officers.
(d) The council shall meet at the call of the presiding
officer.
(e) A member of the council serves at the will of the
appointing official.
(f) A member of the council may not receive compensation for
serving on the council but is entitled to reimbursement for travel
expenses incurred by the member while conducting the business of
the council as provided by the General Appropriations Act.
(g) The council, with assistance from the Health and Human
Services Commission and the health and human services agencies,
shall advise the commissioner of health and human services
concerning:
(1) the powers, duties, functions, programs, and
activities transferred under this article and the funds and
obligations that are related to the powers, duties, functions,
programs, or activities; and
(2) the transfer of the powers, duties, functions,
programs, activities, records, property, funds, obligations, and
employees by the entities listed in Sections 1.18, 1.19, 1.20, and
1.21 of this article in accordance with this article.
(h) The council is abolished December 31, 2004.
SECTION 1.23. TRANSITION PLAN. The transfer of powers,
duties, functions, programs, and activities under Sections 1.18,
1.19, 1.20, and 1.21 of this article to the Health and Human
Services Commission, the Department of Health Services, the
Department of Protective and Regulatory Services, and the
Department of Aging, Community, Disability, and Long-Term Care
Services, respectively, must be accomplished in accordance with a
schedule included in a transition plan developed by the
commissioner of health and human services and submitted to the
governor and the Legislative Budget Board not later than December
1, 2003. The commissioner shall provide to the governor and the
Legislative Budget Board transition plan status reports and updates
on at least a quarterly basis following submission of the initial
transition plan.
SECTION 1.24. APPLICABILITY OF FORMER LAW. An action
brought or proceeding commenced before the date of a transfer
prescribed by this article in accordance with the transition plan
required under Section 1.23 of this article, including a contested
case or a remand of an action or proceeding by a reviewing court, is
governed by the laws and rules applicable to the action or
proceeding before the transfer.
SECTION 1.25. ABOLITION OF STATE AGENCIES AND ENTITIES. (a)
The following state agencies and entities are abolished on the date
on which their respective powers, duties, functions, programs, and
activities are transferred under this article:
(1) the Interagency Council on Early Childhood
Intervention;
(2) the Texas Cancer Council;
(3) the Texas Commission for the Blind;
(4) the Texas Commission for the Deaf and Hard of
Hearing;
(5) the Texas Commission on Alcohol and Drug Abuse;
(6) the Texas Department of Health;
(7) the Texas Department of Human Services;
(8) the Texas Department of Mental Health and Mental
Retardation;
(9) the Texas Department on Aging;
(10) the Texas Health Care Information Council; and
(11) the Texas Rehabilitation Commission.
(b) The abolition of a state agency or entity listed in
Subsection (a) of this section and the transfer of its powers,
duties, functions, programs, activities, obligations, rights,
contracts, records, property, funds, and employees as provided by
this article do not affect or 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.
SECTION 1.26. REPEAL. The following are repealed:
(1) Sections 531.0057, 531.034, and 531.0345,
Government Code;
(2) Sections 40.0225 and 40.023, Human Resources Code;
and
(3) Article 2, Chapter 1505, Acts of the 76th
Legislature, Regular Session, 1999.
SECTION 1.27. EFFECTIVE DATE. (a) Except as provided by
Subsection (b) of this section, this article takes effect September
1, 2003.
(b) 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 2. ADMINISTRATION, OPERATION, AND FINANCING OF
HEALTH AND HUMAN SERVICES PROGRAMS AND PROVISION OF
HEALTH AND HUMAN SERVICES
SECTION 2.01. Section 531.001, Government Code, is amended
by adding Subdivision (1-a) to read as follows:
(1-a) "Child health plan program" means the child
health plan program established under Chapters 62 and 63, Health
and Safety Code.
SECTION 2.02. (a) Subchapter A, Chapter 531, Government
Code, is amended by adding Section 531.017 to read as follows:
Sec. 531.017. PURCHASING DIVISION. (a) The commission
shall establish a purchasing division for the management of
administrative activities related to the purchasing functions of
the commission and the health and human services agencies.
(b) The purchasing division shall:
(1) seek to achieve targeted cost reductions, increase
process efficiencies, improve technological support and customer
services, and enhance purchasing support for each health and human
services agency; and
(2) if cost-effective, contract with private entities
to perform purchasing functions for the commission and the health
and human services agencies.
(b) Not later than January 1, 2004, the Health and Human
Services Commission shall develop and implement a plan to
consolidate the purchasing functions of the commission and health
and human services agencies in a purchasing division under Section
531.017, Government Code, as added by this section.
SECTION 2.03. (a) Subchapter B, Chapter 531, Government
Code, is amended by adding Section 531.0392 to read as follows:
Sec. 531.0392. RECOVERY OF CERTAIN THIRD-PARTY
REIMBURSEMENTS UNDER MEDICAID. (a) In this section, "dually
eligible individual" means an individual who is eligible to receive
health care benefits under both the Medicaid and Medicare programs.
(b) The commission shall obtain Medicaid reimbursement from
each fiscal intermediary who makes a payment to a service provider
on behalf of the Medicare program, including a reimbursement for a
payment made to a home health services provider or nursing facility
for services rendered to a dually eligible individual.
(b) Not later than September 1, 2003, the Health and Human
Services Commission shall 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 Medicaid and Medicare when the
combination of services would be cost-effective for the state.
SECTION 2.04. Subchapter B, Chapter 531, Government Code,
is amended by adding Section 531.063 to read as follows:
Sec. 531.063. CALL CENTER. (a) The commission, by rule,
shall establish a call center for purposes of determining and
certifying or recertifying a person's eligibility and need for
services related to the programs listed under Section 531.008(c),
if cost-effective.
(b) The commission shall contract with a private entity for
the operation of a call center required by this section unless the
commission determines that contracting with a private entity would
not be cost-effective.
SECTION 2.05. (a) Subchapter B, Chapter 531, Government
Code, is amended by adding Section 531.065 to read as follows:
Sec. 531.065. CONSOLIDATION AND COORDINATION OF HEALTH
INSURANCE PREMIUM PAYMENT REIMBURSEMENT PROGRAMS. (a) The
commission shall develop and implement a plan to consolidate and
coordinate the administration of the health insurance premium
payment reimbursement programs prescribed by Section 62.059,
Health and Safety Code, and Section 32.0422, Human Resources Code.
(b) If cost-effective, the commission may contract with a
private entity to assist the commission in developing and
implementing a plan required by this section.
(b) Section 62.059(i), Health and Safety Code, and Section
32.0422(m), Human Resources Code, are repealed.
(c) Not later than January 1, 2004, the Health and Human
Services Commission shall develop and implement a plan to
consolidate and coordinate the administration of health insurance
premium payment reimbursement programs as required by Section
531.065, Government Code, as added by this section.
SECTION 2.06. Subchapter B, Chapter 531, Government Code,
is amended by adding Section 531.067 to read as follows:
Sec. 531.067. PUBLIC ASSISTANCE HEALTH BENEFIT REVIEW AND
DESIGN COMMITTEE. (a) The commission shall appoint a Public
Assistance Health Benefit Review and Design Committee. The
committee consists of nine representatives of health care providers
participating in the Medicaid program or the child health plan
program, or both. The committee membership must include at least
three representatives from each program.
(b) The commissioner shall designate one member to serve as
presiding officer for a term of two years.
(c) The committee shall meet at the call of the presiding
officer.
(d) The committee shall review and provide recommendations
to the commission regarding health benefits and coverages provided
under the state Medicaid program, the child health plan program,
and any other income-based health care program administered by the
commission or a health and human services agency. In performing its
duties under this subsection, the committee must:
(1) review prescription drug benefits provided under
each of the programs; and
(2) review procedures for addressing high utilization
of benefits by recipients.
(e) The commission shall provide administrative support and
resources as necessary for the committee to perform its duties
under this section.
(f) Section 2110.008 does not apply to the committee.
SECTION 2.07. Subchapter B, Chapter 531, Government Code,
is amended by adding Section 531.068 to read as follows:
Sec. 531.068. MEDICAID OR OTHER HEALTH BENEFIT COVERAGE.
In adopting rules or standards governing the state Medicaid program
or rules or standards for the development or implementation of
health benefit coverage for a program administered by the
commission or a health and human services agency, the commission
and each health and human services agency, as appropriate, may take
into consideration any recommendation made with respect to health
benefits provided under their respective programs or the state
Medicaid program by the Public Assistance Health Benefit Review and
Design Committee established under Section 531.067.
SECTION 2.08. Subchapter B, Chapter 531, Government Code,
is amended by adding Section 531.069 to read as follows:
Sec. 531.069. PERIODIC REVIEW OF VENDOR DRUG PROGRAM. (a)
The commission shall 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 under a Medicaid managed care
program or the child health plan program.
(b) In making the determination required by Subsection (a),
the commission shall consider the value of any prescription drug
rebates received by the state.
SECTION 2.09. (a) Subchapter B, Chapter 531, Government
Code, is amended by adding Section 531.070 to read as follows:
Sec. 531.070. SUPPLEMENTAL REBATES. (a) In this section:
(1) "Labeler" means a person that:
(A) has a labeler code from the United States
Food and Drug Administration under 21 C.F.R. Section 207.20; and
(B) receives prescription drugs from a
manufacturer or wholesaler and repackages those drugs for later
retail sale.
(2) "Manufacturer" means a manufacturer of
prescription drugs as defined by 42 U.S.C. Section 1396r-8(k)(5)
and its subsequent amendments, including a subsidiary or affiliate
of a manufacturer.
(3) "Wholesaler" means a person licensed under
Subchapter I, Chapter 431, Health and Safety Code.
(b) Subject to Subsection (c), the commission shall
negotiate with manufacturers and labelers, including generic
manufacturers and labelers, to obtain supplemental rebates for
prescription drugs sold in this state.
(c) The commission may by contract authorize a private
entity to negotiate with manufacturers and labelers on behalf of
the commission.
(d) A manufacturer or labeler that sells prescription drugs
in this state may voluntarily negotiate with the commission and
enter into an agreement to provide supplemental rebates for
prescription drugs provided under:
(1) the Medicaid vendor drug program in excess of the
Medicaid rebates required by 42 U.S.C. Section 1396r-8 and its
subsequent amendments;
(2) the child health plan program; and
(3) any other state program administered by the
commission, including community mental health centers and state
mental health hospitals.
(e) In negotiating terms for a supplemental rebate amount,
the commission shall consider:
(1) rebates calculated under the Medicaid rebate
program in accordance with 42 U.S.C. Section 1396r-8 and its
subsequent amendments; and
(2) any other available information on prescription
drug prices or rebates.
(f) Each year the commission shall provide a written report
to the legislature and the governor. The report shall cover:
(1) the cost of administering the preferred drug lists
adopted under Section 531.072;
(2) an analysis of the utilization trends for medical
services provided by the state and any correlation to the preferred
drug lists;
(3) an analysis of the effect on health outcomes and
results for recipients; and
(4) statistical information related to the number of
approvals granted or denied.
(b) Not later than January 1, 2004, the Health and Human
Services Commission shall implement Section 531.070, Government
Code, as added by this section.
SECTION 2.10. Subchapter B, Chapter 531, Government Code,
is amended by adding Section 531.071 to read as follows:
Sec. 531.071. CONFIDENTIALITY OF INFORMATION REGARDING
DRUG REBATES, PRICING, AND NEGOTIATIONS. (a) Information obtained
or maintained by the commission regarding prescription drug rebate
negotiations or a supplemental medical assistance or other rebate
agreement, including trade secrets, rebate amount, rebate
percentage, and manufacturer or labeler pricing, is confidential
and not subject to disclosure under Chapter 552.
(b) Information that is confidential under Subsection (a)
includes information described by Subsection (a) that is obtained
or maintained by the commission 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.
SECTION 2.11. (a) Subchapter B, Chapter 531, Government
Code, is amended by adding Section 531.072 to read as follows:
Sec. 531.072. PREFERRED DRUG LISTS FOR MEDICAID AND CHILD
HEALTH PLAN PROGRAMS. (a) In a manner that complies with
applicable state and federal law, the commission shall adopt
preferred drug lists for the Medicaid vendor drug program and for
prescription drugs purchased through the child health plan program.
(b) The preferred drug lists may contain only drugs provided
by a manufacturer or labeler that reaches an agreement with the
commission on supplemental rebates under Section 531.070.
(c) In making a decision regarding the placement of a drug
on each of the preferred drug lists, the commission shall consider:
(1) the recommendations of the Pharmaceutical and
Therapeutics Committee established under Section 531.074;
(2) the clinical efficacy of the drug; and
(3) the price of competing drugs after deducting any
federal and state rebate amounts.
(d) The commission shall provide for distribution of
current copies of the preferred drug lists to all appropriate
health care providers in this state before those changes go into
effect.
(e) In this subsection, "labeler" and "manufacturer" have
the meanings assigned by Section 531.070. The commission shall
ensure that:
(1) a manufacturer or labeler may submit written
evidence supporting the inclusion of a drug on the preferred drug
lists before a supplemental agreement is reached with the
commission; and
(2) any drug that has been approved or has had any of
its particular uses approved by the United States Food and Drug
Administration under a priority review classification will be
reviewed by the Pharmaceutical and Therapeutics Committee at the
next regularly scheduled meeting of the committee. On receiving
notice from a manufacturer or labeler of the availability of a new
product, the commission, to the extent possible, shall schedule a
review for the product at the next regularly scheduled meeting of
the committee.
(f) A recipient of drug benefits under the Medicaid vendor
drug program may appeal a denial of prior authorization under
Section 531.073 of a covered drug or covered dosage through the
Medicaid fair hearing process.
(b) Not later than March 1, 2004, the Health and Human
Services Commission shall adopt the preferred drug lists as
required by Section 531.072, Government Code, as added by this
section.
SECTION 2.12. Subchapter B, Chapter 531, Government Code,
is amended by adding Section 531.073 to read as follows:
Sec. 531.073. PRIOR AUTHORIZATION FOR CERTAIN PRESCRIPTION
DRUGS. (a) The commission, in its rules and standards governing
the Medicaid vendor drug program and the child health plan program,
shall require prior authorization for the reimbursement of a drug
that is not included in the appropriate preferred drug list adopted
under Section 531.072, except for any drug exempted from prior
authorization requirements by federal law.
(b) The commission shall establish procedures for the prior
authorization requirement under the Medicaid vendor drug program to
ensure that the requirements of 42 U.S.C. Section 1396r-8(d)(5) and
its subsequent amendments are met. Specifically, the procedures
must ensure that:
(1) there will be a response to a request for prior
authorization by telephone or other telecommunications device
within 24 hours after receipt of a request for prior authorization;
and
(2) a 72-hour supply of the drug prescribed will be
provided in an emergency or if the commission does not provide a
response within the time required by Subdivision (1).
(c) The commission shall ensure that a prescription drug
prescribed for a recipient under the child health plan program, the
Medicaid program, or another state program administered by the
commission or for a person who becomes eligible under the child
health plan program, the Medicaid program, or another state program
administered by the commission is not subject to any requirement
for prior authorization under this section unless the recipient has
exhausted all the prescription, including any authorized refills,
or a period prescribed by the commission has expired, whichever
occurs first.
(d) The commission shall implement procedures to ensure
that a recipient under the child health plan program, the Medicaid
program, or another state program administered by the commission or
a person who becomes eligible under the child health plan program,
the Medicaid program, or another state program administered by the
commission receives continuity of care in relation to certain
prescriptions identified by the commission.
(e) The commission may by contract authorize a private
entity to administer the prior authorization requirements imposed
by this section on behalf of the commission.
SECTION 2.13. (a) Subchapter B, Chapter 531, Government
Code, is amended by adding Section 531.074 to read as follows:
Sec. 531.074. PHARMACEUTICAL AND THERAPEUTICS COMMITTEE.
(a) The Pharmaceutical and Therapeutics Committee is established
for the purposes of developing recommendations for a preferred drug
list for the Medicaid vendor drug program and a preferred drug list
for the child health plan program.
(b) The committee consists of the following members
appointed by the governor:
(1) six physicians licensed under Subtitle B, Title 3,
Occupations Code, and participating in the Medicaid program; and
(2) five pharmacists licensed under Subtitle J, Title
3, Occupations Code, and participating in the Medicaid vendor drug
program.
(c) In making appointments to the committee under
Subsection (b), the governor shall ensure that the committee
includes physicians and pharmacists who:
(1) represent different specialties and provide
services to all segments of the Medicaid program's diverse
population; and
(2) have experience in either developing or practicing
under a preferred drug list.
