80R9058 ABC-D

By: Burnam H.B. No. 2737

A BILL TO BE ENTITLED

AN ACT

relating to universal health coverage for Texans.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:

ARTICLE 1. UNIVERSAL HEALTH COVERAGE

SECTION 1.01. The Health and Safety Code is amended by adding Title 13 to read as follows: TITLE 13. UNIVERSAL HEALTH COVERAGE FOR TEXANS SUBTITLE A. GOVERNANCE CHAPTER 2001. GENERAL PROVISIONS

Sec. 2001.001. DEFINITIONS. In this title:

(1) "Commission" means the Health and Human Services Commission.

(2) "Executive commissioner" means the executive commissioner of the Health and Human Services Commission.

(3) "System" means the Texas Health Coverage System. CHAPTER 2002. GOVERNANCE OF TEXAS HEALTH COVERAGE SYSTEM SUBCHAPTER A. GENERAL PROVISIONS

Sec. 2002.001. DUTIES OF COMMISSION. The Health and Human Services Commission administers the Texas Health Coverage System under this title.

Sec. 2002.002. GRANTS; FEDERAL FUNDING. The commission may accept gifts, grants, and donations, including grants from the federal government, to administer this title and provide health coverage through the system. [Sections 2002.003-2002.050 reserved for expansion] SUBCHAPTER B. EXECUTIVE COMMISSIONER

Sec. 2002.051. POWERS AND DUTIES OF EXECUTIVE COMMISSIONER. (a) The executive commissioner is responsible for administering the system.

(b) The executive commissioner may:

(1) set rates for payment by and to the system, including premium payments owed to the system, and establish the budget for the system;

(2) establish system objectives, priorities, and standards;

(3) define the scope of services provided by the system;

(4) employ personnel for the system, including actuaries, accountants, and other necessary experts;

(5) establish guidelines for evaluating the performance of the system;

(6) establish guidelines for ensuring public input;

(7) establish procedures for redress of grievances; and

(8) allocate system resources in accordance with this title.

(c) The executive commissioner shall establish, within the system:

(1) an office of patient advocacy, under the direction of a deputy commissioner for patient advocacy, to represent the interests of eligible residents entitled to receive health care services through the system;

(2) an office of health care planning, under the direction of a deputy commissioner for health care planning, to plan for the short-term and long-term health care needs of eligible residents of this state in accordance with this title and the policies established by the executive commissioner; and

(3) an office of inspector general, under the direction of an inspector general for health coverage, to investigate fraud and other illegal or inappropriate conduct within the system.

(d) The executive commissioner may adopt rules to administer the system and implement this title in accordance with Subchapter B, Chapter 2001, Government Code.

Sec. 2002.052. HEALTH COVERAGE ADVISORY COMMITTEE. (a) The health coverage advisory committee advises the executive commissioner concerning the implementation of the system.

(b) The health coverage advisory committee is composed of 12 members appointed by the governor, including three public members.

(c) Members of the committee, other than public members, must be selected to represent the interests of physicians, nurses, hospitals, dentists, pharmacists, mental health providers, and other health care practitioners and facilities.

Sec. 2002.053. DISCRIMINATION PROHIBITED. The members of the health coverage advisory committee shall be appointed without regard to the race, color, disability, sex, religion, age, or national origin.

Sec. 2002.054. ELIGIBILITY. (a) A person may not be a public member of the health coverage advisory committee if the person or the person's spouse:

(1) is registered, certified, or licensed by a regulatory commission in the field of health care, health insurance, pharmaceuticals, or medical equipment;

(2) is employed by or participates in the management of a business entity or other organization regulated by or receiving money from the commission;

(3) owns or controls, directly or indirectly, more than a 10 percent interest in a business entity or other organization regulated by or receiving money from the commission; or

(4) uses or receives a substantial amount of tangible goods, services, or money from the commission other than compensation or reimbursement authorized by law for committee membership, attendance, or expenses.

(b) A person may not be a member of the health coverage advisory committee if:

(1) the person is an officer, employee, or paid consultant of a Texas trade association in the field of health care, health insurance, pharmaceuticals, or medical equipment; or

(2) the person's spouse is an officer, manager, or paid consultant of a Texas trade association in the field of health care, health insurance, pharmaceuticals, or medical equipment.

(c) It is a ground for removal from the health coverage advisory committee that a member:

(1) is ineligible for membership under this subchapter;

(2) cannot, because of illness or disability, discharge the member's duties for a substantial part of the member's term; or

(3) is absent from more than half of the regularly scheduled committee meetings that the member is eligible to attend during a calendar year without an excuse approved by a majority vote of the committee.

(d) A person may not serve as a member of the health coverage advisory committee if the person is required to register as a lobbyist under Chapter 305, Government Code, because of the person's activities for compensation on behalf of a profession related to the operation of the system.

