S.B. No. 219

AN ACT

relating to the provision of health and human services in this state, including the powers and duties of the Health and Human Services Commission and other state agencies, and the licensing of certain health professionals; clarifying certain statutory provisions; authorizing the imposition of fees.

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

ARTICLE 1. FAMILY CODE

SECTION 1.001. The heading to Chapter 55, Family Code, is amended to read as follows:

CHAPTER 55. PROCEEDINGS CONCERNING CHILDREN WITH MENTAL ILLNESS

OR INTELLECTUAL DISABILITY [MENTAL RETARDATION]

SECTION 1.002. Section 55.01, Family Code, is amended to read as follows:

Sec. 55.01. MEANING OF "HAVING A MENTAL ILLNESS". For purposes of this chapter, a child who is described as having a mental illness means a child with a [who suffers from] mental illness as defined by Section 571.003, Health and Safety Code.

SECTION 1.003. Section 55.02, Family Code, is amended to read as follows:

Sec. 55.02. MENTAL HEALTH AND INTELLECTUAL DISABILITY [MENTAL RETARDATION] JURISDICTION. For the purpose of initiating proceedings to order mental health or intellectual disability [mental retardation] services for a child or for commitment of a child as provided by this chapter, the juvenile court has jurisdiction of proceedings under Subtitle C or D, Title 7, Health and Safety Code.

SECTION 1.004. Section 55.03(b), Family Code, is amended to read as follows:

(b) Except as provided by this chapter, a child who is committed by a court to a residential care facility due to an intellectual disability [for mental retardation] shall be cared for as provided by Subtitle D, Title 7, Health and Safety Code.

SECTION 1.005. The heading to Subchapter C, Chapter 55, Family Code, is amended to read as follows:

SUBCHAPTER C. CHILD UNFIT TO PROCEED AS A RESULT OF MENTAL ILLNESS

OR INTELLECTUAL DISABILITY [MENTAL RETARDATION]

SECTION 1.006. Sections 55.31(a), (b), and (c), Family Code, are amended to read as follows:

(a) A child alleged by petition or found to have engaged in delinquent conduct or conduct indicating a need for supervision who as a result of mental illness or an intellectual disability [mental retardation] lacks capacity to understand the proceedings in juvenile court or to assist in the child's own defense is unfit to proceed and shall not be subjected to discretionary transfer to criminal court, adjudication, disposition, or modification of disposition as long as such incapacity endures.

(b) On a motion by a party, the juvenile court shall determine whether probable cause exists to believe that a child who is alleged by petition or who is found to have engaged in delinquent conduct or conduct indicating a need for supervision is unfit to proceed as a result of mental illness or an intellectual disability [mental retardation]. In making its determination, the court may:

(1) consider the motion, supporting documents, professional statements of counsel, and witness testimony; and

(2) make its own observation of the child.

(c) If the court determines that probable cause exists to believe that the child is unfit to proceed, the court shall temporarily stay the juvenile court proceedings and immediately order the child to be examined under Section 51.20. The information obtained from the examination must include expert opinion as to whether the child is unfit to proceed as a result of mental illness or an intellectual disability [mental retardation].

SECTION 1.007. Sections 55.32(a), (b), (d), (f), and (g), Family Code, are amended to read as follows:

(a) If the juvenile court determines that evidence exists to support a finding that a child is unfit to proceed as a result of mental illness or an intellectual disability [mental retardation], the court shall set the case for a hearing on that issue.

(b) The issue of whether the child is unfit to proceed as a result of mental illness or an intellectual disability [mental retardation] shall be determined at a hearing separate from any other hearing.

(d) Unfitness to proceed as a result of mental illness or an intellectual disability [mental retardation] must be proved by a preponderance of the evidence.

(f) If the court or jury determines that the child is unfit to proceed as a result of mental illness or an intellectual disability [mental retardation], the court shall:

(1) stay the juvenile court proceedings for as long as that incapacity endures; and

(2) proceed under Section 55.33.

(g) The fact that the child is unfit to proceed as a result of mental illness or an intellectual disability [mental retardation] does not preclude any legal objection to the juvenile court proceedings which is susceptible of fair determination prior to the adjudication hearing and without the personal participation of the child.

SECTION 1.008. Section 55.33(a), Family Code, is amended to read as follows:

(a) If the juvenile court or jury determines under Section 55.32 that a child is unfit to proceed with the juvenile court proceedings for delinquent conduct, the court shall:

(1) if the unfitness to proceed is a result of mental illness or an intellectual disability [mental retardation]:

(A) provided that the child meets the commitment criteria under Subtitle C or D, Title 7, Health and Safety Code, order the child placed with the [Texas] Department of State Health Services or the Department of Aging and Disability Services, as appropriate, [Mental Health and Mental Retardation] for a period of not more than 90 days, which order may not specify a shorter period, for placement in a facility designated by the department; or

(B) on application by the child's parent, guardian, or guardian ad litem, order the child placed in a private psychiatric inpatient facility for a period of not more than 90 days, which order may not specify a shorter period, but only if the placement is agreed to in writing by the administrator of the facility; or

(2) if the unfitness to proceed is a result of mental illness and the court determines that the child may be adequately treated in an alternative setting, order the child to receive treatment for mental illness on an outpatient basis for a period of not more than 90 days, which order may not specify a shorter period.

SECTION 1.009. Section 55.35(a), Family Code, is amended to read as follows:

(a) If the juvenile court issues a placement order under Section 55.33(a), the court shall order the probation department to send copies of any information in the possession of the department and relevant to the issue of the child's mental illness or intellectual disability [mental retardation] to the public or private facility or outpatient center, as appropriate.

SECTION 1.010. Section 55.40, Family Code, is amended to read as follows:

Sec. 55.40. REPORT THAT CHILD IS UNFIT TO PROCEED AS A RESULT OF INTELLECTUAL DISABILITY [MENTAL RETARDATION]. If a report submitted under Section 55.35(b) states that a child is unfit to proceed as a result of an intellectual disability [mental retardation] and that the child meets the commitment criteria for civil commitment under Subtitle D, Title 7, Health and Safety Code, the director of the residential care facility shall submit to the court an affidavit stating the conclusions reached as a result of the diagnosis. On receipt of the affidavit, the court shall:

(1) initiate proceedings as provided by Section 55.41 in the juvenile court for commitment of the child under Subtitle D, Title 7, Health and Safety Code; or

(2) refer the child's case as provided by Section 55.42 to the appropriate court for the initiation of proceedings in that court for commitment of the child under Subtitle D, Title 7, Health and Safety Code.

SECTION 1.011. The heading to Section 55.41, Family Code, is amended to read as follows:

Sec. 55.41. COMMITMENT PROCEEDINGS IN JUVENILE COURT FOR CHILDREN WITH INTELLECTUAL DISABILITY [MENTAL RETARDATION].

SECTION 1.012. Section 55.41(c), Family Code, is amended to read as follows:

(c) On receipt of the court's order, the [Texas] Department of Aging and Disability Services [Mental Health and Mental Retardation] or the appropriate community center shall admit the child to a residential care facility.

SECTION 1.013. The heading to Section 55.42, Family Code, is amended to read as follows:

Sec. 55.42. REFERRAL FOR COMMITMENT PROCEEDINGS FOR CHILDREN WITH INTELLECTUAL DISABILITY [MENTAL RETARDATION].

SECTION 1.014. Section 55.42(a), Family Code, is amended to read as follows:

(a) If the juvenile court refers the child's case to an appropriate court for the initiation of commitment proceedings under Section 55.40(2), the juvenile court shall:

(1) send all papers relating to the child's intellectual disability [mental retardation] to the clerk of the court to which the case is referred;

(2) send to the office of the appropriate county attorney or, if a county attorney is not available, to the office of the appropriate district attorney, copies of all papers sent to the clerk of the court under Subdivision (1); and

(3) if the child is in detention:

(A) order the child released from detention to the child's home or another appropriate place;

(B) order the child detained in an appropriate place other than a juvenile detention facility; or

(C) if an appropriate place to release or detain the child as described by Paragraph (A) or (B) is not available, order the child to remain in the juvenile detention facility subject to further detention orders of the court.

SECTION 1.015. Section 55.43(a), Family Code, is amended to read as follows:

(a) The prosecuting attorney may file with the juvenile court a motion for a restoration hearing concerning a child if:

(1) the child is found unfit to proceed as a result of mental illness or an intellectual disability [mental retardation]; and

(2) the child:

(A) is not:

(i) ordered by a court to receive inpatient mental health services;

(ii) committed by a court to a residential care facility; or

(iii) ordered by a court to receive treatment on an outpatient basis; or

(B) is discharged or currently on furlough from a mental health facility or outpatient center before the child reaches 18 years of age.

SECTION 1.016. Section 55.44(a), Family Code, is amended to read as follows:

(a) The juvenile court shall transfer all pending proceedings from the juvenile court to a criminal court on the 18th birthday of a child for whom the juvenile court or a court to which the child's case is referred has ordered inpatient mental health services or residential care for persons with an intellectual disability [mental retardation] if:

(1) the child is not discharged or currently on furlough from the facility before reaching 18 years of age; and

(2) the child is alleged to have engaged in delinquent conduct that included a violation of a penal law listed in Section 53.045 and no adjudication concerning the alleged conduct has been made.

SECTION 1.017. The heading to Subchapter D, Chapter 55, Family Code, is amended to read as follows:

SUBCHAPTER D. LACK OF RESPONSIBILITY FOR CONDUCT AS A RESULT OF

MENTAL ILLNESS OR INTELLECTUAL DISABILITY [MENTAL RETARDATION]

SECTION 1.018. Section 55.51, Family Code, is amended to read as follows:

Sec. 55.51. LACK OF RESPONSIBILITY FOR CONDUCT DETERMINATION; EXAMINATION. (a) A child alleged by petition to have engaged in delinquent conduct or conduct indicating a need for supervision is not responsible for the conduct if at the time of the conduct, as a result of mental illness or an intellectual disability [mental retardation], the child lacks substantial capacity either to appreciate the wrongfulness of the child's conduct or to conform the child's conduct to the requirements of law.

(b) On a motion by a party in which it is alleged that a child may not be responsible as a result of mental illness or an intellectual disability [mental retardation] for the child's conduct, the court shall order the child to be examined under Section 51.20. The information obtained from the examinations must include expert opinion as to whether the child is not responsible for the child's conduct as a result of mental illness or an intellectual disability [mental retardation].

(c) The issue of whether the child is not responsible for the child's conduct as a result of mental illness or an intellectual disability [mental retardation] shall be tried to the court or jury in the adjudication hearing.

(d) Lack of responsibility for conduct as a result of mental illness or an intellectual disability [mental retardation] must be proved by a preponderance of the evidence.

(e) In its findings or verdict the court or jury must state whether the child is not responsible for the child's conduct as a result of mental illness or an intellectual disability [mental retardation].

