By: Lindsay S.B. No. 428
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
parents of children receiving Medicaid or enrolled in the state
child health plan.
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; and
(3) one representative of small business owners.
(c) A member of the task force serves at the will of the
commissioner.
(d) The commissioner shall designate a member of the task
force to serve as presiding officer.
Sec. 534.102. POWERS AND DUTIES. The task force shall:
(1) assist the commission with the development and
implementation of each of the demonstration projects required to be
established under Subchapter C;
(2) advise the commission on local health care issues
and concerns affecting local governmental entities selected to
participate in a demonstration project required to be established
under Subchapter C;
(3) assist the commission with the preparation of a
report required by Section 534.203; 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.
Sec. 534.104. OTHER LAW. Chapter 2110, Government Code,
does not apply to the task force.
[Sections 534.105-534.200 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 shall
develop and implement 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) In establishing the demonstration project, the
commission shall:
(1) develop a health benefit plan operating as an
extension of the state Medicaid program;
(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,
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;
(6) allow for a local governmental entity to perform
the work of determining the eligibility of an individual to
participate in the project, and, to the extent the federal
government will allow, enroll the participant in the project; and
(7) work in conjunction with the task force to develop
each component of the project.
(c) The 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 the demonstration project may include itself as a
member of the network.
(g) A local governmental entity that wants to participate in
the demonstration project shall notify the commission and task
force of its intention as soon as possible after September 1, 2003.
To implement the project, the commission shall select local
governmental entities that have the necessary health care delivery
infrastructure and financing in place to participate in the
project, either alone or in combination with other local
governmental entities that also want to participate.
(h) 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 shall develop and implement 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 the demonstration project 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) In establishing the demonstration project, the
commission shall:
(1) work in conjunction with the task force to develop
each component of the project;
(2) review similar initiatives in other states;
(3) 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
(4) 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 the health benefit plan under Subsection
(b)(1), the commissioner 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) The 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 shall determine the amounts each person
described by Subsection (b)(1)(A) must contribute to the total cost
of the health benefit plan developed for the demonstration project,
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)(3)(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) To implement the demonstration project, the commission
shall select local governmental entities that have the health care
delivery infrastructure and financing in place for participation in
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.
(i) 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).
(j) This section expires September 1, 2009.
Sec. 534.203. REPORTS. (a) Not later than December 1 of
each even-numbered year, the commission shall submit reports to the
legislature regarding the operation and cost-effectiveness of the
demonstration projects established under Sections 534.201 and
534.202.
(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 534.001, 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.
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 534.001, 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.
SECTION 4. Not later than September 1, 2003, the Health and
Human Services Commission shall 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 the
demonstration projects required by Sections 534.201 and 534.202,
Government Code, as added by this Act. The commission may delay
implementing 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 the 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 the 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 the
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 the 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 Subsection (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 a federal waiver or other authorization is not
obtained before December 1, 2006, from all necessary federal
agencies to implement a demonstration project developed under
Chapter 534, Government Code, as added by this Act, 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
the 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.