78R11854 CLG-F
By: Truitt H.B. No. 3122
Substitute the following for H.B. No. 3122:
By: Wohlgemuth C.S.H.B. No. 3122
A BILL TO BE ENTITLED
AN ACT
relating to the establishment of locally based demonstration
projects to provide health care benefits to certain low-income
individuals.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Subtitle I, Title 4, Government Code, is amended
by adding Chapter 534 to read as follows:
CHAPTER 534. LOCALLY BASED MEDICAID AND OTHER RELATED HEALTH CARE
INITIATIVES
SUBCHAPTER A. GENERAL PROVISIONS
Sec. 534.001. LEGISLATIVE INTENT. It is the intent of the
legislature that certain local governmental entities collaborate
to the extent necessary with other local governmental entities and
small business employers to provide or deliver cost-effective
health care services to persons eligible to participate in the
initiatives established under this chapter.
Sec. 534.002. DEFINITIONS. In this chapter:
(1) "Local governmental entity" means:
(A) a hospital district created and established
under the authority of Sections 4 through 11, Article IX, Texas
Constitution;
(B) a hospital authority created and established
under Chapter 262 or 264, Health and Safety Code, that to some
extent uses tax or other public revenue to provide health care
services to indigent persons;
(C) a hospital owned and operated by a
municipality, county, or hospital authority and created under
Chapter 262 or 264, Health and Safety Code;
(D) a medical school operated by this state;
(E) a medical school that receives state funds
under Section 61.093, Education Code, or a chiropractic school that
receives state funds under the General Appropriations Act;
(F) a teaching hospital operated by The
University of Texas System;
(G) a county that provides health care services
and assistance to indigent residents of the county under Subchapter
B, Chapter 61, Health and Safety Code;
(H) a governmental entity that provides funds to
a public hospital for the provision of health care services to
indigent persons under Section 61.062, Health and Safety Code;
(I) a county with a population of more than
400,000 that provides funds to a public hospital and that is not
included in the boundaries of a hospital district;
(J) a hospital owned by a municipality and leased
to and operated by a nonprofit hospital for a public purpose,
subject to federal approval of matching funds from such an entity;
(K) a health services district created and
established under Chapter 287, Health and Safety Code; and
(L) a statewide rural health care system
established under Chapter 20C or 845, Insurance Code.
(2) "Managed care organization" means a person who is
authorized or otherwise permitted by law to arrange for or provide a
managed care plan.
(3) "Managed care plan" means a plan under which a
person undertakes to provide, arrange for, pay for, or reimburse
any part of the cost of any health care services. A part of the plan
must consist of arranging for or providing health care services as
distinguished from indemnification against the cost of those
services on a prepaid basis through insurance or otherwise. The
term includes a primary care case management provider network. The
term does not include a plan that indemnifies a person for the cost
of health care services through insurance.
(4) "Task force" means the task force on local health
care initiatives established under Section 534.101.
Sec. 534.003. RULES. (a) The commission shall adopt rules
as necessary to implement this chapter.
(b) The commission may require the Texas Department of
Human Services or any other health and human services agency to
adopt, with the approval of the commission, any rules that may be
necessary to implement this chapter.
[Sections 534.004-534.100 reserved for expansion]
SUBCHAPTER B. TASK FORCE
Sec. 534.101. TASK FORCE ON LOCAL HEALTH CARE INITIATIVES.
(a) The commissioner shall establish a task force on local health
care initiatives.
(b) The commissioner shall appoint as members of the task
force:
(1) 10 representatives of local governmental
entities, at least seven of whom must be representatives of local
governmental entities located in counties or municipalities with a
population of 500,000 or more and one of whom represents the
interests of local governmental entities in rural areas;
(2) two representatives of health care providers,
including one member who represents the interests of private
nonprofit health benefit plans;
(3) one representative of small business owners;
(4) one physician licensed under Subtitle B, Title 3,
Occupations Code; and
(5) one public member.
(c) The members of the task force serve staggered two-year
terms with as near as possible to half of the members' terms
expiring February 1 of each year. The members shall draw lots at
the first task force meeting to determine the length of each
member's initial term and the members' terms that expire each year.
