By: Coleman H.B. No. 3436
A BILL TO BE ENTITLED
AN ACT
relating to the restoration and expansion of the medical
assistance, children's health insurance, and other health and human
services programs; making an appropriation.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
ARTICLE 1. LEGISLATIVE FINDINGS; APPROPRIATION
SECTION 1.01. FINDINGS. The legislature finds that:
(1) the drastic reductions in funding for the medical
assistance and children's health insurance programs and the
extensive public policy changes made to those programs in the
regular session of the 78th Legislature have resulted in
devastating effects to the health and well-being of Texas children
and their families and to the overall fiscal health of this state;
(2) economic research has proven that reductions in
state funding for health care services do more harm than good to the
Texas economy because each dollar of state revenue that is
eliminated from the medical assistance and children's health
insurance programs results in:
(A) an average loss of $2.30 in federal health
care funding for Texas and an average loss of approximately $7 in
gross state product, $5 in personal income, and $2 in retail sales;
and
(B) an increase of $1.60 in the insurance
premiums for Texans who have private health insurance, plus a $1.50
increase in those Texans' out-of-pocket health care costs;
(3) as a result of these shortsighted and
counterproductive reductions in health care services made by the
78th Legislature, local taxpayers bear the entire cost of health
care for persons who are no longer receiving services under the
medical assistance or children's health insurance programs, often
through vastly more expensive visits to hospital emergency rooms,
even though the federal government would have paid 60 to 70 percent
of the cost of those services through those programs;
(4) children in other states have already received
over $800 million in federal funds that were intended to provide
health care coverage for Texas children under the children's health
insurance program, and this state will lose additional federal
funds each year if the state fails to restore state funding and
repeal the restrictive eligibility and benefits policies enacted by
the 78th Legislature;
(5) restoring benefits under the children's health
insurance program and expanding that program to cover more
uninsured children will result in healthier future generations of
Texans and immeasurable long-term savings for this state;
(6) providing vision, hearing, and dental health
services through the medical assistance and children's health
programs will improve school performance and average daily
attendance records, which will yield additional federal and state
revenue for local school districts;
(7) reductions in mental health benefits for children
and adults made by the 78th Legislature have been especially
devastating to families, have strained the resources of local
hospitals, community providers, and law enforcement personnel
responding to calls for mental health intervention, and have
resulted in reported increases of as much as 79 percent in some
localities for rates for hospitalization, which is the most
expensive form of treatment;
(8) this state must make its economy stronger and its
workforce more productive by improving access to health care
through prudent and sound fiscal policies that maximize the
availability of federal funds for health care services for
uninsured Texans; and
(9) the investment of state resources to maximize
receipt of federal funds as described by Subdivision (8) of this
section will:
(A) prevent the redistribution to other states of
tax dollars that Texans have paid to the federal government;
(B) alleviate the inefficient cost-shifting of
health care services for uninsured Texans to local governments; and
(C) stem the escalation of costs being passed on
to Texans who have private health insurance.
SECTION 1.02. PURPOSE. As a result of the findings made by
the legislature as stated in Section 1.01 of this article, the
purposes of this Act are to:
(1) restore funding for the medical assistance and
children's health insurance programs that was reduced by the 78th
Legislature;
(2) reverse restrictive policy changes made by that
legislature with respect to those programs; and
(3) expand enrollment in those programs beyond the
enrollment levels that existed before September 1, 2003.
SECTION 1.03. For the state fiscal biennium beginning
September 1, 2005, the Health and Human Services Commission is
appropriated from the general revenue fund the amount needed to
provide services under the medical assistance and children's health
insurance programs in a manner comparable to the manner in which the
services were provided under those programs during the state fiscal
biennium ending August 31, 2003.
ARTICLE 2. RESTORATION AND EXPANSION OF THE
MEDICAL ASSISTANCE PROGRAM
SECTION 2.01. Subchapter B, Chapter 531, Government Code,
is amended by adding Sections 531.02113–531.02117 and 531.02131 to
read as follows:
Sec. 531.02114. MEDICAID ELIGIBILITY AND ENROLLMENT. The
commission shall ensure that:
(1) the Medicaid eligibility policies, processes, and
time frames of each state agency operating a part of the Medicaid
program, including the policies, processes, and time frames
relating to an applicant or recipient whose eligibility status is
on hold, are designed to minimize the time that an applicant or
recipient is required to wait before the applicant or recipient
begins receiving services or is recertified; and
(2) the Medicaid eligibility policies, processes, and
time frames of any agency contractor are designed to minimize the
time that an applicant or recipient is required to wait before
receiving services.
Sec. 531.02115. TEXAS HEALTH STEPS PROGRAM. The commission
shall:
(1) take all actions necessary to simplify:
(A) provider enrollment in the Texas Health Steps
program;
(B) reporting requirements relating to the Texas
Health Steps program; and
(C) billing and coding procedures so that Texas
Health Steps program processes are more consistent with commercial
standards;
(2) in consultation with providers of Texas Health
Steps program services, develop mechanisms to promote accurate,
reliable, and timely reporting of examinations of children
conducted under the program to managed care organizations and other
appropriate entities;
(3) in consultation with providers of Texas Health
Steps program services, develop a mechanism to promote
incorporation of Texas Health Steps program services into a child's
medical home; and
(4) require the external quality monitoring
organization to evaluate the Texas Health Steps program using
information available from all relevant sources and prepare
periodic reports regarding the program for submission by the
commission to the legislature.
Sec. 531.02116. LIMITS ON MEDICAID COST-SHARING. Before
requiring Medicaid recipients to make copayments or comply with
other cost-sharing requirements, the executive commissioner by
rule shall establish monthly limits on total copayments and other
cost-sharing requirements.
Sec. 531.02131. COMMUNITY OUTREACH CAMPAIGN. (a) The
commission shall conduct a community outreach campaign to provide
information relating to the availability of Medicaid coverage for
children and adults and to promote enrollment of eligible children
and adults in Medicaid.
(b) The commission may combine the community outreach
campaign under this section with any other state outreach campaign
or educational activity relating to health care and available
health care coverage.
SECTION 2.03. (a) The purpose of this section is to pilot a
coordinated approach to addressing the needs of homeless people
with chronic illnesses who are recipients of medical assistance
under Chapter 32, Human Resources Code, so that homeless people may
learn to manage their illnesses and become productive members of
society. Current state, federal, and local agencies fund separate
programs that address only one aspect of the needs of homeless
people, such as housing, job training, and medical care. Homeless
people with chronic illnesses will benefit from a coordinated
approach that comprehensively addresses the needs of homeless
people.
