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.