(d) The commissioner shall designate a member of the task
force to serve as presiding officer.
(e) A member of the task force is not entitled to
compensation for service on the task force and is not entitled to
reimbursement for travel expenses.
Sec. 534.102. POWERS AND DUTIES. (a) The task force may,
in conjunction with the commission, develop one or both of the
demonstration projects authorized under Subchapter C.
(b) The task force shall:
(1) advise the commission on local health care issues
and concerns affecting local governmental entities selected to
participate in a demonstration project developed under Subchapter
C;
(2) assist the commission with the preparation of a
report that may be required by Section 534.203;
(3) if one or both of the demonstration projects
authorized under Subchapter C are established, identify
administrative costs that the commission may incur with regard to
the implementation of each of the demonstration projects that is
established and develop a mechanism to provide for the
reimbursement of those costs by the participating local
governmental entities; and
(4) perform any other duty or function prescribed by
this chapter or other law.
Sec. 534.103. MEETINGS. The task force shall meet at the
call of the presiding officer.
[Sections 534.104-534.200 reserved for expansion]
SUBCHAPTER C. DEMONSTRATION PROJECTS TO PROVIDE HEALTH CARE
COVERAGE TO LOW-INCOME PARENTS OF CHILDREN RECEIVING MEDICAID
Sec. 534.201. DEMONSTRATION PROJECT TO EXTEND MEDICAID
COVERAGE TO CERTAIN LOW-INCOME PARENTS. (a) The commission and
task force may jointly develop a locally based demonstration
project to provide medical assistance under the state Medicaid
program to an individual who:
(1) is the parent of a child receiving medical
assistance under the state Medicaid program;
(2) has a family income that is at or below 100 percent
of the federal poverty level;
(3) is not otherwise eligible for medical assistance
under the state Medicaid program at the time the individual's
eligibility for participation in the demonstration project is
determined; and
(4) is not covered by health insurance or another type
of health benefit plan other than a health benefit plan
administered by or on behalf of a local governmental entity.
(b) If the demonstration project is established, the
commission and task force shall jointly:
(1) develop a health benefit plan operating as an
extension of the state Medicaid program and determine the benefits
package included in the plan, which may not include all of the
Medicaid program benefits;
(2) ensure that the project is financed using money
and any other resources made available by participating local
governmental entities to the commission for matching purposes to
maximize federal money for the state Medicaid program;
(3) ensure that each participating local governmental
entity receives money to provide services, through the health
benefit plan, to project participants residing in the geographical
area served by the entity in an amount that is at least equal to the
amount of:
(A) money or other resources that were provided
for matching by the entity for purposes of the project; and
(B) any corresponding federal matching money;
(4) provide participating local governmental entities
with the option to form, with the assistance of the commission and
task force, exclusive provider networks to provide and deliver
health care services to project participants using a managed care
approach;
(5) design the project in a manner that, to the extent
possible, uses a local governmental entity's existing indigent
health care delivery system and administrative structure to provide
services through the health benefit plan to project participants;
and
(6) design the project in a manner that allows, to the
extent allowed by federal law or other federal authorization, local
governmental entities to make determinations of eligibility and
enroll eligible individuals in the project.
(c) A health benefit plan developed under this section may
require an individual who participates in the project to make
copayments or pay deductible amounts on a sliding scale basis.
(d) Local money described by Subsection (b)(2) includes tax
or other revenue spent to provide indigent health care services to
project participants before they were eligible to participate in
the demonstration project.
(e) The manner in which a local governmental entity makes
money available for matching purposes under Subsection (b)(2) may
include an option for the entity to be able to certify the amount of
money considered available instead of sending the money directly to
the state.
(f) A provider network described by Subsection (b)(4) may
include a combination of public and private health care providers.
A local governmental entity that forms an exclusive provider
network under a demonstration project established under this
section may include itself as a member of the network.
(g) The commission may not implement a project without the
approval of the task force.