(b) Subchapter B, Chapter 531, Government Code, is amended
by adding Section 531.084 to read as follows:
Sec. 531.084. PILOT CASE MANAGEMENT PROGRAM. (a) The
commission, in cooperation with the Texas Interagency Council for
the Homeless, shall develop a pilot case management program for
homeless people who have chronic illnesses, including diabetes and
HIV infection or AIDS, and who are recipients of medical assistance
under Chapter 32, Human Resources Code. The council in cooperation
with relevant state agencies shall administer the pilot program
under the direction of the commission.
(b) Using existing resources of the agencies composing the
Texas Interagency Council for the Homeless, the staff of the
council shall:
(1) select a county with a population of more than 2.8
million in which to implement the program;
(2) identify existing services provided through
programs of the agencies composing the council to homeless people
with chronic illnesses who are recipients of medical assistance;
(3) identify existing federal, state, county, and
local sources from which money may be available to fund the pilot
program; and
(4) create a pilot case management program for not
more than 75 homeless people with chronic illnesses who are
recipients of medical assistance using existing financial and
agency resources.
(c) The Texas Interagency Council for the Homeless shall
select, through competitive bidding, a nonprofit entity to
implement the pilot case management program for the homeless. The
pilot program established under this section must:
(1) provide case management services and existing
health-related education services to participants of the program;
and
(2) coordinate housing, medical, job training, and
other necessary services for the participants of the program.
(d) The commission shall identify programs available
through health and human services agencies through which homeless
people described by Subsection (a) may receive housing, medical,
job placement, or other services. The commission shall report to
the Texas Interagency Council for the Homeless information
regarding the identified programs, including the programs' sources
of funding and eligibility requirements.
(e) Not later than December 15 of each even-numbered year,
the Texas Interagency Council for the Homeless shall submit a
report to the governor, the lieutenant governor, and the speaker of
the house of representatives regarding the effectiveness of the
pilot program established under this section.
(f) This section expires September 1, 2009.
(c) The Health and Human Services Commission shall develop
and the Texas Interagency Council for the Homeless shall implement
the pilot program established under this section not later than
November 1, 2005.
SECTION 2.04. The heading to Chapter 533, Government Code,
is amended to read as follows:
CHAPTER 533. DEVELOPMENT AND IMPLEMENTATION
OF MEDICAID MANAGED CARE PROGRAM
SECTION 2.05. Subchapter A, Chapter 533, Government Code,
is amended by amending Sections 533.001 and 533.002 and adding
Sections 533.0021, 533.0022, 533.0023, and 533.0024 to read as
follows:
Sec. 533.001. DEFINITIONS. In this chapter:
(1) "Commission" means the Health and Human Services
Commission or an agency operating part of the state Medicaid
managed care program, as appropriate.
(2) "Executive commissioner" ["Commissioner"] means
the executive commissioner of the Health and Human Services
Commission [health and human services].
(3) "Health and human services agencies" has the
meaning assigned by Section 531.001.
(4) "Managed care organization" means a person who is
authorized or otherwise permitted by law to arrange for or provide a
managed care plan. The term includes a health care system
established under Chapter 845, Insurance Code.
(5) "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 and a
health care system established under Chapter 845, Insurance Code.
The term does not include a plan that indemnifies a person for the
cost of health care services through insurance.
(6) "Recipient" means a recipient of medical
assistance under Chapter 32, Human Resources Code.
(7) "Health care service region" or "region" means a
Medicaid managed care service area as delineated by the commission.
Sec. 533.002. MEDICAID HEALTH CARE DELIVERY SYSTEM. The
commission may develop a health care delivery system that
restructures the delivery of health care services provided under
the state Medicaid program.
Sec. 533.0021. DESIGN AND DEVELOPMENT OF HEALTH CARE
DELIVERY SYSTEM. In developing the health care delivery system
under this chapter, the commission shall:
(1) design the system in a manner that:
(A) improves the health of the people of this
state by:
(i) emphasizing prevention;
(ii) promoting continuity of care; and
(iii) providing a medical home for
recipients;
(B) ensures that each recipient receives
high-quality, comprehensive health care services in the
recipient's local community; and
(C) ensures that the community is given an
opportunity to provide input and participate in the implementation
of the system in the health care service region by holding public
hearings in the community at which the commission takes public
comment from all persons interested in the implementation of the
system;
(2) to the extent that it is cost-effective to this
state and local governments:
(A) maximize the financing of the state Medicaid
program by obtaining federal matching funds for all resources or
other money available for matching;
(B) expand Medicaid eligibility to include
persons who were eligible to receive indigent health care services
through the use of those resources or other money available for
matching before expansion of eligibility; and
(C) develop a sliding scale copayment schedule
for recipients based on income and other factors determined by the
commissioner; and
(3) develop and prepare the waiver or other documents
necessary to obtain federal authorization for the system.
Sec. 533.0022. PURPOSE. The commission shall implement the
Medicaid managed care program as part of the health care delivery
system developed under this chapter [Chapter 532] by contracting
with managed care organizations in a manner that, to the extent
possible:
(1) accomplishes the goals described by Section
533.0021 [improves the health of Texans by:
[(A) emphasizing prevention;
[(B) promoting continuity of care; and
[(C) providing a medical home for recipients;
[(2) ensures that each recipient receives high
quality, comprehensive health care services in the recipient's
local community];
(2) [(3)] encourages the training of and access to
primary care physicians and providers;
(3) [(4)] maximizes cooperation with existing public
health entities, including local departments of health and
community mental health and mental retardation centers established
under Chapter 534, Health and Safety Code;
(4) [(5)] provides incentives to managed care
organizations to improve the quality of health care services for
recipients by providing value-added services; [and]
(5) [(6)] reduces administrative and other
nonfinancial barriers for recipients in obtaining health care
services; and
(6) controls the costs associated with the state
Medicaid program.
Sec. 533.0023. RULES FOR HEALTH CARE DELIVERY SYSTEM.
(a) The commissioner of insurance shall adopt rules as necessary
or appropriate to carry out the functions of the Texas Department of
Insurance under this chapter.
