Amend CSSB 1188 (House Committee Printing) by adding the 
following appropriately numbered SECTIONS to the bill and 
renumbering subsequent SECTIONS of the bill accordingly:
	SECTION ____.  OFFICE OF MEDICAL TECHNOLOGY.  Subchapter A, 
Chapter 531, Government Code, is amended by adding Section 531.0081 
to read as follows:
	Sec. 531.0081.  OFFICE OF MEDICAL TECHNOLOGY.  (a)  In this 
section, "office" means the office of medical technology.
	(b)  The commission shall establish the office of medical 
technology within the commission.  The office shall explore and 
evaluate new developments in medical technology and propose 
implementing the technology in the medical assistance program under 
Chapter 32, Human Resources Code, if appropriate and 
cost-effective.
	(c)  Office staff must have skills and experience in research 
regarding health care technology.
	SECTION ____.  MEDICAID REIMBURSEMENT RATES.  (a)  Section 
531.021, Government Code, is amended by adding Subsections (f) and 
(g) to read as follows:
	(f)  In adopting rates for medical assistance payments under 
Subsection (b)(2), the executive commissioner may adopt 
reimbursement rates for appropriate nursing services provided to 
recipients with certain health conditions if those services are 
determined to provide a cost-effective alternative to 
hospitalization.  A physician must certify that the nursing 
services are medically appropriate for the recipient for those 
services to qualify for reimbursement under this subsection.
	(g)  In adopting rates for medical assistance payments under 
Subsection (b)(2), the executive commissioner may adopt 
cost-effective reimbursement rates for group appointments with 
medical assistance providers for certain diseases and medical 
conditions specified by rules of the executive commissioner.
	(b)  Subchapter B, Chapter 531, Government Code, is amended 
by adding Section 531.02175 to read as follows:
	Sec. 531.02175.  REIMBURSEMENT FOR ONLINE MEDICAL 
CONSULTATIONS.  (a)  In this section, "physician" means a person 
licensed to practice medicine in this state under Subtitle B, Title 
3, Occupations Code.
	(b)  Subject to the requirements of this subsection, the 
executive commissioner by rule may require the commission and each 
health and human services agency that administers a part of the 
Medicaid program to provide Medicaid reimbursement for a medical 
consultation that is provided by a physician or other health care 
professional using the Internet as a cost-effective alternative to 
an in-person consultation.  The executive commissioner may require 
the commission or a health and human services agency to provide the 
reimbursement described by this subsection only if the Centers for 
Medicare and Medicaid Services develop an appropriate Current 
Procedural Terminology code for medical services provided using the 
Internet.
	(c)  The executive commissioner may develop and implement a 
pilot program in one or more sites chosen by the executive 
commissioner under which Medicaid reimbursements are paid for 
medical consultations provided by physicians or other health care 
professionals using the Internet.  The pilot program must be 
designed to test whether an Internet medical consultation is a 
cost-effective alternative to an in-person consultation under the 
Medicaid program.  The executive commissioner may modify the pilot 
program as necessary throughout its implementation to maximize the 
potential cost-effectiveness of Internet medical consultations.  
If the executive commissioner determines from the pilot program 
that Internet medical consultations are cost-effective, the 
executive commissioner may expand the pilot program to additional 
sites or may implement Medicaid reimbursements for Internet medical 
consultations statewide.
	(d)  The executive commissioner is not required to implement 
the pilot program authorized under Subsection (c) as a prerequisite 
to providing Medicaid reimbursement authorized by Subsection (b) on 
a statewide basis.
	SECTION ____.  HOSPITAL EMERGENCY ROOM USE REDUCTION.  (a)  
Subchapter B, Chapter 531, Government Code, is amended by adding 
Section 531.085 to read as follows:
	Sec. 531.085.  HOSPITAL EMERGENCY ROOM USE REDUCTION 
INITIATIVES.  The commission shall develop and implement a 
comprehensive plan to reduce the use of hospital emergency room 
services by recipients under the medical assistance program.  The 
plan may include:
		(1)  a pilot program designed to facilitate program 
participants in accessing an appropriate level of health care, 
which may include as components:
			(A)  providing program participants access to 
bilingual health services providers; and
			(B)  giving program participants information on 
how to access primary care physicians, advanced practice nurses, 
and local health clinics;
		(2)  a pilot program under which health care providers, 
other than hospitals, are given financial incentives for treating 
recipients outside of normal business hours to divert those 
recipients from hospital emergency rooms;
		(3)  payment of a nominal referral fee to hospital 
emergency rooms that perform an initial medical evaluation of a 
recipient and subsequently refer the recipient, if medically 
stable, to an appropriate level of health care, such as care 
provided by a primary care physician, advanced practice nurse, or 
local clinic;
		(4)  a program under which the commission or a managed 
care organization that enters into a contract with the commission 
under Chapter 533 contacts, by telephone or mail, a recipient who 
accesses a hospital emergency room three times during a six-month 
period and provides the recipient with information on ways the 
recipient may secure a medical home to avoid unnecessary treatment 
at hospital emergency rooms;
		(5)  a health care literacy program under which the 
commission develops partnerships with other state agencies and 
private entities to:
			(A)  assist the commission in developing 
materials that:            
				(i)  contain basic health care information 
for parents of young children who are recipients under the medical 
assistance program and who are participating in public or private 
child-care or prekindergarten programs, including federal Head 
Start programs; and
				(ii)  are written in a language 
understandable to those parents and specifically tailored to be 
applicable to the needs of those parents;
			(B)  distribute the materials developed under 
Paragraph (A) to those parents; and
			(C)  otherwise teach those parents about the 
health care needs of their children and ways to address those needs; 
and
		(6)  other initiatives developed and implemented in 
other states that have shown success in reducing the incidence of 
unnecessary treatment in hospital emergency rooms.
