81R11036 KLA-F

By: Rios Ybarra H.B. No. 4320

A BILL TO BE ENTITLED

AN ACT

relating to the integration of the application and eligibility determination processes for the child health plan and children's Medicaid programs.

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

SECTION 1. The legislature finds that it is in the best interests of this state to integrate the application and eligibility processes for the child health plan and children's Medicaid programs in a single application and eligibility determination system operated by trained and knowledgeable state employees.

SECTION 2. Sections 531.063(b) and (e), Government Code, are amended to read as follows:

(b) Except as otherwise provided by this subsection, the [The] commission shall contract with at least one but not more than four private entities for the operation of call centers required by this section unless the commission determines that contracting would not be cost-effective. The commission shall operate any call center that processes applications for or determines the eligibility of a child for the child health plan program under Chapter 62, Health and Safety Code, or the medical assistance program under Chapter 32, Human Resources Code, using the system required by Section 531.192 and using only state employees.

(e) The commission shall develop consumer service and performance standards for the operation of each call center required by this section, including for each call center required under Subsection (b) to be operated only by state employees. The standards shall address a call center's:

(1) ability to serve its consumers in a timely manner, including consideration of the consumers' ability to access the call center, whether the call center has toll-free telephone access, the average amount of time a consumer spends on hold, the frequency of call transfers, whether a consumer is able to communicate with a live person at the call center, and whether the call center makes mail correspondence available;

(2) staff, including employee courtesy, friendliness, training, and knowledge about the programs listed under Section 531.008(c); and

(3) complaint handling procedures, including the level of difficulty involved in filing a complaint and whether the call center's complaint responses are timely.

SECTION 3. Section 531.191(d), Government Code, is amended to read as follows:

(d) Except as provided by Section 531.063(b), on [On] receipt by the state of any necessary federal approval and subject to the approval of the governor and the Legislative Budget Board, the commission may contract for implementation of all or part of the plan required by Subsection (a) if the commission determines that contracting may advance the objectives of Subsections (a) and (b) and meets the criteria set out in the cost-benefit analysis described in this subsection. Before the awarding of a contract, the commission shall provide a detailed cost-benefit analysis to the governor and the Legislative Budget Board. The analysis must demonstrate the cost-effectiveness of the plan, mechanisms for monitoring performance under the plan, and specific improvements to the service delivery system and client access made by the plan. The commission shall make the analysis available to the public. Within 10 days after the release of a request for bids, proposals, offers, or other applicable expressions of interest relating to the development or implementation of the plan required by Subsection (a), the commission shall hold a public hearing and receive public comment on the request.

SECTION 4. Subchapter F, Chapter 531, Government Code, is amended by adding Section 531.192 to read as follows:

Sec. 531.192. INTEGRATED INTAKE SYSTEM FOR CERTAIN PROGRAMS. (a) Notwithstanding any other law, the commission shall implement a single, integrated intake system for the child health plan program under Chapter 62, Health and Safety Code, and the children's Medicaid program under Chapter 32, Human Resources Code, using only trained state employees who are knowledgeable with respect to the eligibility requirements of those programs. For each application submitted for one of those programs, the system must allow a single state employee to:

(1) accept the application;

(2) conduct any necessary eligibility interview;

(3) determine whether the applicant is eligible for the child health plan program or the children's Medicaid program; and

(4) if the applicant is eligible for either program, enroll the applicant in the appropriate program.

(b) Notwithstanding any other law, the commission may not contract with a private entity to perform any function specified by Subsection (a).

SECTION 5. The Health and Human Services Commission shall take any action allowed under state law that is necessary to terminate or modify a contract prohibited by Section 531.192(b), Government Code, as added by this Act, to ensure compliance with that section and Section 531.063(b), Government Code, as amended by this Act. If the commission is unable to terminate or modify a contract in a manner that is allowed under state law as required by this section, the commission may continue the contract, but may not renew the contract.

SECTION 6. Not later than the 30th day after the effective date of this Act, the Health and Human Services Commission shall submit a report to the Legislative Budget Board and the presiding officers of the Senate Health and Human Services Committee and the House Human Services Committee specifying the number of additional full-time equivalent positions the commission needs to comply with the requirements of Section 531.063(b), Government Code, as amended by this Act, and Section 531.192, Government Code, as added by this Act.

SECTION 7. 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 8. 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, 2009.