(h) A local governmental entity that wants to participate in
a project established under this section must obtain approval for
that participation from the entity's governing body, except that a
hospital district created under Chapter 281, Health and Safety
Code, must instead obtain that approval from the commissioners
court of the county in which the district is located. A local
governmental entity that receives permission to participate shall
notify the commission and task force of its intention to
participate as soon as possible after September 1, 2003. If a
project is implemented, the commission shall select each local
governmental entity that makes money available for matching
purposes under Subsection (b)(2).
(i) This section expires September 1, 2009.
Sec. 534.202. DEMONSTRATION PROJECT TO OFFER HEALTH CARE
COVERAGE TO CERTAIN LOW-INCOME WORKING PARENTS. (a) The
commission and task force may jointly develop a demonstration
project in which local governmental entities partner with employers
to offer health benefits coverage to employees who:
(1) are the parents of a child receiving medical
assistance under the state Medicaid program or of a child enrolled
in the state child health plan program under Chapter 62, Health and
Safety Code;
(2) have family incomes that are at or below 200
percent of the federal poverty level; and
(3) are not covered by health insurance or another
type of health benefit plan other than a health benefit plan that is
administered by or on behalf of a local governmental entity.
(b) The components of a demonstration project developed
under this section must include:
(1) the development of a health benefit plan to
provide coverage for health care services to project participants
that:
(A) requires plan coverage to be purchased using
a combination of local, federal, participant, and employer
contributions;
(B) provides a benefits package that is similar
to benefits packages offered by employer-sponsored health benefit
plans but may not cover all of the state Medicaid program benefits;
and
(C) to the extent possible eliminates coverage
for duplicative or extraordinary services; and
(2) the development of sliding scale premiums for
certain project participants, including the manner in which the
premium is paid.
(c) If the demonstration project is established, the
commission and task force shall jointly:
(1) review similar initiatives in other states;
(2) ensure that the project is:
(A) designed and administered in a manner that
qualifies for federal funding; and
(B) financed using a combination of local,
federal, and private money; and
(3) provide a participating local governmental entity
with the option to contract with a managed care organization to
administer the health benefit plan in the geographical area served
by the local governmental entity.
(d) In developing a health benefit plan under Subsection
(b)(1), the commissioner and task force must include provisions
intended to discourage:
(1) employers and other persons from electing to
discontinue offering coverage for individuals under employee or
other group health benefit plans; and
(2) individuals with access to adequate health benefit
plan coverage, other than coverage under the health benefit plan
developed under Subsection (b)(1), from electing not to obtain or
to discontinue that coverage.
(e) A health benefit plan developed under Subsection (b)(1)
is not subject to a law that requires coverage or the offer of
coverage of a health care service or benefit.
(f) The commission and task force shall jointly determine
the amounts each person described by Subsection (b)(1)(A) must
contribute to the total cost of a health benefit plan developed for
a demonstration project established under this section, except that
the commission may not require a project participant whose income
is not greater than 100 percent of the federal poverty level to pay
a premium.
(g) Local money described by Subsection (c)(2)(B) includes
tax or other revenue spent to provide indigent health care services
to project participants before they were eligible to participate in
the project and any other resources made available to the
commission under this section for federal matching purposes.
(h) The commission may not implement a project without the
approval of the task force.
(i) A local governmental entity that wants to participate in
a project established under this section must obtain approval for
that participation from the entity's governing body, except that a
hospital district created under Chapter 281, Health and Safety
Code, must instead obtain that approval from the commissioners
court of the county in which the district is located. If a project
is implemented, the commission and task force shall select each
local governmental entity that makes local money described by
Subsections (c)(2)(B) and (g) available for the project. The
commission shall provide information as requested regarding the
project to any local governmental entity that is interested in
participating in the project.
(j) At the request of the commissioner, the Texas Department
of Insurance shall provide any necessary assistance with the
development of the health benefit plan under Subsection (b)(1).
(k) This section expires September 1, 2009.
Sec. 534.203. REPORTS. (a) If a demonstration project is
established under Section 534.201 or 534.202, the commission, not
later than December 1 of each even-numbered year, shall submit a
report to the legislature regarding the operation and
cost-effectiveness of each project established under those
sections.