(f) If the court or jury finds the child is not responsible for the child's conduct as a result of mental illness or an intellectual disability [mental retardation], the court shall proceed under Section 55.52.

(g) A child found to be not responsible for the child's conduct as a result of mental illness or an intellectual disability [mental retardation] shall not be subject to proceedings under this title with respect to such conduct, other than proceedings under Section 55.52.

SECTION 1.019. Section 55.52(a), Family Code, is amended to read as follows:

(a) If the court or jury finds that a child is not responsible for the child's conduct under Section 55.51, the court shall:

(1) if the lack of responsibility is a result of mental illness or an intellectual disability [mental retardation]:

(A) provided that the child meets the commitment criteria under Subtitle C or D, Title 7, Health and Safety Code, order the child placed with the [Texas] Department of State Health Services or the Department of Aging and Disability Services, as appropriate, [Mental Health and Mental Retardation] for a period of not more than 90 days, which order may not specify a shorter period, for placement in a facility designated by the department; or

(B) on application by the child's parent, guardian, or guardian ad litem, order the child placed in a private psychiatric inpatient facility for a period of not more than 90 days, which order may not specify a shorter period, but only if the placement is agreed to in writing by the administrator of the facility; or

(2) if the child's lack of responsibility is a result of mental illness and the court determines that the child may be adequately treated in an alternative setting, order the child to receive treatment on an outpatient basis for a period of not more than 90 days, which order may not specify a shorter period.

SECTION 1.020. Sections 55.54(a) and (b), Family Code, are amended to read as follows:

(a) If the juvenile court issues a placement order under Section 55.52(a), the court shall order the probation department to send copies of any information in the possession of the department and relevant to the issue of the child's mental illness or intellectual disability [mental retardation] to the public or private facility or outpatient center, as appropriate.

(b) Not later than the 75th day after the date the court issues a placement order under Section 55.52(a), the public or private facility or outpatient center, as appropriate, shall submit to the court a report that:

(1) describes the treatment of the child provided by the facility or center; and

(2) states the opinion of the director of the facility or center as to whether the child has a mental illness or an intellectual disability [is mentally ill or mentally retarded].

SECTION 1.021. Section 55.55, Family Code, is amended to read as follows:

Sec. 55.55. REPORT THAT CHILD DOES NOT HAVE MENTAL ILLNESS OR INTELLECTUAL DISABILITY [IS NOT MENTALLY ILL OR MENTALLY RETARDED]; HEARING ON OBJECTION. (a) If a report submitted under Section 55.54(b) states that a child does not have a mental illness or an intellectual disability [mental retardation], the juvenile court shall discharge the child unless:

(1) an adjudication hearing was conducted concerning conduct that included a violation of a penal law listed in Section 53.045(a) and a petition was approved by a grand jury under Section 53.045; and

(2) the prosecuting attorney objects in writing not later than the second day after the date the attorney receives a copy of the report under Section 55.54(c).

(b) On objection by the prosecuting attorney under Subsection (a), the juvenile court shall hold a hearing without a jury to determine whether the child has a mental illness or an intellectual disability [mental retardation] and whether the child meets the commitment criteria for civil commitment under Subtitle C or D, Title 7, Health and Safety Code.

(c) At the hearing, the burden is on the state to prove by clear and convincing evidence that the child has a mental illness or an intellectual disability [mental retardation] and that the child meets the commitment criteria for civil commitment under Subtitle C or D, Title 7, Health and Safety Code.

(d) If, after a hearing, the court finds that the child does not have a mental illness or an intellectual disability [mental retardation] and that the child does not meet the commitment criteria under Subtitle C or D, Title 7, Health and Safety Code, the court shall discharge the child.

(e) If, after a hearing, the court finds that the child has a mental illness or an intellectual disability [mental retardation] and that the child meets the commitment criteria under Subtitle C or D, Title 7, Health and Safety Code, the court shall issue an appropriate commitment order.

SECTION 1.022. Section 55.59, Family Code, is amended to read as follows:

Sec. 55.59. REPORT THAT CHILD HAS INTELLECTUAL DISABILITY [MENTAL RETARDATION]; INITIATION OF COMMITMENT PROCEEDINGS. If a report submitted under Section 55.54(b) states that a child has an intellectual disability [mental retardation] and that the child meets the commitment criteria for civil commitment under Subtitle D, Title 7, Health and Safety Code, the director of the residential care facility shall submit to the court an affidavit stating the conclusions reached as a result of the diagnosis. On receipt of an affidavit, the juvenile court shall:

(1) initiate proceedings in the juvenile court as provided by Section 55.60 for commitment of the child under Subtitle D, Title 7, Health and Safety Code; or

(2) refer the child's case to the appropriate court as provided by Section 55.61 for the initiation of proceedings in that court for commitment of the child under Subtitle D, Title 7, Health and Safety Code.

SECTION 1.023. The heading to Section 55.60, Family Code, is amended to read as follows:

Sec. 55.60. COMMITMENT PROCEEDINGS IN JUVENILE COURT FOR CHILDREN WITH INTELLECTUAL DISABILITY [MENTAL RETARDATION].

SECTION 1.024. Section 55.60(c), Family Code, is amended to read as follows:

(c) On receipt of the court's order, the [Texas] Department of Aging and Disability Services [Mental Health and Mental Retardation] or the appropriate community center shall admit the child to a residential care facility.

SECTION 1.025. The heading to Section 55.61, Family Code, is amended to read as follows:

Sec. 55.61. REFERRAL FOR COMMITMENT PROCEEDINGS FOR CHILDREN WITH INTELLECTUAL DISABILITY [MENTAL RETARDATION].

SECTION 1.026. Section 55.61(a), Family Code, is amended to read as follows:

(a) If the juvenile court refers the child's case to an appropriate court for the initiation of commitment proceedings under Section 55.59(2), the juvenile court shall:

(1) send all papers relating to the child's intellectual disability [mental retardation] to the clerk of the court to which the case is referred;

(2) send to the office of the appropriate county attorney or, if a county attorney is not available, to the office of the appropriate district attorney, copies of all papers sent to the clerk of the court under Subdivision (1); and

(3) if the child is in detention:

(A) order the child released from detention to the child's home or another appropriate place;

(B) order the child detained in an appropriate place other than a juvenile detention facility; or

(C) if an appropriate place to release or detain the child as described by Paragraph (A) or (B) is not available, order the child to remain in the juvenile detention facility subject to further detention orders of the court.

SECTION 1.027. Section 101.0021, Family Code, is redesignated as Section 101.036, Family Code, and amended to read as follows:

Sec. 101.036 [101.0021]. [BUREAU OF] VITAL STATISTICS UNIT. "Vital [Bureau of vital] statistics unit" means the [bureau of] vital statistics unit of the [Texas] Department of State Health Services.

SECTION 1.028. Section 101.017, Family Code, is amended to read as follows:

Sec. 101.017. LICENSED CHILD PLACING AGENCY. "Licensed child placing agency" means a person, including an organization [private association,] or corporation, licensed or certified under Chapter 42, Human Resources Code, [approved] by the Department of Family and Protective Services to place a child in a child-care facility, agency foster home, agency foster group home, or adoptive home [children for adoption through a license, certification, or other means].

SECTION 1.029. Section 102.003(a), Family Code, is amended to read as follows:

(a) An original suit may be filed at any time by:

(1) a parent of the child;

(2) the child through a representative authorized by the court;

(3) a custodian or person having the right of visitation with or access to the child appointed by an order of a court of another state or country;

(4) a guardian of the person or of the estate of the child;

(5) a governmental entity;

(6) the Department of Family and Protective Services [an authorized agency];

(7) a licensed child placing agency;

(8) a man alleging himself to be the father of a child filing in accordance with Chapter 160, subject to the limitations of that chapter, but not otherwise;

(9) a person, other than a foster parent, who has had actual care, control, and possession of the child for at least six months ending not more than 90 days preceding the date of the filing of the petition;

(10) a person designated as the managing conservator in a revoked or unrevoked affidavit of relinquishment under Chapter 161 or to whom consent to adoption has been given in writing under Chapter 162;

(11) a person with whom the child and the child's guardian, managing conservator, or parent have resided for at least six months ending not more than 90 days preceding the date of the filing of the petition if the child's guardian, managing conservator, or parent is deceased at the time of the filing of the petition;

(12) a person who is the foster parent of a child placed by the Department of Family and Protective Services in the person's home for at least 12 months ending not more than 90 days preceding the date of the filing of the petition;

(13) a person who is a relative of the child within the third degree by consanguinity, as determined by Chapter 573, Government Code, if the child's parents are deceased at the time of the filing of the petition; or

(14) a person who has been named as a prospective adoptive parent of a child by a pregnant woman or the parent of the child, in a verified written statement to confer standing executed under Section 102.0035, regardless of whether the child has been born.

SECTION 1.030. Section 102.011(b), Family Code, is amended to read as follows:

(b) The court may also exercise personal jurisdiction over a person on whom service of citation is required or over the person's personal representative, although the person is not a resident or domiciliary of this state, if:

(1) the person is personally served with citation in this state;

(2) the person submits to the jurisdiction of this state by consent, by entering a general appearance, or by filing a responsive document having the effect of waiving any contest to personal jurisdiction;

(3) the child resides in this state as a result of the acts or directives of the person;

(4) the person resided with the child in this state;

(5) the person resided in this state and provided prenatal expenses or support for the child;

(6) the person engaged in sexual intercourse in this state and the child may have been conceived by that act of intercourse;

(7) the person, as provided by Chapter 160:

(A) registered with the paternity registry maintained by the [bureau of] vital statistics unit; or

(B) signed an acknowledgment of paternity of a child born in this state; or

(8) there is any basis consistent with the constitutions of this state and the United States for the exercise of the personal jurisdiction.

SECTION 1.031. Section 107.001(5), Family Code, is amended to read as follows:

(5) "Guardian ad litem" means a person appointed to represent the best interests of a child. The term includes:

(A) a volunteer advocate from a charitable organization described by [appointed under] Subchapter C who is appointed by the court as the child's guardian ad litem;

(B) a professional, other than an attorney, who holds a relevant professional license and whose training relates to the determination of a child's best interests;

(C) an adult having the competence, training, and expertise determined by the court to be sufficient to represent the best interests of the child; or

(D) an attorney ad litem appointed to serve in the dual role.

SECTION 1.032. Section 107.002(c), Family Code, is amended to read as follows:

(c) A guardian ad litem appointed for the child under this chapter is entitled to:

(1) receive a copy of each pleading or other paper filed with the court in the case in which the guardian ad litem is appointed;

(2) receive notice of each hearing in the case;

(3) participate in case staffings by the Department of Family and Protective Services [an authorized agency] concerning the child;

(4) attend all legal proceedings in the case but may not call or question a witness or otherwise provide legal services unless the guardian ad litem is a licensed attorney who has been appointed in the dual role;

(5) review and sign, or decline to sign, an agreed order affecting the child; and

(6) explain the basis for the guardian ad litem's opposition to the agreed order if the guardian ad litem does not agree to the terms of a proposed order.