	(b)  The Health and Human Services Commission may develop the 
health care literacy component of the comprehensive plan to reduce 
the use of hospital emergency room services required by Section 
531.085(5), Government Code, as added by this section, so that the 
health care literacy component operates in a manner similar to the 
manner in which the Johnson & Johnson/UCLA Health Care Institute 
operates its health care training program that is designed to teach 
parents to better address the health care needs of their children.
	SECTION ____.  PERFORMANCE BONUS PILOT PROGRAM.  Subchapter 
B, Chapter 531, Government Code, is amended by adding Section 
531.086 to read as follows:
	Sec. 531.086.  PERFORMANCE BONUS PILOT PROGRAM.  (a)  The 
commission shall develop a proposal for providing higher 
reimbursement rates to primary care case management providers under 
the Medicaid program who treat program recipients with chronic 
health conditions in accordance with evidence-based, nationally 
accepted best practices and standards of care.
	(b)  The commission shall define the parameters of the 
proposed program, including:
		(1)  the types of chronic health conditions the program 
would target;
		(2)  the best practices and standards of care that must 
be followed for a provider to obtain a higher reimbursement rate 
under the proposed program; and
		(3)  the types of providers to whom the higher 
reimbursement rate would be offered under the proposed program.
	(c)  Not later than December 1, 2006, the Health and Human 
Services Commission shall report to the standing committees of the 
senate and the house of representatives having primary jurisdiction 
over welfare programs regarding the proposed program under this 
section.  The report must include:
		(1)  the anticipated effect of the higher reimbursement 
rates to be offered under the program on the quality of care 
provided and the health outcomes for program recipients;
		(2)  a determination of whether the program would be 
cost-effective; and
		(3)  a recommendation regarding implementation of the 
program.       
	(d)  This section expires September 1, 2007.                            
	SECTION ____.  RETURN OF UNUSED DRUGS.  Section 562.1085, 
Occupations Code, is amended by amending Subsection (a) and adding 
Subsection (f) to read as follows:
	(a)  A pharmacist who practices in or serves as a consultant 
for a health care facility in this state may return to a pharmacy 
certain unused drugs, other than a controlled substance as defined 
by Chapter 481, Health and Safety Code, purchased from the pharmacy 
as provided by board rule.  The unused drugs must:
		(1)  be approved by the federal Food and Drug 
Administration and be:        
			(A)  sealed in [the manufacturer's original] 
unopened tamper-evident packaging and either individually packaged 
or packaged in unit-dose packaging;
			(B)  oral or parenteral medication in sealed 
single-dose containers approved by the federal Food and Drug 
Administration;
			(C)  topical or inhalant drugs in sealed 
units-of-use containers approved by the federal Food and Drug 
Administration; or
			(D)  parenteral medications in sealed 
multiple-dose containers approved by the federal Food and Drug 
Administration from which doses have not been withdrawn; and
		(2)  not be the subject of a mandatory recall by a state 
or federal agency or a voluntary recall by a drug seller or 
manufacturer.
	(f)  The tamper-evident packaging required under Subsection 
(a)(1) for the return of unused drugs is not required to be the 
manufacturer's original packaging unless that packaging is 
required by federal law.
	SECTION ____.  MEDICAID COVERAGE FOR HEALTH INSURANCE 
PREMIUMS AND LONG-TERM CARE NEEDS.  (a)  The Health and Human 
Services Commission shall explore the commission's authority under 
federal law to offer, and the cost and feasibility of offering:
		(1)  a stipend paid by the Medicaid program to a person 
to cover the cost of a private health insurance plan as an 
alternative to providing traditional Medicaid services for the 
person;
		(2)  premium payment assistance through the Medicaid 
program for long-term care insurance for a person with a health 
condition that increases the likelihood that the person will need 
long-term care in the future; and
		(3)  a long-term care partnership between the Medicaid 
program and a person under which the person pays the premiums for 
long-term care insurance and the Medicaid program provides 
continued coverage after benefits under that insurance are 
exhausted.
	(b)  In exploring the feasibility of the options described by 
Subsection (a) of this section, the Health and Human Services 
Commission shall consider whether other state incentives that could 
encourage persons to purchase health insurance plans or long-term 
care insurance are feasible.  The incentives may include offering 
tax credits to businesses to increase the availability of 
affordable insurance.
	(c)  If the Health and Human Services Commission determines 
that any of the options described by Subsection (a) of this section 
are feasible and cost-effective, the commission shall make efforts 
to implement those options to the extent they are authorized by 
federal law.  The commission shall request any necessary waivers 
from the Centers for Medicare and Medicaid Services as soon as 
possible after determining that an option is feasible and 
cost-effective.  If the commission determines that legislative 
changes are necessary to implement an option, the commission shall 
report to the 80th Legislature and specify the changes that are 
needed.