(d) A member of the committee is appointed for a two-year
term and may serve more than one term.
(e) The governor shall appoint a physician to be the
presiding officer of the committee. The presiding officer serves
at the pleasure of the governor.
(f) The committee shall meet at least monthly during the
six-month period following establishment of the committee to enable
the committee to develop recommendations for the initial preferred
drug lists. After that period, the committee shall meet at least
quarterly and at other times at the call of the presiding officer or
a majority of the committee members.
(g) A member of the committee may not receive compensation
for serving on the committee but is entitled to reimbursement for
reasonable and necessary travel expenses incurred by the member
while conducting the business of the committee, as provided by the
General Appropriations Act.
(h) In developing its recommendations for the preferred
drug lists, the committee shall consider the clinical efficacy,
safety, and cost-effectiveness of a product.
(i) The commission shall adopt rules governing the
operation of the committee, including rules governing the
procedures used by the committee for providing notice of a meeting
and rules prohibiting the committee from discussing confidential
information described by Section 531.071 in a public meeting. The
committee shall comply with the rules adopted under this
subsection.
(j) To the extent feasible, the committee shall review all
drug classes included in the preferred drug lists adopted under
Section 531.072 at least once every 12 months and may recommend
inclusions to and exclusions from the list to ensure that the list
provides for cost-effective medically appropriate drug therapies
for Medicaid recipients and children receiving health benefits
coverage under the child health plan program.
(k) The commission shall provide administrative support and
resources as necessary for the committee to perform its duties.
(l) Chapter 2110 does not apply to the committee.
(b) Not later than November 1, 2003, the governor shall
appoint members to the Pharmaceutical and Therapeutics Committee
established under Section 531.074, Government Code, as added by
this section.
(c) Not later than January 1, 2004, the Pharmaceutical and
Therapeutics Committee established under Section 531.074,
Government Code, as added by this section, shall submit
recommendations for the preferred drug lists the committee is
required to develop under that section to the Health and Human
Services Commission.
SECTION 2.14. Subchapter B, Chapter 531, Government Code,
is amended by adding Section 531.075 to read as follows:
Sec. 531.075. PRIOR AUTHORIZATION FOR HIGH-COST MEDICAL
SERVICES. The commission may evaluate and implement, as
appropriate, procedures, policies, and methodologies to require
prior authorization for high-cost medical services and procedures
and may contract with qualified service providers or organizations
to perform those functions.
SECTION 2.15. Section 531.102, Government Code, is amended
by amending Subsections (a) and (d) and adding Subsections (f) and
(g) to read as follows:
(a) The commission, through the commission's office of
investigations and enforcement, is responsible for the
investigation of fraud and abuse in the provision of health and
human services and the enforcement of state law relating to the
provision of those services. The commission may obtain any
information or technology necessary to enable the commission to
meet its responsibility under this subsection.
(d) The commission may require employees of health and human
services agencies to provide assistance to the commission in
connection with the commission's duties relating to the
investigation of fraud and abuse in the provision of health and
human services.
(f) Notwithstanding any other law, for purposes of
obtaining information relevant to the office's duties from a law
enforcement agency, prosecutor, or governmental entity, the office
is considered to be a law enforcement agency and may obtain the
information in the same manner as another law enforcement agency.
Information obtained by the office under this subsection that deals
with the detection, investigation, or prosecution of crime is
excepted from the requirements of Section 552.021 in the manner
provided by Section 552.108.
(g) In connection with the investigation of fraud and abuse
in the provision of health and human services, the office may issue
a subpoena throughout this state to compel the attendance and
testimony of a witness or production of records. The subpoena may
compel attendance or production at the office or at another place
designated in the subpoena.
SECTION 2.16. Subchapter C, Chapter 531, Government Code,
is amended by adding Section 531.1021 to read as follows:
Sec. 531.1021. SEIZURE OF ASSETS. (a) The commission,
through the commission's office of investigations and enforcement,
may seize assets owned by a person if:
(1) the commission determines through an
investigation that there is a substantial likelihood that the
person has engaged in conduct that constitutes fraud or abuse under
the medical assistance program; and
(2) the seizure of assets is necessary to protect the
commission's ability to recover amounts wrongfully obtained by the
person and associated damages and penalties to which the commission
may otherwise be entitled by law.
(b) The commission shall provide a person whose assets are
seized with an opportunity for a hearing at which the person may
contest the seizure.
(c) The commission may not dispose of seized assets until:
(1) the person is determined to have engaged in
conduct that constitutes fraud or abuse under the medical
assistance program; and
(2) the commission's entitlement to the assets is
confirmed in accordance with due process.
SECTION 2.17. (a) Section 531.103, Government Code, is
amended by amending Subsections (a) and (e) and adding Subsections
(c-1) and (e-1) to read as follows:
(a) The commission and the office of the attorney general
shall enter into a memorandum of understanding to develop and
implement joint written procedures for processing cases of
suspected fraud, waste, or abuse under the state Medicaid program.
The memorandum of understanding shall require:
(1) the commission and the office of the attorney
general to set priorities and guidelines for referring cases to
appropriate state agencies for investigation to enhance deterrence
of fraud, waste, or abuse in the program and maximize the imposition
of penalties, the recovery of money, and the successful prosecution
of cases;
(1-a) the commission to refer each case of suspected
provider fraud, waste, or abuse to the office of the attorney
general not later than the 10th business day after the date the
commission determines that the existence of fraud, waste, or abuse,
is reasonably indicated;
(2) the commission to keep detailed records for cases
processed by the commission or the office of the attorney general,
including information on the total number of cases processed and,
for each case:
(A) the agency and division to which the case is
referred for investigation;
(B) the date on which the case is referred; and
(C) the nature of the suspected fraud, waste, or
abuse;
(3) the commission to notify each appropriate division
of the office of the attorney general of each case referred by the
commission;
(4) the office of the attorney general to ensure that
information relating to each case investigated by that office is
available to each division of the office with responsibility for
investigating suspected fraud, waste, or abuse;
(5) the office of the attorney general to notify the
commission of each case the attorney general declines to prosecute
or prosecutes unsuccessfully;
(6) representatives of the commission and of the
office of the attorney general to meet not less than quarterly to
share case information and determine the appropriate agency and
division to investigate each case; and
(7) the commission and the office of the attorney
general to submit information requested by the comptroller about
each resolved case for the comptroller's use in improving fraud
detection.
(c-1) In addition to the report required by Subsection (c),
the office of the attorney general, not later than November 1 of
each year, shall prepare and submit to the governor, the
legislature, and the comptroller a report that specifically
addresses the activities of the attorney general's Medicaid fraud
control unit and civil Medicaid fraud section. The attorney
general shall consult with the comptroller regarding the format of
the report and make reasonable efforts to provide the report in the
format requested by the comptroller. The report must specify, for
the Medicaid fraud control unit and the civil Medicaid fraud
section, respectively, the following information:
(1) total agency expenditures;
(2) caseloads;
(3) the length of time required to complete each case
through each phase of activity;
(4) recoveries and penalties arising from each case;
(5) difficulties in operations; and
(6) any other information considered relevant by the
attorney general to an analysis of the effectiveness of the unit and
section.
(e) The commission shall refer a case of suspected fraud,
waste, or abuse under the state Medicaid program to the appropriate
United States attorney, district attorney, county attorney, city
attorney, or private collection agency if the attorney general
fails to act within 30 days of referral of the case to the office of
the attorney general. A failure by the attorney general to act
within 30 days constitutes approval by the attorney general under
Section 2107.003.
(e-1) In addition to the provisions required by Subsection
(a), the memorandum of understanding required by this section must
identify circumstances under which the commission may refer a case
of suspected fraud, waste, or abuse under the state Medicaid
program directly to the appropriate United States attorney,
district attorney, county attorney, city attorney, or private
collection agency. The memorandum of understanding must require
the commission to provide prompt notice to the office of the
attorney general of each case referred in accordance with this
subsection. A case referred in accordance with this subsection is
considered approved by the attorney general under Section 2107.003.
The memorandum of understanding must also include:
(1) procedures to facilitate the referral of cases
directly to the office of the attorney general; and
(2) provisions for the colocation of employees of the
office of attorney general, including attorneys and investigators,
with employees of the commission administering the commission's
office of investigations and enforcement.
(b) Not later than December 1, 2003, the office of the
attorney general and the Health and Human Services Commission shall
amend the memorandum of understanding required by Section 531.103,
Government Code, as necessary to comply with Sections
531.103(a)(1-a) and (e-1), Government Code, as added by this
section.
SECTION 2.18. (a) Subchapter C, Chapter 531, Government
Code, is amended by adding Section 531.1063 to read as follows:
Sec. 531.1063. MEDICAID FRAUD PILOT PROGRAM. (a) The
commission, with cooperation from the Texas Department of Human
Services, shall develop and implement a front-end Medicaid fraud
reduction pilot program in one or more counties in this state to
address provider fraud and appropriate cases of third-party and
recipient fraud.
(b) The program must be designed to reduce:
(1) the number of fraud cases arising from
authentication fraud and abuse;
(2) the total amount of Medicaid expenditures; and
(3) the number of fraudulent participants.
(c) The program must include:
(1) an integrated front-end smart card;
(2) secure mathematical algorithm fingerprint-imaging
and the use of any existing state database of fingerprint images
developed in connection with the financial assistance program under
Chapter 31, Human Resources Code;
(3) a real-time monitoring system that resides at the
point of contact with Medicaid providers, recipients,
participating pharmacies, hospitals, and appropriate third-party
participants;
(4) system components that provide for individual
smart cards, smart cards and biometric readers that are based at the
provider, pharmacy, or hospital, and local and systemwide software
that is Health Level 7 (HL7) compliant; and
(5) the ability to add other components to the program
and incorporate clinically oriented software to increase the
portability of medical information throughout the Medicaid system.
(d) To ensure reliability, the program and all associated
hardware and software must be initially tested in a physician
environment in this state and determined to be successful in
authenticating recipients, providers, and provider staff members
before the program is implemented throughout the program area.
(e) The commission may extend the program to additional
counties if the commission determines that expansion would be
cost-effective.
(b) Not later than January 1, 2004, the Health and Human
Services Commission shall begin implementation of the program
required by Section 531.1063, Government Code, as added by this
section.
(c) Not later than February 1, 2005, the Health and Human
Services Commission shall report to the governor, the lieutenant
governor, and the speaker of the house of representatives regarding
the program required by Section 531.1063, Government Code, as added
by this section. The report must include:
(1) an identification and evaluation of the benefits
of the program; and
(2) recommendations regarding expanding the program
statewide.
SECTION 2.19. Section 531.107(b), Government Code, is
amended to read as follows:
(b) The task force is composed of a representative of the:
(1) attorney general's office, appointed by the
attorney general;
(2) comptroller's office, appointed by the
comptroller;
(3) Department of Public Safety, appointed by the
public safety director;
(4) state auditor's office, appointed by the state
auditor;
(5) commission, appointed by the commissioner of
health and human services;
(6) Texas Department of Human Services, appointed by
the commissioner of human services; [and]
(7) Texas Department of Insurance, appointed by the
commissioner of insurance; and
(8) Texas Department of Health, appointed by the
commissioner of public health.
SECTION 2.20. (a) Subchapter C, Chapter 531, Government
Code, is amended by adding Section 531.113 to read as follows:
Sec. 531.113. MANAGED CARE ORGANIZATIONS: SPECIAL
INVESTIGATIVE UNITS OR CONTRACTS. (a) Each managed care
organization that provides or arranges for the provision of health
care services to an individual under a government-funded program,
including the Medicaid program and the child health plan program,
shall:
(1) establish and maintain a special investigative
unit within the managed care organization to investigate fraudulent
claims and other types of program abuse by recipients and service
providers; or
(2) contract with another entity for the investigation
of fraudulent claims and other types of program abuse by recipients
and service providers.
(b) Each managed care organization subject to this section
shall adopt a plan to prevent and reduce fraud and abuse and
annually file that plan with the commission's office of
investigations and enforcement for approval. The plan must
include:
(1) a description of the managed care organization's
procedures for detecting and investigating possible acts of fraud
or abuse;
(2) a description of the managed care organization's
procedures for the mandatory reporting of possible acts of fraud or
abuse to the commission's office of investigations and enforcement;
(3) a description of the managed care organization's
procedures for educating and training personnel to prevent fraud
and abuse;
(4) the name, address, telephone number, and fax
number of the individual responsible for carrying out the plan;
(5) a description or chart outlining the
organizational arrangement of the managed care organization's
personnel responsible for investigating and reporting possible
acts of fraud or abuse;
(6) a detailed description of the results of
investigations of fraud and abuse conducted by the managed care
organization's special investigative unit or the entity with which
the managed care organization contracts under Subsection (a)(2);
and
(7) provisions for maintaining the confidentiality of
any patient information relevant to an investigation of fraud or
abuse.
(c) If a managed care organization contracts for the
investigation of fraudulent claims and other types of program abuse
by recipients and service providers under Subsection (a)(2), the
managed care organization shall file with the commission's office
of investigations and enforcement:
(1) a copy of the written contract;
(2) the names, addresses, telephone numbers, and fax
numbers of the principals of the entity with which the managed care
organization has contracted; and
(3) a description of the qualifications of the
principals of the entity with which the managed care organization
has contracted.
(d) The commission's office of investigations and
enforcement may review the records of a managed care organization
to determine compliance with this section.
(e) The commissioner shall adopt rules as necessary to
accomplish the purposes of this section.
(b) A managed care organization subject to Section 531.113,
Government Code, as added by this section, shall comply with the
requirements of that section not later than September 1, 2004.
SECTION 2.21. (a) Subchapter C, Chapter 531, Government
Code, is amended by adding Section 531.114 to read as follows:
Sec. 531.114. FINANCIAL ASSISTANCE FRAUD. (a) For
purposes of establishing or maintaining the eligibility of a person
and the person's family for financial assistance under Chapter 31,
Human Resources Code, or for purposes of increasing or preventing a
reduction in the amount of that assistance, a person may not
intentionally:
(1) make a statement that the person knows is false or
misleading;
(2) misrepresent, conceal, or withhold a fact; or
(3) knowingly misrepresent a statement as being true.
(b) If after an investigation the commission determines
that a person violated Subsection (a), the commission shall:
(1) notify the person of the alleged violation not
later than the 30th day after the date the commission completes the
investigation and provide the person with an opportunity for a
hearing on the matter; or
(2) refer the matter to the appropriate prosecuting
attorney for prosecution.
(c) If a person waives the right to a hearing or if a hearing
officer at an administrative hearing held under this section
determines that a person violated Subsection (a), the person is
ineligible to receive financial assistance as provided by
Subsection (d). A person who a hearing officer determines violated
Subsection (a) may appeal that determination by filing a petition
in the district court in the county in which the violation occurred
not later than the 30th day after the date the hearing officer made
the determination.
(d) A person determined under Subsection (c) to have
violated Subsection (a) is not eligible for financial assistance:
(1) before the first anniversary of the date of that
determination, if the person has no previous violations; and
(2) permanently, if the person was previously
determined to have committed a violation.
(e) If a person is convicted of a state or federal offense
for conduct described by Subsection (a), or if the person is granted
deferred adjudication or placed on community supervision for that
conduct, the person is permanently disqualified from receiving
financial assistance.
(f) This section does not affect the eligibility for
financial assistance of any other member of the household of a
person ineligible as a result of Subsection (d) or (e).
(g) The commission shall adopt rules as necessary to
implement this section.
(b) Section 531.114, Government Code, as added by this
section, applies only to conduct occurring on or after the
effective date of this section. Conduct occurring before the
effective date of this section is governed by the law in effect on
the date the conduct occurred, and the former law is continued in
effect for that purpose.
SECTION 2.22. Subchapter C, Chapter 531, Government Code,
is amended by adding Section 531.115 to read as follows:
Sec. 531.115. FEDERAL FELONY MATCH. The commission shall
develop and implement a system to cross-reference data collected
for the programs listed under Section 531.008(c) with the list of
fugitive felons maintained by the federal government.
SECTION 2.23. Subchapter A, Chapter 533, Government Code,
is amended by adding Section 533.0025 to read as follows:
Sec. 533.0025. DELIVERY OF SERVICES. (a) In this section,
"medical assistance" has the meaning assigned by Section 32.003,
Human Resources Code.