SECTION 1.033. Section 107.003(a), Family Code, is amended to read as follows:

(a) An attorney ad litem appointed to represent a child or an amicus attorney appointed to assist the court:

(1) shall:

(A) subject to Rules 4.02, 4.03, and 4.04, Texas Disciplinary Rules of Professional Conduct, and within a reasonable time after the appointment, interview:

(i) the child in a developmentally appropriate manner, if the child is four years of age or older;

(ii) each person who has significant knowledge of the child's history and condition, including any foster parent of the child; and

(iii) the parties to the suit;

(B) seek to elicit in a developmentally appropriate manner the child's expressed objectives of representation;

(C) consider the impact on the child in formulating the attorney's presentation of the child's expressed objectives of representation to the court;

(D) investigate the facts of the case to the extent the attorney considers appropriate;

(E) obtain and review copies of relevant records relating to the child as provided by Section 107.006;

(F) participate in the conduct of the litigation to the same extent as an attorney for a party;

(G) take any action consistent with the child's interests that the attorney considers necessary to expedite the proceedings;

(H) encourage settlement and the use of alternative forms of dispute resolution; and

(I) review and sign, or decline to sign, a proposed or agreed order affecting the child;

(2) must be trained in child advocacy or have experience determined by the court to be equivalent to that training; and

(3) is entitled to:

(A) request clarification from the court if the role of the attorney is ambiguous;

(B) request a hearing or trial on the merits;

(C) consent or refuse to consent to an interview of the child by another attorney;

(D) receive a copy of each pleading or other paper filed with the court;

(E) receive notice of each hearing in the suit;

(F) participate in any case staffing concerning the child conducted by the Department of Family and Protective Services [an authorized agency]; and

(G) attend all legal proceedings in the suit.

SECTION 1.034. Section 108.001, Family Code, is amended to read as follows:

Sec. 108.001. TRANSMITTAL OF RECORDS OF SUIT BY CLERK. (a) Except as provided by this chapter, the clerk of the court shall transmit to the [bureau of] vital statistics unit a certified record of the order rendered in a suit, together with the name and all prior names, birth date, and place of birth of the child on a form provided by the unit [bureau]. The form shall be completed by the petitioner and submitted to the clerk at the time the order is filed for record.

(b) The [bureau of] vital statistics unit shall maintain these records in a central file according to the name, birth date, and place of birth of the child, the court that rendered the order, and the docket number of the suit.

(c) Except as otherwise provided by law, the records required under this section to be maintained by the [bureau of] vital statistics unit are confidential.

(d) In a Title IV-D case, the Title IV-D agency may transmit the record and information specified by Subsection (a) to the [bureau of] vital statistics unit, with a copy to the clerk of the court on request by the clerk. The record and information are not required to be certified if transmitted by the Title IV-D agency under this subsection.

SECTION 1.035. Section 108.003, Family Code, is amended to read as follows:

Sec. 108.003. TRANSMITTAL OF INFORMATION REGARDING ADOPTION. (a) The clerk of a court that renders a decree of adoption shall, not later than the 10th day of the first month after the month in which the adoption is rendered, transmit to the central registry of the [bureau of] vital statistics unit a certified report of adoption that includes:

(1) the name of the adopted child after adoption as shown in the adoption order;

(2) the birth date of the adopted child;

(3) the docket number of the adoption suit;

(4) the identity of the court rendering the adoption;

(5) the date of the adoption order;

(6) the name and address of each parent, guardian, managing conservator, or other person whose consent to adoption was required or waived under Chapter 162, or whose parental rights were terminated in the adoption suit;

(7) the identity of the licensed child placing agency, if any, through which the adopted child was placed for adoption; and

(8) the identity, address, and telephone number of the registry through which the adopted child may register as an adoptee.

(b) Except as otherwise provided by law, for good cause shown, or on an order of the court that granted the adoption or terminated the proceedings under Section 155.001, the records concerning a child maintained by the district clerk after rendition of a decree of adoption, the records of a child-placing agency that has ceased operations, and the records required under this section to be maintained by the [bureau of] vital statistics unit are confidential, and no person is entitled to access to or information from these records.

(c) If the [bureau of] vital statistics unit determines that a report filed with the unit [bureau] under this section requires correction, the unit [bureau] shall mail the report directly to an attorney of record with respect to the adoption. The attorney shall return the corrected report to the unit [bureau]. If there is no attorney of record, the unit [bureau] shall mail the report to the clerk of the court for correction.

SECTION 1.036. Section 108.004, Family Code, is amended to read as follows:

Sec. 108.004. TRANSMITTAL OF FILES ON LOSS OF JURISDICTION. On the loss of jurisdiction of a court under Chapter 155, 159, or 262, the clerk of the court shall transmit to the central registry of the [bureau of] vital statistics unit a certified record, on a form provided by the unit [bureau], stating that jurisdiction has been lost, the reason for the loss of jurisdiction, and the name and all previous names, date of birth, and place of birth of the child.

SECTION 1.037. The heading to Section 108.005, Family Code, is amended to read as follows:

Sec. 108.005. ADOPTION RECORDS RECEIVED BY [BUREAU OF] VITAL STATISTICS UNIT.

SECTION 1.038. Section 108.005(a), Family Code, is amended to read as follows:

(a) When the [bureau of] vital statistics unit receives a record from the district clerk showing that continuing, exclusive jurisdiction of a child has been lost due to the adoption of the child, the unit [bureau] shall close the records concerning that child.

SECTION 1.039. Sections 108.006(a), (c), and (d), Family Code, are amended to read as follows:

(a) The Department of State Health Services [bureau of vital statistics] may charge a reasonable fee to cover the cost of determining and sending information concerning the identity of the court with continuing, exclusive jurisdiction.

(c) The clerk shall send the fees collected under Subsection (b) to the Department of State Health Services [bureau of vital statistics] for deposit in a special fund in the state treasury from which the legislature may appropriate money only to operate and maintain the central file and central registry of the vital statistics unit [bureau].

(d) The receipts from the fees charged under Subsection (a) shall be deposited in a financial institution as determined by the Department of State Health Services [director of the bureau of vital statistics] and withdrawn as necessary for the sole purpose of operating and maintaining the central record file.

SECTION 1.040. Section 108.007, Family Code, is amended to read as follows:

Sec. 108.007. MICROFILM. (a) The [bureau of] vital statistics unit may use microfilm or other suitable means for maintaining the central record file.

(b) A certified reproduction of a document maintained by the [bureau of] vital statistics unit is admissible in evidence as the original document.

SECTION 1.041. Section 108.008(a), Family Code, is amended to read as follows:

(a) On a determination of paternity, the petitioner shall provide the clerk of the court in which the order was rendered the information necessary to prepare the report of determination of paternity. The clerk shall:

(1) prepare the report on a form provided by the vital statistics unit [Bureau of Vital Statistics]; and

(2) complete the report immediately after the order becomes final.

SECTION 1.042. Section 108.110, Family Code, is amended to read as follows:

Sec. 108.110. RELEASE OF INFORMATION BY [BUREAU OF] VITAL STATISTICS UNIT. (a) The [bureau of] vital statistics unit shall provide to the Department of Family and Protective [and Regulatory] Services:

(1) adoption information as necessary for the department to comply with federal law or regulations regarding the compilation or reporting of adoption information to federal officials; and

(2) other information as necessary for the department to administer its duties.

(b) The unit [bureau] may release otherwise confidential information from the unit's [bureau's] central record files to another governmental entity that has a specific need for the information and maintains appropriate safeguards to prevent further dissemination of the information.

SECTION 1.043. Section 153.005(b), Family Code, is amended to read as follows:

(b) A managing conservator must be a parent, a competent adult, the Department of Family and Protective Services [an authorized agency], or a licensed child-placing agency.

SECTION 1.044. Section 153.371, Family Code, is amended to read as follows:

Sec. 153.371. RIGHTS AND DUTIES OF NONPARENT APPOINTED AS SOLE MANAGING CONSERVATOR. Unless limited by court order or other provisions of this chapter, a nonparent, a licensed child-placing agency, or the Department of Family and Protective Services [authorized agency] appointed as a managing conservator of the child has the following rights and duties:

(1) the right to have physical possession and to direct the moral and religious training of the child;

(2) the duty of care, control, protection, and reasonable discipline of the child;

(3) the duty to provide the child with clothing, food, shelter, education, and medical, psychological, and dental care;

(4) the right to consent for the child to medical, psychiatric, psychological, dental, and surgical treatment and to have access to the child's medical records;

(5) the right to receive and give receipt for payments for the support of the child and to hold or disburse funds for the benefit of the child;

(6) the right to the services and earnings of the child;

(7) the right to consent to marriage and to enlistment in the armed forces of the United States;

(8) the right to represent the child in legal action and to make other decisions of substantial legal significance concerning the child;

(9) except when a guardian of the child's estate or a guardian or attorney ad litem has been appointed for the child, the right to act as an agent of the child in relation to the child's estate if the child's action is required by a state, the United States, or a foreign government;

(10) the right to designate the primary residence of the child and to make decisions regarding the child's education; and

(11) if the parent-child relationship has been terminated with respect to the parents, or only living parent, or if there is no living parent, the right to consent to the adoption of the child and to make any other decision concerning the child that a parent could make.

SECTION 1.045. Section 153.372(a), Family Code, is amended to read as follows:

(a) A nonparent, the Department of Family and Protective Services [authorized agency], or a licensed child-placing agency appointed as a joint managing conservator may serve in that capacity with either another nonparent or with a parent of the child.

SECTION 1.046. Section 153.373, Family Code, is amended to read as follows:

Sec. 153.373. VOLUNTARY SURRENDER OF POSSESSION REBUTS PARENTAL PRESUMPTION. The presumption that a parent should be appointed or retained as managing conservator of the child is rebutted if the court finds that:

(1) the parent has voluntarily relinquished actual care, control, and possession of the child to a nonparent, a licensed child-placing agency, or the Department of Family and Protective Services [authorized agency] for a period of one year or more, a portion of which was within 90 days preceding the date of intervention in or filing of the suit; and

(2) the appointment of the nonparent, [or] agency, or Department of Family and Protective Services as managing conservator is in the best interest of the child.

SECTION 1.047. Section 153.374, Family Code, is amended to read as follows:

Sec. 153.374. DESIGNATION OF MANAGING CONSERVATOR IN AFFIDAVIT OF RELINQUISHMENT. (a) A parent may designate a competent person, the Department of Family and Protective Services [authorized agency], or a licensed child-placing agency to serve as managing conservator of the child in an unrevoked or irrevocable affidavit of relinquishment of parental rights executed as provided by Chapter 161.

