By: Nelson, et al. S.B. No. 10
 
 
A BILL TO BE ENTITLED
AN ACT
relating to the operation and financing of the medical assistance
program and other programs to provide health care benefits and
services to persons in this state; providing penalties.
       BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
       SECTION 1.  Subchapter B, Chapter 531, Government Code, is
amended by adding Section 531.02192 to read as follows:
       Sec. 531.02192.  FEDERALLY QUALIFIED HEALTH CENTER AND RURAL
HEALTH CLINIC SERVICES. (a)  In this section:
             (1)  "Federally qualified health center" has the
meaning assigned by 42 U.S.C. Section 1396d(l)(2)(B).
             (2)  "Federally qualified health center services" has
the meaning assigned by 42 U.S.C. Section 1396d(l)(2)(A).
             (3)  "Rural health clinic" and "rural health clinic
services" have the meanings assigned by 42 U.S.C. Section
1396d(l)(1).
       (b)  Notwithstanding any provision of this chapter, Chapter
32, Human Resources Code, or any other law, the commission may not
provide Medicaid services to a recipient through a delivery model
or by enrolling the recipient in a program, including a delivery
model or program implemented under a waiver obtained under Section
1115 of the federal Social Security Act (42 U.S.C. Section 1315),
unless under the delivery model or program:
             (1)  the recipient has access to federally qualified
health center services or rural health clinic services; and
             (2)  payment for federally qualified health center
services or rural health clinic services is in accordance with 42
U.S.C. Section 1396a(bb).
       SECTION 2.  Subchapter B, Chapter 531, Government Code, is
amended by adding Section 531.02414 to read as follows:
       Sec. 531.02414.  BILLING COORDINATION SYSTEM.  (a)  The
commission shall, on or before March 1, 2008, contract for the
implementation of a billing coordination system that will, upon
entry in the claims system, identify within 24 hours whether
another entity has primary responsibility for paying the claim and
submit the claim to the issuer the system determines is the primary
payor.
       (b)  The executive commissioner shall adopt rules for the
purpose of enabling the system to identify an entity with primary
responsibility for paying a claim and establish reporting
requirements for any entity that may have a contractual
responsibility to pay for the types of services provided under the
Medicaid program.
       (c)  An entity that holds a permit, license, or certificate
of authority issued by a regulatory agency of the state must allow
the contractor under Subsection (a) access to databases to allow
the contractor to carry out the purposes of this subchapter subject
to the contractor's contract with the commission and rules adopted
under this subchapter and is subject to an administrative penalty
or other sanction as provided by the law applicable to the permit,
license, or certificate of authority for a violation by the entity
of a rule adopted under this subchapter.
       (d)  After June 1, 2008, no public funds shall be expended on
entities not in compliance with this subchapter unless a memorandum
of understanding is entered into between the entity and the
executive commissioner.
       (e)  Information obtained under this subchapter is
confidential.  The agent may use the information only for the
purposes authorized under this subchapter.  A person commits an
offense if the person knowingly uses information obtained under
this subchapter for any purpose not authorized under this
subchapter.  An offense under this subsection is a Class B
misdemeanor.
       SECTION 3.  (a)  Subchapter B, Chapter 531, Government Code,
is amended by adding Sections 531.094, 531.0941, 531.097, and
531.0971 to read as follows:
       Sec. 531.094.  PILOT PROGRAM AND OTHER PROGRAMS TO PROMOTE
HEALTHY LIFESTYLES. (a)  The commission shall develop and
implement a pilot program in one region of this state under which
Medicaid recipients are provided positive incentives to lead
healthy lifestyles, including through participating in certain
health-related programs or engaging in certain health-conscious
behaviors, thereby resulting in better health outcomes for those
recipients.
       (b)  Except as provided by Subsection (c), in implementing
the pilot program, the commission may provide:
             (1)  expanded health care benefits or value-added
services for Medicaid recipients who participate in certain
programs, such as specified weight loss or smoking cessation
programs;
             (2)  individual health rewards accounts that allow
Medicaid recipients who follow certain disease management
protocols to receive credits in the accounts that may be exchanged
for health-related items specified by the commission that are not
covered by Medicaid; and
             (3)  any other positive incentive the commission
determines would promote healthy lifestyles and improve health
outcomes for Medicaid recipients.
       (c)  The commission shall consider similar incentive
programs implemented in other states to determine the most
cost-effective measures to implement in the pilot program under
this section.
       (d)  Not later than December 1, 2010, the commission shall
submit a report to the legislature that:
             (1)  describes the operation of the pilot program;
             (2)  analyzes the effect of the incentives provided
under the pilot program on the health of program participants; and
             (3)  makes recommendations regarding the continuation
or expansion of the pilot program.
       (e)  In addition to developing and implementing the pilot
program under this section, the commission may, if feasible and
cost-effective, develop and implement an additional incentive
program to encourage Medicaid recipients who are younger than 21
years of age to make timely health care visits under the early and
periodic screening, diagnosis, and treatment program. The
commission shall provide incentives under the program for managed
care organizations contracting with the commission under Chapter
533 and Medicaid providers to encourage those organizations and
providers to support the delivery and documentation of timely and
complete health care screenings under the early and periodic
screening, diagnosis, and treatment program.
       (f)  This section expires September 1, 2011.
       Sec. 531.0941.  MEDICAID HEALTH SAVINGS ACCOUNT PILOT
PROGRAM. (a)  If the commission determines that it is
cost-effective and feasible, the commission shall develop and
implement a Medicaid health savings account pilot program that is
consistent with federal law to:
             (1)  encourage health care cost awareness and
sensitivity by adult recipients; and
             (2)  promote appropriate utilization of Medicaid
services by adult recipients.
       (b)  If the commission implements a pilot program under this
section, the commission may only include adult recipients as
participants in the program.
       (c)  If the commission implements a Medicaid health savings
account pilot program under this section, the commission shall
ensure that:
             (1)  participation in the pilot program is voluntary;
and
             (2)  a recipient who participates in the pilot program
may, at the recipient's option, discontinue participation in the
program and resume receiving benefits and services under the
traditional Medicaid delivery model.
       Sec. 531.097.  TAILORED BENEFIT PACKAGES FOR CERTAIN
CATEGORIES OF THE MEDICAID POPULATION.  (a)  The executive
commissioner may seek a waiver under Section 1115 of the federal
Social Security Act (42 U.S.C. Section 1315) to develop and,
subject to Subsection (c), implement tailored benefit packages
designed to:
             (1)  provide Medicaid benefits that are customized to
meet the health care needs of recipients within defined categories
of the Medicaid population through a defined system of care;
             (2)  improve health outcomes for those recipients;
             (3)  improve those recipients' access to services;
             (4)  achieve cost containment and efficiency; and
             (5)  reduce the administrative complexity of
delivering Medicaid benefits.
