82S10017 ALB-D
 
  By: Kolkhorst H.B. No. 13
 
 
 
A BILL TO BE ENTITLED
 
AN ACT
  relating to the Medicaid program and alternate methods of providing
  health services to low-income persons in this state.
         BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
         SECTION 1.  Subtitle I, Title 4, Government Code, is amended
  by adding Chapter 537 to read as follows:
  CHAPTER 537.  MEDICAID REFORM WAIVER
         Sec. 537.001.  DEFINITIONS. In this chapter:
               (1)  "Commission" means the Health and Human Services
  Commission.
               (2)  "Executive commissioner" means the executive
  commissioner of the Health and Human Services Commission.
         Sec. 537.002.  FEDERAL AUTHORIZATION FOR MEDICAID REFORM.
  (a) The executive commissioner shall seek a waiver under Section
  1115 of the federal Social Security Act (42 U.S.C. Section 1315) to
  the state Medicaid plan.
         (b)  The waiver under this section must be designed to
  achieve the following objectives regarding the Medicaid program and
  alternatives to the program:
               (1)  provide flexibility to determine Medicaid
  eligibility categories and income levels;
               (2)  provide flexibility to design Medicaid benefits
  that meet the demographic, public health, clinical, and cultural
  needs of this state or regions within this state;
               (3)  encourage use of the private health benefits
  coverage market rather than public benefits systems;
               (4)  encourage people who have access to private
  employer-based health benefits to obtain or maintain those
  benefits;
               (5)  create a culture of shared financial
  responsibility, accountability, and participation in the Medicaid
  program by:
                     (A)  establishing and enforcing copayment
  requirements similar to private sector principles for all
  eligibility groups;
                     (B)  promoting the use of health savings accounts
  to influence a culture of individual responsibility; and
                     (C)  promoting the use of vouchers for
  consumer-directed services in which consumers manage and pay for
  health-related services provided to them using program vouchers;
               (6)  consolidate federal funding streams, including
  funds from the disproportionate share hospitals and upper payment
  limit supplemental payment programs and other federal Medicaid
  funds, to ensure the most effective and efficient use of those
  funding streams;
               (7)  allow flexibility in the use of state funds used to
  obtain federal matching funds, including allowing the use of
  intergovernmental transfers, certified public expenditures, costs
  not otherwise matchable, or other funds and funding mechanisms to
  obtain federal matching funds;
               (8)  empower individuals who are uninsured to acquire
  health benefits coverage through the promotion of cost-effective
  coverage models that provide access to affordable primary,
  preventive, and other health care on a sliding scale, with fees paid
  at the point of service; and
               (9)  allow for the redesign of long-term care services
  and supports to increase access to patient-centered care in the
  most cost-effective manner.
         SECTION 2.  (a)  In this section:
               (1)  "Commission" means the Health and Human Services
  Commission.
               (2)  "FMAP" means the federal medical assistance
  percentage by which state expenditures under the Medicaid program
  are matched with federal funds.
               (3)  "Illegal immigrant" means an individual who is not
  a citizen or national of the United States and who is unlawfully
  present in the United States.
               (4)  "Medicaid program" means the medical assistance
  program under Chapter 32, Human Resources Code.
         (b)  The commission shall actively pursue a modification to
  the formula prescribed by federal law for determining this state's
  FMAP to achieve a formula that would produce an FMAP that accounts
  for and is periodically adjusted to reflect changes in the
  following factors in this state:
               (1)  the total population;
               (2)  the population growth rate; and
               (3)  the percentage of the population with household
  incomes below the federal poverty level.
         (c)  The commission shall pursue the modification as
  required by Subsection (b) of this section by providing to the Texas
  delegation to the United States Congress and the federal Centers
  for Medicare and Medicaid Services and other appropriate federal
  agencies data regarding the factors listed in that subsection and
  information indicating the effects of those factors on the Medicaid
  program that are unique to this state.
         (d)  In addition to the modification to the FMAP described by
  Subsection (b) of this section, the commission shall make efforts
  to obtain additional federal Medicaid funding for Medicaid services
  required to be provided to illegal immigrants in this state. As
  part of that effort, the commission shall provide to the Texas
  delegation to the United States Congress and the federal Centers
  for Medicare and Medicaid Services and other appropriate federal
  agencies data regarding the costs to this state of providing those
  services.
         (e)  This section expires September 1, 2013.
         SECTION 3.  (a)  The Medicaid Reform Waiver Legislative
  Oversight Committee is created to facilitate the reform waiver
  efforts with respect to Medicaid.
         (b)  The committee is composed of eight members, as follows:
               (1)  four members of the senate, appointed by the
  lieutenant governor not later than October 1, 2011; and
               (2)  four members of the house of representatives,
  appointed by the speaker of the house of representatives not later
  than October 1, 2011.
         (c)  A member of the committee serves at the pleasure of the
  appointing official.
         (d)  The speaker of the house of representatives shall
  designate a member of the committee as the presiding officer.
         (e)  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.
         (f)  The committee shall:
               (1)  facilitate the design and development of the
  Medicaid reform waiver required by Chapter 537, Government Code, as
  added by this Act;
               (2)  facilitate a smooth transition from existing
  Medicaid payment systems and benefit designs to a new model of
  Medicaid enabled by the waiver described by Subdivision (1) of this
  subsection;
               (3)  meet at the call of the presiding officer; and
               (4)  research, take public testimony, and issue reports
  requested by the lieutenant governor or speaker of the house of
  representatives.
         (g)  The committee may request reports and other information
  from the Health and Human Services Commission.
         (h)  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.
         (i)  Chapter 551, Government Code, applies to the committee.
         (j)  The committee shall report to the lieutenant governor
  and speaker of the house of representatives not later than November
  15, 2012. The report must include:
               (1)  identification of significant issues that 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.
         (k)  This section expires September 1, 2013, and the
  committee is abolished on that date.
         SECTION 4.  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 on the 91st day after the last day of the
  legislative session.