(b) The executive commissioner shall adopt rules and obtain
public input in accordance with Chapter 2001 before making
substantive changes to policies or programs under the Medicaid
managed care program.
Sec. 533.0024. RESOLUTION OF IMPLEMENTATION ISSUES. The
commission shall conduct a meeting at least quarterly with managed
care organizations that contract with the commission under this
chapter and health care providers to identify and resolve
implementation issues with respect to the Medicaid managed care
program.
SECTION 2.06. Subchapter A, Chapter 533, Government Code,
is amended by adding Section 533.0035 to read as follows:
Sec. 533.0035. LIMITATION ON NUMBER OF CONTRACTS AWARDED.
The commission shall:
(1) evaluate the number of managed care organizations
with which the commission contracts to provide health care services
in each health care service region, focusing particularly on the
market share of those managed care organizations; and
(2) limit the number of contracts awarded to managed
care organizations under this chapter in a manner that promotes the
successful implementation of the delivery of health care services
through the state Medicaid managed care program.
SECTION 2.07. (a) Section 533.005, Government Code, is
amended to read as follows:
Sec. 533.005. REQUIRED CONTRACT PROVISIONS. [(a)] A
contract between a managed care organization and the commission for
the organization to provide health care services to recipients must
contain:
(1) procedures to ensure accountability to the state
for the provision of health care services, including procedures for
financial reporting, quality assurance, utilization review, and
assurance of contract and subcontract compliance;
(2) capitation and provider payment rates that ensure
the cost-effective provision of quality health care;
(3) a requirement that the managed care organization
provide ready access to a person who assists recipients in
resolving issues relating to enrollment, plan administration,
education and training, access to services, and grievance
procedures;
(4) a requirement that the managed care organization
provide ready access to a person who assists providers in resolving
issues relating to payment, plan administration, education and
training, and grievance procedures;
(5) a requirement that the managed care organization
provide information and referral about the availability of
educational, social, and other community services that could
benefit a recipient;
(6) procedures for recipient outreach and education;
(7) a requirement that the managed care organization
make payment to a physician or provider for health care services
rendered to a recipient under a managed care plan not later than the
45th day after the date a claim for payment is received with
documentation reasonably necessary for the managed care
organization to process the claim, or within a period, not to exceed
60 days, specified by a written agreement between the physician or
provider and the managed care organization;
(8) a requirement that the commission, on the date of a
recipient's enrollment in a managed care plan issued by the managed
care organization, inform the organization of the recipient's
Medicaid certification date;
(9) a requirement that the managed care organization
comply with Section 533.006 as a condition of contract retention
and renewal;
(10) a requirement that the managed care organization
provide the information required by Section 533.012 and otherwise
comply and cooperate with the commission's office of inspector
general [investigations and enforcement];
(11) a process by which the commission is required to:
(A) provide in writing to the managed care
organization the projected fiscal impact on the state and managed
care organizations that contract with the commission under this
chapter of proposed Medicaid managed care program, benefit, or
contract changes; and
(B) negotiate in good faith regarding
appropriate operational and financial changes to the contract with
the managed care organization before implementing those changes;
(12) a requirement that the managed care organization
providing services to recipients under a Medicaid STAR + Plus pilot
program:
(A) have an appropriate number of clinically
trained case managers within the Medicaid STAR + Plus pilot program
service delivery area to manage medically complex patients; and
(B) implement disease management programs that
address the medical conditions of the Medicaid STAR + Plus pilot
program population, including persons with HIV infection, AIDS, or
sickle cell anemia;
(13) a requirement that the renewal date of the
contract coincide with the beginning of the state fiscal year; and
(14) a requirement that the managed care organization
reimburse health care providers for an appropriate emergency
medical screening that is within the capability of the hospital's
emergency department, including ancillary services routinely
available to the emergency department, and that is provided to
determine whether:
(A) an emergency medical or psychiatric
condition exists; and
(B) additional medical examination and treatment
is required to stabilize the emergency medical or psychiatric
condition
(b) The changes in law made by Section 533.005, Government
Code, as amended by this section, apply to a contract between the
Health and Human Services Commission and a managed care
organization under Chapter 533, Government Code, that is entered
into or renewed on or after the effective date of this section. A
contract that is entered into or renewed before the effective date
of this section is governed by the law in effect on the date the
contract was entered into or renewed, and the former law is
continued in effect for that purpose.
SECTION 2.08. (a) Subchapter A, Chapter 533, Government
Code, is amended by adding Sections 533.0051, 533.0077, 533.0091,
and 533.019 through 533.0202 to read as follows:
Sec. 533.0051. CONTRACT RENEWAL. Before renewing a
contract with a managed care organization under this chapter, the
commission shall consider:
(1) the managed care organization's:
(A) overall contract compliance;
(B) implementation of simplified administrative
processes for health care providers and recipients;
(C) compliance with statutory requirements to
promptly reimburse health care providers for covered services
provided under the Medicaid managed care program;
(D) compliance with the requirements under
Chapter 1301, Insurance Code, and Section 843.312, Insurance Code,
to identify advanced practice nurses and physician assistants as
providers in the managed care organization's provider network;
(E) financial performance; and
(F) participation in the state child health plan
under Chapter 62, Health and Safety Code; and
(2) the level of satisfaction of recipients and health
care providers with the managed care organization.
Sec. 533.0091. UNIFORM STANDARDS FOR IDENTIFYING
RECIPIENTS WITH DISABILITIES OR CHRONIC CONDITIONS. (a) The
commission shall collaborate with managed care organizations that
contract with the commission under this chapter to develop a
uniform screening tool to be used by the managed care organizations
to identify adult recipients with disabilities or chronic health
conditions and assist those recipients in accessing health care
services.
(b) The executive commissioner, in cooperation with the
Department of State Health Services, by rule shall adopt criteria
by which to classify a child with certain health conditions as a
child with special health care needs. In adopting the criteria, the
commission must include children who have:
(1) severe disabilities;
(2) severe mental or emotional disorders;
(3) medically complex or fragile health conditions; or
(4) rare or chronic health conditions that are likely
to last at least one year and result in limitations on the child's
functioning and activities when compared to other children of the
same age who do not have those conditions.