(b) The person, Department of Family and Protective Services, or agency designated to serve as managing conservator shall be appointed managing conservator unless the court finds that the appointment would not be in the best interest of the child.

SECTION 1.048. Section 153.376(a), Family Code, is amended to read as follows:

(a) Unless limited by court order or other provisions of this chapter, a nonparent, a licensed child-placing agency, or the Department of Family and Protective Services [authorized agency] appointed as a possessory conservator has the following rights and duties during the period of possession:

(1) the duty of care, control, protection, and reasonable discipline of the child;

(2) the duty to provide the child with clothing, food, and shelter; and

(3) the right to consent to medical, dental, and surgical treatment during an emergency involving an immediate danger to the health and safety of the child.

SECTION 1.049. Section 153.434, Family Code, is amended to read as follows:

Sec. 153.434. LIMITATION ON RIGHT TO REQUEST POSSESSION OR ACCESS. A biological or adoptive grandparent may not request possession of or access to a grandchild if:

(1) each of the biological parents of the grandchild has:

(A) died;

(B) had the person's parental rights terminated; or

(C) executed an affidavit of waiver of interest in child or an affidavit of relinquishment of parental rights under Chapter 161 and the affidavit designates the Department of Family and Protective Services [an authorized agency], a licensed child-placing agency, or a person other than the child's stepparent as the managing conservator of the child; and

(2) the grandchild has been adopted, or is the subject of a pending suit for adoption, by a person other than the child's stepparent.

SECTION 1.050. Section 155.004(a), Family Code, is amended to read as follows:

(a) A court of this state loses its continuing, exclusive jurisdiction to modify its order if:

(1) an order of adoption is rendered after the court acquires continuing, exclusive jurisdiction of the suit;

(2) the parents of the child have remarried each other after the dissolution of a previous marriage between them and file a suit for the dissolution of their subsequent marriage combined with a suit affecting the parent-child relationship as if there had not been a prior court with continuing, exclusive jurisdiction over the child; or

(3) another court assumed jurisdiction over a suit and rendered a final order based on incorrect information received from the [bureau of] vital statistics unit that there was no court of continuing, exclusive jurisdiction.

SECTION 1.051. Sections 155.101(a), (b), and (d), Family Code, are amended to read as follows:

(a) The petitioner or the court shall request from the [bureau of] vital statistics unit identification of the court that last had continuing, exclusive jurisdiction of the child in a suit unless:

(1) the petition alleges that no court has continuing, exclusive jurisdiction of the child and the issue is not disputed by the pleadings; or

(2) the petition alleges that the court in which the suit or petition to modify has been filed has acquired and retains continuing, exclusive jurisdiction of the child as the result of a prior proceeding and the issue is not disputed by the pleadings.

(b) The [bureau of] vital statistics unit shall, on the written request of the court, an attorney, or a party:

(1) identify the court that last had continuing, exclusive jurisdiction of the child in a suit and give the docket number of the suit; or

(2) state that the child has not been the subject of a suit.

(d) The [bureau of] vital statistics unit shall transmit the information not later than the 10th day after the date on which the request is received.

SECTION 1.052. Section 155.103, Family Code, is amended to read as follows:

Sec. 155.103. RELIANCE ON [BUREAU OF] VITAL STATISTICS UNIT INFORMATION. (a) A court shall have jurisdiction over a suit if it has been, correctly or incorrectly, informed by the [bureau of] vital statistics unit that the child has not been the subject of a suit and the petition states that no other court has continuing, exclusive jurisdiction over the child.

(b) If the [bureau of] vital statistics unit notifies the court that the unit [bureau] has furnished incorrect information regarding the existence of another court with continuing, exclusive jurisdiction before the rendition of a final order, the provisions of this chapter apply.

SECTION 1.053. Section 155.104, Family Code, is amended to read as follows:

Sec. 155.104. VOIDABLE ORDER. (a) If a request for information from the [bureau of] vital statistics unit relating to the identity of the court having continuing, exclusive jurisdiction of the child has been made under this subchapter, a final order, except an order of dismissal, may not be rendered until the information is filed with the court.

(b) If a final order is rendered in the absence of the filing of the information from the [bureau of] vital statistics unit, the order is voidable on a showing that a court other than the court that rendered the order had continuing, exclusive jurisdiction.

SECTION 1.054. Section 159.201(a), Family Code, is amended to read as follows:

(a) In a proceeding to establish or enforce a support order or to determine parentage, a tribunal of this state may exercise personal jurisdiction over a nonresident individual or the individual's guardian or conservator if:

(1) the individual is personally served with citation in this state;

(2) the individual submits to the jurisdiction of this state by consent, by entering a general appearance, or by filing a responsive document having the effect of waiving any contest to personal jurisdiction;

(3) the individual resided with the child in this state;

(4) the individual resided in this state and provided prenatal expenses or support for the child;

(5) the child resides in this state as a result of the acts or directives of the individual;

(6) the individual engaged in sexual intercourse in this state and the child may have been conceived by that act of intercourse;

(7) the individual asserted parentage in the paternity registry maintained in this state by the [bureau of] vital statistics unit; or

(8) there is any other basis consistent with the constitutions of this state and the United States for the exercise of personal jurisdiction.

SECTION 1.055. Section 160.204(a), Family Code, is amended to read as follows:

(a) A man is presumed to be the father of a child if:

(1) he is married to the mother of the child and the child is born during the marriage;

(2) he is married to the mother of the child and the child is born before the 301st day after the date the marriage is terminated by death, annulment, declaration of invalidity, or divorce;

(3) he married the mother of the child before the birth of the child in apparent compliance with law, even if the attempted marriage is or could be declared invalid, and the child is born during the invalid marriage or before the 301st day after the date the marriage is terminated by death, annulment, declaration of invalidity, or divorce;

(4) he married the mother of the child after the birth of the child in apparent compliance with law, regardless of whether the marriage is or could be declared invalid, he voluntarily asserted his paternity of the child, and:

(A) the assertion is in a record filed with the [bureau of] vital statistics unit;

(B) he is voluntarily named as the child's father on the child's birth certificate; or

(C) he promised in a record to support the child as his own; or

(5) during the first two years of the child's life, he continuously resided in the household in which the child resided and he represented to others that the child was his own.

SECTION 1.056. Section 160.302(b), Family Code, is amended to read as follows:

(b) An acknowledgment of paternity is void if it:

(1) states that another man is a presumed father of the child, unless a denial of paternity signed or otherwise authenticated by the presumed father is filed with the [bureau of] vital statistics unit;

(2) states that another man is an acknowledged or adjudicated father of the child; or

(3) falsely denies the existence of a presumed, acknowledged, or adjudicated father of the child.

SECTION 1.057. Section 160.304(c), Family Code, is amended to read as follows:

(c) Subject to Subsection (a), an acknowledgment of paternity or denial of paternity takes effect on the date of the birth of the child or the filing of the document with the [bureau of] vital statistics unit, whichever occurs later.

SECTION 1.058. Section 160.305, Family Code, is amended to read as follows:

Sec. 160.305. EFFECT OF ACKNOWLEDGMENT OR DENIAL OF PATERNITY. (a) Except as provided by Sections 160.307 and 160.308, a valid acknowledgment of paternity filed with the [bureau of] vital statistics unit is the equivalent of an adjudication of the paternity of a child and confers on the acknowledged father all rights and duties of a parent.

(b) Except as provided by Sections 160.307 and 160.308, a valid denial of paternity filed with the [bureau of] vital statistics unit in conjunction with a valid acknowledgment of paternity is the equivalent of an adjudication of the nonpaternity of the presumed father and discharges the presumed father from all rights and duties of a parent.

SECTION 1.059. Section 160.306, Family Code, is amended to read as follows:

Sec. 160.306. FILING FEE NOT REQUIRED. The Department of State Health Services [bureau of vital statistics] may not charge a fee for filing:

(1) an acknowledgment of paternity;

(2) a denial of paternity; or

(3) a rescission of an acknowledgment of paternity or denial of paternity.

SECTION 1.060. Sections 160.307(b) and (c), Family Code, are amended to read as follows:

(b) A signatory seeking to rescind an acknowledgment of paternity or denial of paternity must file with the [bureau of] vital statistics unit a completed rescission, on the form prescribed under Section 160.312, in which the signatory declares under penalty of perjury that:

(1) as of the date the rescission is filed, a proceeding has not been held affecting the child identified in the acknowledgment of paternity or denial of paternity, including a proceeding to establish child support;

(2) a copy of the completed rescission was sent by certified or registered mail, return receipt requested, to:

(A) if the rescission is of an acknowledgment of paternity, the other signatory of the acknowledgment of paternity and the signatory of any related denial of paternity; or

(B) if the rescission is of a denial of paternity, the signatories of the related acknowledgment of paternity; and

(3) if a signatory to the acknowledgment of paternity or denial of paternity is receiving services from the Title IV-D agency, a copy of the completed rescission was sent by certified or registered mail to the Title IV-D agency.

(c) On receipt of a completed rescission, the [bureau of] vital statistics unit shall void the acknowledgment of paternity or denial of paternity affected by the rescission and amend the birth record of the child, if appropriate.

SECTION 1.061. Sections 160.309(b) and (e), Family Code, are amended to read as follows:

(b) For purposes of a challenge to an acknowledgment of paternity or denial of paternity, a signatory submits to the personal jurisdiction of this state by signing the acknowledgment or denial. The jurisdiction is effective on the filing of the document with the [bureau of] vital statistics unit.

(e) At the conclusion of a proceeding to challenge an acknowledgment of paternity or a denial of paternity, the court shall order the [bureau of] vital statistics unit to amend the birth record of the child, if appropriate.

SECTION 1.062. Section 160.312(a), Family Code, is amended to read as follows:

(a) To facilitate compliance with this subchapter, the [bureau of] vital statistics unit shall prescribe forms for the:

(1) acknowledgment of paternity;

(2) denial of paternity; and

(3) rescission of an acknowledgment or denial of paternity.

SECTION 1.063. Section 160.313, Family Code, is amended to read as follows:

Sec. 160.313. RELEASE OF INFORMATION. The [bureau of] vital statistics unit may release information relating to the acknowledgment of paternity or denial of paternity to a signatory of the acknowledgment or denial and to the courts and Title IV-D agency of this or another state.

SECTION 1.064. Section 160.314, Family Code, is amended to read as follows:

Sec. 160.314. ADOPTION OF RULES. The Title IV-D agency and the executive commissioner of the Health and Human Services Commission [bureau of vital statistics] may adopt rules to implement this subchapter.

SECTION 1.065. Section 160.315, Family Code, is amended to read as follows:

Sec. 160.315. MEMORANDUM OF UNDERSTANDING. (a) The Title IV-D agency and the [bureau of] vital statistics unit shall adopt a memorandum of understanding governing the collection and transfer of information for the voluntary acknowledgment of paternity.