(b) Except as otherwise provided by this section and
notwithstanding any other law, the commission shall provide medical
assistance through the most cost-effective model of Medicaid
managed care as determined by the commission. If the commission
determines that it is more cost-effective, the commission may
provide medical assistance in a certain part of this state or to a
certain population of recipients using:
(1) a health maintenance organization model,
including Medicaid Star + Plus pilot programs;
(2) a primary care case management model;
(3) a prepaid health plan model;
(4) an exclusive provider organization model; or
(5) another Medicaid managed care model or
arrangement.
(c) In determining whether a model or arrangement described
by Subsection (b) is more cost-effective, the commissioner must
consider:
(1) the scope, duration, and types of health benefits
or services to be provided in a certain part of this state or to a
certain population of recipients;
(2) administrative costs necessary to meet federal and
state statutory and regulatory requirements;
(3) the anticipated effect of market competition
associated with the configuration of Medicaid service delivery
models determined by the commission; and
(4) the gain or loss to this state of a tax collected
under Article 4.11, Insurance Code.
(d) If the commission determines that it is not more
cost-effective to use a Medicaid managed care model to provide
certain types of medical assistance in a certain area or to certain
medical assistance recipients as prescribed by this section, the
commission shall provide medical assistance through a traditional
fee-for-service arrangement.
SECTION 2.24. Subchapter A, Chapter 533, Government Code,
is amended by adding Section 533.0132 to read as follows:
Sec. 533.0132. STATE TAXES. The commission shall ensure
that any experience rebate or profit sharing for managed care
organizations is calculated by treating premium, maintenance, and
other taxes under the Insurance Code and any other taxes payable to
this state as allowable expenses for purposes of determining the
amount of the experience rebate or profit sharing.
SECTION 2.25. Sections 403.105(a) and (c), Government Code,
are amended to read as follows:
(a) The permanent fund for health and tobacco education and
enforcement is a dedicated account in the general revenue fund. The
fund is composed of:
(1) money transferred to the fund at the direction of
the legislature;
(2) gifts and grants contributed to the fund; and
(3) the available earnings of the fund determined in
accordance with Section 403.1068.
(c) The available earnings of the fund may be appropriated
to the Texas Department of Health for:
(1) programs to reduce the use of cigarettes and
tobacco products in this state, including:
(A) [(1)] smoking cessation programs;
(B) [(2)] enforcement of Subchapters H, K, and N,
Chapter 161, Health and Safety Code, or other laws relating to
distribution of cigarettes or tobacco products to minors or use of
cigarettes or tobacco products by minors;
(C) [(3)] public awareness programs relating to
use of cigarettes and tobacco products, including general
educational programs and programs directed toward youth; and
(D) [(4)] specific programs for communities
traditionally targeted, by advertising and other means, by
companies that sell cigarettes or tobacco products; and
(2) the provision of coordinated essential public
health services administered by the department.
SECTION 2.26. The heading to Section 403.105, Government
Code, is amended to read as follows:
Sec. 403.105. PERMANENT FUND FOR HEALTH AND TOBACCO
EDUCATION AND ENFORCEMENT.
SECTION 2.27. Section 403.1055(c), Government Code, is
amended to read as follows:
(c) The available earnings of the fund may be appropriated
to:
(1) the Texas Department of Health for the purpose of:
(A) developing and demonstrating cost-effective
prevention and intervention strategies for improving health
outcomes for children and the public;
(B) [and for] providing grants to local
communities to address specific public health priorities,
including sickle cell anemia, diabetes, high blood pressure,
cancer, heart attack, stroke, keloid tissue and scarring, and
respiratory disease;[,] and
(C) [for] providing grants to local communities
for essential public health services as defined in the Health and
Safety Code; and
(2) the Interagency Council on Early Childhood
Intervention to provide intervention services for children with
developmental delay or who have a high probability of developing
developmental delay and the families of those children.
SECTION 2.28. Sections 403.1065(a) and (c), Government
Code, are amended to read as follows:
(a) The permanent fund for rural health facilities and
health centers [facility capital improvement] is a dedicated
account in the general revenue fund. The fund is composed of:
(1) money transferred to the fund at the direction of
the legislature;
(2) payments of interest and principal on loans made
under Subchapter H [G], Chapter 487 [106], [Health and Safety
Code,] and fees collected under that subchapter;
(3) gifts and grants contributed to the fund; and
(4) the available earnings of the fund determined in
accordance with Section 403.1068.
(c) The available earnings of the fund may be appropriated
to:
(1) the Office of Rural Community Affairs for the
purposes of Subchapter H, Chapter 487; or
(2) another agency for the promotion, construction, or
operation of federally qualified health centers in rural areas of
the state based on medically underserved need.
SECTION 2.29. The heading to Section 403.1065, Government
Code, is amended to read as follows:
Sec. 403.1065. PERMANENT FUND FOR RURAL HEALTH FACILITIES
AND HEALTH CENTERS [FACILITY CAPITAL IMPROVEMENT].
SECTION 2.30. Sections 403.1066(a) and (c), Government
Code, are amended to read as follows:
(a) The permanent fund for community hospitals and urban
health centers [hospital capital improvement fund] is a dedicated
account in the general revenue fund. The fund is composed of:
(1) money transferred to the fund at the direction of
the legislature;
(2) payments of interest and principal on loans and
fees collected under this section;
(3) gifts and grants contributed to the fund; and
(4) the available earnings of the fund determined in
accordance with Section 403.1068.
(c) The available earnings of the fund may be appropriated
to:
(1) the Texas Department of Health for the purpose of
providing grants, loans, or loan guarantees to public or nonprofit
community hospitals with 125 beds or fewer located in an urban area
of the state; or
(2) another agency for the promotion, construction, or
operation of federally qualified health centers in urban areas of
the state based on medically underserved need.
SECTION 2.31. The heading to Section 403.1066, Government
Code, is amended to read as follows:
Sec. 403.1066. PERMANENT FUND FOR COMMUNITY HOSPITALS AND
URBAN HEALTH CENTERS [HOSPITAL CAPITAL IMPROVEMENT FUND].
SECTION 2.32. Section 466.408(b), Government Code, is
amended to read as follows:
(b) If a claim is not made for prize money on or before the
180th day after the date on which the winner was selected, the prize
money shall be deposited to the credit of the Texas Department of
Health state-owned multicategorical teaching hospital account or
the tertiary care facility account as follows:
(1) not more than $25 [$40] million in prize money each
biennium may be deposited to or appropriated from the Texas
Department of Health state-owned multicategorical teaching
hospital account, which is an account in the general revenue fund;
and
(2) all prize money subject to this section in excess
of $25 [$40] million each biennium shall be deposited in the
tertiary care facility account. Money deposited in the tertiary
care facility account may only be appropriated to the department
for purposes specified in Chapter 46 or 61, Health and Safety Code.
SECTION 2.33. (a) Subchapter B, Chapter 12, Health and
Safety Code, is amended by adding Sections 12.0111 and 12.0112 to
read as follows:
Sec. 12.0111. LICENSING FEES. (a) This section applies in
relation to each licensing program administered by the department
or administered by a regulatory board or other agency that is under
the jurisdiction of the department or administratively attached to
the department. In this section and Section 12.0112, "license"
includes a permit, certificate, or registration.
(b) Notwithstanding other law, the department shall charge
a fee for issuing or renewing a license that is in an amount
designed to allow the department to recover from its license
holders all of the department's direct and indirect costs in
administering and enforcing the applicable licensing program.
(c) Notwithstanding other law, each regulatory board or
other agency that is under the jurisdiction of the department or
administratively attached to the department and that issues
licenses shall charge a fee for issuing or renewing a license that
is in an amount designed to allow the department and the regulatory
board or agency to recover from the license holders all of the
direct and indirect costs to the department and to the regulatory
board or agency in administering and enforcing the applicable
licensing program.
Sec. 12.0112. TERM OF LICENSE. Notwithstanding other law,
the term of each license issued by the department, or by a
regulatory board or other agency that is under the jurisdiction of
the department or administratively attached to the department, is
three years.
(b) Section 12.0111, Health and Safety Code, as added by
this section, applies only to a license, permit, certificate, or
registration issued or renewed by the Texas Department of Health,
or by a regulatory board or other agency that is under the
jurisdiction of the department or administratively attached to the
department, on or after January 1, 2004.
(c) Section 12.0112, Health and Safety Code, as added by
this section, applies only to a license, permit, certificate, or
registration that is issued or renewed on or after January 1, 2005.
SECTION 2.34. Sections 62.055(a), (d), and (e), Health and
Safety Code, are amended to read as follows:
(a) It is the intent of the legislature that the commission
maximize the use of private resources in administering the child
health plan created under this chapter. In administering the child
health plan, the commission may contract with[:
[(1)] a third party administrator to provide
enrollment and related services under the state child health plan[;
or
[(2) another entity, including the Texas Healthy Kids
Corporation under Subchapter F, Chapter 109, to obtain health
benefit plan coverage for children who are eligible for coverage
under the state child health plan].
(d) A third party administrator [or other entity] may
perform tasks under the contract that would otherwise be performed
by the Texas Department of Health or Texas Department of Human
Services under this chapter.
(e) The commission shall:
(1) retain all policymaking authority over the state
child health plan;
(2) procure all contracts with a third party
administrator [or other entity] through a competitive procurement
process in compliance with all applicable federal and state laws or
regulations; and
(3) ensure that all contracts with child health plan
providers under Section 62.155 are procured through a competitive
procurement process in compliance with all applicable federal and
state laws or regulations.
SECTION 2.35. (a) Subchapter B, Chapter 62, Health and
Safety Code, is amended by adding Section 62.0582 to read as
follows:
Sec. 62.0582. THIRD-PARTY BILLING VENDORS. (a) A
third-party billing vendor may not submit a claim with the
commission for payment on behalf of a health plan provider under the
program unless the vendor has entered into a contract with the
commission authorizing that activity.
(b) To the extent practical, the contract shall contain
provisions comparable to the provisions contained in contracts
between the commission and health plan providers, with an emphasis
on provisions designed to prevent fraud or abuse under the program.
At a minimum, the contract must require the third-party billing
vendor to:
(1) provide documentation of the vendor's authority to
bill on behalf of each provider for whom the vendor submits claims;
(2) submit a claim in a manner that permits the
commission to identify and verify the vendor, any computer or
telephone line used in submitting the claim, any relevant user
password used in submitting the claim, and any provider number
referenced in the claim; and
(3) subject to any confidentiality requirements
imposed by federal law, provide the commission, the office of the
attorney general, or authorized representatives with:
(A) access to any records maintained by the
vendor, including original records and records maintained by the
vendor on behalf of a provider, relevant to an audit or
investigation of the vendor's services or another function of the
commission or office of attorney general relating to the vendor;
and
(B) if requested, copies of any records described
by Paragraph (A) at no charge to the commission, the office of the
attorney general, or authorized representatives.
(c) On receipt of a claim submitted by a third-party billing
vendor, the commission shall send a remittance notice directly to
the provider referenced in the claim. The notice must:
(1) include detailed information regarding the claim
submitted on behalf of the provider; and
(2) require the provider to review the claim for
accuracy and notify the commission promptly regarding any errors.
(d) The commission shall take all action necessary,
including any modifications of the commission's claims processing
system, to enable the commission to identify and verify a
third-party billing vendor submitting a claim for payment under the
program, including identification and verification of any computer
or telephone line used in submitting the claim, any relevant user
password used in submitting the claim, and any provider number
referenced in the claim.
(b) Section 62.0582, Health and Safety Code, as added by
this section, takes effect January 1, 2004.
SECTION 2.36. Sections 62.101(b) and (c), Health and Safety
Code, are amended to read as follows:
(b) The commission shall establish income eligibility
levels consistent with Title XXI, Social Security Act (42 U.S.C.
Section 1397aa et seq.), as amended, and any other applicable law or
regulations, and subject to the availability of appropriated money,
so that a child who is younger than 19 years of age and whose net
family income is at or below 150 [200] percent of the federal
poverty level is eligible for health benefits coverage under the
program.
(c) The commissioner shall evaluate enrollment levels and
program impact every six months during the first 12 months of
implementation and at least annually thereafter and shall submit a
finding of fact to the Legislative Budget Board and the Governor's
Office of Budget and Planning as to the adequacy of funding and the
ability of the program to sustain enrollment at the eligibility
level established by Subsection (b). In the event that
appropriated money is insufficient to sustain enrollment at the
authorized eligibility level or enrollment exceeds the number of
children authorized to be enrolled in the child health plan under
the General Appropriations Act, the commissioner shall:
(1) suspend enrollment in the child health plan;
(2) establish a waiting list for applicants for
coverage; and
(3) establish a process for periodic or continued
enrollment of applicants in the child health plan program as the
availability of money allows.
SECTION 2.37. Section 62.1015(b), Health and Safety Code,
is amended to read as follows:
(b) A child of an employee of a charter school, school
district, other educational district whose employees are members of
the Teacher Retirement System of Texas, or regional education
service center may be enrolled in health benefits coverage under
the child health plan. A child enrolled in the child health plan
under this section:
(1) participates in the same manner as any other child
enrolled in the child health plan; and
(2) is subject to the same requirements and
restrictions relating to income eligibility, continuous coverage,
and enrollment, including applicable waiting periods, as any other
child enrolled in the child health plan.
SECTION 2.38. Section 62.102, Health and Safety Code, is
amended to read as follows:
Sec. 62.102. CONTINUOUS COVERAGE. The commission shall
provide that an individual who is determined to be eligible for
coverage under the child health plan remains eligible for those
benefits until the earlier of:
(1) the end of a period, not to exceed 180 days [12
months], following the date of the eligibility determination; or
(2) the individual's 19th birthday.
SECTION 2.39. Section 62.105, Health and Safety Code, is
amended to read as follows:
Sec. 62.105. COVERAGE FOR QUALIFIED ALIENS. The commission
may [shall] provide coverage under the state Medicaid program and
under the program established under this chapter to a child who is a
qualified alien, as that term is defined by 8 U.S.C. Section
1641(b), if the federal government authorizes the state to provide
that coverage. The commission shall comply with any prerequisite
imposed under the federal law to providing that coverage.
SECTION 2.40. Section 62.151, Health and Safety Code, is
amended by amending Subsection (b) and adding Subsections (e) and
(f) to read as follows:
(b) In developing the covered benefits, the commission
shall consider the health care needs of healthy children and
children with special health care needs. At the time the child
health plan program is first implemented, the child health plan
must provide a benefits package that is actuarially equivalent, as
determined in accordance with 42 U.S.C. Section 1397cc, to the
basic plan for active state employees offered through health
maintenance organizations under Chapter 1551, Insurance Code [the
Texas Employees Uniform Group Insurance Benefits Act (Article
3.50-2, Vernon's Texas Insurance Code)], as determined by the
commission. [The child health plan must provide at least the
covered benefits described by the recommended benefits package
described for a state-designed child health plan by the Texas House
of Representatives Committee on Public Health "CHIP" Interim Report
to the Seventy-Sixth Texas Legislature dated December, 1998, and
the Senate Interim Committee on Children's Health Insurance Report
to the Seventy-Sixth Texas Legislature dated December 1, 1998.]
(e) In developing the covered benefits, the commission
shall seek input from the Public Assistance Health Benefit Review
and Design Committee established under Section 531.067, Government
Code.
(f) The commission, if it determines the policy to be
cost-effective, may ensure that an enrolled child does not, unless
authorized by the commission in consultation with the child's
attending physician or advanced practice nurse, receive under the
child health plan:
(1) more than four different outpatient brand-name
prescription drugs during a month; or
(2) more than a 34-day supply of a brand-name
prescription drug at any one time.
SECTION 2.41. Section 62.153, Health and Safety Code, is
amended by amending Subsection (b) and adding Subsection (d) to
read as follows:
(b) Subject to Subsection (d), cost-sharing [Cost-sharing]
provisions adopted under this section shall ensure that families
with higher levels of income are required to pay progressively
higher percentages of the cost of the plan.
(d) Cost-sharing provisions adopted under this section may
be determined based on the maximum level authorized under federal
law and applied to income levels in a manner that minimizes
administrative costs.
SECTION 2.42. (a) The heading to Section 62.154, Health and
Safety Code, is amended to read as follows:
Sec. 62.154. WAITING PERIOD; CROWD OUT.