(c) The commission, in cooperation with the Department of
State Health Services, shall:
(1) monitor and assess health care services provided
under the state Medicaid managed care program and the medical
assistance program under Chapter 32, Human Resources Code, to
children with special health care needs as determined by the
criteria adopted under Subsection (b);
(2) adopt specific quality of care standards
applicable to health care services provided under the state
Medicaid managed care program to children described by Subdivision
(1); and
(3) undertake initiatives to develop, test, and
implement optimum methods for the delivery of appropriate,
comprehensive, and cost-effective health care services under the
state Medicaid managed care program to children described by
Subdivision (1), including initiatives to:
(A) coordinate health care services with
educational programs and other social and community services; and
(B) promote family involvement and support.
Sec. 533.019. PREAUTHORIZATION FOR CERTAIN SERVICES NOT
REQUIRED. The commission, in consultation with physicians,
hospitals, and managed care organizations contracting with the
commission under this chapter, shall develop:
(1) a process by which the managed care organizations
eliminate preauthorization processes for covered services that are
considered to be routine services; and
(2) a process by which to notify health care providers
of covered services under the Medicaid managed care program for
which preauthorization is not required.
Sec. 533.020. UTILIZATION REVIEW UNDER PRIMARY CARE CASE
MANAGEMENT NETWORK. To the extent allowed by federal law, the
commission shall require a managed care organization that contracts
with the commission under this chapter and that provides health
care services to recipients through a primary care case management
network to conduct utilization review of those services in
accordance with Article 21.58A, Insurance Code.
Sec. 533.0201. NOTICE OF DETERMINATIONS MADE BY UTILIZATION
REVIEW AGENTS. (a) In this section, "utilization review agent"
has the meaning assigned by Section 2, Article 21.58A, Insurance
Code.
(b) A utilization review agent shall notify a recipient or a
person acting on behalf of the recipient and the recipient's health
care provider of a utilization review determination in accordance
with this section and Section 5(a), Article 21.58A, Insurance Code,
with respect to services provided under the state Medicaid managed
care program.
(c) If the utilization review agent makes an adverse
determination, the notice required by this section must include:
(1) the principal reasons for the adverse
determination;
(2) the clinical basis for the adverse determination;
(3) a description or the source of the screening
criteria used as guidelines in making the determination; and
(4) a description of the procedure for the complaint
and appeal process, including a description provided to the
recipient of:
(A) the recipient's right to a Medicaid fair
hearing at any time; and
(B) the procedures for appealing an adverse
determination at a Medicaid fair hearing.
(d) The utilization review agent must provide notice of an
adverse determination:
(1) to the recipient and the recipient's health care
provider of record by telephone or electronic transmission not
later than the next business day after the date the determination is
made if the recipient is hospitalized when the determination is
made, to be followed not later than the third business day after the
date the determination is made by a written notice of the
determination;
(2) to the recipient and the recipient's health care
provider of record by written notice not later than the third
business day after the date the determination is made if the
recipient is not hospitalized when the determination is made; or
(3) to the recipient's treating physician or health
care provider within the time appropriate to the circumstances that
relate to the delivery of the services and the condition of the
patient, but not later than one hour after the recipient's treating
physician or provider requests poststabilization care following
emergency treatment.
(e) The executive commissioner shall adopt rules to
implement this section.
Sec. 533.0202. IMPLEMENTATION OF CERTAIN MANAGED CARE PLANS
IN CERTAIN COUNTIES. (a) Notwithstanding any other law, before
implementing a Medicaid managed care plan that uses capitation as a
method of payment in a county with a population of less than
100,000, the commission must determine that implementation is
economically efficient.
(b) Notwithstanding Subsection (a), the commission may
continue implementation of a Medicaid managed care plan described
by Subsection (a) in a county with a population of less than 100,000
if implementation of the plan in the county was in progress on
January 1, 2005.
(b) The changes in law made by Section 533.0201, Government
Code, as added by this section, apply to a contract between the
Health and Human Services Commission and a managed care
organization under Chapter 533, Government Code, that is entered
into or renewed on or after the effective date of this section. A
contract that is entered into or renewed before the effective date
of this section is governed by the law in effect on the date the
contract was entered into or renewed, and the former law is
continued in effect for that purpose.
SECTION 2.09. (a) Section 31.0032(d), Human Resources
Code, is amended to read as follows:
(d) 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, from providing medical assistance, child care, or
any other related 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.
(b) The changes in law made to Section 31.0032, Human
Resources Code, by this section apply to a person receiving
financial assistance under Chapter 31, Human Resources Code, on or
after the effective date of this Act, regardless of the date on
which eligibility for financial assistance was determined.
SECTION 2.10. Section 32.024, Human Resources Code, is
amended by reenacting and amending Subsection (i), as amended by
Chapters 198 and 1251, Acts of the 78th Legislature, Regular
Session, 2003, and Subsection (w), and adding Subsections (bb),
(cc), and (dd) to read as follows:
(i) The department shall [in its adoption of rules may]
establish a medically needy program that serves pregnant women,
children, and caretakers who have high medical expenses[, subject
to availability of appropriated funds].
(w) The department shall set a personal needs allowance of
not less than $60 [$45] a month for a resident of a convalescent or
nursing home or related institution licensed under Chapter 242,
Health and Safety Code, personal care facility, ICF-MR facility, or
other similar long-term care facility who receives medical
assistance. The department may send the personal needs allowance
directly to a resident who receives Supplemental Security Income
(SSI) (42 U.S.C. Section 1381 et seq.). This subsection does not
apply to a resident who is participating in a medical assistance
waiver program administered by the department.
(bb) The department shall ensure that each of the following
programs and services under the medical assistance program is
provided at or above the level for which the program or service was
funded during the state fiscal biennium ending August 31, 2003:
(1) community care programs;
(2) services for pregnant women; and
(3) optional services for adult recipients, including
mental health services, podiatric services, eyeglasses, and
hearing aids.
(dd) The department shall provide hyperbaric oxygen therapy
to the extent permitted by federal law.
SECTION 2.11. Subchapter B, Chapter 32, Human Resources
Code, is amended by adding Section 32.0248 to read as follows:
Sec. 32.0248. ELIGIBILITY OF CERTAIN ALIENS. (a) The
department shall provide medical assistance in accordance with 8
U.S.C. Section 1612(b) to a person who:
(1) is a qualified alien, as defined by 8 U.S.C.
Sections 1641(b) and (c);
(2) meets the eligibility requirements of the medical
assistance program;
(3) entered the United States on or after August 22,
1996; and
(4) has resided in the United States for a period of
five years after the date the person entered as a qualified alien.