(b) The Title IV-D agency and the [bureau of] vital statistics unit shall review the memorandum semiannually and renew or modify the memorandum as necessary.

SECTION 1.066. Section 160.401, Family Code, is amended to read as follows:

Sec. 160.401. ESTABLISHMENT OF REGISTRY. A registry of paternity is established in the [bureau of] vital statistics unit.

SECTION 1.067. Section 160.402(c), Family Code, is amended to read as follows:

(c) A registrant shall promptly notify the registry in a record of any change in the information provided by the registrant. The [bureau of] vital statistics unit shall incorporate all new information received into its records but is not required to affirmatively seek to obtain current information for incorporation in the registry.

SECTION 1.068. Section 160.404, Family Code, is amended to read as follows:

Sec. 160.404. TERMINATION OF PARENTAL RIGHTS: FAILURE TO REGISTER. The parental rights of a man alleged to be the father of a child may be terminated without notice as provided by Section 161.002 if the man:

(1) did not timely register with the [bureau of] vital statistics unit; and

(2) is not entitled to notice under Section 160.402 or 161.002.

SECTION 1.069. Section 160.411, Family Code, is amended to read as follows:

Sec. 160.411. REQUIRED FORM. The [bureau of] vital statistics unit shall adopt a form for registering with the registry. The form must require the signature of the registrant. The form must state that:

(1) the form is signed under penalty of perjury;

(2) a timely registration entitles the registrant to notice of a proceeding for adoption of the child or for termination of the registrant's parental rights;

(3) a timely registration does not commence a proceeding to establish paternity;

(4) the information disclosed on the form may be used against the registrant to establish paternity;

(5) services to assist in establishing paternity are available to the registrant through the support enforcement agency;

(6) the registrant should also register in another state if the conception or birth of the child occurred in the other state;

(7) information on registries in other states is available from the [bureau of] vital statistics unit; and

(8) procedures exist to rescind the registration of a claim of paternity.

SECTION 1.070. Section 160.412(a), Family Code, is amended to read as follows:

(a) The [bureau of] vital statistics unit is not required to attempt to locate the mother of a child who is the subject of a registration. The [bureau of] vital statistics unit shall send a copy of the notice of the registration to a mother who has provided an address.

SECTION 1.071. Section 160.415, Family Code, is amended to read as follows:

Sec. 160.415. UNTIMELY REGISTRATION. If a man registers later than the 31st day after the date of the birth of the child, the [bureau of] vital statistics unit shall notify the registrant that the registration was not timely filed.

SECTION 1.072. Section 160.416(b), Family Code, is amended to read as follows:

(b) Except as otherwise provided by Subsection (c), the [bureau of] vital statistics unit may charge a reasonable fee for making a search of the registry and for furnishing a certificate.

SECTION 1.073. Section 160.421(a), Family Code, is amended to read as follows:

(a) If a father-child relationship has not been established under this chapter, a petitioner for the adoption of or the termination of parental rights regarding the child must obtain a certificate of the results of a search of the registry. The petitioner may request a search of the registry on or after the 32nd day after the date of the birth of the child, and the executive commissioner of the Health and Human Services Commission [bureau of vital statistics] may not by rule impose a waiting period that must elapse before the vital statistics unit [bureau] will conduct the requested search.

SECTION 1.074. Sections 160.422(a) and (b), Family Code, are amended to read as follows:

(a) The [bureau of] vital statistics unit shall furnish a certificate of the results of a search of the registry on request by an individual, a court, or an agency listed in Section 160.412(b).

(b) The certificate of the results of a search must be signed on behalf of the unit [bureau] and state that:

(1) a search has been made of the registry; and

(2) a registration containing the information required to identify the registrant:

(A) has been found and is attached to the certificate; or

(B) has not been found.

SECTION 1.075. Section 160.636(f), Family Code, is amended to read as follows:

(f) If the order of the court is at variance with the child's birth certificate, the court shall order the [bureau of] vital statistics unit to issue an amended birth record.

SECTION 1.076. Section 160.760(b), Family Code, is amended to read as follows:

(b) After receiving notice of the birth, the court shall render an order that:

(1) confirms that the intended parents are the child's parents;

(2) requires the gestational mother to surrender the child to the intended parents, if necessary; and

(3) requires the [bureau of] vital statistics unit to issue a birth certificate naming the intended parents as the child's parents.

SECTION 1.077. Section 160.763, Family Code, is amended to read as follows:

Sec. 160.763. HEALTH CARE FACILITY REPORTING REQUIREMENT. (a) The executive commissioner of the Health and Human Services Commission [Texas Department of Health] by rule shall develop and implement a confidential reporting system that requires each health care facility in this state at which assisted reproduction procedures are performed under gestational agreements to report statistics related to those procedures.

(b) In developing the reporting system, the executive commissioner [department] shall require each health care facility described by Subsection (a) to annually report:

(1) the number of assisted reproduction procedures under a gestational agreement performed at the facility during the preceding year; and

(2) the number and current status of embryos created through assisted reproduction procedures described by Subdivision (1) that were not transferred for implantation.

SECTION 1.078. Section 161.001, Family Code, is amended to read as follows:

Sec. 161.001. INVOLUNTARY TERMINATION OF PARENT-CHILD RELATIONSHIP. (a) In this section, "born addicted to alcohol or a controlled substance" means a child:

(1) who is born to a mother who during the pregnancy used a controlled substance, as defined by Chapter 481, Health and Safety Code, other than a controlled substance legally obtained by prescription, or alcohol; and

(2) who, after birth as a result of the mother's use of the controlled substance or alcohol:

(A) experiences observable withdrawal from the alcohol or controlled substance;

(B) exhibits observable or harmful effects in the child's physical appearance or functioning; or

(C) exhibits the demonstrable presence of alcohol or a controlled substance in the child's bodily fluids.

(b) The court may order termination of the parent-child relationship if the court finds by clear and convincing evidence:

(1) that the parent has:

(A) voluntarily left the child alone or in the possession of another not the parent and expressed an intent not to return;

(B) voluntarily left the child alone or in the possession of another not the parent without expressing an intent to return, without providing for the adequate support of the child, and remained away for a period of at least three months;

(C) voluntarily left the child alone or in the possession of another without providing adequate support of the child and remained away for a period of at least six months;

(D) knowingly placed or knowingly allowed the child to remain in conditions or surroundings which endanger the physical or emotional well-being of the child;

(E) engaged in conduct or knowingly placed the child with persons who engaged in conduct which endangers the physical or emotional well-being of the child;

(F) failed to support the child in accordance with the parent's ability during a period of one year ending within six months of the date of the filing of the petition;

(G) abandoned the child without identifying the child or furnishing means of identification, and the child's identity cannot be ascertained by the exercise of reasonable diligence;

(H) voluntarily, and with knowledge of the pregnancy, abandoned the mother of the child beginning at a time during her pregnancy with the child and continuing through the birth, failed to provide adequate support or medical care for the mother during the period of abandonment before the birth of the child, and remained apart from the child or failed to support the child since the birth;

(I) contumaciously refused to submit to a reasonable and lawful order of a court under Subchapter D, Chapter 261;

(J) been the major cause of:

(i) the failure of the child to be enrolled in school as required by the Education Code; or

(ii) the child's absence from the child's home without the consent of the parents or guardian for a substantial length of time or without the intent to return;

(K) executed before or after the suit is filed an unrevoked or irrevocable affidavit of relinquishment of parental rights as provided by this chapter;

(L) been convicted or has been placed on community supervision, including deferred adjudication community supervision, for being criminally responsible for the death or serious injury of a child under the following sections of the Penal Code or adjudicated under Title 3 for conduct that caused the death or serious injury of a child and that would constitute a violation of one of the following Penal Code sections:

(i) Section 19.02 (murder);

(ii) Section 19.03 (capital murder);

(iii) Section 19.04 (manslaughter);

(iv) Section 21.11 (indecency with a child);

(v) Section 22.01 (assault);

(vi) Section 22.011 (sexual assault);

(vii) Section 22.02 (aggravated assault);

(viii) Section 22.021 (aggravated sexual assault);

(ix) Section 22.04 (injury to a child, elderly individual, or disabled individual);

(x) Section 22.041 (abandoning or endangering child);

(xi) Section 25.02 (prohibited sexual conduct);

(xii) Section 43.25 (sexual performance by a child);

(xiii) Section 43.26 (possession or promotion of child pornography);

(xiv) Section 21.02 (continuous sexual abuse of young child or children);

(xv) Section 20A.02(a)(7) or (8) (trafficking of persons); and

(xvi) Section 43.05(a)(2) (compelling prostitution);

(M) had his or her parent-child relationship terminated with respect to another child based on a finding that the parent's conduct was in violation of Paragraph (D) or (E) or substantially equivalent provisions of the law of another state;

(N) constructively abandoned the child who has been in the permanent or temporary managing conservatorship of the Department of Family and Protective Services [or an authorized agency] for not less than six months, and:

(i) the department [or authorized agency] has made reasonable efforts to return the child to the parent;

(ii) the parent has not regularly visited or maintained significant contact with the child; and

(iii) the parent has demonstrated an inability to provide the child with a safe environment;

(O) failed to comply with the provisions of a court order that specifically established the actions necessary for the parent to obtain the return of the child who has been in the permanent or temporary managing conservatorship of the Department of Family and Protective Services for not less than nine months as a result of the child's removal from the parent under Chapter 262 for the abuse or neglect of the child;

(P) used a controlled substance, as defined by Chapter 481, Health and Safety Code, in a manner that endangered the health or safety of the child, and:

(i) failed to complete a court-ordered substance abuse treatment program; or

(ii) after completion of a court-ordered substance abuse treatment program, continued to abuse a controlled substance;

(Q) knowingly engaged in criminal conduct that has resulted in the parent's:

(i) conviction of an offense; and

(ii) confinement or imprisonment and inability to care for the child for not less than two years from the date of filing the petition;

(R) been the cause of the child being born addicted to alcohol or a controlled substance, other than a controlled substance legally obtained by prescription[, as defined by Section 261.001];

(S) voluntarily delivered the child to a designated emergency infant care provider under Section 262.302 without expressing an intent to return for the child; or

(T) been convicted of:

(i) the murder of the other parent of the child under Section 19.02 or 19.03, Penal Code, or under a law of another state, federal law, the law of a foreign country, or the Uniform Code of Military Justice that contains elements that are substantially similar to the elements of an offense under Section 19.02 or 19.03, Penal Code;

(ii) criminal attempt under Section 15.01, Penal Code, or under a law of another state, federal law, the law of a foreign country, or the Uniform Code of Military Justice that contains elements that are substantially similar to the elements of an offense under Section 15.01, Penal Code, to commit the offense described by Subparagraph (i); or

(iii) criminal solicitation under Section 15.03, Penal Code, or under a law of another state, federal law, the law of a foreign country, or the Uniform Code of Military Justice that contains elements that are substantially similar to the elements of an offense under Section 15.03, Penal Code, of the offense described by Subparagraph (i); and

(2) that termination is in the best interest of the child.