(e) If the executive commissioner has knowledge that a potential ground for removal exists, the executive commissioner shall notify the presiding officer of the committee of the potential ground. The presiding officer shall then notify the governor and the attorney general that a potential ground for removal exists. If the potential ground for removal involves the presiding officer, the executive commissioner shall notify the next highest ranking officer of the committee who shall then notify the governor and the attorney general that a potential ground for removal exists.

Sec. 2002.055. TRAINING. (a) A person who is appointed to and qualifies for office as a member of the health care advisory committee may not vote, deliberate, or be counted as a member in attendance at a meeting of the committee until the person completes a training program that complies with this section.

(b) The training program must provide the person with information regarding:

(1) this title;

(2) the programs, functions, rules, and budget of the system;

(3) the results of the most recent formal audit of the system;

(4) the requirements of laws relating to open meetings, public information, administrative procedure, and conflicts of interest; and

(5) any applicable ethics policies adopted by the commission or the Texas Ethics Commission.

(c) A person appointed to the health care advisory committee is entitled to reimbursement, as provided by the General Appropriations Act, for the travel expenses incurred in attending the training program regardless of whether the attendance at the program occurs before or after the person qualifies for office.

Sec. 2002.056. COMPENSATION; REIMBURSEMENT. A person appointed to the health coverage advisory committee is not entitled to compensation for service on the committee but is entitled to reimbursement, as provided by the General Appropriations Act, for the expenses incurred in attending committee meetings or performing other official functions of the committee.

Sec. 2002.057. APPLICABILITY OF OTHER LAW. Chapter 2110, Government Code, does not apply to the health coverage advisory committee. [Sections 2002.058-2002.100 reserved for expansion] SUBCHAPTER C. HEALTH CARE DELIVERY REGIONS

Sec. 2002.101. HEALTH CARE DELIVERY REGIONS. The executive commissioner may establish health care delivery regions to facilitate and administer the delivery of health care in regions of this state. CHAPTER 2003. FISCAL MANAGEMENT SUBCHAPTER A. HEALTH COVERAGE FUND

Sec. 2003.001. FUND. The health coverage fund is a fund in the state treasury. The fund is composed of:

(1) federal money allocated to the fund; and

(2) other money allocated to the fund under law.

Sec. 2003.002. ADMINISTRATION OF FUND. The executive commissioner administers the fund.

Sec. 2003.003. USE OF FUND. Money in the fund may be used in accordance with the General Appropriations Act to pay claims for health care services provided through the system and the administrative costs of the system.

Sec. 2003.004. LEGISLATIVE APPROPRIATION REQUEST. Not later than November 1 of each even-numbered year, the executive commissioner shall submit to the Legislative Budget Board:

(1) an estimate of projected system revenue under this title and other law;

(2) an estimate of projected system liabilities for the succeeding fiscal biennium; and

(3) a legislative appropriation request for the succeeding fiscal biennium.

Sec. 2003.005. DUTY TO MONITOR SYSTEM SOLVENCY. The executive commissioner shall monitor the solvency of the system. [Sections 2003.006-2003.050 reserved for expansion] SUBCHAPTER B. FEDERAL FUNDING

Sec. 2003.051. APPLICATION FOR FEDERAL FUNDING. The executive commissioner, through applications for appropriate waivers from the Centers for Medicare and Medicaid Services or other appropriate funding sources, shall seek federal funding for the operation of the system. [Sections 2003.052-2003.100 reserved for expansion] SUBCHAPTER C. CLAIMS PAYMENT

Sec. 2003.101. RATES AND TERMS OF PAYMENT. The executive commissioner shall establish the rate and terms applicable to payment of claims for health care services provided to eligible residents under the system. SUBTITLE B. TEXAS HEALTH COVERAGE SYSTEM CHAPTER 2101. ELIGIBILITY SUBCHAPTER A. GENERAL ELIGIBILITY REQUIREMENTS

Sec. 2101.001. RESIDENT. Each resident of this state is eligible for health coverage provided through the system.

Sec. 2101.002. EXCEPTION. Notwithstanding Section 2101.001, the executive commissioner may exclude from eligibility a resident of this state the commissioner finds has adequate health coverage from another source. [Sections 2101.003-2101.050 reserved for expansion] SUBCHAPTER B. ELIGIBILITY DETERMINATIONS

Sec. 2101.051. VERIFICATION OF ELIGIBILITY. The executive commissioner by rule shall adopt procedures for verifying residence to establish eligibility for health coverage provided through the system.

Sec. 2101.052. EVIDENCE OF COVERAGE. The system may issue an identification card or other evidence of coverage to be used by an eligible resident to show proof that the resident is eligible for health coverage provided through the system. CHAPTER 2102. HEALTH CARE SERVICES

Sec. 2102.001. COVERAGE FOR HEALTH CARE SERVICES. The system must provide health coverage for all services the executive commissioner determines are reasonably needed to maintain good health and that are medically necessary for the eligible resident. CHAPTER 2103. COST SHARING

Sec. 2103.001. PREMIUM. The executive commissioner by rule shall establish requirements for the payment of premium for participation in the system.