(b) If authorized by federal law, the department shall
provide pregnancy-related medical assistance to the maximum extent
permitted by the federal law to a person who is pregnant and is a
lawfully present alien as defined by 8 C.F.R. Section 103.12,
including a battered alien under 8 U.S.C. Section 1641(c),
regardless of the date on which the person entered the United
States. The department shall comply with any prerequisite imposed
under the federal law for providing medical assistance under this
subsection.
SECTION 2.12. Subchapter B, Chapter 32, Human Resources
Code, is amended by adding Section 32.0252 to read as follows:
Sec. 32.0252. CONTRACT TO PROVIDE ELIGIBILITY
DETERMINATION SERVICES. (a) To the extent allowed by federal law,
and except as otherwise provided by this section, the department
may contract for the provision of medical assistance eligibility
services with:
(1) a hospital district created under the authority of
Sections 4-11, Article IX, Texas Constitution;
(2) a hospital authority created under the authority
of Chapter 262 or 264, Health and Safety Code, that uses resources
to provide health care services to indigent persons to some extent;
(3) a hospital owned and operated by a municipality or
county or by a hospital authority created under Chapter 262 or 264,
Health and Safety Code;
(4) a medical school operated by this state;
(5) a medical school that receives state money under
Section 61.093, Education Code, or a chiropractic school that
receives state money under the General Appropriations Act;
(6) a teaching hospital operated by The University of
Texas System;
(7) a county that is required to provide health care
assistance to eligible county residents under Subchapter B, Chapter
61, Health and Safety Code;
(8) a governmental entity that is required to provide
money to a public hospital under Section 61.062, Health and Safety
Code;
(9) a county with a population of more than 400,000
that provides money to a public hospital and that is not included in
the boundaries of a hospital district;
(10) a hospital owned by a municipality and leased to
and operated by a nonprofit hospital for a public purpose;
(11) a hospital that receives Medicaid
disproportionate share payments;
(12) a community mental health and mental retardation
center;
(13) a local mental health or mental retardation
authority;
(14) a local health department or public health
district;
(15) a school-based health center;
(16) a community health center; and
(17) a federally qualified health center.
(b) The department may contract with an entity described by
Subsection (a) for the entity to designate one or more employees of
the entity to process medical assistance application forms and
conduct client interviews for eligibility determinations.
(c) Except as provided by Subsection (d), the contract must
require each designated employee to submit completed application
forms to the appropriate agency as determined by the department to
finally determine eligibility and to enroll eligible persons in the
program. A designated employee may not make a final determination
of eligibility or enroll an eligible person in the program.
(d) Notwithstanding Subsection (c), the executive
commissioner of the Health and Human Services Commission may apply
for federal authorization to allow a designated employee of an
entity described by Subsection (a) to make a final determination of
eligibility or enroll an eligible person in the program.
(e) The department may:
(1) monitor the eligibility and application
processing program used by an entity with which the department
contracts; and
(2) provide on-site supervision of the program for
quality control.
(f) The Health and Human Services Commission shall ensure
that there are adequate protections to avoid a conflict of interest
with an entity described by Subsection (a) that has a contract for
eligibility services and also has a contract, either directly or
through an affiliated entity, as a managed care organization for
the Medicaid program or for the child health plan program under
Chapter 62, Health and Safety Code. The commission shall ensure
that there are adequate protections for recipients to freely choose
a health plan without being inappropriately induced to join an
entity's health plan.
SECTION 2.13. Section 32.027(j), Human Resources Code, as
added by Chapter 812, Acts of the 77th Legislature, Regular
Session, 2001, is amended to read as follows:
(j) Subject to Section 32.0271, the [The] department shall
assure that a recipient of medical assistance under this chapter
may select a nurse first assistant, as defined by that section
[Section 301.1525, Occupations Code], to perform any health care
service or procedure covered under the medical assistance program
[if:
[(1) the selected nurse first assistant is authorized
by law to perform the service or procedure; and
[(2) the physician requests that the service or
procedure be performed by the nurse first assistant].
SECTION 2.14. Subchapter B, Chapter 32, Human Resources
Code, is amended by adding Section 32.0271 to read as follows:
Sec. 32.0271. SELECTION OF NURSE FIRST ASSISTANT. (a) In
this section, "nurse first assistant" means a registered nurse who:
(1) is certified in perioperative nursing by an
organization recognized by the Board of Nurse Examiners; and
(2) has completed a nurse first assistant educational
program approved by an organization recognized by the Board of
Nurse Examiners.
(b) As required by Section 32.027(j), as added by Chapter
812, Acts of the 77th Legislature, Regular Session, 2001, the
department shall ensure that a recipient of medical assistance may
select a nurse first assistant to perform any health care service or
procedure covered under the medical assistance program if:
(1) the selected nurse first assistant is authorized
by law to perform the service or procedure; and
(2) the physician requests that the service or
procedure be performed by the nurse first assistant.
(c) A managed care organization or a managed care plan, as
those terms are defined by Section 533.001, Government Code, may
not by contract or any other method require a physician to use the
services of a nurse first assistant in providing care to a recipient
of medical assistance.
(d) The Board of Nurse Examiners may adopt rules governing
nurse first assistants for purposes of this section.
SECTION 2.15. Section 32.028, Human Resources Code, is
amended by adding Subsection (n) to read as follows:
(n) The executive commissioner of the Health and Human
Services Commission, in adopting reasonable rules and standards
governing the allocation of any funds appropriated for rate
increases for physician services and outpatient hospital services,
shall establish a provider reimbursement methodology that
recognizes and rewards high-volume providers, with an emphasis on
providers located in areas of this state where medical assistance
payments are particularly vital to the health care delivery system.
SECTION 2.16. Subchapter B, Chapter 32, Human Resources
Code, is amended by adding Section 32.0471 to read as follows:
Sec. 32.0471. FAMILY PLANNING COUNSELING SERVICES;
PROVIDER QUALIFICATIONS. The department shall require that anyone
who provides counseling services related to family planning
services provided under this chapter must be:
(1) a licensed health care provider or a licensed
counseling professional; or
(2) under the supervision of a licensed health care
professional or a licensed counseling professional.