(b) Sections 62.154(a), (b), and (d), Health and Safety
Code, are amended to read as follows:
(a) To the extent permitted under Title XXI of the Social
Security Act (42 U.S.C. Section 1397aa et seq.), as amended, and any
other applicable law or regulations, the child health plan must
include a waiting period. The child health plan [and] may include
copayments and other provisions intended to discourage:
(1) employers and other persons from electing to
discontinue offering coverage for children under employee or other
group health benefit plans; and
(2) individuals with access to adequate health benefit
plan coverage, other than coverage under the child health plan,
from electing not to obtain or to discontinue that coverage for a
child.
(b) A child is not subject to a waiting period adopted under
Subsection (a) if:
(1) the family lost coverage for the child as a result
of:
(A) termination of employment because of a layoff
or business closing;
(B) termination of continuation coverage under
the Consolidated Omnibus Budget Reconciliation Act of 1985 (Pub. L.
No. 99-272);
(C) change in marital status of a parent of the
child;
(D) termination of the child's Medicaid
eligibility because:
(i) the child's family's earnings or
resources increased; or
(ii) the child reached an age at which
Medicaid coverage is not available; or
(E) a similar circumstance resulting in the
involuntary loss of coverage;
(2) the family terminated health benefits plan
coverage for the child because the cost to the child's family for
the coverage exceeded 10 percent of the family's net income; [or]
(3) the child has access to group-based health
benefits plan coverage and is required to participate in the health
insurance premium payment reimbursement program administered by
the commission; or
(4) the commission has determined that other grounds
exist for a good cause exception.
(d) The waiting period required by Subsection (a) must[:
[(1)] extend for a period of 90 days after the [last]
date on which the applicant applies to be enrolled under the child
health plan [was covered under a health benefits plan; and
[(2) apply to a child who was covered by a health
benefits plan at any time during the 90 days before the date of
application for coverage under the child health plan, other than a
child who was covered under a health benefits plan provided under
Chapter 109].
SECTION 2.43. Sections 62.155(c) and (d), Health and Safety
Code, are amended to read as follows:
(c) In selecting a health plan provider, the commission:
(1) may give preference to a person who provides
similar coverage under the Medicaid program [or through the Texas
Healthy Kids Corporation]; and
(2) shall provide for a choice of not more than [at
least] two health plan providers in each service [metropolitan]
area.
(d) The commissioner may authorize an exception to
Subsection (c)(2) if it is cost-effective to do so and there are
more than two [is only one] acceptable applicants [applicant] to
become [a] health plan providers [provider] in the service
[metropolitan] area.
SECTION 2.44. Subchapter D, Chapter 62, Health and Safety
Code, is amended by adding Section 62.158 to read as follows:
Sec. 62.158. STATE TAXES. The commission shall ensure that
any experience rebate or profit-sharing for health plan providers
under the child health plan is calculated by treating premium,
maintenance, and other taxes under the Insurance Code and any other
taxes payable to this state as allowable expenses for purposes of
determining the amount of the experience rebate or profit-sharing.
SECTION 2.45. (a) Section 242.063(d), Health and Safety
Code, is amended to read as follows:
(d) A [Notwithstanding Chapter 15, Civil Practice and
Remedies Code, or Section 65.023, Civil Practice and Remedies Code,
a] suit for a temporary restraining order or other injunctive
relief must [may] be brought in [Travis County or in] the county in
which the alleged violation occurs.
(b) Section 242.063(e), Health and Safety Code, is
repealed.
(c) The changes in law made by this section to Section
242.063(d), Health and Safety Code, apply only to a suit filed on or
after the effective date of this section. A suit filed before the
effective date of this section is covered by the law in effect when
the suit was filed, and that law is continued in effect for that
purpose.
SECTION 2.46. Section 242.065(b), Health and Safety Code,
is amended to read as follows:
(b) In determining the amount of a penalty to be awarded
under this section, the trier of fact shall consider:
(1) the seriousness of the violation[, including the
nature, circumstances, extent, and gravity of the violation and the
hazard or potential hazard created by the violation to the health or
safety of a resident];
(2) the history of violations committed by the person
or the person's affiliate, employee, or controlling person;
(3) the amount necessary to deter future violations;
(4) the efforts made to correct the violation;
(5) any misrepresentation made to the department or to
another person regarding:
(A) the quality of services rendered or to be
rendered to residents;
(B) the compliance history of the institution or
any institutions owned or controlled by an owner or controlling
person of the institution; or
(C) the identity of an owner or controlling
person of the institution;
(6) the culpability of the individual who committed
the violation; and
(7) any other matter that should, as a matter of
justice or equity, be considered.
SECTION 2.47. (a) Section 242.070, Health and Safety Code,
is amended to read as follows:
Sec. 242.070. APPLICATION OF OTHER LAW. The department may
not assess more than one monetary penalty under this chapter and
Chapter 32, Human Resources Code, for a violation arising out of the
same act or failure to act, except as provided by Section
242.0665(c). The [This section does not prohibit the] department
may assess the greater of [from assessing] a monetary penalty under
this chapter or [and] a monetary penalty under Chapter 32, Human
Resources Code, for the same act or failure to act.
(b) The change in law made by this section to Section
242.070, Health and Safety Code, applies only to a penalty assessed
on or after the effective date of this section.
SECTION 2.48. Subchapter K, Chapter 242, Health and Safety
Code, is amended by adding Section 242.406 to read as follows:
Sec. 242.406. GRANT PROGRAM FOR NURSING FACILITIES
PROVIDING QUALITY ENVIRONMENTS. (a) The department shall
establish a competitive grant program to pay part of the costs of a
project proposed by a nursing facility that is designed to improve
the quality of life for residents of the facility by providing:
(1) homelike environments for residents, including
providing opportunities for residents to engage in meaningful
activities such as gardening or other outdoor activities;
(2) direct care staff members who tailor care to the
individual needs of a resident and allow the resident and the
resident's family members to participate in the decision-making
process regarding that care;
(3) opportunities for residents to interact with
companion animals, children, family members, and other visitors
from the community; or
(4) other innovative programs designed to improve the
quality of residents' care.
(b) A project proposed by a nursing facility under
Subsection (a) must be designed to serve as a model of best
practices for the nursing facility industry.
(c) The department shall monitor the expenditure of grant
money to ensure that the money is being used for the intended
purpose.
(d) The department by rule shall establish guidelines for
the grant program, including guidelines that specify:
(1) the procedures for submitting a grant proposal;
(2) the criteria the department will follow in
evaluating the proposals; and
(3) the reports that a grant recipient must file to
allow the department and the industry to evaluate the feasibility
and success of the project.
(e) The department shall fund the grant program using
available resources attributable to the savings realized from
implementing Section 32.050(e), Human Resources Code.
(f) The department shall award each grant under a contract.
A contract may further detail:
(1) reports that the grant recipient must file; and
(2) monitoring of the project that the grant recipient
must allow.
(g) The department shall post a summary of best practices
under the grant program on its Internet website to serve as a model
of best practices for the industry. The department shall report to
the legislature regarding those best practices.
SECTION 2.49. Section 242.601(a), Health and Safety Code,
is amended to read as follows:
(a) An institution must establish medication administration
procedures [to ensure that:
[(1) medications to be administered are checked
against the order of a physician, advanced practice nurse, or
physician assistant pursuant to protocols jointly developed with a
physician;
[(2) the resident is identified before the
administration of a medication;
[(3) each resident's clinical record includes an
individual medication record in which the dose of medication
administered is properly recorded by the person who administered
the medication;
[(4) medications and biologicals are prepared and
administered to a resident by the same individual, except under
unit-of-use package distribution systems; and
[(5) a medication prescribed for one resident is not
administered to any other person].
SECTION 2.50. Section 242.603(a), Health and Safety Code,
is amended to read as follows:
(a) An institution shall store medications under
appropriate conditions of sanitation, temperature, light,
moisture, ventilation, segregation, and security. [Poisons,
medications used externally, and medications taken internally
shall be stored on separate shelves or in separate cabinets.
Medication stored in a refrigerator containing other items shall be
kept in a separate compartment with appropriate security. The
institution shall store a medication in a locked area that must
remain locked unless an individual authorized to distribute the
medication is present.]
SECTION 2.51. (a) Section 252.202(a), Health and Safety
Code, is amended to read as follows:
(a) A quality assurance fee is imposed on each facility for
which a license fee must be paid under Section 252.034, [and] on
each facility owned by a community mental health and mental
retardation center, as described by Subchapter A, Chapter 534, and
on each facility owned by the Texas Department of Mental Health and
Mental Retardation. The fee:
(1) is an amount established under Subsection (b)
multiplied by the number of patient days as determined in
accordance with Section 252.203;
(2) is payable monthly; and
(3) is in addition to other fees imposed under this
chapter.
(b) Not later than January 1, 2004, each facility owned by
the Texas Department of Mental Health and Mental Retardation shall
pay the quality assurance fee imposed by Section 252.202, Health
and Safety Code, as amended by this section, for patient days
occurring between September 1, 2002, and July 31, 2003.
SECTION 2.52. Section 252.203, Health and Safety Code, is
amended to read as follows:
Sec. 252.203. PATIENT DAYS. For each calendar day, a
facility shall determine the number of patient days by adding the
following:
(1) the number of patients occupying a facility bed
immediately before midnight of that day; and
(2) [the number of beds that are on hold on that day
and that have been placed on hold for a period not to exceed three
consecutive calendar days during which a patient is in a hospital;
and
[(3)] the number of beds that are on hold on that day
and that have been placed on hold for a period not to exceed three
consecutive calendar days during which a patient is on therapeutic
[home] leave.
SECTION 2.53. Section 252.204(b), Health and Safety Code,
is amended to read as follows:
(b) Each facility shall:
(1) not later than the 20th [10th] day after the last
day of a month file a report with the Health and Human Services
Commission or the department, as appropriate, stating the total
patient days for the month; and
(2) not later than the 30th day after the last day of
the month pay the quality assurance fee.
SECTION 2.54. Sections 252.207(a) and (c), Health and
Safety Code, are amended to read as follows:
(a) Subject to legislative appropriation and state and
federal law, the [The] Health and Human Services Commission may
[shall] use money in the quality assurance fund, together with any
federal money available to match that money[, to]:
(1) to offset [allowable] expenses incurred to
administer the quality assurance fee under this chapter [under the
Medicaid program]; [or]
(2) to increase reimbursement rates paid under the
Medicaid program to facilities or waiver programs for persons with
mental retardation operated in accordance with 42 U.S.C. Section
1396n(c) and its subsequent amendments; or
(3) for any other health and human services purpose
approved by the governor and Legislative Budget Board[, subject to
Section 252.206(d)].
(c) If money in the quality assurance fund is used to
increase a reimbursement rate in the Medicaid program, the [The]
Health and Human Services Commission shall ensure that the
reimbursement methodology used to set that rate describes how the
money in the fund will be used to increase the rate and [formula
devised under Subsection (b)] provides incentives to increase
direct care staffing and direct care wages and benefits.
SECTION 2.55. (a) Section 461.018(b), Health and Safety
Code, is amended to read as follows:
(b) The commission's program under Subsection (a) must
include:
(1) [establishing and maintaining a toll-free "800"
telephone number to provide crisis counseling and referral services
to families experiencing difficulty as a result of problem or
compulsive gambling;
[(2)] promoting public awareness regarding the
recognition and prevention of problem or compulsive gambling;
(2) [(3)] facilitating, through in-service training
and other means, the availability of effective assistance programs
for problem or compulsive gamblers; and
(3) [(4)] conducting studies to identify adults and
juveniles in this state who are, or who are at risk of becoming,
problem or compulsive gamblers.
(b) Section 466.251(b), Government Code, and Section
2001.417(b), Occupations Code, are repealed.
SECTION 2.56. Subchapter B, Chapter 533, Health and Safety
Code, is amended by adding Section 533.0354 to read as follows:
Sec. 533.0354. DISEASE MANAGEMENT PRACTICES AND JAIL
DIVERSION MEASURES OF LOCAL MENTAL HEALTH AUTHORITIES. (a) A local
mental health authority shall provide assessment services, crisis
services, and intensive and comprehensive services using disease
management practices for adults with bipolar disorder,
schizophrenia, or clinically severe depression and for children
with serious emotional illnesses. The local mental health
authority shall engage an individual with treatment services that
are:
(1) ongoing and matched to the needs of the individual
in type, duration, and intensity;
(2) focused on a process of recovery designed to allow
the individual to progress through levels of service;
(3) guided by evidence-based protocols and a
strength-based paradigm of service; and
(4) monitored by a system that holds the local
authority accountable for specific outcomes, while allowing
flexibility to maximize local resources.
(b) The department shall require each local mental health
authority to incorporate jail diversion strategies into the
authority's disease management practices for managing adults with
schizophrenia and bipolar disorder to reduce the involvement of
those client populations with the criminal justice system.
(c) The department shall enter into performance contracts
between the department and each local mental health authority for
the fiscal years ending August 31, 2004, and August 31, 2005, that
specify measurable outcomes related to their success in using
disease management practices to meet the needs of the target
populations.
(d) The department shall study the implementation of
disease management practices, including the jail diversion
measures, and shall submit to the governor, the lieutenant
governor, and the speaker of the house of representatives a report
on the progress in implementing disease management practices and
jail diversion measures by local mental health authorities. The
report must be delivered not later than December 31, 2004, and must
include specific information on:
(1) the implementation of jail diversion measures
undertaken; and
(2) the effect of disparities in per capita funding
levels among local mental health authorities on the implementation
and effectiveness of disease management practices and jail
diversion measures.
(e) The department may use the fiscal year ending August 31,
2004, as a transition period for implementing the requirements of
Subsections (a)-(c).
SECTION 2.57. (a) Subchapter C, Chapter 533, Health and
Safety Code, is amended by adding Sections 533.061 and 533.0611 to
read as follows:
Sec. 533.061. REQUIRED CONTRACT PROVISIONS. (a) The
department shall include in a contract with an ICF-MR program
provider a provision stating that the contract terminates if the
department imposes a vendor hold on payments made to the facility
under the medical assistance program under Chapter 32, Human
Resources Code, three times during an 18-month period.
(b) The department shall ensure that each provision of a
contract with an ICF-MR program provider is consistent with
department and Texas Department of Human Services rules that govern
the program.
Sec. 533.0611. SANCTIONS. If the Texas Department of Human
Services recommends that a vendor hold be imposed on payments made
to an ICF-MR program provider or that the contract with the ICF-MR
program provider be terminated, the Texas Department of Mental
Health and Mental Retardation shall immediately impose the vendor
hold or terminate the contract, as appropriate, without conducting
a further investigation or providing the program provider an
opportunity to take corrective action.
(b) A rule adopted by the Texas Board of Mental Health and
Mental Retardation before September 1, 2003, relating to the
imposition of a vendor hold on payments made to an ICF-MR program
provider or the cancellation of a contract with an ICF-MR program
provider after the imposition of vendor holds, is repealed on
September 1, 2003.
(c) The change in law made by Section 533.061, Health and
Safety Code, as added by this section, applies only to a contract
entered into with an ICF-MR program provider on or after the
effective date of this section. A contract entered into with an
ICF-MR program provider before the effective date of this section
is governed by the law in effect on the date the contract was
entered into, and the former law is continued in effect for that
purpose.
SECTION 2.58. Section 533.084, Health and Safety Code, is
amended by adding Subsections (b-1) and (b-2) to read as follows:
(b-1) Notwithstanding Subsection (b) or any other law, the
proceeds from the disposal of any surplus real property by the
department that occurs before September 1, 2005:
(1) are not required to be deposited to the credit of
the department in the Texas capital trust fund established under
Chapter 2201, Government Code; and
(2) may be appropriated for any general governmental
purpose.
(b-2) Subsection (b-1) and this subsection expire September
1, 2005.
SECTION 2.59. Subchapter D, Chapter 533, Health and Safety
Code, is amended by adding Section 533.0844 to read as follows:
Sec. 533.0844. MENTAL HEALTH COMMUNITY SERVICES TRUST FUND.
(a) In this section:
(1) "Trust fund" means the mental health community
services trust fund.
(2) "Trust fund account" means the mental health
community services trust fund account.
(b) The trust fund and the trust fund account are trust
funds held outside the state treasury by the comptroller. The trust
fund is composed of money deposited as provided by Subsection (c).
The trust fund account is composed of money deposited as provided by
Subsection (d). The comptroller is trustee of the assets of the
trust fund and trust fund account.
(c) The comptroller shall deposit to the credit of the trust
fund any money donated to the state for deposit in the trust fund,
including life insurance proceeds designated for deposit to the
trust fund.