SECTION 1.079. Section 161.002(e), Family Code, is amended to read as follows:

(e) The court shall not render an order terminating parental rights under Subsection (b)(2) or (3) unless the court receives evidence of a certificate of the results of a search of the paternity registry under Chapter 160 from the [bureau of] vital statistics unit indicating that no man has registered the intent to claim paternity.

SECTION 1.080. Section 161.003(a), Family Code, is amended to read as follows:

(a) The court may order termination of the parent-child relationship in a suit filed by the Department of Family and Protective [and Regulatory] Services if the court finds that:

(1) the parent has a mental or emotional illness or a mental deficiency that renders the parent unable to provide for the physical, emotional, and mental needs of the child;

(2) the illness or deficiency, in all reasonable probability, proved by clear and convincing evidence, will continue to render the parent unable to provide for the child's needs until the 18th birthday of the child;

(3) the department has been the temporary or sole managing conservator of the child of the parent for at least six months preceding the date of the hearing on the termination held in accordance with Subsection (c);

(4) the department has made reasonable efforts to return the child to the parent; and

(5) the termination is in the best interest of the child.

SECTION 1.081. Section 161.005(b), Family Code, is amended to read as follows:

(b) If the petition designates the Department of Family and Protective [and Regulatory] Services as managing conservator, the department shall be given service of citation. The court shall notify the department if the court appoints the department as the managing conservator of the child.

SECTION 1.082. Sections 161.103(c) and (e), Family Code, are amended to read as follows:

(c) The affidavit may contain:

(1) a waiver of process in a suit to terminate the parent-child relationship filed under this chapter or in a suit to terminate joined with a petition for adoption; and

(2) a consent to the placement of the child for adoption by the Department of Family and Protective [and Regulatory] Services or by a licensed child-placing agency.

(e) The relinquishment in an affidavit that designates the Department of Family and Protective [and Regulatory] Services or a licensed child-placing agency to serve as the managing conservator is irrevocable. A relinquishment in any other affidavit of relinquishment is revocable unless it expressly provides that it is irrevocable for a stated period of time not to exceed 60 days after the date of its execution.

SECTION 1.083. Section 161.104, Family Code, is amended to read as follows:

Sec. 161.104. RIGHTS OF DESIGNATED MANAGING CONSERVATOR PENDING COURT APPOINTMENT. A person, licensed child-placing agency, or the Department of Family and Protective Services [authorized agency] designated managing conservator of a child in an irrevocable or unrevoked affidavit of relinquishment has a right to possession of the child superior to the right of the person executing the affidavit, the right to consent to medical, surgical, dental, and psychological treatment of the child, and the rights and duties given by Chapter 153 to a possessory conservator until such time as these rights and duties are modified or terminated by court order.

SECTION 1.084. Section 161.106(e), Family Code, is amended to read as follows:

(e) An affidavit of waiver of interest in a child may be used in a suit in which the affiant attempts to establish an interest in the child. The affidavit may not be used in a suit brought by another person, licensed child-placing agency, or the Department of Family and Protective Services [authorized agency] to establish the affiant's paternity of the child.

SECTION 1.085. Section 161.108(a), Family Code, is amended to read as follows:

(a) Before or at the time an affidavit of relinquishment of parental rights under Section 161.103 is executed, the mother of a newborn child may authorize the release of the child from the hospital or birthing center to a licensed child-placing agency, the Department of Family and Protective [and Regulatory] Services, or another designated person.

SECTION 1.086. Section 161.109, Family Code, is amended to read as follows:

Sec. 161.109. REQUIREMENT OF PATERNITY REGISTRY CERTIFICATE. (a) If a parent-child relationship does not exist between the child and any man, a certificate from the [bureau of] vital statistics unit signed by the registrar that a diligent search has been made of the paternity registry maintained by the unit [bureau] and that a registration has not been found pertaining to the father of the child in question must be filed with the court before a trial on the merits in the suit for termination may be held.

(b) In a proceeding to terminate parental rights in which the alleged or probable father has not been personally served with citation or signed an affidavit of relinquishment or an affidavit of waiver of interest, the court may not terminate the parental rights of the alleged or probable father, whether known or unknown, unless a certificate from the [bureau of] vital statistics unit signed by the registrar states that a diligent search has been made of the paternity registry maintained by the unit [bureau] and that a filing or registration has not been found pertaining to the father of the child in question.

SECTION 1.087. Section 161.2061(a), Family Code, is amended to read as follows:

(a) If the court finds it to be in the best interest of the child, the court may provide in an order terminating the parent-child relationship that the biological parent who filed an affidavit of voluntary relinquishment of parental rights under Section 161.103 shall have limited post-termination contact with the child as provided by Subsection (b) on the agreement of the biological parent and the Department of Family and Protective [and Regulatory] Services.

SECTION 1.088. Section 161.207(a), Family Code, is amended to read as follows:

(a) If the court terminates the parent-child relationship with respect to both parents or to the only living parent, the court shall appoint a suitable, competent adult, the Department of Family and Protective [and Regulatory] Services, or a licensed child-placing agency[, or an authorized agency] as managing conservator of the child. An agency designated managing conservator in an unrevoked or irrevocable affidavit of relinquishment shall be appointed managing conservator.

SECTION 1.089. Section 161.208, Family Code, is amended to read as follows:

Sec. 161.208. APPOINTMENT OF DEPARTMENT OF FAMILY AND PROTECTIVE [AND REGULATORY] SERVICES AS MANAGING CONSERVATOR. If a parent of the child has not been personally served in a suit in which the Department of Family and Protective [and Regulatory] Services seeks termination, the court that terminates a parent-child relationship may not appoint the Department of Family and Protective [and Regulatory] Services as permanent managing conservator of the child unless the court determines that:

(1) the department has made a diligent effort to locate a missing parent who has not been personally served and a relative of that parent; and

(2) a relative located by the department has had a reasonable opportunity to request appointment as managing conservator of the child or the department has not been able to locate the missing parent or a relative of the missing parent.

SECTION 1.090. Section 162.001(c), Family Code, is amended to read as follows:

(c) If an affidavit of relinquishment of parental rights contains a consent for the Department of Family and Protective [and Regulatory] Services or a licensed child-placing agency to place the child for adoption and appoints the department or agency managing conservator of the child, further consent by the parent is not required and the adoption order shall terminate all rights of the parent without further termination proceedings.

SECTION 1.091. Section 162.005(b), Family Code, is amended to read as follows:

(b) Before placing a child for adoption, the Department of Family and Protective [and Regulatory] Services, a licensed child-placing agency, or the child's parent or guardian shall compile a report on the available health, social, educational, and genetic history of the child to be adopted.

SECTION 1.092. Section 162.006(a), Family Code, is amended to read as follows:

(a) The Department of Family and Protective Services [department], licensed child-placing agency, or other person placing a child for adoption shall inform the prospective adoptive parents of their right to examine the records and other information relating to the history of the child. The department, licensed child-placing agency, or other person placing the child for adoption shall edit the records and information to protect the identity of the biological parents and any other person whose identity is confidential.

SECTION 1.093. Section 162.0065, Family Code, is amended to read as follows:

Sec. 162.0065. EDITING ADOPTION RECORDS IN DEPARTMENT PLACEMENT. Notwithstanding any other provision of this chapter, in an adoption in which a child is placed for adoption by the Department of Family and Protective [and Regulatory] Services, the department is not required to edit records to protect the identity of birth parents and other persons whose identity is confidential if the department determines that information is already known to the adoptive parents or is readily available through other sources, including the court records of a suit to terminate the parent-child relationship under Chapter 161.

SECTION 1.094. Section 162.008(b), Family Code, is amended to read as follows:

(b) A petition for adoption may not be granted until the following documents have been filed:

(1) a copy of the health, social, educational, and genetic history report signed by the child's adoptive parents; and

(2) if the report is required to be submitted to the Department of Family and Protective Services [bureau of vital statistics] under Section 162.006(e), a certificate from the department [bureau] acknowledging receipt of the report.

SECTION 1.095. Section 162.0085(a), Family Code, is amended to read as follows:

(a) In a suit affecting the parent-child relationship in which an adoption is sought, the court shall order each person seeking to adopt the child to obtain that person's own criminal history record information. The court shall accept under this section a person's criminal history record information that is provided by the Department of Family and Protective [and Regulatory] Services or by a licensed child-placing agency that received the information from the department if the information was obtained not more than one year before the date the court ordered the history to be obtained.

SECTION 1.096. Sections 162.018(a) and (d), Family Code, are amended to read as follows:

(a) The adoptive parents are entitled to receive copies of the records and other information relating to the history of the child maintained by the Department of Family and Protective Services [department], licensed child-placing agency, person, or entity placing the child for adoption.

(d) At the time an adoption order is rendered, the court shall provide to the parents of an adopted child information provided by the [bureau of] vital statistics unit that describes the functions of the voluntary adoption registry under Subchapter E. The licensed child-placing agency shall provide to each of the child's biological parents known to the agency, the information when the parent signs an affidavit of relinquishment of parental rights or affidavit of waiver of interest in a child. The information shall include the right of the child or biological parent to refuse to participate in the registry. If the adopted child is 14 years old or older the court shall provide the information to the child.

SECTION 1.097. Section 162.021(b), Family Code, is amended to read as follows:

(b) Rendition of the order does not relieve the clerk from the duty to send information regarding adoption to the [bureau of] vital statistics unit as required by this subchapter and Chapter 108.

SECTION 1.098. Sections 162.101(1) and (2), Family Code, are amended to read as follows:

(1) "Appropriate public authorities," with reference to this state, means the commissioner of the Department of Family and Protective Services [executive director].

(2) "Appropriate authority in the receiving state," with reference to this state, means the commissioner of the Department of Family and Protective Services [executive director].

SECTION 1.099. Section 162.103, Family Code, is amended to read as follows:

Sec. 162.103. FINANCIAL RESPONSIBILITY FOR CHILD. (a) Financial responsibility for a child placed as provided in the compact is determined, in the first instance, as provided in Article V of the compact. After partial or complete default of performance under the provisions of Article V assigning financial responsibility, the commissioner of the Department of Family and Protective Services [executive director] may bring suit under Chapter 154 and may file a complaint with the appropriate prosecuting attorney, claiming a violation of Section 25.05, Penal Code.

(b) After default, if the commissioner of the Department of Family and Protective Services [executive director] determines that financial responsibility is unlikely to be assumed by the sending agency or the child's parents, the commissioner [executive director] may cause the child to be returned to the sending agency.

(c) After default, the Department of Family and Protective Services [department] shall assume financial responsibility for the child until it is assumed by the child's parents or until the child is safely returned to the sending agency.