SECTION 2.17. (a) Subchapter B, Chapter 32, Human
Resources Code, is amended by adding Sections 32.071 through 32.074
to read as follows:
Sec. 32.071. DEMONSTRATION PROJECT FOR CERTAIN MEDICATIONS
AND RELATED SERVICES. (a) The department shall establish a
demonstration project to provide to a person through the medical
assistance program psychotropic medications and related laboratory
and medical services necessary to conform to a prescribed medical
regime for those medications.
(b) A person is eligible to participate in the demonstration
project if the person:
(1) has been diagnosed as having a mental impairment,
including schizophrenia or bipolar disorder, that is expected to
cause the person to become a disabled individual, as defined by
Section 1614(a) of the federal Social Security Act (42 U.S.C.
Section 1382c);
(2) is at least 19 years of age, but not more than 64
years of age;
(3) has a net family income that is at or below 200
percent of the federal poverty level;
(4) is not covered by a health benefits plan offering
adequate coverage, as determined by the department; and
(5) is not otherwise eligible for medical assistance
at the time the person's eligibility for participation in the
demonstration project is determined.
(c) To the extent allowed by federal law, and except as
otherwise provided by this section, the department may contract for
the provision of eligibility services for the demonstration project
with a local mental health authority.
(d) Notwithstanding any other provision of this section,
the department shall provide each participant in the demonstration
project with a 12-month period of continuous eligibility for
participation in the project.
(e) Participation in the demonstration project does not
entitle a participant to other services provided under the medical
assistance program.
(f) The department shall establish an appropriate
enrollment limit for the demonstration project and may not allow
participation in the project to exceed that limit. Once the limit
is reached, the department shall establish a waiting list for
enrollment in the demonstration project.
(g) To the extent permitted by federal law, the department
may require a participant in the demonstration project to make
cost-sharing payments for services provided through the project.
(h) To the maximum extent possible, the department shall use
existing resources to fund the demonstration project.
(i) Not later than December 1 of each even-numbered year,
the department shall submit a biennial report to the legislature
regarding the department's progress in establishing and operating
the demonstration project.
(j) Not later than December 1, 2010, the department shall
evaluate the cost-effectiveness of the demonstration project,
including whether the preventive drug treatments and related
services provided under the project offset future long-term care
costs for project participants. If the results of the evaluation
indicate that the project is cost-effective, the department shall
incorporate a request for funding for the continuation of the
program in the department's budget request for the next state
fiscal biennium.
(k) This section expires September 1, 2016.
Sec. 32.072. DEMONSTRATION PROJECT FOR PERSONS WITH HIV
INFECTION OR AIDS. (a) In this section, "AIDS" and "HIV" have the
meanings assigned by Section 81.101, Health and Safety Code.
(b) The department shall establish a demonstration project
to provide a person with HIV infection or AIDS with the following
services and medications through the medical assistance program:
(1) services provided by a physician, physician
assistant, advanced practice nurse, or other health care provider
specified by the department;
(2) medications not included in the formulary for the
HIV medication program operated by the department, but determined
to be necessary for treatment of a condition related to HIV
infection or AIDS;
(3) vaccinations for hepatitis B and pneumonia;
(4) pap smears, colposcopy, and other diagnostic
procedures necessary to monitor gynecologic complications
resulting from HIV infection or AIDS in women;
(5) hospitalization;
(6) laboratory and other diagnostic services,
including periodic testing for CD4 T-cell counts, viral load
determination, and phenotype or genotype testing if clinically
indicated; and
(7) other laboratory and radiological testing
necessary to monitor potential toxicity of therapy.
(c) The department shall establish the demonstration
project in at least two counties with a high prevalence of HIV
infection and AIDS. The department shall ensure that the
demonstration project is financed using funds made available by the
counties in which the department establishes the demonstration
project. The manner in which a county makes funds available may
include an option for the county to be able to certify the amount of
funds considered available instead of sending the funds to the
state.
(d) A person is eligible to participate in the demonstration
project if the person:
(1) has been diagnosed with HIV infection or AIDS by a
physician;
(2) is under 65 years of age;
(3) has a net family income that is at or below 200
percent of the federal poverty level;
(4) is a resident of a county included in the project
or, subject to guidelines established by the department, is
receiving medical care for HIV infection or AIDS through a facility
located in a county included in the project;
(5) is not covered by a health benefits plan offering
adequate coverage, as determined by the department; and
(6) is not otherwise eligible for medical assistance
at the time the person's eligibility for participation in the
demonstration project is determined.
(e) Participation in the demonstration project does not
entitle a participant to other services provided under the medical
assistance program.
(f) The department shall establish an appropriate
enrollment limit for the demonstration project and may not allow
participation in the project to exceed that limit. Once the limit
is reached, the department:
(1) shall establish a waiting list for enrollment in
the demonstration project; and
(2) may allow eligible persons on the waiting list to
enroll solely in the HIV medication program operated by the
department.
(g) The department shall ensure that a participant in the
demonstration project is also enrolled in the HIV medication
program operated by the department.
(h) Notwithstanding any other provision of this section,
the department shall provide each participant in the project with a
six-month period of continuous eligibility for participation in the
project.
(i) Not later than December 1 of each even-numbered year,
the department shall submit a biennial report to the legislature
regarding the department's progress in establishing and operating
the demonstration project.
(j) Not later than December 1, 2010, the department shall
evaluate the cost-effectiveness of the demonstration project,
including whether the services and medications provided offset
future higher costs for project participants. If the results of the
evaluation indicate that the project is cost-effective, the
department shall incorporate a request for funding for the
expansion of the project into additional counties or throughout the
state, as appropriate, in the department's budget request for the
next state fiscal biennium.
(k) This section expires September 1, 2016.
Sec. 32.073. DEMONSTRATION PROJECTS FOR PROVISION OF
MEDICAL ASSISTANCE TO CERTAIN LOW-INCOME INDIVIDUALS. (a) The
Health and Human Services Commission shall establish demonstration
projects to provide medical assistance under this chapter to adult
individuals who are not otherwise eligible for medical assistance
and whose incomes are at or below 200 percent of the federal poverty
level.
(b) The Health and Human Services Commission shall select
one or more municipalities or counties in which to implement the
demonstration projects.
(c) The Health and Human Services Commission, in
conjunction with local governmental entities that make funds
available to the commission in accordance with this section, shall
design the components of the demonstration project and shall ensure
that:
(1) each demonstration project is financed using funds
made available by certain local governmental entities, through a
certification process, to the commission for matching purposes to
maximize federal funds for the medical assistance program; and
(2) a participant in a demonstration project is not
subject to a limitation imposed on prescription drug benefits under
the medical assistance program.