       (b)  The commission:
             (1)  shall develop a tailored benefit package that is
customized to meet the health care needs of Medicaid recipients who
are children with special health care needs, subject to approval of
the waiver described by Subsection (a); and
             (2)  may develop tailored benefit packages that are
customized to meet the health care needs of other categories of
Medicaid recipients.
       (c)  If the commission develops tailored benefit packages
under Subsection (b)(2), the commission shall submit a report to
the standing committees of the senate and house of representatives
having primary jurisdiction over the Medicaid program that
specifies, in detail, the categories of Medicaid recipients to
which each of those packages will apply and the services available
under each package. The commission may not implement a package
developed under Subsection (b)(2) before September 1, 2009.
       (d)  Except as otherwise provided by this section and subject
to the terms of the waiver authorized by this section, the
commission has broad discretion to develop the tailored benefit
packages under this section and determine the respective categories
of Medicaid recipients to which the packages apply in a manner that
preserves recipients' access to necessary services and is
consistent with federal requirements.
       (e)  Each tailored benefit package developed under this
section must include:
             (1)  a basic set of benefits that are provided under all
tailored benefit packages; and
             (2)  to the extent applicable to the category of
Medicaid recipients to which the package applies:
                   (A)  a set of benefits customized to meet the
health care needs of recipients in that category; and
                   (B)  services to integrate the management of a
recipient's acute and long-term care needs, to the extent feasible.
       (f)  In addition to the benefits required by Subsection (e),
a tailored benefit package developed under this section that
applies to Medicaid recipients who are children must provide at
least the services required by federal law under the early and
periodic screening, diagnosis, and treatment program.
       (g)  A tailored benefit package developed under this section
may include any service available under the state Medicaid plan or
under any federal Medicaid waiver, including any preventive health
or wellness service.
       (g-1)  A tailored benefit package implemented under this
section may not reduce the scope of benefits that were available
under the Medicaid state plan immediately before September 1, 2007,
to the category of Medicaid recipients to which the package
applies.
       (h)  In developing the tailored benefit packages, the
commission shall consider similar benefit packages established in
other states as a guide.
       (i)  The executive commissioner, by rule, shall define each
category of recipients to which a tailored benefit package applies
and a mechanism for appropriately placing recipients in specific
categories.  Recipient categories must include children with
special health care needs and may include:
             (1)  persons with disabilities or special health needs;
             (2)  elderly persons;
             (3)  children without special health care needs; and
             (4)  working-age parents and caretaker relatives.
       (j)  This section does not apply to a tailored benefit
package or similar package of benefits implemented before September
1, 2007.
       Sec. 531.0971.  TAILORED BENEFIT PACKAGES FOR NON-MEDICAID
POPULATIONS.  (a)  The commission shall identify state or federal
non-Medicaid programs that provide health care services to persons
whose health care needs could be met by providing customized
benefits through a system of care that is used under a Medicaid
tailored benefit package implemented under Section 531.097.
       (b)  If the commission determines that it is feasible and to
the extent permitted by federal and state law, the commission
shall:
             (1)  provide the health care services for persons
identified under Subsection (a) through the applicable Medicaid
tailored benefit package; and
             (2)  if appropriate or necessary to provide the
services as required by Subdivision (1), develop and implement a
system of blended funding methodologies to provide the services in
that manner.
       (b)  Not later than September 1, 2008, the Health and Human
Services Commission shall implement the pilot program under Section
531.094, Government Code, as added by this section.
       SECTION 4.  (a)  Subchapter C, Chapter 531, Government Code,
is amended by adding Section 531.1112 to read as follows:
       Sec. 531.1112.  STUDY CONCERNING INCREASED USE OF TECHNOLOGY
TO STRENGTHEN FRAUD DETECTION AND DETERRENCE; IMPLEMENTATION.  
(a)  The commission and the commission's office of inspector
general shall jointly study the feasibility of increasing the use
of technology to strengthen the detection and deterrence of fraud
in the state Medicaid program.  The study must include the
determination of the feasibility of using technology to verify a
person's citizenship and eligibility for coverage.
       (b)  The commission shall implement any methods the
commission and the commission's office of inspector general
determine are effective at strengthening fraud detection and
deterrence.
       (b)  Not later than December 1, 2008, the Health and Human
Services Commission shall submit to the legislature a report
detailing the findings of the study required by Section 531.1112,
Government Code, as added by this section.  The report must include
a description of any method described by Subsection (b), Section
531.1112, Government Code, as added by this section, that the
commission has implemented or intends to implement.
       SECTION 5.  (a)  Chapter 531, Government Code, is amended by
adding Subchapter N to read as follows:
SUBCHAPTER N. TEXAS HEALTH OPPORTUNITY POOL
       Sec. 531.501.  DIRECTION TO OBTAIN FEDERAL WAIVER FOR POOLED
FUNDS. (a)  The executive commissioner may seek a waiver under
Section 1115 of the federal Social Security Act (42 U.S.C. Section
1315) to the state Medicaid plan to allow the commission to more
efficiently and effectively use federal money paid to this state
under various programs to defray costs associated with providing
uncompensated health care in this state by:
             (1)  depositing that federal money and, to the extent
necessary, state money, into a pooled fund established in the state
treasury outside the general revenue fund; and
             (2)  using the money for purposes consistent with this
subchapter.
       (b)  The federal money the executive commissioner may seek
approval to pool includes:
             (1)  money provided under the disproportionate share
hospitals and upper payment limit supplemental payment programs,
other than money provided under the disproportionate share
hospitals supplemental payment program to state-owned and operated
hospitals;
             (2)  money provided by the federal government in lieu
of some or all of the payments under those programs;
             (3)  any combination of funds authorized to be pooled
by Subdivisions (1) and (2); and
             (4)  any other money available for that purpose,
including federal money and money identified under Subsection (c).
       (c)  The commission shall seek to optimize federal funding
by:
             (1)  identifying health care related state and local
funds and program expenditures that, before September 1, 2007, are
not being matched with federal money; and
             (2)  exploring the feasibility of:
                   (A)  certifying or otherwise using those funds and
expenditures as state expenditures for which this state may receive
federal matching money; and
                   (B)  pooling federal matching money received as
provided by Paragraph (A) with other federal money pooled under
Subsection (b), or substituting that federal matching money for
federal money that otherwise would be received under the
disproportionate share hospitals and upper payment limit
supplemental payment programs as a match for local funds received
by this state through intergovernmental transfers.