Sec. 2103.002. COPAYMENTS AUTHORIZED. The executive commissioner may establish copayment amounts to be paid at the point of service by an eligible resident receiving health care services for which coverage is provided through the system.

Sec. 2103.003. DEDUCTIBLE AMOUNTS. The executive commissioner may establish deductible amounts that an eligible resident receiving health care services is responsible to pay before coverage is provided through the system. CHAPTER 2104. HEALTH CARE PROVIDER

Sec. 2104.001. CREDENTIALING. The executive commissioner by rule may establish standards for participation in the system as a physician, health care practitioner, or health care facility.

Sec. 2104.002. PRIMARY CARE PROVIDER; REQUIRED REFERRAL. The executive commissioner by rule may establish requirements under which an eligible resident must designate a primary care provider and must obtain a referral from that provider to obtain coverage for specialty care services.

ARTICLE 2. CONFORMING AMENDMENTS

SECTION 2.01. Subchapter A, Chapter 531, Government Code, is amended by adding Section 531.0001 to read as follows:

Sec. 531.0001. COORDINATION WITH TEXAS HEALTH COVERAGE SYSTEM. (a) Notwithstanding any provision of this chapter or any other law of this state, on and after January 1, 2010, the Texas Health Coverage System is responsible for administering the system for providing health coverage and health care services in this state.

(b) Each health and human services agency remains responsible for safety and licensing functions within the jurisdiction of the agency before January 1, 2010, but functions of the agency relating to the provision of health coverage or health care services are transferred to the Texas Health Coverage System in accordance with Title 13, Health and Safety Code.

SECTION 2.02. Chapter 30, Insurance Code, is amended by adding Section 30.005 to read as follows:

Sec. 30.005. COORDINATION WITH TEXAS HEALTH COVERAGE SYSTEM. Notwithstanding any provision of this code or any other law of this state, on and after January 1, 2010, an insurer, health maintenance organization, or other entity may not offer a health benefits plan in this state to the extent that plan duplicates coverage provided under the Texas Health Coverage System.

ARTICLE 3. TRANSITION PLAN

SECTION 3.01. (a) Not later than January 1, 2008, the executive commissioner of the Health and Human Services Commission shall appoint a transition advisory group. The transition advisory group must include representatives of the public, the health care industry, issuers of health benefit plans, and other experts identified by the executive commissioner.

(b) In consultation with the transition advisory group, the executive commissioner of the Health and Human Services Commission shall develop a plan for the orderly implementation of Title 13, Health and Safety Code, as added by this Act.

SECTION 3.02. The Texas Health Coverage System shall become effective to provide coverage in accordance with Title 13, Health and Safety Code, as added by this Act, not later than January 1, 2010.

SECTION 3.03. (a) In this section, "affected state agency" means:

(1) the Health and Human Services Commission;

(2) the Texas Department of Insurance; and

(3) any health and human services agency described by Section 531.001, Government Code, that is designated as affected by the executive commissioner of the Health and Human Services Commission.

(b) Effective January 1, 2010, or on an earlier date specified by the executive commissioner of the Health and Human Services Commission:

(1) each affected state agency shall transfer any property or records of the state agency related to the administration of health coverage, health benefits, or health care services within the jurisdiction of the Texas Health Coverage System to the Texas Health Coverage System to assist the Health and Human Services Commission to begin administering Title 13, Health and Safety Code, as added by this Act, as efficiently as practicable;

(2) all powers, duties, functions, activities, obligations, rights, contracts, records, property, and appropriations or other money of the affected state agency related to the administration of health coverage, health benefits, or health care services within the jurisdiction of the Texas Health Coverage System are transferred to the Health and Human Services Commission;

(3) a rule or form adopted by each affected state agency related to the administration of health coverage, health benefits, or health care services within the jurisdiction of the Texas Health Coverage System is a rule or form of the Health and Human Services Commission and remains in effect until altered by that commission; and

(4) a reference in law or an administrative rule to an affected state agency that relates to the administration of health coverage, health benefits, or health care services within the jurisdiction of the Texas Health Coverage System means the Health and Human Services Commission.

(c) Until the date of the transfer specified by Subsection (b) of this section, and subject to the transition plan adopted by the executive commissioner of the Health and Human Services Commission under this article, each affected state agency shall continue to exercise the powers and perform the duties assigned to the state agency under the law as it existed immediately before the effective date of this Act or as modified by another Act of the 80th Legislature, Regular Session, 2007, that becomes law, and the former law is continued in effect for that purpose.

ARTICLE 4. EFFECTIVE DATE

SECTION 4.01. This Act takes effect immediately if it 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 immediate effect, this Act takes effect September 1, 2007.