SECTION 1.100. Section 162.104, Family Code, is amended to read as follows:

Sec. 162.104. APPROVAL OF PLACEMENT. The commissioner of the Department of Family and Protective Services [executive director] may not approve the placement of a child in this state without the concurrence of the individuals with whom the child is proposed to be placed or the head of an institution with which the child is proposed to be placed.

SECTION 1.101. Section 162.106, Family Code, is amended to read as follows:

Sec. 162.106. COMPACT AUTHORITY. (a) The governor shall appoint the commissioner [executive director] of the Department of Family and Protective [and Regulatory] Services as compact administrator.

(b) The commissioner of the Department of Family and Protective Services [executive director] shall designate a deputy compact administrator and staff necessary to execute the terms of the compact in this state.

SECTION 1.102. Section 162.107(b), Family Code, is amended to read as follows:

(b) An individual, agency, corporation, child-care facility, or general residential operation [child-care institution] in this state that violates Article IV of the compact commits an offense. An offense under this subsection is a Class B misdemeanor. On conviction, the court shall revoke any license to operate as a child-care facility or general residential operation [child-care institution] issued by the Department of Family and Protective Services [department] to the entity convicted and shall revoke any license or certification of the individual, agency, or corporation necessary to practice in the state.

SECTION 1.103. Section 162.201, Family Code, is amended to read as follows:

Sec. 162.201. ADOPTION OF COMPACT; TEXT. The Interstate Compact on Adoption and Medical Assistance is adopted by this state and entered into with all other jurisdictions joining in the compact in form substantially as provided under this subchapter.

INTERSTATE COMPACT ON ADOPTION AND MEDICAL ASSISTANCE

ARTICLE I. FINDINGS

The legislature finds that:

(a) Finding adoptive families for children for whom state assistance is desirable, under Subchapter D, Chapter 162, and assuring the protection of the interest of the children affected during the entire assistance period require special measures when the adoptive parents move to other states or are residents of another state.

(b) The provision of medical and other necessary services for children, with state assistance, encounters special difficulties when the provision of services takes place in other states.

ARTICLE II. PURPOSES

The purposes of the compact are to:

(a) authorize the Department of Family and Protective [and Regulatory] Services, with the concurrence of the Health and Human Services Commission, to enter into interstate agreements with agencies of other states for the protection of children on behalf of whom adoption assistance is being provided by the Department of Family and Protective [and Regulatory] Services; and

(b) provide procedures for interstate children's adoption assistance payments, including medical payments.

ARTICLE III. DEFINITIONS

In this compact:

(a) "Adoption assistance state" means the state that signs an adoption assistance agreement in a particular case.

(b) "Residence state" means the state in which the child resides by virtue of the residence of the adoptive parents.

(c) "State" means a state of the United States, the District of Columbia, the Commonwealth of Puerto Rico, the Virgin Islands, Guam, the Commonwealth of the Northern Mariana Islands, or a territory or possession of or a territory or possession administered by the United States.

ARTICLE IV. COMPACTS AUTHORIZED

The Department of Family and Protective [and Regulatory] Services, through its commissioner [executive director], is authorized to develop, participate in the development of, negotiate, and enter into one or more interstate compacts on behalf of this state with other states to implement one or more of the purposes of this compact. An interstate compact authorized by this article has the force and effect of law.

ARTICLE V. CONTENTS OF COMPACTS

A compact entered into under the authority conferred by this compact shall contain:

(1) a provision making the compact available for joinder by all states;

(2) a provision for withdrawal from the compact on written notice to the parties, with a period of one year between the date of the notice and the effective date of the withdrawal;

(3) a requirement that protections under the compact continue for the duration of the adoption assistance and apply to all children and their adoptive parents who on the effective date of the withdrawal are receiving adoption assistance from a party state other than the one in which they reside and have their principal place of abode;

(4) a requirement that each case of adoption assistance to which the compact applies be covered by a written adoption assistance agreement between the adoptive parents and the state child welfare agency of the state that provides the adoption assistance and that the agreement be expressly for the benefit of the adopted child and enforceable by the adoptive parents and the state agency providing the adoption assistance; and

(5) other provisions that are appropriate for the proper administration of the compact.

ARTICLE VI. OPTIONAL CONTENTS OF COMPACTS

A compact entered into under the authority conferred by this compact may contain the following provisions, in addition to those required under Article V of this compact:

(1) provisions establishing procedures and entitlement to medical, developmental, child-care, or other social services for the child in accordance with applicable laws, even if the child and the adoptive parents are in a state other than the one responsible for or providing the services or the funds to defray part or all of the costs thereof; and

(2) other provisions that are appropriate or incidental to the proper administration of the compact.

ARTICLE VII. MEDICAL ASSISTANCE

(a) A child with special needs who resides in this state and who is the subject of an adoption assistance agreement with another state is entitled to receive a medical assistance identification from this state on the filing in the state medical assistance agency of a certified copy of the adoption assistance agreement obtained from the adoption assistance state. In accordance with rules of the state medical assistance agency, the adoptive parents, at least annually, shall show that the agreement is still in effect or has been renewed.

(b) The state medical assistance agency shall consider the holder of a medical assistance identification under this article as any other holder of a medical assistance identification under the laws of this state and shall process and make payment on claims on the holder's account in the same manner and under the same conditions and procedures as for other recipients of medical assistance.

(c) The state medical assistance agency shall provide coverage and benefits for a child who is in another state and who is covered by an adoption assistance agreement made by the Department of Family and Protective [and Regulatory] Services for the coverage or benefits, if any, not provided by the residence state. The adoptive parents acting for the child may submit evidence of payment for services or benefit amounts not payable in the residence state and shall be reimbursed for those amounts. Services or benefit amounts covered under any insurance or other third-party medical contract or arrangement held by the child or the adoptive parents may not be reimbursed. The state medical assistance agency shall adopt rules implementing this subsection. The additional coverage and benefit amounts provided under this subsection are for services for which there is no federal contribution or services that, if federally aided, are not provided by the residence state. The rules shall include procedures for obtaining prior approval for services in cases in which prior approval is required for the assistance.

(d) The submission of a false, misleading, or fraudulent claim for payment or reimbursement for services or benefits under this article or the making of a false, misleading, or fraudulent statement in connection with the claim is an offense under this subsection if the person submitting the claim or making the statement knows or should know that the claim or statement is false, misleading, or fraudulent. A person who commits an offense under this subsection may be liable for a fine not to exceed $10,000 or imprisonment for not more than two years, or both the fine and the imprisonment. An offense under this subsection that also constitutes an offense under other law may be punished under either this subsection or the other applicable law.

(e) This article applies only to medical assistance for children under adoption assistance agreements with states that have entered into a compact with this state under which the other state provides medical assistance to children with special needs under adoption assistance agreements made by this state. All other children entitled to medical assistance under adoption assistance agreements entered into by this state are eligible to receive the medical assistance in accordance with the laws and procedures that apply to the agreement.

ARTICLE VIII. FEDERAL PARTICIPATION

Consistent with federal law, the Department of Family and Protective [and Regulatory] Services and the Health and Human Services Commission, in connection with the administration of this compact or a compact authorized by this compact, shall include the provision of adoption assistance and medical assistance for which the federal government pays some or all of the cost in any state plan made under the Adoption Assistance and Child Welfare Act of 1980 (Pub. L. No. 96-272), Titles IV-E and XIX of the Social Security Act, and other applicable federal laws. The Department of Family and Protective [and Regulatory] Services and the Health and Human Services Commission shall apply for and administer all relevant federal aid in accordance with law.

SECTION 1.104. Section 162.202, Family Code, is amended to read as follows:

Sec. 162.202. AUTHORITY OF DEPARTMENT OF FAMILY AND PROTECTIVE [AND REGULATORY] SERVICES. The Department of Family and Protective [and Regulatory] Services, with the concurrence of the Health and Human Services Commission, may develop, participate in the development of, negotiate, and enter into one or more interstate compacts on behalf of this state with other states to implement one or more of the purposes of this subchapter. An interstate compact authorized by this subchapter [article] has the force and effect of law.

SECTION 1.105. Section 162.203, Family Code, is amended to read as follows:

Sec. 162.203. COMPACT ADMINISTRATION. The commissioner [executive director] of the Department of Family and Protective [and Regulatory] Services shall serve as the compact administrator. The administrator shall cooperate with all departments, agencies, and officers of this state and its subdivisions in facilitating the proper administration of the compact and any supplemental agreements entered into by this state. The commissioner of the Department of Family and Protective Services [executive director] and the executive commissioner of the Health and Human Services Commission [human services] shall designate deputy compact administrators to represent adoption assistance services and medical assistance services provided under Title XIX of the Social Security Act.

SECTION 1.106. The heading to Subchapter D, Chapter 162, Family Code, is amended to read as follows:

SUBCHAPTER D. ADOPTION SERVICES BY THE DEPARTMENT OF

FAMILY AND PROTECTIVE [AND REGULATORY] SERVICES

SECTION 1.107. Sections 162.301(1) and (3), Family Code, are amended to read as follows:

(1) "Adoption assistance agreement" means a written agreement, binding on the parties to the agreement, between the Department of Family and Protective Services [department] and the prospective adoptive parents that specifies the nature and amount of any payment, services, or assistance to be provided under the agreement and stipulates that the agreement will remain in effect without regard to the state in which the prospective adoptive parents reside at any particular time.

(3) "Department" means the Department of Family and Protective [and Regulatory] Services.

SECTION 1.108. Section 162.302(c), Family Code, is amended to read as follows:

(c) The program shall be carried out by licensed child-placing agencies or county child-care or welfare units under department rules [adopted by the department].

SECTION 1.109. Sections 162.309(b) and (i), Family Code, are amended to read as follows:

(b) The committee is composed of 12 members appointed by the commissioner [board] of the department [Department of Protective and Regulatory Services]. The commissioner [board] shall appoint to the committee individuals who in the aggregate have knowledge of and experience in community education, cultural relations, family support, counseling, and parenting skills and education. At least six members must be ordained members of the clergy.

(i) On receiving the committee's recommendations, the department may [adopt rules to] implement a program or project recommended under this section. The executive commissioner of the Health and Human Services Commission may adopt rules necessary for the implementation of a program or project by the department. The department may solicit, accept, and use gifts and donations to implement a program or project recommended by the committee.

SECTION 1.110. Sections 162.402(7), (11), (12), and (14), Family Code, are amended to read as follows:

(7) "Authorized agency" means a public agency authorized to care for or to place children for adoption or a private entity approved for that purpose by the department through a license, certification, or other means. The term includes a licensed child-placing agency or a previously licensed child-placing agency that has ceased operations and has transferred its adoption records to the vital statistics unit [bureau] or an agency authorized by the department to place children for adoption and a licensed child-placing agency that has been acquired by, merged with, or otherwise succeeded by an agency authorized by the department to place children for adoption.