       (d)  The terms of a waiver approved under this section must:
             (1)  include safeguards to ensure that the total amount
of federal money in the pooled fund and any federal money provided
under the disproportionate share hospitals and upper payment limit
supplemental payment programs that is not included in the pooled
fund is, for a particular state fiscal year, at least equal to the
greater of the annualized amount provided to this state under those
supplemental payment programs during state fiscal year 2007,
excluding amounts provided during that state fiscal year that are
retroactive payments, or the state fiscal years during which the
waiver is in effect; and
             (2)  allow for the development by this state of a
methodology for allocating money in the pooled fund to:
                   (A)  offset, in part, the uncompensated health
care costs incurred by hospitals;
                   (B)  reduce the number of persons in this state
who do not have health benefits coverage; and
                   (C)  maintain and enhance the community public
health infrastructure provided by hospitals.
       (e)  In a waiver under this section, the executive
commissioner shall seek to:
             (1)  obtain maximum flexibility with respect to using
the money in the pooled fund for purposes consistent with this
subchapter;
             (2)  include an annual adjustment to the aggregate caps
under the upper payment limit supplemental payment program to
account for inflation, population growth, and other appropriate
demographic factors that affect the ability of residents of this
state to obtain health benefits coverage;
             (3)  ensure, for the term of the waiver, that the
aggregate caps under the upper payment limit supplemental payment
program for each of the three classes of hospitals are not less than
the aggregate caps that applied during state fiscal year 2007; and
             (4)  to the extent allowed by federal rule, federal
regulations, and federal waiver authority, preserve existing
resources funded by intergovernmental transfer or certified public
expenditure that are used to optimize Medicaid payments to safety
net hospitals for uncompensated care, unless the need for the
resources is revised through measures that reduce the Medicaid
shortfall or uncompensated care costs.
       (f)  The executive commissioner shall seek broad-based
stakeholder input in the development of the waiver under this
section and shall provide information to stakeholders regarding the
terms and components of the waiver for which the executive
commissioner seeks federal approval.
       (g)  The executive commissioner shall seek the advice of the
Legislative Budget Board before finalizing the terms and conditions
of the negotiated waiver.
       Sec. 531.502.  ESTABLISHMENT OF TEXAS HEALTH OPPORTUNITY
POOL. Subject to approval of the waiver authorized by Section
531.501, the Texas health opportunity pool is established in
accordance with the terms of that waiver as an account in the state
treasury outside the general revenue fund. Money in the pool may be
used only for purposes consistent with this subchapter and the
terms of the waiver.
       Sec. 531.503.  USE OF TEXAS HEALTH OPPORTUNITY POOL IN
GENERAL; RULES FOR ALLOCATION. (a)  Except as otherwise provided
by the terms of a waiver authorized by Section 531.501, money in the
Texas health opportunity pool may be used:
             (1)  subject to Section 531.504, to provide
reimbursements to health care providers that:
                   (A)  are based on the providers' costs related to
providing uncompensated care; and
                   (B)  compensate the providers for at least a
portion of those costs;
             (2)  to reduce the number of persons in this state who
do not have health benefits coverage;
             (3)  to reduce the need for uncompensated health care
provided by hospitals in this state; and
             (4)  for any other purpose specified by this subchapter
or the waiver.
       (b)  On approval of the waiver, the executive commissioner
shall:
             (1)  seek input from a broad base of stakeholder
representatives on the development of rules with respect to, and
the implementation of, the pool; and
             (2)  by rule develop a methodology for allocating money
in the pool that is consistent with the terms of the waiver.
       Sec. 531.504.  REIMBURSEMENTS FOR UNCOMPENSATED HEALTH CARE
COSTS. (a)  Except as otherwise provided by the terms of a waiver
authorized by Section 531.501 and subject to Subsections (b) and
(c), money in the Texas health opportunity pool may be allocated to
hospitals in this state and political subdivisions of this state to
defray the costs of providing uncompensated health care in this
state.
       (b)  To be eligible for money from the pool under this
section, a hospital or political subdivision must use a portion of
the money to implement strategies that will reduce the need for
uncompensated inpatient and outpatient care, including care
provided in a hospital emergency room. Strategies that may be
implemented by a hospital or political subdivision, as applicable,
include:
             (1)  fostering improved access for patients to primary
care systems or other programs that offer those patients medical
homes, including the following programs:
                   (A)  three share or multiple share programs;
                   (B)  programs to provide premium subsidies for
health benefits coverage; and
                   (C)  other programs to increase access to health
benefits coverage; and
             (2)  creating health care systems efficiencies, such as
using electronic medical records systems.
       (c)  The allocation methodology adopted by the executive
commissioner under Section 531.503(b) must specify the percentage
of the money from the pool allocated to a hospital or political
subdivision that the hospital or political subdivision must use for
strategies described by Subsection (b).
       Sec. 531.505.  INCREASING ACCESS TO HEALTH BENEFITS
COVERAGE. (a)  Except as otherwise provided by the terms of a
waiver authorized by Section 531.501, money in the Texas health
opportunity pool that is available to reduce the number of persons
in this state who do not have health benefits coverage or to reduce
the need for uncompensated health care provided by hospitals in
this state may be used for purposes relating to increasing access to
health benefits coverage for low-income persons, including:
             (1)  providing premium payment assistance to those
persons through a premium payment assistance program developed
under this section;
             (2)  making contributions to health savings accounts
for those persons; and
             (3)  providing other financial assistance to those
persons through alternate mechanisms established by hospitals in
this state or political subdivisions of this state that meet
certain criteria, as specified by the commission.
       (b)  The commission and the Texas Department of Insurance
shall jointly develop a premium payment assistance program designed
to assist persons described by Subsection (a) in obtaining and
maintaining health benefits coverage.  The program may provide
assistance in the form of payments for all or part of the premiums
for that coverage.  In developing the program, the executive
commissioner shall adopt rules establishing:
             (1)  eligibility criteria for the program;
             (2)  the amount of premium payment assistance that will
be provided under the program;
             (3)  the process by which that assistance will be paid;
and
             (4)  the mechanism for measuring and reporting the
number of persons who obtained health insurance or other health
benefits coverage as a result of the program.
       (c)  The commission shall implement the premium payment
assistance program developed under Subsection (b), subject to
appropriations for that purpose.
