By: Herrero H.B. No. 3976
 
 
A BILL TO BE ENTITLED
AN ACT
relating to the operation of certain health and human services
systems and programs.
       BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
       SECTION 1.  STUDY AND MODIFICATION OF CERTAIN HEALTH AND
HUMAN SERVICES PROGRAMS AND SYSTEMS.  (a)  The Health and Human
Services Commission shall investigate the operation of the
redesigned integrated eligibility and benefits determination
system for health and human services. The commission's
investigation must include:
             (1)  investigating the implementation and determining
the functionality of the Texas Integrated Eligibility and Redesign
System, including:
                   (A)  determining the general functionality of the
system with respect to its intended purposes;
                   (B)  identifying the actions that would be
necessary to improve the system's functionality with respect to
those purposes, and whether those actions are feasible; and
                   (C)  determining the functionality of the system
with respect to integrating benefits eligibility determination for
the child health plan program under Chapter 62, Health and Safety
Code, and the medical assistance program under Chapter 32, Human
Resources Code;
             (2)  analyzing the process by which the commission
selected and entered into contracts with persons and entities for
the implementation of the redesigned integrated eligibility and
benefits determination system for health and human services and the
terms of those contracts;
             (3)  assessing the performance of persons and entities
with which the commission entered into contracts for the purposes
described by Subdivision (2) of this subsection;
             (4)  assessing the performance of subcontractors of the
contractors described by Subdivision (3) of this subsection that
contract to implement a component of the system;
             (5)  identifying actions that may be taken to stop
operating the system through contractors and instead operate the
system using state employees; and
             (6)  identifying actions necessary to stop processing
applications for the child health plan program using the system,
including alternate application and benefits determination systems
that may be used to process those applications.
       (b)  The commission shall investigate the Medicaid Star +
Plus pilot program operating under Chapter 533, Government Code.
The investigation must include:
             (1)  determining whether the program should be
terminated, operated only in the areas of this state in which the
program has already been implemented, or implemented in additional
areas;
             (2)  determining whether there are certain areas in
this state in which the program should not operate;
             (3)  analyzing the process by which the commission
selected and entered into contracts with persons and entities for
the implementation of the program and the terms of those contracts;
             (4)  assessing the performance of persons and entities
with which the commission entered into contracts for the purposes
described by Subdivision (3) of this subsection;
             (5)  assessing the performance of subcontractors of the
contractors described by Subdivision (4) of this subsection that
contract to implement a component of the program;
             (6)  determining a process by which the contracts with
persons and entities described by Subdivisions (4) and (5) of this
subsection are evaluated on an annual basis;
             (7)  identifying actions that may be taken to terminate
or modify the contracts with persons and entities described by
Subdivisions (4) and (5) of this subsection;
             (8)  identifying actions that are necessary to cease
using contractors to negotiate and oversee contracts with managed
care organizations implementing the program and instead use state
employees to perform those functions; and
             (9)  investigating problems experienced by health care
providers participating in the program, including:
                   (A)  problems with respect to obtaining payment
for services provided under the program; and
                   (B)  the failure of managed care organizations to
give the providers adequate information concerning the
requirements to obtain reimbursements under the program, including
guidelines with respect to submitting claims.
       (c)  The commission shall take any action identified as
required by Subsection (a) or (b) that the commission determines
will be beneficial for this state, provided that the commission is
otherwise authorized by law to take the action.
       (d)  The commission shall submit periodic reports to the
standing committees of the senate and house of representatives
having primary jurisdiction over health and human services programs
detailing the status of the commission's investigations and any
actions taken under this section.
       SECTION 2.  EXPANSION OF REDESIGNED INTEGRATED ELIGIBILITY
AND AND BENEFITS DETERMINATION SYSTEM LIMITED.  (a)  Subject to
Subsection (b) of this section, on and after September 1, 2007, the
Health and Human Services Commission may not implement the
redesigned integrated eligibility and benefits determination
system for health and human services, including the Texas
Integrated Eligibility and Redesign System, in any area of this
state in which the system was not operating immediately before that
date.
       (b)  On and after September 1, 2007, the Health and Human
Services Commission may not enter into or renew a contract for the
operation of any component of the redesigned integrated eligibility
and benefits determination system for health and human services,
including the Texas Integrated Eligibility and Redesign System.
       SECTION 3.  EXPANSION OF MEDICAID STAR + PLUS PROGRAM
LIMITED.  (a)  Subject to Subsection (b) of this section, on and
after September 1, 2007, the Health and Human Services Commission
may not implement the Medicaid Star + Plus program in any area of
this state in which the program was not operating immediately
before that date.
       (b)  On and after September 1, 2007, the Health and Human
Services Commission may not enter into or renew a contract for the
operation of any component of the Medicaid Star + Plus program.
       SECTION 4.  TERMINATION.  (a)  On and after September 1,
2009, the Health and Human Services Commission shall cease using
the redesigned integrated eligibility and benefits determination
system for health and human services, including the Texas
Integrated Eligibility and Redesign System, in any area of this
state in which the system was implemented, except to the extent
required by a contract entered into before September 1, 2007.
       (b)  On and after September 1, 2009, the Health and Human
Services Commission shall cease operating the Medicaid Star + Plus
program in any area of this state in which the program was
implemented, except to the extent required by a contract entered
into before September 1, 2007.
       SECTION 5.  EFFECTIVE DATE. 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.