(d) The comptroller shall deposit to the credit of the trust
fund account:
(1) interest and other investment proceeds earned on
the trust fund; and
(2) any money donated to the state for inclusion in the
trust fund account, including life insurance proceeds designated
for deposit to the trust fund account.
(e) The comptroller shall invest the trust fund to provide
for income and preservation of the trust fund's principal.
Investment earnings on the principal of the trust fund shall be
deposited to the trust fund account. Before depositing money to the
trust fund account the comptroller may deduct from the money the
comptroller's expenses incurred in managing the trust fund and the
trust fund account. The amount of deposits to the trust fund account
under this subsection shall be determined by the comptroller in a
manner intended to provide a stable and predictable stream of
annual deposits and to maintain over time the purchasing power of
trust fund investments. If the purchasing power of trust fund
investments for any 10-year period is not preserved, the
comptroller may not increase the amount of deposits to the trust
fund account until the purchasing power of the trust fund
investments is restored.
(f) Money in the trust fund account may be used only for the
provision of mental health services by or under contract with the
department. The comptroller shall make available to the department
without appropriation money in the account for expenditures
consistent with this subsection.
SECTION 2.60. Subchapter D, Chapter 533, Health and Safety
Code, is amended by adding Section 533.0846 to read as follows:
Sec. 533.0846. MENTAL RETARDATION COMMUNITY SERVICES TRUST
FUND. (a) In this section:
(1) "Trust fund" means the mental retardation
community services trust fund.
(2) "Trust fund account" means the mental retardation
community services trust fund account.
(b) The trust fund and the trust fund account are trust
funds held outside the state treasury by the comptroller. The trust
fund is composed of money deposited as provided by Subsection (c).
The trust fund account is composed of money deposited as provided by
Subsection (d). The comptroller is trustee of the assets of the
trust fund and trust fund account.
(c) The comptroller shall deposit to the credit of the trust
fund any money donated to the state for deposit in the trust fund,
including life insurance proceeds designated for deposit to the
trust fund.
(d) The comptroller shall deposit to the credit of the trust
fund account:
(1) interest and other investment proceeds earned on
the trust fund; and
(2) any money donated to the state for inclusion in the
trust fund account, including life insurance proceeds designated
for deposit to the trust fund account.
(e) The comptroller shall invest the trust fund to provide
for income and preservation of the trust fund's principal.
Investment earnings on the principal of the trust fund shall be
deposited to the trust fund account. Before depositing money to the
trust fund account the comptroller may deduct from the money the
comptroller's expenses incurred in managing the trust fund and the
trust fund account. The amount of deposits to the trust fund
account under this subsection shall be determined by the
comptroller in a manner intended to provide a stable and
predictable stream of annual deposits and to maintain over time the
purchasing power of trust fund investments. If the purchasing
power of trust fund investments for any 10-year period is not
preserved, the comptroller may not increase the amount of deposits
to the trust fund account until the purchasing power of the trust
fund investments is restored.
(f) Money in the trust fund account may be used only for the
provision of mental retardation services by or under contract with
the department. The comptroller shall make available to the
department without appropriation money in the account for
expenditures consistent with this subsection.
SECTION 2.61. Chapter 22, Human Resources Code, is amended
by adding Section 22.040 to read as follows:
Sec. 22.040. THIRD-PARTY INFORMATION. Notwithstanding any
other provision of this code, the department may use information
obtained from a third party to verify the assets and resources of a
person for purposes of determining the person's eligibility and
need for medical assistance, financial assistance, or nutritional
assistance. Third-party information includes information obtained
from:
(1) a consumer reporting agency, as defined by Section
20.01, Business & Commerce Code;
(2) an appraisal district; or
(3) the Texas Department of Transportation's vehicle
registration record database.
SECTION 2.62. (a) Section 31.0031, Human Resources Code,
is amended by amending Subsections (d) and (g) and adding
Subsection (h) to read as follows:
(d) The responsibility agreement shall require that:
(1) the parent of a dependent child cooperate with the
department and the Title IV-D agency if necessary to establish the
paternity of the dependent child and to establish or enforce child
support;
(2) if adequate and accessible providers of the
services are available in the geographic area and subject to the
availability of funds, each dependent child, as appropriate,
complete early and periodic screening, diagnosis, and treatment
checkups on schedule and receive the immunization series prescribed
by Section 161.004, Health and Safety Code, unless the child is
exempt under that section;
(3) each adult recipient, or teen parent recipient who
has completed the requirements regarding school attendance in
Subdivision (6), not voluntarily terminate paid employment of at
least 30 hours each week without good cause in accordance with rules
adopted by the department;
(4) each adult recipient for whom a needs assessment
is conducted participate in an activity to enable that person to
become self-sufficient by:
(A) continuing the person's education or
becoming literate;
(B) entering a job placement or employment skills
training program;
(C) serving as a volunteer in the person's
community; or
(D) serving in a community work program or other
work program approved by the department;
(5) each caretaker relative or parent receiving
assistance not use, sell, or possess marihuana or a controlled
substance in violation of Chapter 481, Health and Safety Code, or
abuse alcohol;
(6) each dependent child younger than 18 years of age
or teen parent younger than 19 years of age attend school regularly,
unless the child has a high school diploma or high school
equivalency certificate or is specifically exempted from school
attendance under Section 25.086, Education Code;
(7) each recipient comply with department rules
regarding proof of school attendance; [and]
(8) each recipient attend appropriate parenting
skills training classes, as determined by the needs assessment; and
(9) each recipient claim the federal earned income tax
credit on the recipient's federal income tax return for each tax
year the recipient qualifies for that credit.
(g) In this section:
(1) "Caretaker [, "caretaker] relative" means a person
who is listed as a relative eligible to receive assistance under 42
U.S.C. Section 602(a).
(2) "Payee" means a person who resides in a household
with a dependent child and who is within the degree of relationship
with the child that is required of a caretaker, but whose needs are
not included in determining the amount of financial assistance
provided for the person's household.
(h) The department shall require each payee to sign a bill
of responsibilities that defines the responsibilities of the state
and of the payee. The responsibility agreement must require that a
payee comply with the requirements of Subsections (d)(1), (2), (5),
(6), and (7).
(b) Not later than January 1, 2004, the Texas Department of
Human Services shall require each payee of financial assistance
under Chapter 31, Human Resources Code, who received that
assistance on behalf of a dependent child before September 1, 2003,
and each recipient of financial assistance under Chapter 31, Human
Resources Code, who received that assistance before September 1,
2003, to enter into a responsibility agreement that complies with
the requirements of Section 31.0031, Human Resources Code, as
amended by this section, to continue receiving that assistance.
The department may not enforce the terms of the new agreement until
the payee or recipient has an opportunity to enter into the
agreement.
SECTION 2.63. (a) Sections 31.0032, 31.0033, and 31.0034,
Human Resources Code, are amended to read as follows:
Sec. 31.0032. PAYMENT OF ASSISTANCE AFTER PERFORMANCE
[PENALTIES AND SANCTIONS]. (a) Except as provided by Section
31.0033 and notwithstanding any other law, a person for whom the
department has made an initial determination of eligibility for
financial assistance may not begin receiving any amount of that
assistance until the person cooperates with the requirements of the
responsibility agreement under Section 31.0031 for a one-month
period. The person may receive a financial assistance payment each
month only if the person cooperated with those requirements during
the previous month [231.115, Family Code, as added by Chapter 911,
Acts of the 75th Legislature, Regular Session, 1997, if after an
investigation the department or the Title IV-D agency determines
that a person is not complying with a requirement of the
responsibility agreement required under Section 31.0031, the
department immediately shall apply appropriate sanctions or
penalties regarding the assistance provided to or for that person
under this chapter].
(b) The department shall immediately notify the caretaker
relative, second parent, or payee receiving the financial
assistance if the department will not make the financial assistance
payment for a one-month period because of a person's failure to
cooperate with the requirements of the responsibility agreement
during that month [whether sanctions will be applied under this
section].
(c) This section does not prohibit the Texas Workforce
Commission, the Health and Human Services Commission, or any health
and human services agency, as defined by Section 531.001,
Government Code, [department] from providing medical assistance,
child care, or any other social or support services for an
individual who is eligible for financial assistance but to whom
that assistance is not paid because of the individual's failure to
cooperate [subject to sanctions or penalties under this chapter].
(d) The department by rule shall establish procedures to
determine whether a person has cooperated with the requirements of
the responsibility agreement during each one-month period.
Sec. 31.0033. GOOD CAUSE [NONCOMPLIANCE] HEARING FOR
FAILURE TO COOPERATE. (a) If the department or Title IV-D agency
determines that a person has failed to cooperate with the
requirements of the responsibility agreement under Section 31.0031
during a one-month period [penalties and sanctions should be
applied under Section 31.0032], the person determined to have
failed to cooperate [not complied] or, if different, the person
receiving the financial assistance may request a hearing to show
good cause for failure to cooperate [noncompliance] not later than
the 13th day after the date on which notice is received under
Section 31.0032. On a showing of good cause for failure to
cooperate [noncompliance], the person may receive a financial
assistance payment for the month in which the person failed to
cooperate [sanctions may not be imposed].
(b) The department shall promptly conduct a hearing if a
timely request is made under Subsection (a).
(c) If the department finds that good cause for the person's
failure to cooperate [noncompliance] was not shown at a hearing,
the department may not make a financial assistance payment in any
amount to the person for the person or the person's family for the
month in which the person failed to cooperate [shall apply
appropriate sanctions or penalties to or for that person until the
department, or the Title IV-D agency in a Title IV-D case,
determines that the person is in compliance with the terms of the
responsibility agreement].
(d) The department by rule shall establish criteria for good
cause failure to cooperate [noncompliance] and guidelines for what
constitutes a good faith effort on behalf of a recipient under this
section.
(e) A person has good cause for failing or refusing to
cooperate with the requirement of the responsibility agreement
under Section 31.0031(d)(1) only if the person's cooperation would
be harmful to the physical, mental, or emotional health of the
person or the person's dependent child.
Sec. 31.0034. ANNUAL REPORT. The department shall prepare
and submit an annual report to the legislature that contains
statistical information regarding persons who are applying for or
receiving financial assistance or services under this chapter,
including the number of persons receiving assistance, the type of
assistance those persons are receiving, and the length of time
those persons have been receiving the assistance. The report also
must contain information on:
(1) the number of persons to whom [sanctions and] time
limits apply;
(2) the number of persons under each time limit
category;
(3) the number of persons who are exempt from
participation under Section 31.012(c);
(4) the number of persons who were receiving financial
assistance under this chapter but are no longer eligible to receive
that assistance because they failed to cooperate [comply] with the
requirements prescribed by Section 31.0031;
(5) the number of persons who are no longer eligible to
receive financial assistance or transitional benefits under this
chapter because:
(A) the person's household income has increased
due to employment; or
(B) the person has exhausted the person's
benefits under this chapter; [and]
(6) the number of persons receiving child care, job
training, or other support services designed to assist the
transition to self-sufficiency; and
(7) the number of persons who were eligible to receive
financial assistance under this chapter for each one-month period
but to whom that financial assistance was not paid because the
person failed to cooperate with the requirements of the
responsibility agreement under Section 31.0031.
(b) Subchapter A, Chapter 31, Human Resources Code, is
amended by adding Section 31.00331 to read as follows:
Sec. 31.00331. PENALTY FOR FAILURE TO COOPERATE. (a) A
person who, during a one-month period, fails to cooperate with the
requirements of the responsibility agreement under Section 31.0031
without good cause may not receive a financial assistance payment
for the person or the person's family for that month.
(b) When the department is notified by the Texas Workforce
Commission that a client failed to cooperate with work
requirements, the department shall suspend the case for 13 days to
allow the client to appeal that finding. The case shall be denied
if the client fails to request an appeal within that 13-day period.
If the client requests an appeal and the appeal is denied, the case
shall be denied immediately. If the appeal is upheld, the case
shall be reinstated.
(c) A person who fails to cooperate with the responsibility
agreement for two consecutive months becomes ineligible for
financial assistance for the person or the person's family. The
person may reapply for financial assistance, but must cooperate
with the requirements of the responsibility agreement for a
one-month period before receiving an assistance payment for that
month.
(c) The changes in law made by this section apply to a person
receiving financial assistance under Chapter 31, Human Resources
Code, on or after the effective date of this section, regardless of
the date on which eligibility for financial assistance was
determined.
SECTION 2.64. Subchapter A, Chapter 31, Human Resources
Code, is amended by adding Section 31.0038 to read as follows:
Sec. 31.0038. TEMPORARY EXCLUSION OF NEW SPOUSE'S INCOME.
(a) Subject to the limitations prescribed by Subsection (b),
income earned by an individual who marries an individual receiving
financial assistance at the time of the marriage may not be
considered by the department during the six-month period following
the date of the marriage for purposes of determining:
(1) the amount of financial assistance granted to an
individual under this chapter for the support of dependent
children; or
(2) whether the family meets household income and
resource requirements for financial assistance under this chapter.
(b) To be eligible for the income disregard provided by
Subsection (a), the combined income of the individual receiving
financial assistance and the new spouse cannot exceed 200 percent
of the federal poverty level for their family size.
SECTION 2.65. Sections 31.012(b) and (c), Human Resources
Code, are amended to read as follows:
(b) The department by rule shall establish criteria for good
cause failure to cooperate [noncompliance] and for notification
procedures regarding participation in work or employment
activities under this section.
(c) A person who is the caretaker of a physically or
mentally disabled child who requires the caretaker's presence is
not required to participate in a program under this section. A
[Effective January 1, 2000, a single person who is the caretaker of
a child is not required to participate in a program under this
section until the caretaker's youngest child at the time the
caretaker first became eligible for assistance reaches the age of
three. Effective September 1, 2000, a single person who is the
caretaker of a child is exempt until the caretaker's youngest child
at the time the caretaker first became eligible for assistance
reaches the age of two. Effective September 1, 2001, a] single
person who is the caretaker of a child is exempt until the
caretaker's youngest child at the time the caretaker first became
eligible for assistance reaches the age of one. Notwithstanding
Sections 31.0035(b) and 32.0255(b), the department shall provide to
a person who is exempt under this subsection and who voluntarily
participates in a program under Subsection (a)(2) six months of
transitional benefits in addition to the applicable limit
prescribed by Section 31.0065.
SECTION 2.66. Subchapter A, Chapter 31, Human Resources
Code, is amended by adding Section 31.015 to read as follows:
Sec. 31.015. HEALTH, ABSTINENCE, AND MARITAL DEVELOPMENT
PROGRAM. (a) Subject to available federal funding, the department
shall develop and implement a health, abstinence, and marital
development program for recipients of financial assistance under
this chapter.
(b) The health, abstinence, and marital development program
shall promote and provide three instructional courses on the
following topics:
(1) premarital counseling for engaged couples and
marriage counseling for married couples that includes skill
development for:
(A) anger resolution;
(B) communication;
(C) honoring your spouse; and
(D) managing a budget;
(2) physical fitness and active lifestyles and
nutrition and cooking, including:
(A) abstinence for all unmarried persons,
including abstinence for persons who have previously been married;
and
(B) nutrition on a budget; and
(3) parenting skills, including parenting skills for
character development, academic success, and stepchildren.
(c) The department shall provide to a recipient of financial
assistance under this chapter additional financial assistance of
not more than $20 for the recipient's participation in a course
offered through the health, abstinence, and marital development
program up to a maximum payment of $60 a month.
(d) The department may provide the courses or may contract
with any person, including a community or faith-based organization,
for the provision of the courses.
(e) The department shall develop rules as necessary for the
administration of the health, abstinence, and marital development
program.
SECTION 2.67. Section 31.032, Human Resources Code, is
amended by adding Subsection (f) to read as follows:
(f) An applicant is not eligible for assistance authorized
by this chapter if the applicant qualified for the federal earned
income tax credit for the tax year preceding the date of
application, but did not claim the credit on the applicant's
federal income tax return. The department by rule shall require an
applicant to provide:
(1) proof of having claimed the credit; or
(2) sufficient information to support the applicant's
determination that the applicant did not qualify for the credit.
SECTION 2.68. (a) Section 32.021, Human Resources Code, is
amended by adding Subsections (q), (r), and (s) to read as follows:
(q) The department shall include in its contracts for the
delivery of medical assistance by nursing facilities clearly
defined minimum standards that relate directly to the quality of
care for residents of those facilities. The department shall
consider the recommendations made by the nursing facility quality
assurance team under Section 32.060 in establishing the standards.