(d) The Health and Human Services Commission shall appoint
regional advisory committees to assist the commission in
establishing and implementing demonstration projects under this
section. An advisory committee must include health care providers,
employers, and local government officials.
Sec. 32.074. DEMONSTRATION PROJECT FOR WOMEN'S HEALTH CARE
SERVICES. (a) The department shall establish a five-year
demonstration project through the medical assistance program to
expand access to preventive health and family planning services for
women. A woman eligible under Subsection (b) to participate in the
demonstration project may receive preventive health and family
planning services, including:
(1) medical history;
(2) physical examinations;
(3) counseling and education on contraceptive methods
that includes:
(A) promoting abstinence as the preferred choice
of behavior related to all sexual activity for unmarried persons;
(B) emphasizing abstinence from sexual activity,
if used consistently and correctly, is the only method that is 100
percent effective in preventing pregnancy, sexually transmitted
diseases, infection with human immunodeficiency virus or acquired
immune deficiency syndrome, and the emotional trauma associated
with adolescent sexual activity; and
(C) informing single and divorced adults that
abstinence from sexual activity before marriage is the most
effective way to prevent pregnancy, sexually transmitted diseases,
and infection with human immunodeficiency virus or acquired immune
deficiency syndrome;
(4) provision of contraceptives;
(5) health screenings, including screening for:
(A) diabetes;
(B) cervical cancer;
(C) breast cancer;
(D) sexually transmitted diseases;
(E) hypertension;
(F) cholesterol; and
(G) tuberculosis;
(6) risk assessment; and
(7) referral of medical problems to appropriate
providers.
(b) A woman is eligible to participate in the demonstration
project if the woman:
(1) is 18 years of age or older;
(2) has a net family income that is at or below 185
percent of the federal poverty level; and
(3) is not otherwise eligible for the medical
assistance program.
(c) The department shall develop procedures for determining
and certifying presumptive eligibility for a woman eligible under
Subsection (b). The department shall integrate these procedures
with current procedures to minimize duplication of effort by
providers, the department, and other state agencies.
(d) The department shall provide for 12 months of continuous
eligibility for a woman eligible under Subsection (b).
(e) The department shall compile a list of potential funding
sources a client can use to help pay for treatment for health
problems:
(1) identified using services provided to the client
under the demonstration project; and
(2) for which the client is not eligible to receive
treatment under the medical assistance program.
(f) Not later than December 1 of each even-numbered year,
the department shall submit a report to the legislature that
includes a statement of the department's progress in establishing
and operating the demonstration project.
(g) The department shall ensure that money under the
demonstration project established by this section may not be used
for an abortion, as that term is defined by Section 245.002, Health
and Safety Code.
(h) To the extent required by federal budget neutrality
requirements, the department may establish an appropriate
enrollment limit for the demonstration project.
(i) This section expires September 1, 2011.
(b) The state agency responsible for implementing the
demonstration projects required by Sections 32.071 through 32.074,
Human Resources Code, as added by this section, shall request and
actively pursue any necessary waivers or authorizations from the
Centers for Medicare and Medicaid Services or other appropriate
entities to enable the agency to implement the demonstration
projects not later than September 1, 2006. The agency may delay
implementing a demonstration project until the necessary waivers or
authorizations are granted.
SECTION 2.18. (a) The executive commissioner of the Health
and Human Services Commission shall conduct a study regarding the
feasibility of expanding the medical assistance program under
Chapter 32, Human Resources Code, to provide medical assistance to
disabled children 18 years of age or younger in accordance with 42
U.S.C. Section 1396a(e)(3).
(b) In conducting the study, the executive commissioner
shall evaluate:
(1) the number of children who would be eligible for
medical assistance under the expanded program and who would be
likely to enroll;
(2) the effect of other health insurance coverage
provided for children who would be eligible under the expanded
medical assistance program on the cost of expanding the program;
(3) utilization patterns of similar populations of
disabled children under similar programs in this state and other
states;
(4) the cost to the state of inappropriate
institutionalization of disabled children resulting from
unavailability of health insurance coverage for those children; and
(5) options for setting an income eligibility cap for
the expanded medical assistance program.
(c) Not later than December 1, 2006, the executive
commissioner shall submit a report to the legislature regarding the
results of the study conducted under this section. The report must
include a recommendation regarding expanding the medical
assistance program to provide that assistance to disabled children
in accordance with 42 U.S.C. Section 1396a(e)(3).
SECTION 2.19. The executive commissioner of the Health and
Human Services Commission shall examine the reimbursement
methodology for air ambulance services purchased under the medical
assistance program and may implement any changes necessary to
maintain a viable air ambulance system through the state.
SECTION 2.20. The following laws are repealed:
(1) Sections 531.0392, 531.070(l), 531.072, 531.073,
531.074, 531.075, and Government Code; and
(2) Sections 31.0032(c), as added by Chapter 198, Acts
of the 78th Legislature, Regular Session, 2003, 32.024(z-1), and
32.064, Human Resources Code.
SECTION 2.21. Except as otherwise provided by this article,
this article applies to a person receiving medical assistance on or
after the effective date of this article, regardless of the date on
which the person began receiving that medical assistance.
ARTICLE 3. RESTORATION AND EXPANSION OF THE CHILDREN'S HEALTH
INSURANCE PROGRAM
SECTION 3.01. Section 62.002(4), Health and Safety Code, is
amended to read as follows:
(4) "Net [Gross] family income" means the [total]
amount of income established for a family after reduction for
offsets for expenses such as child care and work-related expenses,
in accordance with standards applicable under the Medicaid [without
consideration of any reduction for offsets that may be available to
the family under any other] program.
SECTION 3.02. Subchapter B, Chapter 62, Health and Safety
Code, is amended by adding Sections 62.056, 62.057, 62.060, and
62.061 to read as follows:
Sec. 62.056. COMMUNITY OUTREACH CAMPAIGN; TOLL-FREE
HOTLINE. (a) The commission shall conduct a community outreach and
education campaign to provide information relating to the
availability of health benefits for children under this chapter.
The commission shall conduct the campaign in a manner that promotes
enrollment in, and minimizes duplication of effort among, all
state-administered child health programs.