       Sec. 531.506.  INFRASTRUCTURE IMPROVEMENTS.  (a)  Except as
otherwise provided by the terms of a waiver authorized by Section
531.501 and subject to Subsection (c), money in the Texas health
opportunity pool may be used for purposes related to developing and
implementing initiatives to improve the infrastructure of local
provider networks that provide services to Medicaid recipients and
low-income uninsured persons in this state.
       (b)  Infrastructure improvements under this section may
include developing and implementing a system for maintaining
medical records in an electronic format.
       (c)  Not more than 10 percent of the total amount of the money
in the pool used in a state fiscal year for purposes other than
providing reimbursements to hospitals for uncompensated health
care may be used for infrastructure improvements described by
Subsection (b).
       (b)  If the executive commissioner of the Health and Human
Services Commission obtains federal approval for a waiver under
Section 531.501, Government Code, as added by this Act, the
executive commissioner shall submit a report to the Legislative
Budget Board that outlines the components and terms of that waiver
as soon as possible after federal approval is granted.
       SECTION 6.  (a)  Chapter 531, Government Code, is amended by
adding Subchapter O to read as follows:
SUBCHAPTER O. UNCOMPENSATED HOSPITAL CARE
       Sec. 531.551.  UNCOMPENSATED HOSPITAL CARE REPORTING AND
ANALYSIS. (a)  The executive commissioner shall adopt rules
providing for:
             (1)  a standard definition of "uncompensated hospital
care";
             (2)  a methodology to be used by hospitals in this state
to compute the cost of that care that incorporates the standard set
of adjustments described by Section 531.552(g)(4); and
             (3)  procedures to be used by those hospitals to report
the cost of that care to the commission and to analyze that cost.
       (b)  The rules adopted by the executive commissioner under
Subsection (a)(3) may provide for procedures by which the
commission may periodically verify the completeness and accuracy of
the information reported by hospitals.
       (c)  The commission shall notify the attorney general of a
hospital's failure to report the cost of uncompensated care on or
before the date the report was due in accordance with rules adopted
under Subsection (a)(3). On receipt of the notice, the attorney
general shall impose an administrative penalty on the hospital in
the amount of $1,000 for each day after the date the report was due
that the hospital has not submitted the report, not to exceed
$10,000.
       (d)  If the commission determines through the procedures
adopted under Subsection (b) that a hospital submitted a report
with incomplete or inaccurate information, the commission shall
notify the hospital of the specific information the hospital must
submit and prescribe a date by which the hospital must provide that
information. If the hospital fails to submit the specified
information on or before the date prescribed by the commission, the
commission shall notify the attorney general of that failure. On
receipt of the notice, the attorney general shall impose an
administrative penalty on the hospital in an amount not to exceed
$10,000. In determining the amount of the penalty to be imposed,
the attorney general shall consider:
             (1)  the seriousness of the violation;
             (2)  whether the hospital had previously committed a
violation; and
             (3)  the amount necessary to deter the hospital from
committing future violations.
       (e)  A report by the commission to the attorney general under
Subsection (c) or (d) must state the facts on which the commission
based its determination that the hospital failed to submit a report
or failed to completely and accurately report information, as
applicable.
       (f)  The attorney general shall give written notice of the
commission's report to the hospital alleged to have failed to
comply with a requirement. The notice must include a brief summary
of the alleged violation, a statement of the amount of the
administrative penalty to be imposed, and a statement of the
hospital's right to a hearing on the alleged violation, the amount
of the penalty, or both.
       (g)  Not later than the 20th day after the date the notice is
sent under Subsection (f), the hospital must make a written request
for a hearing or remit the amount of the administrative penalty to
the attorney general. Failure to timely request a hearing or remit
the amount of the administrative penalty results in a waiver of the
right to a hearing under this section. If the hospital timely
requests a hearing, the attorney general shall conduct the hearing
in accordance with Chapter 2001, Government Code. If the hearing
results in a finding that a violation has occurred, the attorney
general shall:
             (1)  provide to the hospital written notice of:
                   (A)  the findings established at the hearing; and
                   (B)  the amount of the penalty; and
             (2)  enter an order requiring the hospital to pay the
amount of the penalty.
       (h)  Not later than the 30th day after the date the hospital
receives the order entered by the attorney general under Subsection
(g), the hospital shall:
             (1)  pay the amount of the administrative penalty;
             (2)  remit the amount of the penalty to the attorney
general for deposit in an escrow account and file a petition for
judicial review contesting the occurrence of the violation, the
amount of the penalty, or both; or
             (3)  without paying the amount of the penalty, file a
petition for judicial review contesting the occurrence of the
violation, the amount of the penalty, or both and file with the
court a sworn affidavit stating that the hospital is financially
unable to pay the amount of the penalty.
       (i)  The attorney general's order is subject to judicial
review as a contested case under Chapter 2001, Government Code.
       (j)  If the hospital paid the penalty and on review the court
does not sustain the occurrence of the violation or finds that the
amount of the administrative penalty should be reduced, the
attorney general shall remit the appropriate amount to the hospital
not later than the 30th day after the date the court's judgment
becomes final.
       (k)  If the court sustains the occurrence of the violation:
             (1)  the court:
                   (A)  shall order the hospital to pay the amount of
the administrative penalty; and
                   (B)  may award to the attorney general the
attorney's fees and court costs incurred by the attorney general in
defending the action; and
             (2)  the attorney general shall remit the amount of the
penalty to the comptroller for deposit in the general revenue fund.
       (l)  If the hospital does not pay the amount of the
administrative penalty after the attorney general's order becomes
final for all purposes, the attorney general may enforce the
penalty as provided by law for legal judgments.
       Sec. 531.552.  WORK GROUP ON UNCOMPENSATED HOSPITAL CARE.  
(a)  In this section, "work group" means the work group on
uncompensated hospital care.
       (b)  The executive commissioner shall establish the work
group on uncompensated hospital care to assist the executive
commissioner in developing rules required by Section 531.551 by
performing the functions described by Subsection (g).
       (c)  The executive commissioner shall determine the number
of members of the work group. The executive commissioner shall
ensure that the work group includes representatives from the office
of the attorney general and the hospital industry. A member of the
work group serves at the will of the executive commissioner.
       (d)  The executive commissioner shall designate a member of
the work group to serve as presiding officer. The members of the
work group shall elect any other necessary officers.
       (e)  The work group shall meet at the call of the executive
commissioner.
