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A BILL TO BE ENTITLED
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AN ACT
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relating to a pilot project to increase enrollee access to primary |
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care services and simplify enrollment procedures under the child |
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health plan program. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Subchapter D, Chapter 62, Health and Safety |
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Code, is amended by adding Section 62.160 to read as follows: |
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Sec. 62.160. PILOT PROJECT TO INCREASE ENROLLEE ACCESS TO |
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PRIMARY CARE SERVICES AND SIMPLIFY ENROLLMENT PROCEDURES. (a) In |
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this section: |
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(1) "CPT code" means the number assigned to identify a |
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specific health care procedure performed by a health care provider |
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under the American Medical Association's "Current Procedural |
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Terminology 2009 Professional Edition" or a subsequent edition of |
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that publication adopted by the executive commissioner by rule. |
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(2) "Lower-cost medical setting" means a facility, |
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clinic, center, office, or other setting primarily used to provide |
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primary care services. |
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(3) "Primary care services" means health services |
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generally provided through a general, family, internal medicine, or |
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pediatrics practice. The term does not include services provided |
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through a hospital emergency room or surgical services. |
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(4) "Service area" means the geographical area |
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described by Subsection (b) in which the pilot project is |
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established. |
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(b) The commission shall establish a two-year pilot project |
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in one or more Medicaid Service Areas to: |
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(1) increase child health plan enrollee access to |
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primary care services; and |
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(2) simplify child health plan enrollment procedures. |
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(c) In establishing the pilot project under this section, |
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the executive commissioner shall: |
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(1) for the service area, establish health care |
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provider reimbursement rates for primary care services provided in |
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lower-cost medical settings that are comparable to the federal |
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Medicare program rates for the same or similar services; |
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(2) waive the copayment requirement for primary care |
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services under Section 62.153 for an enrollee who resides in the |
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service area and who receives primary care services in a lower-cost |
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medical setting, but continue to impose other copayments required |
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under that section; |
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(3) identify CPT codes that represent primary care |
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services for purposes of Subdivisions (1) and (2); |
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(4) prescribe and use an alternative application for |
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child health plan coverage that is written on a sixth-grade reading |
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comprehension level; and |
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(5) require any enrollment services provider in the |
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service area to reduce application processing delays and procedural |
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denials and increase renewal rates. |
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(d) Notwithstanding Section 62.102(a), an individual who |
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resides in the service area and who is determined eligible for |
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coverage under the child health plan remains eligible for benefits |
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until the earlier of: |
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(1) the end of a period not to exceed 24 months, |
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beginning on the first day of the month following the date of the |
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eligibility determination; |
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(2) the individual's 19th birthday; or |
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(3) the date the pilot project expires, subject to |
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Subsection (f). |
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(e) The commission shall: |
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(1) perform the review required by Section 62.102(b) |
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during the 12th month, rather than the sixth month, following the |
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date of initial enrollment or reenrollment of an individual who |
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resides in the service area and who would otherwise be subject to |
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that section; and |
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(2) provide at least one point of service contact in |
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each county in the service area where trained personnel are |
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available to personally assist interested individuals who reside in |
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the service area with the application form and procedures for child |
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health plan coverage. |
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(f) If under Subsection (d)(3) an individual's coverage |
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under the child health plan would end on a date that is earlier than |
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the date the period described by Section 62.102(a)(1) expires, the |
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individual remains eligible until the expiration of the period |
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provided by Section 62.102. The executive commissioner shall adopt |
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rules specifying the applicability of the review under Section |
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62.102(b) to an individual described by this section. |
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(g) Not later than December 1, 2010, the commission shall |
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submit an initial report to the governor, the lieutenant governor, |
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the speaker of the house of representatives, and the presiding |
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officers of the standing committees of the senate and house of |
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representatives having primary jurisdiction over the child health |
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plan program. The report must evaluate the operation of the pilot |
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project and make recommendations regarding the continuation or |
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expansion of the pilot project. The report must: |
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(1) state whether: |
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(A) a higher percentage of eligible individuals |
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in the service area enrolled in the child health plan as a result of |
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the pilot project, as compared to percentages in other areas; |
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(B) a higher percentage of health plan providers |
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in the service area participated in the child health plan as a |
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result of the pilot project, as compared to percentages in other |
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areas; and |
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(C) the enrollment changes implemented under the |
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pilot project: |
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(i) reduced application processing delays |
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and procedural denials; and |
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(ii) affected reenrollment rates; and |
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(2) include recommendations for the statewide |
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implementation of successful pilot project strategies. |
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(h) The commission shall submit a final report regarding the |
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results of the pilot project in the manner prescribed by Subsection |
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(g) not later than November 1, 2011. The report must contain the |
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information required by Subsection (g). |
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(i) This section expires December 1, 2011. |
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SECTION 2. Not later than October 1, 2009, the Health and |
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Human Services Commission shall establish the pilot project |
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required under Section 62.160, Health and Safety Code, as added by |
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this Act. |
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SECTION 3. If before implementing any provision of this Act |
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a state agency determines that a waiver or authorization from a |
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federal agency is necessary for implementation of that provision, |
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the agency affected by the provision shall request the waiver or |
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authorization and may delay implementing that provision until the |
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waiver or authorization is granted. |
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SECTION 4. This Act takes effect immediately if it receives |
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a vote of two-thirds of all the members elected to each house, as |
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provided by Section 39, Article III, Texas Constitution. If this |
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Act does not receive the vote necessary for immediate effect, this |
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Act takes effect September 1, 2009. |