The department shall include in each contract:
(1) specific performance measures by which the
department may evaluate the extent to which the nursing facility is
meeting the standards; and
(2) provisions that allow the department to terminate
the contract if the nursing facility is not meeting the standards.
(r) The department may not award a contract for the delivery
of medical assistance to a nursing facility that does not meet the
minimum standards that would be included in the contract as
required by Subsection (q). The department shall terminate a
contract for the delivery of medical assistance by a nursing
facility that does not meet or maintain the minimum standards
included in the contract in a manner consistent with the terms of
the contract.
(s) Not later than November 15 of each even-numbered year,
the department shall submit a report to the legislature regarding
nursing facilities that contract with the department to provide
medical assistance under this chapter and other nursing facilities
with which the department was prohibited to contract as provided by
Subsection (r). The department may include the report required
under this section with the report made by the long-term care
legislative oversight committee as required by Section 242.654,
Health and Safety Code. The report must include:
(1) recommendations for improving the quality of
information provided to consumers about the facilities;
(2) the minimum standards and performance measures
included in the department's contracts with those facilities;
(3) the performance of the facilities with regard to
the minimum standards;
(4) the number of facilities with which the department
has terminated a contract or to which the department will not award
a contract because the facilities do not meet the minimum
standards; and
(5) the overall impact of the minimum standards on the
quality of care provided by the facilities, consumers' access to
facilities, and cost of care.
(b) Section 32.021(q), Human Resources Code, as added by
this section, applies only to a contract for the delivery of medical
assistance by a nursing facility that is entered into or renewed on
or after May 1, 2004. A contract for the delivery of medical
assistance by a nursing facility entered into before that date is
governed by the law in effect on the date the contract was entered
into, and the former law is continued in effect for that purpose.
SECTION 2.69. Subchapter B, Chapter 32, Human Resources
Code, is amended by adding Section 32.0212 to read as follows:
Sec. 32.0212. DELIVERY OF MEDICAL ASSISTANCE.
Notwithstanding any other law and subject to Section 533.0025,
Government Code, the department shall provide medical assistance
through the Medicaid managed care system implemented under Chapter
533, Government Code.
SECTION 2.70. (a) Section 32.024, Human Resources Code, is
amended by adding Subsections (t-1), (z), and (z-1) to read as
follows:
(t-1) The department, in its rules governing the medical
transportation program, may not prohibit a recipient of medical
assistance from receiving transportation services through the
program on the basis that the recipient resides in a nursing
facility.
(z) In its rules and standards governing the vendor drug
program, the department, to the extent allowed by federal law and if
the department determines the policy to be cost-effective, may
ensure that a recipient of prescription drug benefits under the
medical assistance program does not, unless authorized by the
department in consultation with the recipient's attending
physician or advanced practice nurse, receive under the medical
assistance program:
(1) more than four different outpatient brand-name
prescription drugs during a month; or
(2) more than a 34-day supply of a brand-name
prescription drug at any one time.
(z-1) Subsection (z) does not affect any other limit on
prescription medications otherwise prescribed by department rule.
(b) Section 32.024(z), Human Resources Code, as added by
this section, applies to a person receiving medical assistance on
or after the effective date of this section regardless of the date
on which the person began receiving that medical assistance.
SECTION 2.71. Section 32.026(e), Human Resources Code, is
amended to read as follows:
(e) The department shall permit a recertification review of
the eligibility and need for medical assistance of a child under 19
years of age to be conducted by a person-to-person telephone
interview or through a combination of a telephone interview and
mail correspondence instead of through a personal appearance at a
department office.
SECTION 2.72. Section 10(c), Chapter 584, Acts of the 77th
Legislature, Regular Session, 2001, is amended to read as follows:
(c) The Health and Human Services Commission or the
appropriate state agency operating part of the medical assistance
program under Chapter 32, Human Resources Code, shall adopt rules
required by Section 32.0261, Human Resources Code, as added by this
Act, so that the rules take effect in accordance with that section
not earlier than September 1, 2002, or later than June 1, 2004
[2003]. The rules must provide for a 12-month period of continuous
eligibility in accordance with that section for a child whose
initial or continued eligibility is determined on or after the
effective date of the rules.
SECTION 2.73. Section 32.028, Human Resources Code, is
amended by amending Subsection (g) and adding Subsection (i) to
read as follows:
(g) Subject to Subsection (i), the [The] Health and Human
Services Commission shall ensure that the rules governing the
determination of rates paid for nursing home services improve the
quality of care by:
(1) providing a program offering incentives for
increasing direct care staff and direct care wages and benefits,
but only to the extent that appropriated funds are available after
money is allocated to base rate reimbursements as determined by the
Health and Human Services Commission's nursing facility rate
setting methodologies; and
(2) if appropriated funds are available after money is
allocated for payment of incentive-based rates under Subdivision
(1), providing incentives that incorporate the use of a quality of
care index, a customer satisfaction index, and a resolved
complaints index developed by the commission.
(i) The Health and Human Services Commission shall ensure
that rules governing the incentives program described by Subsection
(g)(1):
(1) provide that participation in the program by a
nursing home is voluntary;
(2) do not impose on a nursing home not participating
in the program a minimum spending requirement for direct care staff
wages and benefits; and
(3) do not set a base rate for a nursing home
participating in the program that is more than the base rate for a
nursing home not participating in the program.
SECTION 2.74. Subchapter B, Chapter 32, Human Resources
Code, is amended by adding Section 32.0291 to read as follows:
Sec. 32.0291. PREPAYMENT REVIEWS AND POSTPAYMENT HOLDS.
(a) Notwithstanding any other law, the department may:
(1) perform a prepayment review of a claim for
reimbursement under the medical assistance program to determine
whether the claim involves fraud or abuse; and
(2) as necessary to perform that review, withhold
payment of the claim for not more than five working days without
notice to the person submitting the claim.
(b) Notwithstanding any other law, the department may
impose a postpayment hold on payment of future claims submitted by a
provider if the department has reliable evidence that the provider
has committed fraud or wilful misrepresentation regarding a claim
for reimbursement under the medical assistance program. The
department must notify the provider of the postpayment hold not
later than the fifth working day after the date the hold is imposed.
SECTION 2.75. Section 32.032, Human Resources Code, is
amended to read as follows:
Sec. 32.032. PREVENTION AND DETECTION OF FRAUD AND ABUSE.
The department shall adopt reasonable rules for minimizing the
opportunity for fraud and abuse, for establishing and maintaining
methods for detecting and identifying situations in which a
question of fraud or abuse in the program may exist, and for
referring cases where fraud or abuse appears to exist to the
appropriate law enforcement agencies for prosecution.
SECTION 2.76. Section 32.0321(a), Human Resources Code, is
amended to read as follows:
(a) The department by rule may require each provider of
medical assistance in a provider type that has demonstrated
significant potential for fraud or abuse to file with the
department a surety bond in a reasonable amount. The department by
rule shall require a provider of medical assistance to file with the
department a surety bond in a reasonable amount if the department
identifies an irregularity relating to the provider's services
under the medical assistance program that indicates the need for
protection against potential future acts of fraud or abuse.
SECTION 2.77. (a) Subchapter B, Chapter 32, Human
Resources Code, is amended by adding Section 32.0423 to read as
follows:
Sec. 32.0423. RECOVERY OF REIMBURSEMENTS FROM HEALTH
COVERAGE PROVIDERS. To the extent allowed by federal law, a health
care service provider must seek reimbursement from available
third-party health coverage or insurance before billing the medical
assistance program.
(b) Section 32.0423, Human Resources Code, as added by this
section, applies to a person receiving medical assistance on or
after the effective date of this section regardless of the date on
which the person began receiving that medical assistance.
SECTION 2.78. (a) Subchapter B, Chapter 32, Human
Resources Code, is amended by adding Section 32.0462 to read as
follows:
Sec. 32.0462. MEDICATIONS AND MEDICAL SUPPLIES. The
department may adopt rules establishing procedures for the purchase
and distribution of medically necessary, over-the-counter
medications and medical supplies under the medical assistance
program that were previously being provided by prescription if the
department determines it is more cost-effective than obtaining
those medications and medical supplies through a prescription.
(b) Not later than January 1, 2004, the Health and Human
Services Commission shall submit a report to the clerks of the
standing committees of the senate and house of representatives with
jurisdiction over the state Medicaid program describing the status
of any cost savings generated by purchasing over-the-counter
medications and medical supplies as provided by Section 32.0462,
Human Resources Code, as added by this section. The report must be
updated not later than January 1, 2005.
SECTION 2.79. Section 32.050, Human Resources Code, is
amended by adding Subsections (d) and (e) to read as follows:
(d) A nursing facility, a home health services provider, or
any other similar long-term care services provider must:
(1) seek reimbursement from Medicare before billing
the medical assistance program for services provided to an
individual identified under Subsection (a); and
(2) as directed by the department, appeal Medicare
claim denials for payment services provided to an individual
identified under Subsection (a).
(e) If the Medicare reimbursement rate for a service
provided to an individual identified under Subsection (a) exceeds
the medical assistance reimbursement rate for a comparable service,
the medical assistance program may not pay a Medicare coinsurance
or deductible amount for that service.
SECTION 2.80. (a) Subchapter B, Chapter 32, Human
Resources Code, is amended by adding Section 32.060 to read as
follows:
Sec. 32.060. NURSING FACILITY QUALITY ASSURANCE TEAM. (a)
The nursing facility quality assurance team is established to make
recommendations to the department designed to promote high-quality
care for residents of nursing facilities.
(b) The team is composed of nine members appointed by the
governor as follows:
(1) two physicians with expertise in providing
long-term care;
(2) one registered nurse with expertise in providing
long-term care;
(3) three nursing facility advocates not affiliated
with the nursing facility industry; and
(4) three representatives of the nursing facility
industry.
(c) The governor shall designate a member of the team to
serve as presiding officer. The members of the team shall elect any
other necessary officers.
(d) The team shall meet at the call of the presiding
officer.
(e) A member of the team serves at the will of the governor.
(f) A member of the team may not receive compensation for
serving on the team but is entitled to reimbursement for travel
expenses incurred by the member while conducting the business of
the team as provided by the General Appropriations Act.
(g) The team shall:
(1) develop and recommend clearly defined minimum
standards to be included in contracts between the department and
nursing facilities for the delivery of medical assistance under
this chapter that are designed to:
(A) ensure that the care provided by nursing
facilities to residents who are recipients of medical assistance
meets or exceeds the minimum acceptable standard of care; and
(B) encourage nursing facilities to provide the
highest quality of care to those residents; and
(2) develop and recommend improvements to consumers'
access to information regarding the quality of care provided by
nursing facilities that contract with the department to provide
medical assistance, including improvements in:
(A) the types and amounts of information to which
consumers have access, such as expanding the types and amounts of
information available through the department's Internet website;
and
(B) the department's data systems that compile
nursing facilities' inspection or survey data and other data
relating to quality of care in nursing facilities.
(h) In developing minimum standards for contracts as
required by Subsection (g)(1), the team shall:
(1) study the risk factors identified by the Texas
Department of Insurance as contributing to lawsuits against nursing
facilities;
(2) consider for inclusion in the minimum standards:
(A) the practices the Texas Department of
Insurance recommends nursing facilities adopt to reduce the
likelihood of those lawsuits; and
(B) other standards designed to improve the
quality of care; and
(3) focus on a minimum number of critical standards
necessary to identify nursing facilities with poor quality services
that should not be awarded contracts for the delivery of medical
assistance.
(i) The department shall ensure the accuracy of information
provided to the team for use by the team in performing the team's
duties under this section. The Health and Human Services
Commission shall provide administrative support and resources to
the team and request additional administrative support and
resources from health and human services agencies as necessary.
(b) The governor shall appoint the members of the nursing
facility quality assurance team established under Section 32.060,
Human Resources Code, as added by this section, not later than
January 1, 2004.
(c) The nursing facility quality assurance team shall
develop and make the recommendations required by Section 32.060,
Human Resources Code, as added by this section, not later than May
1, 2004.
(d) The Texas Department of Human Services shall implement
the recommendations for improving the quality of nursing facility
information provided to consumers that are made by the nursing
facility quality assurance team as required by Section 32.060,
Human Resources Code, as added by this section, and that the
department determines are appropriate not later than September 1,
2004.
SECTION 2.81. Subchapter B, Chapter 32, Human Resources
Code, is amended by adding Section 32.061 to read as follows:
Sec. 32.061. COMMUNITY ATTENDANT SERVICES PROGRAM. Any home
and community-based services that the department provides under
Section 1929, Social Security Act (42 U.S.C. Section 1396t) and its
subsequent amendments to functionally disabled individuals who
have income that exceeds the limit established by federal law for
Supplemental Security Income (SSI) (42 U.S.C. Section 1381 et seq.)
and its subsequent amendments shall be provided through the
community attendant services program.
SECTION 2.82. (a) Subchapter B, Chapter 32, Human
Resources Code, is amended by adding Section 32.063 to read as
follows:
Sec. 32.063. THIRD-PARTY BILLING VENDORS. (a) A
third-party billing vendor may not submit a claim with the
department for reimbursement on behalf of a provider of medical
services under the medical assistance program unless the vendor has
entered into a contract with the department authorizing that
activity.
(b) To the extent practical, the contract shall contain
provisions comparable to the provisions contained in contracts
between the department and providers of medical services, with an
emphasis on provisions designed to prevent fraud or abuse under the
medical assistance program. At a minimum, the contract must
require the third-party billing vendor to:
(1) provide documentation of the vendor's authority to
bill on behalf of each provider for whom the vendor submits claims;
(2) submit a claim in a manner that permits the
department to identify and verify the vendor, any computer or
telephone line used in submitting the claim, any relevant user
password used in submitting the claim, and any provider number
referenced in the claim; and
(3) subject to any confidentiality requirements
imposed by federal law, provide the department, the office of the
attorney general, or authorized representatives with:
(A) access to any records maintained by the
vendor, including original records and records maintained by the
vendor on behalf of a provider, relevant to an audit or
investigation of the vendor's services or another function of the
department or office of the attorney general relating to the
vendor; and
(B) if requested, copies of any records described
by Paragraph (A) at no charge to the department, the office of the
attorney general, or authorized representatives.
(c) On receipt of a claim submitted by a third-party billing
vendor, the department shall send a remittance notice directly to
the provider referenced in the claim. The notice must:
(1) include detailed information regarding the claim
submitted on behalf of the provider; and
(2) require the provider to review the claim for
accuracy and notify the department promptly regarding any errors.
(d) The department shall take all action necessary,
including any modifications of the department's claims processing
system, to enable the department to identify and verify a
third-party billing vendor submitting a claim for reimbursement
under the medical assistance program, including identification and
verification of any computer or telephone line used in submitting
the claim, any relevant user password used in submitting the claim,
and any provider number referenced in the claim.
(b) Section 32.063, Human Resources Code, as added by this
section, takes effect January 1, 2004.
SECTION 2.83. (a) Subchapter B, Chapter 32, Human
Resources Code, is amended by adding Section 32.064 to read as
follows:
Sec. 32.064. COST SHARING. (a) To the extent permitted
under Title XIX, Social Security Act (42 U.S.C. Section 1396 et
seq.), as amended, and any other applicable law or regulations, the
Health and Human Services Commission shall adopt provisions
requiring recipients of medical assistance to share the cost of
medical assistance, including provisions requiring recipients to
pay:
(1) a copayment for services provided under the
medical assistance program;
(2) an enrollment fee;
(3) a deductible; or
(4) coinsurance or a portion of the plan premium, if
the recipients receive medical assistance under the Medicaid
managed care program under Chapter 533, Government Code, or a
Medicaid managed care demonstration project under Section 32.041.
(b) Subject to Subsection (d), cost-sharing provisions
adopted under this section shall ensure that families with higher
levels of income are required to pay progressively higher
percentages of the cost of the medical assistance.
(c) If cost-sharing provisions imposed under Subsection (a)
include requirements that recipients pay a portion of the plan
premium, the commission shall specify the manner in which the
premium is paid. The commission may require that the premium be
paid to the commission, an agency operating part of the medical
assistance program, or the provider of medical assistance.
(d) Cost-sharing provisions adopted under this section may
be determined based on the maximum level authorized under federal
law and applied to income levels in a manner that minimizes
administrative costs.