       (f)  A member of the work group may not receive compensation
for serving on the work group but is entitled to reimbursement for
travel expenses incurred by the member while conducting the
business of the work group as provided by the General
Appropriations Act.
       (g)  The work group shall study and advise the executive
commissioner in:
             (1)  identifying the number of different reports
required to be submitted to the state that address uncompensated
hospital care, care for low-income uninsured persons in this state,
or both;
             (2)  standardizing the definitions used to determine
uncompensated hospital care for purposes of those reports;
             (3)  improving the tracking of hospital charges, costs,
and adjustments as those charges, costs, and adjustments relate to
identifying uncompensated hospital care and maintaining a
hospital's tax-exempt status;
             (4)  developing and applying a standard set of
adjustments to a hospital's initial computation of the cost of
uncompensated hospital care that account for all funding streams
that:
                   (A)  are not patient-specific; and
                   (B)  are used to offset the hospital's initially
computed amount of uncompensated care;
             (5)  developing a standard and comprehensive center for
data analysis and reporting with respect to uncompensated hospital
care; and
             (6)  analyzing the effect of the standardization of the
definition of uncompensated hospital care and the computation of
its cost, as determined in accordance with the rules adopted by the
executive commissioner, on the laws of this state, and analyzing
potential legislation to incorporate the changes made by the
standardization.
       (b)  The executive commissioner of the Health and Human
Services Commission shall:
             (1)  establish the work group on uncompensated hospital
care required by Section 531.552, Government Code, as added by this
section, not later than October 1, 2007; and
             (2)  adopt the rules required by Section 531.551,
Government Code, as added by this section, not later than March 1,
2008.
       (c)  The executive commissioner of the Health and Human
Services Commission shall review the methodology used under the
Medicaid disproportionate share hospitals supplemental payment
program to compute low-income utilization costs to ensure that the
Medicaid disproportionate share methodology  is consistent with the
standardized adjustments to uncompensated care costs described by
Subdivision (4), Subsection (g), Section 531.552, Government Code,
as added by this Act, and adopted by the executive commissioner.
       SECTION 7.  (a)  Subchapter A, Chapter 533, Government Code,
is amended by adding Section 533.019 to read as follows:
       Sec. 533.019.  VALUE-ADDED SERVICES. The commission shall
actively encourage managed care organizations that contract with
the commission to offer benefits, including health care services or
benefits or other types of services, that:
             (1)  are in addition to the services ordinarily covered
by the managed care plan offered by the managed care organization;
and
             (2)  have the potential to improve the health status of
enrollees in the plan.
       (b)  The changes in law made by Section 533.019, Government
Code, as added by this Act, 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.  The commission shall seek
to amend contracts entered into with managed care organizations
under that chapter before the effective date of this Act to
authorize those managed care organizations to offer value-added
services to enrollees in accordance with Section 533.019,
Government Code, as added by this section.
       SECTION 8.  Subchapter B, Chapter 32, Human Resources Code,
is amended by adding Section 32.0214 to read as follows:
       Sec. 32.0214.  DESIGNATIONS OF PRIMARY CARE PHYSICIAN BY
CERTAIN RECIPIENTS. (a)  If the department determines that it is
cost-effective and feasible and subject to Subsection (b), the
department shall require each recipient of medical assistance to
designate a primary care physician with whom the recipient will
have a continuous, ongoing professional relationship and who will
manage and coordinate all aspects of the recipient's health care.
       (b)  A recipient who receives medical assistance through a
Medicaid managed care model or arrangement under Chapter 533,
Government Code, that requires the designation of a primary care
physician shall designate the recipient's primary care physician as
required by that model or arrangement.
       SECTION 9.  Section 32.0422, Human Resources Code, is
amended to read as follows:
       Sec. 32.0422.  HEALTH INSURANCE PREMIUM PAYMENT
REIMBURSEMENT PROGRAM FOR MEDICAL ASSISTANCE RECIPIENTS. (a)  In
this section:
             (1)  "Commission" ["Department"] means the Health and
Human Services Commission [Texas Department of Health].
             (2)  "Executive commissioner" means the executive
commissioner of the Health and Human Services Commission.
             (3)  "Group health benefit plan" means a plan described
by Section 1207.001, Insurance Code.
       (b)  The commission [department] shall identify individuals,
otherwise entitled to medical assistance, who are eligible to
enroll in a group health benefit plan. The commission [department]
must include individuals eligible for or receiving health care
services under a Medicaid managed care delivery system.
       (b-1)  To assist the commission in identifying individuals
described by Subsection (b):
             (1)  the commission shall include on an application for
medical assistance and on a form for recertification of a
recipient's eligibility for medical assistance:
                   (A)  an inquiry regarding whether the applicant or
recipient, as applicable, is eligible to enroll in a group health
benefit plan; and
                   (B)  a statement informing the applicant or
recipient, as applicable, that reimbursements for required
premiums and cost-sharing obligations under the group health
benefit plan may be available to the applicant or recipient; and
             (2)  not later than the 15th day of each month, the
office of the attorney general shall provide to the commission the
name, address, and social security number of each newly hired
employee reported to the state directory of new hires operated
under Chapter 234, Family Code, during the previous calendar month.
       (c)  The commission [department] shall require an individual
requesting medical assistance or a recipient, during the
recipient's eligibility recertification review, to provide
information as necessary relating to any [the availability of a]
group health benefit plan that is available to the individual or
recipient through an employer of the individual or recipient  or an
employer of the individual's or recipient's spouse or parent to
assist the commission in making the determination required by
Subsection (d).
       (d)  For an individual identified under Subsection (b), the
commission [department] shall determine whether it is
cost-effective to enroll the individual in the group health benefit
plan under this section.
       (e)  If the commission [department] determines that it is
cost-effective to enroll the individual in the group health benefit
plan, the commission [department] shall:
             (1)  require the individual to apply to enroll in the
group health benefit plan as a condition for eligibility under the
medical assistance program; and
             (2)  provide written notice to the issuer of the group
health benefit plan in accordance with Chapter 1207, Insurance
Code.
       (e-1)  This subsection applies only to an individual who is
identified under Subsection (b) as being eligible to enroll in a
group health benefit plan offered by the individual's employer. If
the commission determines under Subsection (d) that enrolling the
individual in the group health benefit plan is not cost-effective,
but the individual prefers to enroll in that plan instead of
receiving benefits and services under the medical assistance
program, the commission, if authorized by a waiver obtained under
federal law, shall:
             (1)  allow the individual to voluntarily opt out of
receiving services through the medical assistance program and
enroll in the group health benefit plan;
             (2)  consider that individual to be a recipient of
medical assistance; and
             (3)  provide written notice to the issuer of the group
health benefit plan in accordance with Chapter 1207, Insurance
Code.