(b) The report for the demonstration project established
under Section 534.202 must include a recommendation regarding the
feasibility of expanding the project statewide.
(c) This section expires September 1, 2009.
[Sections 534.204-534.300 reserved for expansion]
SUBCHAPTER D. MISCELLANEOUS PROVISIONS
Sec. 534.301. EXPIRATION. This chapter expires September
1, 2011.
SECTION 2. Section 285.091, Health and Safety Code, is
amended by adding Subsection (c) to read as follows:
(c) A hospital district created under general or special law
may contract or collaborate with a local governmental entity, as
defined by Section 534.002, Government Code, or any other public or
private entity as necessary to provide or deliver health care
services under a demonstration project established under Section
534.201 or 534.202, Government Code, in which the hospital district
participates.
SECTION 3. Section 287.078, Health and Safety Code, is
amended to read as follows:
Sec. 287.078. DISTRICT [OPERATING AND MANAGEMENT]
CONTRACTS AND COLLABORATIONS. (a) The board may enter into
operating or management contracts relating to health care
facilities owned by the district or for which the district assumes
responsibility for managing and operating under the terms of the
contract with the counties and hospital districts that created the
district.
(b) The board may contract or collaborate with a local
governmental entity, as defined by Section 534.002, Government
Code, or any other public or private entity as necessary to provide
or deliver health care services under a demonstration project
established under Section 534.201 or 534.202, Government Code, in
which the district participates.
SECTION 4. The Health and Human Services Commission may
request and actively pursue any necessary waivers, including a
Health Insurance Flexibility and Accountability (HIFA) waiver,
from a federal agency or any other appropriate entity to enable the
commission to implement a demonstration project established under
Section 534.201 or 534.202, Government Code, as added by this Act.
The commission may not implement a demonstration project described
by this section until the necessary waivers or authorizations are
granted.
SECTION 5. Not later than January 1, 2004, the commissioner
of health and human services shall appoint members to the task force
on local health care initiatives established under Section 534.101,
Government Code, as added by this Act.
SECTION 6. (a) On the first anniversary of the date of
approval of a federal waiver or other authorization submitted under
Section 4 of this Act for the implementation of a demonstration
project established by Section 534.201, Government Code, as added
by this Act, the Health and Human Services Commission shall submit a
report on the operation of the project to the governor, lieutenant
governor, speaker of the house of representatives, and clerks of
the standing committees of the senate and house of representatives
with primary jurisdiction over the state Medicaid program and
indigent health care matters. The report must include:
(1) a detailed description of the project's impact, if
any, on the number of uninsured individuals in the state;
(2) the amount of cost-savings generated by each of
the local governmental entities participating in the project; and
(3) information on the overall effectiveness and
efficiency of the project, including the identification of any
barriers to achieving the efficient operation of the project.
(b) On the first anniversary of the date of approval of a
federal waiver or other authorization submitted under Section 4 of
this Act for the implementation of a demonstration project
established by Section 534.202, Government Code, as added by this
Act, the Health and Human Services Commission shall submit a report
on the operation of the project to the governor, lieutenant
governor, speaker of the house of representatives, and clerks of
the standing committees of the senate and house of representatives
with primary jurisdiction over the state Medicaid program and
indigent health care matters. The report must include:
(1) the information required by Subsections
(a)(1)-(3) of this section; and
(2) a description of the project's impact on the small
business community, including the employers participating in the
project.
(c) A report required by this section shall be prepared with
the assistance of the task force on local health care initiatives
established under Section 534.101, Government Code, as added by
this Act.
SECTION 7. If the Health and Human Services Commission
requests a federal waiver or other authorization under Section 4 of
this Act but does not obtain the waiver or authorization, the Health
and Human Services Commission shall:
(1) identify any federal, state, or local issues that
may have impacted the determination for approval or disapproval of
the authorization; and
(2) submit a report of its findings to the governor,
lieutenant governor, speaker of the house of representatives, and
clerks of the standing committees of the senate and house of
representatives with primary jurisdiction over the state Medicaid
program and indigent health care matters.
SECTION 8. This Act takes effect September 1, 2003.