(b) The community outreach campaign must include:
(1) outreach efforts that involve school-based health
clinics; and
(2) a toll-free telephone number through which
families may obtain information about health benefits coverage for
children.
(c) The commission shall contract with community-based
organizations or coalitions of community-based organizations to
implement the community outreach campaign and shall also promote
and encourage voluntary efforts to implement the community outreach
campaign. The commission shall procure the contracts through a
process designed by the commission to encourage broad participation
of organizations, including organizations that target population
groups with high levels of uninsured children.
Sec. 62.057. REGIONAL ADVISORY COMMITTEES. (a) The
commission shall appoint regional advisory committees to provide
recommendations on the operation of the child health plan program.
(b) The advisory committees, to the extent possible, must be
composed of representatives of:
(1) hospitals;
(2) insurance companies and health maintenance
organizations eligible to offer the health benefits coverage under
the child health plan;
(3) primary care providers;
(4) consumer advocates, including advocates for
children with special health care needs;
(5) parents of children who are enrolled in the child
health plan;
(6) rural health care providers;
(7) specialty health care providers, including
pediatric providers;
(8) community-based organizations that provide
community outreach under Section 62.056; and
(9) state agencies.
(c) The commission shall establish the regional advisory
committees, consistent with Subsection (b), in regions of this
state in a manner that ensures geographic representation.
(d) In implementing this section, the commission may use
other regional advisory structures, augmented to ensure the
representation required by Subsection (b), to the extent necessary
to avoid duplication of administrative activities.
(e) The advisory committees shall meet at least quarterly
and are subject to Chapter 551, Government Code.
(f) Section 2110.008, Government Code, does not apply to the
advisory committees.
Sec. 62.060. AMOUNT OF STATE CONTRIBUTION. (a) Not later
than November 1 preceding each regular session of the legislature,
the executive commissioner of the commission shall certify to the
Legislative Budget Board the amount necessary to draw down the
maximum amount of federal money available for the child health plan
during the following state fiscal biennium, including any federal
money unused from a previous biennium that is available for that
biennium.
(b) Each legislative session the legislature shall
appropriate to the commission for the purpose of providing services
under the child health plan the amount certified under Subsection
(a).
Sec. 62.061. EXPENDITURE OF AVAILABLE MONEY. For each
state fiscal biennium the commission shall develop a plan to use all
federal money available for the state child health plan for that
biennium, including money remaining from previous years'
allocations of federal money for the plan, by maximizing the number
of children provided services under the plan.
SECTION 3.03. Section 62.101(b), Health and Safety Code, is
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
[gross] family income is at or below 200 percent of the federal
poverty level is eligible for health benefits coverage under the
program. [In addition, the commission may establish eligibility
standards regarding the amount and types of allowable assets for a
family whose gross family income is above 150 percent of the federal
poverty level.]
SECTION 3.04. Section 62.102, Health and Safety Code, is
amended to read as follows:
Sec. 62.102. CONTINUOUS COVERAGE. [(a)] 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 12 months,
following the date of the eligibility determination; or
(2) the individual's 19th birthday.
[(b) The period of continuous eligibility may be
established at an interval of 6 months beginning immediately upon
passage of this Act and ending September 1, 2005, at which time an
interval of 12 months of continuous eligibility will be
re-established.]
SECTION 3.05. Section 62.151(b), Health and Safety Code, is
amended 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. 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. The child health plan must include at least the
covered benefits provided under the plan on June 1, 2003.
SECTION 3.06. Section 62.153(b), Health and Safety Code, is
amended to read as follows:
(b) Cost-sharing [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 plan.
SECTION 3.07. Sections 62.154(a) 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 and[. The child health plan] 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.
(d) The waiting period required by Subsection (a) must:
(1) extend for a period of 90 days after[:
[(1)] the last date on [first day of the month in]
which the applicant 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 [is enrolled
under the child health plan, if the date of enrollment is on or
before the 15th day of the month; or
[(2) the first day of the month after which the
applicant is enrolled under the child health plan, if the date of
enrollment is after the 15th day of the month].
SECTION 3.08. 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; and
(2) shall provide for a choice of at least two health
plan providers in each metropolitan [service] area.
(d) The commissioner may authorize an exception to
Subsection (c)(2) if there is only one acceptable applicant to
become a health plan provider in the metropolitan [service] area.
SECTION 3.09. The following laws are repealed:
(1) Section 62.151(f), Health and Safety Code; and
(2) Section 62.153(d), Health and Safety Code.
ARTICLE 4. ADDITIONAL CHANGES TO HEALTH AND HUMAN SERVICES
PROGRAMS
SECTION 4.01. CALL CENTERS. (a) The Health and Human
Services Commission may not accept a proposal for the establishment
of a call center under Section 531.063, Government Code, as added by
Chapter 198, Acts of the 78th Legislature, Regular Session, 2003,
or conduct negotiations regarding a proposed contract for a call
center under that section on or after the effective date of this
article.
(b) If the Health and Human Services Commission entered into
a contract for the establishment of a call center under Section
531.063, Government Code, as added by Chapter 198, Acts of the 78th
Legislature, Regular Session, 2003, before the effective date of
this article, the commission may not renew the contract. During the
term of the contract and except as provided by Sections 32.0252 and
32.071, Human Resources Code, as added by this Act, the commission:
(1) must continue to directly operate local offices
for the purpose of determining an applicant's eligibility for
health and human services programs and allow an applicant to access
a local office in lieu of accessing a call center for an eligibility
determination; and
(2) may not terminate the employment of any state
employee whose primary job function involves determining the
eligibility of an applicant for health and human services programs
on the basis that the performance of those functions is no longer
needed.
(c) Section 531.063, Government Code, as added by Chapter
198, Acts of the 78th Legislature, Regular Session, 2003, is
repealed.
SECTION 4.02. EFFECTIVE DATE OF ARTICLE. This article
takes effect immediately if this Act receives a vote of two-thirds
of all the members elected to each house, as provided by Section 39,
Article III, Texas Constitution. If this Act does not receive the
vote necessary for this article to have immediate effect, this
article takes effect September 1, 2005.
ARTICLE 5. COMPLIANCE WITH FEDERAL REQUIREMENTS; EFFECTIVE DATE
SECTION 5.01. FEDERAL WAIVER AS PREREQUISITE TO
IMPLEMENTATION. 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 5.02. EFFECTIVE DATE. Except as otherwise provided
by this Act, this Act takes effect September 1, 2005.