       (f)  Except as provided by Subsection (f-1), the commission
[The department] shall provide for payment of:
             (1)  the employee's share of required premiums for
coverage of an individual enrolled in the group health benefit
plan; and
             (2)  any deductible, copayment, coinsurance, or other
cost-sharing obligation imposed on the enrolled individual for an
item or service otherwise covered under the medical assistance
program.
       (f-1)  For an individual described by Subsection (e-1) who
enrolls in a group health benefit plan, the commission shall
provide for payment of the employee's share of the required
premiums, except that if the employee's share of the required
premiums exceeds the total estimated Medicaid costs for the
individual, as determined by the executive commissioner, the
individual shall pay the difference between the required premiums
and those estimated costs. The individual shall also pay all
deductibles, copayments, coinsurance, and other cost-sharing
obligations imposed on the individual under the group health
benefit plan.
       (g)  A payment made by the commission [department] under
Subsection (f) or (f-1) is considered to be a payment for medical
assistance.
       (h)  A payment of a premium for an individual who is a member
of the family of an individual enrolled in a group health benefit
plan under Subsection (e) [this section] and who is not eligible for
medical assistance is considered to be a payment for medical
assistance for an eligible individual if:
             (1)  enrollment of the family members who are eligible
for medical assistance is not possible under the plan without also
enrolling members who are not eligible; and
             (2)  the commission [department] determines it to be
cost-effective.
       (i)  A payment of any deductible, copayment, coinsurance, or
other cost-sharing obligation of a family member who is enrolled in
a group health benefit plan in accordance with Subsection (h) and
who is not eligible for medical assistance:
             (1)  may not be paid under this chapter; and
             (2)  is not considered to be a payment for medical
assistance for an eligible individual.
       (i-1)  The commission shall make every effort to expedite
payments made under this section, including by ensuring that those
payments are made through electronic transfers of money to the
recipient's account at a financial institution, if possible. In
lieu of reimbursing the individual enrolled in the group health
benefit plan for required premium or cost-sharing payments made by
the individual, the commission may, if feasible:
             (1)  make payments under this section for required
premiums directly to the employer providing the group health
benefit plan in which an individual is enrolled; or
             (2)  make payments under this section for required
premiums and cost-sharing obligations directly to the group health
benefit plan issuer.
       (j)  The commission [department] shall treat coverage under
the group health benefit plan as a third party liability to the
program. Subject to Subsection (j-1), enrollment [Enrollment] of
an individual in a group health benefit plan under this section does
not affect the individual's eligibility for medical assistance
benefits, except that the state is entitled to payment under
Sections 32.033 and 32.038.
       (j-1)  An individual described by Subsection (e-1) who
enrolls in a group health benefit plan is not ineligible for
community-based services provided under a Section 1915(c) waiver
program or another federal waiver program solely based on the
individual's enrollment in the group health benefit plan, and the
individual may receive those services if the individual is
otherwise eligible for the program.  The individual is otherwise
limited to the health benefits coverage provided under the health
benefit plan in which the individual is enrolled, and the
individual may not receive any benefits or services under the
medical assistance program other than the premium payment as
provided by Subsection (f-1) and, if applicable, waiver program
services described by this subsection.
       (k)  The commission [department] may not require or permit an
individual who is enrolled in a group health benefit plan under this
section to participate in the Medicaid managed care program under
Chapter 533, Government Code, or a Medicaid managed care
demonstration project under Section 32.041.
       (l)  The commission, in consultation with the Texas
Department of Insurance, shall provide training to agents who hold
a general life, accident, and health license under Chapter 4054,
Insurance Code, regarding the health insurance premium payment
reimbursement program and the eligibility requirements for
participation in the program. Participation in a training program
established under this subsection is voluntary, and a general life,
accident, and health agent who successfully completes the training
is entitled to receive continuing education credit under Subchapter
B, Chapter 4004, Insurance Code, in accordance with rules adopted
by the commissioner of insurance.
       (m)  The commission may pay a referral fee, in an amount
determined by the commission, to each general life, accident, and
health agent who, after completion of the training program
established under Subsection (l), successfully refers an eligible
individual to the commission for enrollment in a [Texas Department
of Human Services shall provide information and otherwise cooperate
with the department as necessary to ensure the enrollment of
eligible individuals in the] group health benefit plan under this
section.
       (n)  The commission shall develop procedures by which an
individual described by Subsection (e-1) who enrolls in a group
health benefit plan may, at the individual's option, resume
receiving benefits and services under the medical assistance
program instead of the group health benefit plan.
       (o)  The commission shall develop procedures which ensure
that, prior to allowing an individual described by Subsection (e-1)
to enroll in a group health benefit plan or allowing the parent or
caretaker of an individual described by Subsection (e-1) under the
age of 21 to enroll that child in a group health benefit plan:
             (1)  the individual must receive counseling informing
them that for the period in which the individual is enrolled in the
group health benefit plan:
                   (A)  the individual shall be limited to the health
benefits coverage provided under the health benefit plan in which
the individual is enrolled;
                   (B)  the individual may not receive any benefits
or services under the medical assistance program other than the
premium payment as provided by Subsection (f-1);
                   (C)  the individual shall pay the difference
between the required premiums and the premium payment as provided
by Subsection (f-1) and shall also pay all deductibles, copayments,
coinsurance, and other cost-sharing obligations imposed on the
individual under the group health benefit plan; and
                   (D)  the individual may, at the individual's
option, resume receiving benefits and services under the medical
assistance program instead of the group health benefit plan; and
             (2)  the individual must sign and the commission shall
retain a copy of a waiver indicating the individual has provided
informed consent.
       (p)  The executive commissioner [department] shall adopt
rules as necessary to implement this section.