(e) During the fiscal biennium ending August 31, 2005, the
commission shall evaluate the effect of copayment requirements to
determine the cost to providers of collecting and recording
copayments, the frequency of payments made by recipients, including
any regional variation in collection, and the extent to which
copayment requirements modify recipient behavior in accessing
services. Any reduction to provider reimbursement rates, in
anticipation of the collection of copayments, may be made only
after the completion of the evaluation required by this subsection.
(b) The changes in law made by Section 32.064, Human
Resources Code, as added by this section, apply to a person
receiving medical assistance on or after the effective date of this
section, regardless of the date on which eligibility for that
assistance was determined.
SECTION 2.84. Section 73.0051, Human Resources Code, is
amended by adding Subsection (l) to read as follows:
(l) The council by rule may establish a system of payments
by families of children receiving services under this chapter,
including a schedule of sliding fees, in a manner consistent with 34
C.F.R. Sections 303.12(a)(3)(iv), 303.520, and 303.521.
SECTION 2.85. (a) Sections 91.027(a) and (b), Human
Resources Code, are amended to read as follows:
(a) To the extent that funds are available under Sections
521.421(f), as added by Chapter 510, Acts of the 75th Legislature,
Regular Session, 1997, and 521.422(b), Transportation Code, the
[The] commission shall operate [develop] a Blindness Education,
Screening, and Treatment Program to provide:
(1) blindness prevention education and [to provide]
screening and treatment to prevent blindness for residents who are
not covered under an adequate health benefit plan; and
(2) transition services to blind disabled individuals
eligible for vocational rehabilitation services under Section
91.052.
(b) [The commission shall implement the program only to the
extent that funds are available under Section 521.421(f),
Transportation Code.] The program shall include:
(1) public education about blindness and other eye
conditions;
(2) screenings and eye examinations to identify
conditions that may cause blindness; [and]
(3) treatment procedures necessary to prevent
blindness; and
(4) transition services.
(b) The Texas Commission for the Blind shall establish the
consolidated program under Section 91.027, Human Resources Code, as
amended by this section, not later than the 90th day after the
effective date of this section.
SECTION 2.86. (a) Section 111.052, Human Resources Code,
is amended to read as follows:
Sec. 111.052. GENERAL FUNCTIONS. (a) The commission
shall, to the extent of resources available and priorities
established by the board, provide rehabilitation services directly
or through public or private resources to individuals determined by
the commission to be eligible for the services under a vocational
rehabilitation program[, an extended rehabilitation services
program,] or other program established to provide rehabilitative
services.
(b) In carrying out the purposes of this chapter, the
commission may:
(1) cooperate with other departments, agencies,
political subdivisions, and institutions, both public and private,
in providing the services authorized by this chapter to eligible
individuals, in studying the problems involved, and in planning,
establishing, developing, and providing necessary or desirable
programs, facilities, and services, including those jointly
administered with state agencies;
(2) enter into reciprocal agreements with other
states;
(3) establish or construct rehabilitation facilities
and workshops, contract with or provide grants to agencies,
organizations, or individuals as necessary to implement this
chapter, make contracts or other arrangements with public and other
nonprofit agencies, organizations, or institutions for the
establishment of workshops and rehabilitation facilities, and
operate facilities for carrying out the purposes of this chapter;
(4) conduct research and compile statistics relating
to the provision of services to or the need for services by disabled
individuals;
(5) provide for the establishment, supervision,
management, and control of small business enterprises to be
operated by individuals with significant disabilities where their
operation will be improved through the management and supervision
of the commission;
(6) contract with schools, hospitals, private
industrial firms, and other agencies and with doctors, nurses,
technicians, and other persons for training, physical restoration,
transportation, and other rehabilitation services; and
(7) assess the statewide need for services necessary
to prepare students with disabilities for a successful transition
to employment, establish collaborative relationships with each
school district with education service centers to the maximum
extent possible within available resources, and develop strategies
to assist vocational rehabilitation counselors in identifying and
reaching students in need of transition planning [contract with a
public or private agency to provide and pay for rehabilitative
services under the extended rehabilitation services program,
including alternative sheltered employment or community integrated
employment for a person participating in the program].
(b) Sections 111.002(7), 111.0525(a), and 111.073, Human
Resources Code, are repealed.
SECTION 2.87. Section 111.060, Human Resources Code, is
amended by adding Subsection (d) to read as follows:
(d) Notwithstanding any other provision of this section,
any money in the comprehensive rehabilitation fund may be used for
general governmental purposes if:
(1) the comptroller certifies that appropriations
from general revenue made by the preceding legislature for the
current biennium exceed available general revenues and cash
balances for the remainder of that biennium;
(2) an estimate of anticipated revenues for a
succeeding biennium prepared by the comptroller in accordance with
Section 49a, Article III, Texas Constitution, is less than the
revenues that are estimated at the same time by the comptroller to
be available for the current biennium; or
(3) the Legislative Budget Board otherwise determines
that a state fiscal emergency exists that requires use of any money
in the fund for general governmental purposes.
SECTION 2.88. (a) Subchapter I, Chapter 264, Family Code,
is transferred to Chapter 33, Education Code, is redesignated as
Subchapter E, Chapter 33, Education Code, and is amended to read as
follows:
SUBCHAPTER E [I]. COMMUNITIES IN SCHOOLS PROGRAM
Sec. 33.151 [264.751]. DEFINITIONS. In this subchapter:
(1) "Department" ["Agency"] means the Department of
Protective and Regulatory Services [Texas Education Agency].
(2) "Communities In Schools program" means an
exemplary youth dropout prevention program.
(3) "Delinquent conduct" has the meaning assigned by
Section 51.03, Family Code.
(4) "Student at risk of dropping out of school" means:
(A) a student at risk of dropping out of school as
defined [has the meaning assigned] by Section 29.081;
(B) a student who is educationally
disadvantaged; [, Education Code, or means a student who is
eligible for a free or reduced lunch] or
(C) a student who is in family conflict or
crisis.
Sec. 33.152 [264.752]. STATEWIDE OPERATION OF PROGRAM. It
is the intent of the legislature that the Communities In Schools
program operate throughout this state. It is also the intent of the
legislature that programs established under Chapter 305, Labor
Code, as that chapter existed on August 31, 1999, and its
predecessor statute, the Texas Unemployment Compensation Act
(Article 5221b-9d, Vernon's Texas Civil Statutes), and programs
established under this subchapter shall remain eligible to
participate in the Communities In Schools program if funds are
available and if their performance meets the criteria established
by the agency [department] for renewal of their contracts.
Sec. 33.153 [264.753]. STATE DIRECTOR. The commissioner
[executive director of the department] shall designate a state
director for the Communities In Schools program.
Sec. 33.154 [264.754]. DUTIES OF STATE DIRECTOR. The state
director shall:
(1) coordinate the efforts of the Communities In
Schools program with other social service organizations and
agencies and with public school personnel to provide services to
students who are at risk of dropping out of school or engaging in
delinquent conduct, including students who are in family conflict
or emotional crisis;
(2) set standards for the Communities In Schools
program and establish state performance goals, objectives, and
measures for the program;
(3) obtain information to determine accomplishment of
state performance goals, objectives, and measures;
(4) promote and market the program in communities in
which the program is not established;
(5) help communities that want to participate in the
program establish a local funding base; and
(6) provide training and technical assistance for
participating communities and programs.
Sec. 33.155 [264.755]. DEPARTMENT [AGENCY] COOPERATION;
MEMORANDUM OF UNDERSTANDING. (a) The agency, the department, and
Communities In Schools, Inc. shall work together to maximize the
effectiveness of the Communities In Schools program.
(b) The agency and the department shall develop and
[mutually] agree to a memorandum of understanding to clearly define
the responsibilities of the agency and of the department under this
subchapter. The memorandum must address:
(1) the roles [role] of the agency and department in
encouraging local business to participate in local Communities In
Schools programs;
(2) the role of the agency in obtaining information
from participating school districts;
(3) the use of federal or state funds available to the
agency or the department for programs of this nature; and
(4) other areas identified by the agency and the
department that require clarification.
(c) The agency and the department shall adopt rules to
implement the memorandum and shall update the memorandum and rules
annually.
Sec. 33.156 [264.756]. FUNDING; EXPANSION OF
PARTICIPATION. (a) The agency [department] shall develop and
implement an equitable formula for the funding of local Communities
In Schools programs. The formula may provide for the reduction of
funds annually contributed by the state to a local program by an
amount not more than 50 percent of the amount contributed by the
state for the first year of the program. The formula must consider
the financial resources of individual communities and school
districts. Savings accomplished through the implementation of the
formula may be used to extend services to counties and
municipalities currently not served by a local program or to extend
services to counties and municipalities currently served by an
existing local program.
(b) Each local Communities In Schools program shall develop
a funding plan which ensures that the level of services is
maintained if state funding is reduced.
(c) A local Communities In Schools program may accept
federal funds, state funds, private contributions, grants, and
public and school district funds to support a campus participating
in the program.
Sec. 33.157 [264.757]. PARTICIPATION IN PROGRAM. An
elementary or secondary school receiving funding [designated]
under Section 33.156 [264.756] shall participate in a local
Communities In Schools program if the number of students enrolled
in the school who are at risk of dropping out of school is equal to
at least 10 percent of the number of students in average daily
attendance at the school, as determined by the agency.
Sec. 33.158 [264.758]. DONATIONS TO PROGRAM. (a) The
agency [department] may accept a donation of services or money or
other property that the agency [department] determines furthers the
lawful objectives of the agency [department] in connection with the
Communities In Schools program.
(b) Each donation, with the name of the donor and the
purpose of the donation, must be reported in the public records of
the agency [department].
(b) Section 302.062(g), Labor Code, is amended to read as
follows:
(g) Block grant funding under this section does not apply
to:
(1) the work and family policies program under Chapter
81;
(2) a program under the skills development fund
created under Chapter 303;
(3) the job counseling program for displaced
homemakers under Chapter 304;
(4) the Communities In Schools program under
Subchapter E [I], Chapter 33 [264], Education [Family] Code, to the
extent that funds are available to the commission for that program;
(5) the reintegration of offenders program under
Chapter 306;
(6) apprenticeship programs under Chapter 133,
Education Code;
(7) the continuity of care program under Section
501.095, Government Code;
(8) employment programs under Chapter 31, Human
Resources Code;
(9) the senior citizens employment program under
Chapter 101, Human Resources Code;
(10) the programs described by Section 302.021(b)(3);
(11) the community service program under the National
and Community Service Act of 1990 (42 U.S.C. Section 12501 et seq.);
(12) the trade adjustment assistance program under
Part 2, Subchapter II, Trade Act of 1974 (19 U.S.C. Section 2271 et
seq.);
(13) the programs to enhance the employment
opportunities of veterans; and
(14) the functions of the State Occupational
Information Coordinating Committee.
(c) On September 1, 2003:
(1) all powers, duties, functions, and activities
relating to the Communities In Schools program assigned to or
performed by the Department of Protective and Regulatory Services
immediately before September 1, 2003, are transferred to the Texas
Education Agency;
(2) all funds, rights, obligations, and contracts of
the Department of Protective and Regulatory Services related to the
Communities In Schools program are transferred to the Texas
Education Agency for the Communities In Schools program;
(3) all property and records in the custody of the
Department of Protective and Regulatory Services related to the
Communities In Schools program and all funds appropriated by the
legislature for the Communities In Schools program are transferred
to the Texas Education Agency for the Communities In Schools
program; and
(4) all employees of the Department of Protective and
Regulatory Services who primarily perform duties related to the
Communities In Schools program become employees of the Texas
Education Agency, to be assigned duties related to the Communities
In Schools program.
(d) For the 2003 and 2004 state fiscal years, all full-time
equivalent positions (FTEs) authorized by the General
Appropriations Act for the Communities In Schools program are
transferred to the Texas Education Agency and are not included in
determining the agency's compliance with any limitation on the
number of full-time equivalent positions (FTEs) imposed by the
General Appropriations Act.
(e) A reference in law or administrative rule to the
Department of Protective and Regulatory Services that relates to
the Communities In Schools program means the Texas Education
Agency. A reference in law or administrative rule to the executive
director of the Department of Protective and Regulatory Services
that relates to the Communities In Schools program means the
commissioner of education.
(f) A rule of the Department of Protective and Regulatory
Services relating to the Communities In Schools program continues
in effect as a rule of the commissioner of education until
superseded by rule of the commissioner of education. The secretary
of state is authorized to adopt rules as necessary to expedite the
implementation of this subsection.
(g) The transfer of the Communities In Schools program and
associated powers, duties, functions, and activities under this
section does not affect or impair any act done, any obligation,
right, order, license, permit, rule, criterion, standard, or
requirement existing, any investigation begun, or any penalty
accrued under former law, and that law remains in effect for any
action concerning those matters.
(h) An action brought or proceeding commenced before
September 1, 2003, including a contested case or a remand of any
action or proceeding by a reviewing court, is governed by the law
and rules applicable to the action or proceeding immediately before
September 1, 2003.
SECTION 2.89. (a) Section 2(c), Article 4.11, Insurance
Code, is amended to read as follows:
(c) "Gross premiums" are the total gross amount of all
premiums, membership fees, assessments, dues, and any other
considerations for such insurance received during the taxable year
on each and every kind of such insurance policy or contract covering
persons located in the State of Texas and arising from the types of
insurance specified in Section 1 of this article, but deducting
returned premiums, any dividends applied to purchase paid-up
additions to insurance or to shorten the endowment or premium
payment period, and excluding those premiums received from
insurance carriers for reinsurance and there shall be no deduction
for premiums paid for reinsurance. For purposes of this article, a
stop-loss or excess loss insurance policy issued to a health
maintenance organization, as defined under the Texas Health
Maintenance Organization Act (Chapter 20A, Vernon's Texas
Insurance Code), shall be considered reinsurance. Such gross
premiums shall not include premiums received from the [Treasury of
the State of Texas or from the] Treasury of the United States for
[insurance contracted for by the state or federal government for
the purpose of providing welfare benefits to designated welfare
recipients or for] insurance contracted for by the [state or]
federal government in accordance with or in furtherance of the
provisions of Title XVIII of [2, Human Resources Code, or] the
Federal Social Security Act (42 U.S.C. Section 1395c et seq.) and
its subsequent amendments. The gross premiums receipts so reported
shall not include the amount of premiums paid on group health,
accident, and life policies in which the group covered by the policy
consists of a single nonprofit trust established to provide
coverage primarily for employees of:
(1) a municipality, county, or hospital district in
this state; or
(2) a county or municipal hospital, without regard to
whether the employees are employees of the county or municipality
or another entity operating the hospital on behalf of the county or
municipality.
(b) The change in law made by this section applies only to a
tax report originally due on or after January 1, 2004.
SECTION 2.90. (a) Article 4.17(a), Insurance Code, is
amended to read as follows:
(a) The commissioner shall annually determine the rate of
assessment of a maintenance tax to be paid on an annual, semiannual,
or other periodic basis, as determined by the comptroller. The rate
of assessment may not exceed .04 percent of the correctly reported
gross premiums of life, health, and accident insurance coverages
and the gross considerations for annuity and endowment contracts
collected by all authorized insurers writing life, health, and
accident insurance, annuity, or endowment contracts in this state.
The comptroller shall collect the maintenance tax. For purposes of
this article, the gross premiums on which an assessment is based may
not include premiums received from [this state or] the United
States for insurance contracted for by [this state or] the United
States [for the purpose of providing welfare benefits to designated
welfare recipients or for insurance contracted for by this state or
the United States] in accordance with or in furtherance of Title
XVIII of [2, Human Resources Code, or] the federal Social Security
Act (42 U.S.C. Section 1395c et seq.) and its subsequent amendments
[(42 U.S.C. Section 301 et seq.)].
(b) The change in law made by this section applies only to a
tax report originally due on or after January 1, 2004.
SECTION 2.91. (a) Section 20A.33(d), Texas Health
Maintenance Organization Act (Article 20A.33, Vernon's Texas
Insurance Code), is amended to read as follows:
(d) The commissioner shall annually determine the rate of
assessment of a per capita maintenance tax to be paid on an annual
or semiannual basis, on the correctly reported gross revenues for
the issuance of health maintenance certificates or contracts
collected by all authorized health maintenance organizations
issuing such coverages in this state. The rate of assessment may
not exceed $2 for each enrollee. The rate of assessment may differ
between basic health care plans, limited health care service plans,
and single health care service plans and shall equitably reflect
any differences in regulatory resources attributable to each type
of plan. The comptroller shall collect the maintenance tax. For
purposes of this section, the amount of maintenance tax assessed
may not be computed on enrollees who as individual certificate
holders or their dependents are covered by a master group policy
paid for by revenues received from [this state or] the United States
for insurance contracted for by [this state or] the United States
[for the purpose of providing welfare benefits to designated
welfare recipients or for insurance contracted for by this state or
the United States] in accordance with or in furtherance of Title
XVIII of [2, Human Resources Code, or] the federal Social Security
Act (42 U.S.C. Section 1395c et seq.) and its subsequent amendments
[(42 U.S.C. Section 301 et seq.)].