       SECTION 10.  Subchapter B, Chapter 32, Human Resources Code,
is amended by adding Section 32.0641 to read as follows:
       Sec. 32.0641.  COST SHARING FOR CERTAIN HIGH-COST MEDICAL
SERVICES.  If the department determines that it is feasible and
cost-effective, and to the extent permitted under Title XIX, Social
Security Act (42 U.S.C. Section 1396 et seq.) and any other
applicable law or regulation or under a federal waiver or other
authorization, the executive commissioner of the Health and Human
Services Commission shall adopt cost-sharing provisions that
require a recipient who chooses a high-cost medical service
provided through a hospital emergency room to pay a copayment,
premium payment, or other cost-sharing payment for the high-cost
medical service if:
             (1)  the hospital from which the recipient seeks
service:
                   (A)  performs an appropriate medical screening
and determines that the recipient does not have a condition
requiring emergency medical services;
                   (B)  informs the recipient:
                         (i)  that the recipient does not have a
condition requiring emergency medical services;
                         (ii)  that, if the hospital provides the
nonemergency service, the hospital may require payment of a
copayment, premium payment, or other cost-sharing payment by the
recipient in advance; and
                         (iii)  of the name and address of a
nonemergency Medicaid provider who can provide the appropriate
medical service without imposing a cost-sharing payment; and
                   (C)  offers to provide the recipient with a
referral to the nonemergency provider to facilitate scheduling of
the service; and
             (2)  after receiving the information and assistance
described by Subdivision (1) from the hospital, the recipient
chooses to obtain emergency medical services despite having access
to medically acceptable, lower-cost medical services.
       SECTION 11.  (a)  The heading to Subtitle C, Title 2, Health
and Safety Code, is amended to read as follows:
SUBTITLE C.  PROGRAMS PROVIDING [INDIGENT] HEALTH CARE BENEFITS AND
SERVICES
       (b)  Subtitle C, Title 2, Health and Safety Code, is amended
by adding Chapter 76 to read as follows:
CHAPTER 76. MULTIPLE SHARE PROGRAM
SUBCHAPTER A.  GENERAL PROVISIONS
       Sec. 76.001.  DEFINITIONS. In this chapter:
             (1)  "Commission" means the Health and Human Services
Commission.
             (2)  "Employee" means an individual who is employed by
an employer for compensation. The term includes a partner of a
partnership.
             (3)  "Employer" means a person who employs two or more
employees.
             (4)  "Executive commissioner" means the executive
commissioner of the Health and Human Services Commission.
             (5)  "Multiple share program" means an
employer-sponsored commercial insurance product or noninsurance
health benefit plan funded by a combination of:
                   (A)  employer contributions;
                   (B)  employee cost sharing; and
                   (C)  public or philanthropic funds.
             (6)  "Partnering entity" means a local entity that
partners with the commission to obtain funding for a multiple share
program.
             (7)  "Public share" means the portion of the cost of a
multiple share program comprised of public funds.
[Sections 76.002-76.050 reserved for expansion]
SUBCHAPTER B. AUTHORITY OF COMMISSION; METHODS OF FUNDING
       Sec. 76.051.  MULTIPLE SHARE PROGRAM.  A local entity may
propose a multiple share program to the commission and may, subject
to rules adopted under Section 76.103, act as a partnering entity.
       Sec. 76.052.  FUNDING. The commission may seek a waiver from
the Centers for Medicare and Medicaid Services or another
appropriate federal agency to use Medicaid or child health plan
program funds to finance the public share of a multiple share
program.  The commission may cooperate with a partnering entity to
finance the public share.
       Sec. 76.053.  AUTHORITY TO DETERMINE SCOPE. The commission
may determine if a multiple share program proposed by a partnering
entity should be local, regional, or statewide in scope. The
commission shall base this determination on:
             (1)  appropriate methods to meet the needs of the
uninsured community; and
             (2)  federal guidance.
       Sec. 76.054.  METHOD OF FINANCE. If the legislature does not
appropriate sufficient money from the general revenue to fund a
multiple share program, a partnering entity may use the following
types of funding to maximize this state's receipt of available
federal matching funds provided through Medicaid and the child
health plan:
             (1)  local funds made available to this state through
intergovernmental transfers from local governments; and
             (2)  certified public expenditures.
[Sections 76.055-76.100 reserved for expansion]
SUBCHAPTER C. COST OF PROGRAM; CONTRIBUTION OF SHARES
       Sec. 76.101.  CONTRIBUTION OF SHARES. A multiple share
program may require that:
             (1)  each participating employer contribute at least
one-third of the cost of coverage; and
             (2)  this state, a political subdivision of this state,
or a nonprofit organization contribute not more than one-third of
the cost of coverage.
       Sec. 76.102.  COST SHARING. Subject to applicable federal
law, an employee who participates in a multiple share program may be
required to pay:
             (1)  a share of the premium;
             (2)  copayments;
             (3)  coinsurance; and
             (4)  deductibles.
       Sec. 76.103.  STANDARDS AND PROCEDURES. The executive
commissioner by rule shall:
             (1)  define the types of local entities that may be
partnering entities;
             (2)  determine eligibility criteria for participating
employers and employees;
             (3)  determine a minimum benefit package for multiple
share programs that offer noninsurance health benefit plans;
             (4)  determine methods for limiting substitution of
coverage in multiple share programs of partnering entities;
             (5)  determine methods for limiting adverse selection
in multiple share programs of partnering entities; and
             (6)  determine how a multiple share program participant
may continue program coverage if the participant leaves the
employment of a participating employer or becomes ineligible due to
income.
       (c)  Not later than January 1, 2008, the executive
commissioner of the Health and Human Services Commission shall
adopt rules and procedures necessary to implement the multiple
share program created by Chapter 76, Health and Safety Code, as
added by this section.  In adopting the rules and procedures, the
executive commissioner may consult with the Texas Department of
Insurance.
       (d)  This section 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 section to
have immediate effect, this section takes effect September 1, 2007.
       SECTION 12.  (a)  In this section, "committee" means the
committee on health and long-term care insurance incentives.
       (b)  The committee on health and long-term care insurance
incentives is established to study and develop recommendations
regarding methods by which this state may reduce the need for
residents of this state to rely on the Medicaid program by providing
incentives for employers to provide health insurance, long-term
care insurance, or both, to their employees.
       (c)  The committee on health and long-term care insurance
incentives is composed of:
             (1)  the presiding officers of:
                   (A)  the Senate Committee on Health and Human
Services;
                   (B)  the House Committee on Public Health;
                   (C)  the Senate Committee on State Affairs; and
                   (D)  the House Committee on Insurance;
             (2)  three public members, appointed by the governor,
who collectively represent the diversity of businesses in this
state, including diversity with respect to:
                   (A)  the geographic regions in which those
businesses are located;
                   (B)  the types of industries in which those
businesses are engaged; and
                   (C)  the sizes of those businesses, as determined
by number of employees; and
             (3)  the following ex officio members:
                   (A)  the comptroller of public accounts;
                   (B)  the commissioner of insurance; and
                   (C)  the executive commissioner of the Health and
Human Services Commission.
       (d)  The committee shall elect a presiding officer from the
committee members and shall meet at the call of the presiding
officer.
       (e)  The committee shall study and develop recommendations
regarding incentives this state may provide to employers to
encourage those employers to provide health insurance, long-term
care insurance, or both, to employees who would otherwise rely on
the Medicaid program to meet their health and long-term care needs.
In conducting the study, the committee shall:
             (1)  examine the feasibility and determine the cost of
providing incentives through:
                   (A)  the franchise tax under Chapter 171, Tax
Code, including allowing exclusions from an employer's total
revenue of insurance premiums paid for employees, regardless of
whether the employer chooses under Subparagraph (ii), Paragraph
(B), Subdivision (1), Subsection (a), Section 171.101, Tax Code, as
effective January 1, 2008, to subtract cost of goods sold or
compensation for purposes of determining the employer's taxable
margin;
                   (B)  deductions from or refunds of other taxes
imposed on the employer; and
                   (C)  any other means, as determined by the
committee; and
             (2)  for each incentive the committee examines under
Subdivision (1) of this subsection, determine the impact that
implementing the incentive would have on reducing the number of
individuals in this state who do not have private health or
long-term care insurance coverage, including individuals who are
Medicaid recipients.
       (f)  Not later than September 1, 2008, the committee shall
submit to the Senate Committee on Health and Human Services, the
House Committee on Public Health, the Senate Committee on State
Affairs, and the House Committee on Insurance a report regarding
the results of the study required by this section. The report must
include a detailed description of each incentive the committee
examined and determined is feasible and, for each of those
incentives, specify:
             (1)  the anticipated cost associated with providing
that incentive;
             (2)  any statutory changes needed to implement the
incentive; and
             (3)  the impact that implementing the incentive would
have on reducing:
                   (A)  the number of individuals in this state who
do not have private health or long-term care insurance coverage;
and
                   (B)  the number of individuals in this state who
are Medicaid recipients.
       SECTION 13.  (a)  The Health and Human Services Commission
shall conduct a study regarding the feasibility and
cost-effectiveness of developing and implementing an integrated
Medicaid managed care model designed to improve the management of
care provided to Medicaid recipients who are aging, blind, or
disabled or have chronic health care needs and are not enrolled in a
managed care plan offered under a capitated Medicaid managed care
model, including recipients who reside in:
             (1)  rural areas of this state; or
             (2)  urban or surrounding areas in which the Medicaid
Star + Plus program or another capitated Medicaid managed care
model is not available.
       (b)  Not later than September 1, 2008, the Health and Human
Services Commission shall submit a report regarding the results of
the study to the standing committees of the senate and house of
representatives having primary jurisdiction over the Medicaid
program.
       SECTION 14.  (a)  In this section:
             (1)  "Child health plan program" means the state child
health plan program authorized by Chapter 62, Health and Safety
Code.
             (2)  "Medicaid" means the medical assistance program
provided under Chapter 32, Human Resources Code.
       (b)  The Health and Human Services Commission shall conduct a
study of the feasibility of providing a health passport for:
             (1)  children under 19 years of age who are receiving
Medicaid and are not provided a health passport under another law of
this state; and
             (2)  children enrolled in the child health plan
program.
       (c)  The feasibility study must:
             (1)  examine the cost-effectiveness of the use of a
health passport in conjunction with the coordination of health care
services under each program;
             (2)  identify any barriers to the implementation of the
health passport developed for each program and recommend strategies
for the removal of those barriers;
             (3)  examine whether the use of a health passport will
improve the quality of care for children described in Subsection
(b) of this section; and
             (4)  determine the fiscal impact to this state of the
proposed initiative.
       (d)  Not later than January 1, 2009, the Health and Human
Services Commission shall submit to the governor, lieutenant
governor, speaker of the house of representatives, and presiding
officers of each standing committee of the legislature with
jurisdiction over the commission a written report containing the
findings of the study and the commission's recommendations.
       (e)  This section expires September 1, 2009.
       SECTION 15.  (a)  The Health and Human Services Transition
Legislative Oversight Committee is created to facilitate the reform
efforts in Medicaid, the process of addressing the issues of
uncompensated hospital care, and the establishment of programs
addressing the uninsured.
       (b)  The committee is composed of six members, as follows:
             (1)  three members of the senate, appointed by the
lieutenant governor not later than October 1, 2007; and
             (2)  three members of the house of representatives,
appointed by the speaker of the house of representatives not later
than October 1, 2007.
       (c)  The executive commissioner of the Health and Human
Services Commission serves as an ex officio member of the
committee.
       (d)  A member of the committee serves at the pleasure of the
appointing official.
       (e)  The lieutenant governor and the speaker of the house of
representatives shall alternate designating a presiding officer
from among their respective appointments. The lieutenant governor
shall make the first appointment after the effective date of this
Act.
       (f)  A member of the committee may not receive compensation
for serving on the committee but is entitled to reimbursement for
travel expenses incurred by the member while conducting the
business of the committee as provided by the General Appropriations
Act.
       (g)  The committee shall:
             (1)  facilitate the design and development of any
Medicaid waivers needed to affect reform as directed by this Act;
             (2)  facilitate the establishment of common
definitions for uncompensated hospital care and any application of
those definitions in the determination of policy that affects
reimbursement for that care;
             (3)  facilitate a smooth transition from existing
Medicaid payment systems and benefit designs to the new model of
Medicaid enabled by waiver or policy change by the Health and Human
Services Commission;
             (4)  meet at the call of the presiding officer; and
             (5)  research, take public testimony, and issue reports
on other appropriate issues or specific issues requested by the
lieutenant governor or speaker of the house of representatives.
       (h)  The committee may request reports and other information
from the Health and Human Services Commission.
       (i)  The committee shall use existing staff of the senate,
the house of representatives, and the Texas Legislative Council to
assist the committee in performing its duties under this section.
       (j)  Chapter 551, Government Code, applies to the committee.
       (k)  The committee shall report to the lieutenant governor
and speaker of the house of representatives not later than November
15 of each even-numbered year. The report must include:
             (1)  identification of significant issues which impede
the transition to a more effective Medicaid program;
             (2)  the measures of effectiveness associated with
changes to the Medicaid program;
             (3)  the impact of Medicaid changes on safety net
hospitals and other significant traditional providers; and
             (4)  the impact on the uninsured in Texas.
       SECTION 16.  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 17.  Except as otherwise provided by this Act, this
Act takes effect September 1, 2007.