(b) The change in law made by this section applies only to a
tax report originally due on or after January 1, 2004.
SECTION 2.92. Section 2, Article 21.52K, Insurance Code, is
amended by amending Subsections (c) and (d) and adding Subsection
(g) to read as follows:
(c) If an individual described by Subsection (a), [or] (b),
or (g) of this section is not eligible to enroll in the plan unless a
family member of the individual is also enrolled in the plan, the
issuer, on receipt of the written notice or request under
Subsection (a), [or] (b), or (g) of this section, shall enroll both
the individual and the family member in the plan.
(d) Unless enrollment occurs during an established
enrollment period, enrollment under this article takes effect on
the first day of the calendar month that begins at least 30 days
after the date written notice or request is received by the issuer
under Subsection (a), [or] (b), or (g) of this section.
(g) The issuer of a group health benefit plan shall permit
an individual who is otherwise eligible for enrollment in the plan
to enroll in the plan without regard to any enrollment period
restriction if the individual:
(1) becomes ineligible for medical assistance under
the state Medicaid program or enrollment in the state child health
plan under Chapter 62, Health and Safety Code, after initially
establishing eligibility; and
(2) provides a written request for enrollment in the
group health benefit plan not later than the 30th day after the date
the individual's eligibility for the state Medicaid program or the
state child health plan terminated.
SECTION 2.93. (a) Article 21.53F, Insurance Code, as added
by Chapter 683, Acts of the 75th Legislature, Regular Session,
1997, is amended by adding Section 9 to read as follows:
Sec. 9. OFFER OF COVERAGE REQUIRED; CERTAIN THERAPIES FOR
CHILDREN WITH DEVELOPMENTAL DELAYS. (a) For purposes of this
section, rehabilitative and habilitative therapies include:
(1) occupational therapy evaluations and services;
(2) physical therapy evaluations and services;
(3) speech therapy evaluations and services; and
(4) dietary or nutritional evaluations.
(b) The issuer of a health benefit plan must offer coverage
that complies with this section. The individual or group policy or
contract holder may reject coverage required to be offered under
this subsection.
(c) A health benefit plan that provides coverage for
rehabilitative and habilitative therapies under this section may
not prohibit or restrict payment for covered services provided to a
child and determined to be necessary to and provided in accordance
with an individualized family service plan issued by the
Interagency Council on Early Childhood Intervention under Chapter
73, Human Resources Code.
(d) Rehabilitative and habilitative therapies described by
Subsection (c) of this section must be covered in the amount,
duration, scope, and service setting established in the child's
individualized family service plan.
(e) Under the coverage required to be offered under this
section, a health benefit plan issuer may not:
(1) apply the cost of rehabilitative and habilitative
therapies described by Subsection (c) of this section to an annual
or lifetime maximum plan benefit or similar provision under the
plan; or
(2) use the cost of rehabilitative or habilitative
therapies described by Subsection (c) of this section as the sole
justification for:
(A) increasing plan premiums; or
(B) terminating the insured's or enrollee's
participation in the plan.
(b) The change in law made by this section applies only to a
health benefit plan that is delivered, issued for delivery, or
renewed on or after January 1, 2004. A health benefit plan that is
delivered, issued for delivery, or renewed before January 1, 2004,
is governed by the law as it existed immediately before the
effective date of this section, and the former law is continued in
effect for that purpose.
SECTION 2.94. Section 455.0015, Transportation Code, is
amended by adding Subsection (c) to read as follows:
(c) The Texas Department of Health shall contract with the
department for the department to assume all responsibilities of the
Texas Department of Health relating to the provision of
transportation services.
SECTION 2.95. Section 40.002, Human Resources Code, is
amended by adding Subsection (f) to read as follows:
(f) The department shall contract with the Texas Department
of Transportation for the Texas Department of Transportation to
assume all responsibilities of the department relating to the
provision of transportation services.
SECTION 2.96. Section 22.001, Human Resources Code, is
amended by adding Subsection (e) to read as follows:
(e) The department shall contract with the Texas Department
of Transportation for the Texas Department of Transportation to
assume all responsibilities of the department relating to the
provision of transportation services.
SECTION 2.97. Section 91.021, Human Resources Code, is
amended by adding Subsection (g) to read as follows:
(g) The commission shall contract with the Texas Department
of Transportation for the Texas Department of Transportation to
assume all responsibilities of the commission relating to the
provision of transportation services.
SECTION 2.98. Section 101.0256, Human Resources Code, is
amended to read as follows:
Sec. 101.0256. COORDINATED ACCESS TO LOCAL
SERVICES. (a) The department and the Texas Department of Human
Services shall develop standardized assessment procedures to share
information on common clients served in a similar service region.
(b) The department shall contract with the Texas Department
of Transportation for the Texas Department of Transportation to
assume all responsibilities of the department relating to the
provision of transportation services.
SECTION 2.99. Section 111.0525, Human Resources Code, is
amended by adding Subsection (d) to read as follows:
(d) The commission shall contract with the Texas Department
of Transportation for the Texas Department of Transportation to
assume all responsibilities of the commission relating to the
provision of transportation services.
SECTION 2.100. Section 461.012(a), Health and Safety Code,
is amended to read as follows:
(a) The commission shall:
(1) provide for research and study of the problems of
chemical dependency in this state and seek to focus public
attention on those problems through public information and
education programs;
(2) plan, develop, coordinate, evaluate, and
implement constructive methods and programs for the prevention,
intervention, treatment, and rehabilitation of chemical dependency
in cooperation with federal and state agencies, local governments,
organizations, and persons, and provide technical assistance,
funds, and consultation services for statewide and community-based
services;
(3) cooperate with and enlist the assistance of:
(A) other state, federal, and local agencies;
(B) hospitals and clinics;
(C) public health, welfare, and criminal justice
system authorities;
(D) educational and medical agencies and
organizations; and
(E) other related public and private groups and
persons;
(4) expand chemical dependency services for children
when funds are available because of the long-term benefits of those
services to the state and its citizens;
(5) sponsor, promote, and conduct educational
programs on the prevention and treatment of chemical dependency,
and maintain a public information clearinghouse to purchase and
provide books, literature, audiovisuals, and other educational
material for the programs;
(6) sponsor, promote, and conduct training programs
for persons delivering prevention, intervention, treatment, and
rehabilitation services and for persons in the criminal justice
system or otherwise in a position to identify chemically dependent
persons and their families in need of service;
(7) require programs rendering services to chemically
dependent persons to safeguard those persons' legal rights of
citizenship and maintain the confidentiality of client records as
required by state and federal law;
(8) maximize the use of available funds for direct
services rather than administrative services;
(9) consistently monitor the expenditure of funds and
the provision of services by all grant and contract recipients to
assure that the services are effective and properly staffed and
meet the standards adopted under this chapter;
(10) make the monitoring reports prepared under
Subdivision (9) a matter of public record;
(11) license treatment facilities under Chapter 464;
(12) use funds appropriated to the commission to carry
out this chapter and maximize the overall state allotment of
federal funds;
(13) develop and implement policies that will provide
the public with a reasonable opportunity to appear before the
commission and to speak on any issue under the commission's
jurisdiction;
(14) establish minimum criteria that peer assistance
programs must meet to be governed by and entitled to the benefits of
a law that authorizes licensing and disciplinary authorities to
establish or approve peer assistance programs for impaired
professionals;
(15) adopt rules governing the functions of the
commission, including rules that prescribe the policies and
procedures followed by the commission in administering any
commission programs;
(16) plan, develop, coordinate, evaluate, and
implement constructive methods and programs to provide healthy
alternatives for youth at risk of selling controlled substances;
(17) submit to the federal government reports and
strategies necessary to comply with Section 1926 of the federal
Alcohol, Drug Abuse, and Mental Health Administration
Reorganization Act, Pub. L. 102-321 (42 U.S.C. Section 300x-26);
reports and strategies are to be coordinated with appropriate state
governmental entities; [and]
(18) regulate, coordinate, and provide training for
alcohol awareness courses required under Section 106.115,
Alcoholic Beverage Code, and may charge a fee for an activity
performed by the commission under this subdivision; and
(19) contract with the Texas Department of
Transportation for the Texas Department of Transportation to assume
all responsibilities of the commission relating to the provision of
transportation services.
SECTION 2.101. Section 533.012, Health and Safety Code, is
amended to read as follows:
Sec. 533.012. COOPERATION OF STATE AGENCIES. (a) At the
department's request, all state departments, agencies, officers,
and employees shall cooperate with the department in activities
that are consistent with their functions.
(b) The department shall contract with the Texas Department
of Transportation for the Texas Department of Transportation to
assume all responsibilities of the department relating to the
provision of transportation services.
SECTION 2.102. (a) Section 1551.159, Insurance Code, as
effective June 1, 2003, is amended by amending Subsection (a) and
adding Subsection (h) to read as follows:
(a) Subject to any applicable limit in the General
Appropriations Act, the board of trustees shall use money
appropriated for employer contributions to fund 80 percent of the
cost of basic coverage for a child who:
(1) is a dependent of an employee;
(2) would be eligible, if the child were not the
dependent of the employee, for benefits under the state child
health plan established under Chapter 62, Health and Safety Code
[the program established by the state to implement Title XXI,
Social Security Act (42 U.S.C. Section 1397aa et seq.), as
amended]; and
(3) is not eligible for the state Medicaid program.
(h) A child enrolled in dependent child coverage under this
section is subject to the same requirements and restrictions
relating to income eligibility, continuous coverage, and
enrollment, including applicable waiting periods, as a child
enrolled in the state child health plan under Chapter 62, Health and
Safety Code.
(b) The change in law made by this section applies only to a
child enrolled in dependent child coverage under the state
employees group benefits program on and after September 1, 2003.
SECTION 2.103. Section 57.046, Utilities Code, is amended
by adding Subsection (c) to read as follows:
(c) In addition to the purposes for which the qualifying
entities account may be used, the board may use money in the account
to award grants to the Health and Human Services Commission for
technology initiatives of the commission.
SECTION 2.104. STUDY. (a) The Medicaid and Public
Assistance Fraud Oversight Task Force, with the participation of
the Texas Department of Health's bureau of vital statistics and
other agencies designated by the comptroller, shall study
procedures and documentation requirements used by the state in
confirming a person's identity for purposes of establishing
entitlement to Medicaid and other benefits provided through health
and human services programs.
(b) Not later than December 1, 2004, the Medicaid and Public
Assistance Fraud Oversight Task Force, with assistance from the
agencies participating in the study required by Subsection (a) of
this section, shall submit a report to the legislature containing
recommendations for improvements in the procedures and
documentation requirements described by Subsection (a) of this
section that would strengthen the state's ability to prevent fraud
and abuse in the Medicaid program and other health and human
services programs.
SECTION 2.105. TRANSFER OF MEDICAL TRANSPORTATION PROGRAM.
(a) On September 1, 2004, or on an earlier date specified by the
Health and Human Services Commission:
(1) all powers, duties, functions, activities,
obligations, rights, contracts, records, property, and
appropriations or other money of the Texas Department of Health
that are determined by the commissioner of health and human
services to be essential to the administration of the medical
transportation program are transferred to the Health and Human
Services Commission;
(2) a rule or form adopted by the Texas Department of
Health that relates to the medical transportation program is a rule
or form of the Health and Human Services Commission and remains in
effect until altered by the commission;
(3) a reference in law or an administrative rule to the
Texas Department of Health that relates to the medical
transportation program means the Health and Human Services
Commission;
(4) a license, permit, or certification in effect that
was issued by the Texas Department of Health and that relates to the
medical transportation program is continued in effect as a license,
permit, or certification of the Health and Human Services
Commission; and
(5) a complaint, investigation, or other proceeding
pending before the Texas Department of Health that relates to the
medical transportation program is transferred without change in
status to the Health and Human Services Commission.
(b) The Health and Human Services Commission shall take all
action necessary to provide for the transfer of the medical
transportation program to the commission as soon as possible after
the effective date of this section but not later than September 1,
2004.
SECTION 2.106. CONSOLIDATION OF CERTAIN DIVISIONS AND
ACTIVITIES. (a) Not later than March 1, 2004, the Health and Human
Services Commission shall consolidate the Medicaid post-payment
third-party recovery divisions or activities of the Texas
Department of Human Services, the Medicaid vendor drug program, and
the state's Medicaid claims administrator with the Medicaid
post-payment third-party recovery function.
(b) The Health and Human Services Commission shall use the
commission's Medicaid post-payment third-party recovery contractor
for the consolidated division.
(c) The Health and Human Services Commission shall update
its computer system to facilitate the consolidation.
SECTION 2.107. ABOLITION OF ADVISORY COMMITTEES. (a)
Notwithstanding any other provision of state law, each advisory
committee, as that term is defined by Section 2110.001, Government
Code, created before the effective date of this section that
advises a health and human services agency is abolished on the
effective date of this section unless the committee:
(1) is required by federal law; or
(2) advises an agency with respect to certification or
licensing programs, the regulation of entities providing health and
human services, or the implementation of a duty prescribed under
this article, as determined by the commissioner of health and human
services.
(b) The commissioner of health and human services shall
certify which advisory committees are exempt from abolition under
Subsection (a) of this section and shall publish that certification
in the Texas Register.
SECTION 2.108. CHILD HEALTH PLAN PROGRAM WAIVER. Not later
than October 1, 2003, the Health and Human Services Commission
shall request and actively pursue any necessary waivers from a
federal agency or any other appropriate entity to allow families
enrolled in the state Medicaid program to opt into the child health
plan program under Chapter 62, Health and Safety Code, while
retaining the appropriate federal match rate.
SECTION 2.109. STATE CHILD HEALTH PLAN AMENDMENT. (a) In
this section, "group plan" means the group health benefit plan
under the health insurance premium payment reimbursement program
established under Section 62.059, Health and Safety Code.
(b) As soon as possible after the effective date of this
section, the Health and Human Services Commission shall submit for
approval a plan amendment relating to the state child health plan
under 42 U.S.C. Section 1397ff, as amended, as necessary to include
the employers' share of required premiums for coverage of
individuals enrolled in the group plan as expenditures for the
purpose of determining the state children's health insurance
expenditures, as that term is defined by 42 U.S.C. Section
1397ee(d)(2)(B), as amended, for federal match funding for the
child health plan program provided under Chapter 62, Health and
Safety Code.
SECTION 2.110. STATE MEDICAID PLAN AMENDMENT. (a) In this
section, "group plan" means the group health benefit plan under the
health insurance premium payment reimbursement program for
Medicaid recipients established under Section 32.0422, Human
Resources Code.
(b) As soon as possible after the effective date of this
section, the Health and Human Services Commission shall submit an
amendment to the state Medicaid plan as necessary to allow this
state to include the employers' share of required premiums for
coverage of individuals enrolled in the group plan as expenditures
for the purpose of determining this state's Medicaid program
expenditures for federal match funding for the state Medicaid
program.
SECTION 2.111. REPEAL. (a) The following are repealed:
(1) Sections 62.055(b) and (c), 62.056, 62.057,
252.206(d), and 252.207(b), Health and Safety Code; and
(2) Section 32.0315, Human Resources Code.
(b) An advisory committee established under Section 62.057,
Health and Safety Code, is abolished on the effective date of this
section.
SECTION 2.112. In the event of a conflict between a
provision of this Act and another Act passed by the 78th
Legislature, Regular Session, 2003, that becomes law, this Act
prevails and controls regardless of the relative dates of
enactment.
SECTION 2.113. FEDERAL AUTHORIZATION OR WAIVER. If before
implementing any provision of this Act a state agency determines
that a waiver or authorization from a federal agency is necessary
for implementation of that provision, the agency affected by the
provision shall request the waiver or authorization and may delay
implementing that provision until the waiver or authorization is
granted.
SECTION 2.114. EFFECTIVE DATE. Except as otherwise
provided by this article, this article takes effect September 1,
2003.