(11) "Central registry" means the mutual consent voluntary adoption registry established and maintained by the vital statistics unit [bureau] under this subchapter.

(12) "Department" means the Department of Family and Protective [and Regulatory] Services.

(14) "Vital statistics unit" ["Bureau"] means the [bureau of] vital statistics unit of the Department of State Health Services.

SECTION 1.111. Sections 162.403(a) and (c), Family Code, are amended to read as follows:

(a) The vital statistics unit [bureau] shall establish and maintain a mutual consent voluntary adoption registry.

(c) An authorized agency that did not directly or by contract provide registry services as required by this subchapter on January 1, 1984, may not provide its own registry service. The vital statistics unit [bureau] shall operate through the central registry those services for agencies not permitted to provide a registry under this section.

SECTION 1.112. Section 162.407(b), Family Code, is amended to read as follows:

(b) An adoptee adopted or placed through an authorized agency may register through the registry maintained by that agency or the registry to which the agency has delegated registry services or through the central registry maintained by the vital statistics unit [bureau].

SECTION 1.113. Section 162.408, Family Code, is amended to read as follows:

Sec. 162.408. PROOF OF IDENTITY. The rules and minimum standards of the Department [Texas Board] of State Health Services for the vital statistics unit [bureau] must provide for proof of identity in order to facilitate the purposes of this subchapter and to protect the privacy rights of adoptees, adoptive parents, birth parents, biological siblings, and their families.

SECTION 1.114. Section 162.411(d), Family Code, is amended to read as follows:

(d) The fees collected by the vital statistics unit [bureau] shall be deposited in a special fund in the general revenue fund. Funds in the special fund may be appropriated only for the administration of the central registry.

SECTION 1.115. Section 162.414(c), Family Code, is amended to read as follows:

(c) To establish or corroborate a match, the administrator shall request confirmation of a possible match from the vital statistics unit [bureau]. If the agency operating the registry has in its own records sufficient information through which the match may be confirmed, the administrator may, but is not required to, request confirmation from the vital statistics unit [bureau]. The vital statistics unit [bureau] may confirm or deny the match without breaching the duty of confidentiality to the adoptee, adoptive parents, birth parents, or biological siblings and without a court order.

SECTION 1.116. Section 162.420, Family Code, is amended to read as follows:

Sec. 162.420. RULEMAKING. (a) The executive commissioner of the Health and Human Services Commission [Texas Board of Health] shall make rules and adopt minimum standards for the Department of State Health Services [bureau] to:

(1) administer the provisions of this subchapter; and

(2) ensure that each registry respects the right to privacy and confidentiality of an adoptee, birth parent, and biological sibling who does not desire to disclose the person's identity.

(b) The Department of State Health Services [bureau] shall conduct a comprehensive review of all rules and standards adopted under this subchapter not less than every six years.

(c) In order to provide the administrators an opportunity to review proposed rules and standards and send written suggestions to the executive commissioner of the Health and Human Services Commission [Texas Board of Health], the executive commissioner [board] shall, before adopting rules and minimum standards, send a copy of the proposed rules and standards not less than 60 days before the date they take effect to:

(1) the administrator of each registry established under this subchapter; and

(2) the administrator of each agency authorized by the department to place children for adoption.

SECTION 1.117. Section 162.421(a), Family Code, is amended to read as follows:

(a) This subchapter does not prevent the Department of State Health Services [bureau] from making known to the public, by appropriate means, the existence of voluntary adoption registries.

SECTION 1.118. Sections 162.422(a) and (b), Family Code, are amended to read as follows:

(a) The Department of State Health Services [bureau] or authorized agency establishing or operating a registry is not liable to any person for obtaining or disclosing identifying information about a birth parent, adoptee, or biological sibling within the scope of this subchapter and under its provisions.

(b) An employee or agent of the Department of State Health Services [bureau] or of an authorized agency establishing or operating a registry under this subchapter is not liable to any person for obtaining or disclosing identifying information about a birth parent, adoptee, or biological sibling within the scope of this subchapter and under its provisions.

SECTION 1.119. Section 162.601(a), Family Code, is amended to read as follows:

(a) Subject to the availability of funds, the Department of Family and Protective [and Regulatory] Services shall pay, in addition to any other amounts due, a monetary incentive to a licensed child-placing agency for the completion of an adoption:

(1) of a child, as defined by Section 162.301, receiving or entitled to receive foster care at department expense; and

(2) arranged with the assistance of the agency.

SECTION 1.120. Section 261.001(7), Family Code, is amended to read as follows:

(7) "Executive commissioner" ["Board"] means the executive commissioner of the Health and Human Services Commission [Board of Protective and Regulatory Services].

SECTION 1.121. Sections 261.002(a) and (b), Family Code, are amended to read as follows:

(a) The department shall establish and maintain [in Austin] a central registry of the names of individuals found by the department to have abused or neglected a [reported cases of] child [abuse or neglect].

(b) The executive commissioner [department] may adopt rules necessary to carry out this section. The rules shall provide for cooperation with local child service agencies, including hospitals, clinics, and schools, and cooperation with other states in exchanging reports to effect a national registration system.

SECTION 1.122. Section 261.101(b-1), Family Code, is amended to read as follows:

(b-1) In addition to the duty to make a report under Subsection (a) or (b), a person or professional shall make a report in the manner required by Subsection (a) or (b), as applicable, if the person or professional has cause to believe that an adult was a victim of abuse or neglect as a child and the person or professional determines in good faith that disclosure of the information is necessary to protect the health and safety of:

(1) another child; or

(2) an elderly person or [disabled] person with a disability as defined by Section 48.002, Human Resources Code.

SECTION 1.123. Section 261.103(a), Family Code, is amended to read as follows:

(a) Except as provided by Subsections (b) and (c) and Section 261.405, a report shall be made to:

(1) any local or state law enforcement agency;

(2) the department; or

(3) the state agency that operates, licenses, certifies, or registers the facility in which the alleged abuse or neglect occurred[; or

[(4) the agency designated by the court to be responsible for the protection of children].

SECTION 1.124. Sections 261.105(a), (b), and (c-1), Family Code, are amended to read as follows:

(a) All reports received by a local or state law enforcement agency that allege abuse or neglect by a person responsible for a child's care, custody, or welfare shall be referred immediately to the department [or the designated agency].

(b) The department [or designated agency] shall immediately notify the appropriate state or local law enforcement agency of any report it receives, other than a report from a law enforcement agency, that concerns the suspected abuse or neglect of a child or death of a child from abuse or neglect.

(c-1) Notwithstanding Subsections (b) and (c), if a report under this section relates to a child with an intellectual disability [mental retardation] receiving services in a state supported living center as defined by Section 531.002, Health and Safety Code, or the ICF-IID [ICF-MR] component of the Rio Grande State Center, the department shall proceed with the investigation of the report as provided by Section 261.404.

SECTION 1.125. Section 261.1055, Family Code, is amended to read as follows:

Sec. 261.1055. NOTIFICATION OF DISTRICT ATTORNEYS. (a) A district attorney may inform the department [or designated agency] that the district attorney wishes to receive notification of some or all reports of suspected abuse or neglect of children who were in the county at the time the report was made or who were in the county at the time of the alleged abuse or neglect.

(b) If the district attorney makes the notification under this section, the department [or designated agency] shall, on receipt of a report of suspected abuse or neglect, immediately notify the district attorney as requested and the department [or designated agency] shall forward a copy of the reports to the district attorney on request.

SECTION 1.126. Section 261.109(b), Family Code, is amended to read as follows:

(b) An offense under Subsection (a) is a Class A misdemeanor, except that the offense is a state jail felony if it is shown on the trial of the offense that the child was a person with an intellectual disability who resided in a state supported living center, the ICF-IID [ICF-MR] component of the Rio Grande State Center, or a facility licensed under Chapter 252, Health and Safety Code, and the actor knew that the child had suffered serious bodily injury as a result of the abuse or neglect.

SECTION 1.127. Section 261.111, Family Code, is amended to read as follows:

Sec. 261.111. REFUSAL OF PSYCHIATRIC OR PSYCHOLOGICAL TREATMENT OF CHILD. (a) In this section, "psychotropic medication [drug]" has the meaning assigned by Section 266.001 [means a substance that is:

[(1) used in the diagnosis, treatment, or prevention of a disease or as a component of a medication; and

[(2) intended to have an altering effect on perception, emotion, or behavior].

(b) The refusal of a parent, guardian, or managing or possessory conservator of a child to administer or consent to the administration of a psychotropic medication [drug] to the child, or to consent to any other psychiatric or psychological treatment of the child, does not by itself constitute neglect of the child unless the refusal to consent:

(1) presents a substantial risk of death, disfigurement, or bodily injury to the child; or

(2) has resulted in an observable and material impairment to the growth, development, or functioning of the child.

SECTION 1.128. Section 261.201(e), Family Code, is amended to read as follows:

(e) Before placing a child who was the subject of an investigation, the department shall notify the prospective adoptive parents of their right to examine any report, record, working paper, or other information in the possession, custody, or control of the department [state] that pertains to the history of the child.

SECTION 1.129. Sections 261.301(a), (d), and (e), Family Code, are amended to read as follows:

(a) With assistance from the appropriate state or local law enforcement agency as provided by this section, the department [or designated agency] shall make a prompt and thorough investigation of a report of child abuse or neglect allegedly committed by a person responsible for a child's care, custody, or welfare. The investigation shall be conducted without regard to any pending suit affecting the parent-child relationship.

(d) The executive commissioner [department] shall by rule assign priorities and prescribe investigative procedures for investigations based on the severity and immediacy of the alleged harm to the child. The primary purpose of the investigation shall be the protection of the child. The rules must require the department, subject to the availability of funds, to:

(1) immediately respond to a report of abuse and neglect that involves circumstances in which the death of the child or substantial bodily harm to the child would result unless the department immediately intervenes;

(2) respond within 24 hours to a report of abuse and neglect that is assigned the highest priority, other than a report described by Subdivision (1); and

(3) respond within 72 hours to a report of abuse and neglect that is assigned the second highest priority.

(e) As necessary to provide for the protection of the child, the department [or designated agency] shall determine:

(1) the nature, extent, and cause of the abuse or neglect;

(2) the identity of the person responsible for the abuse or neglect;

(3) the names and conditions of the other children in the home;

(4) an evaluation of the parents or persons responsible for the care of the child;

(5) the adequacy of the home environment;

(6) the relationship of the child to the persons responsible for the care, custody, or welfare of the child; and

(7) all other pertinent data.

SECTION 1.130. The heading to Section 261.3015, Family Code, is amended to read as follows:

Sec. 261.3015. ALTERNATIVE [FLEXIBLE] RESPONSE SYSTEM.

SECTION 1.131. Sections 261.3015(a) and (d), Family Code, are amended to read as follows:

(a) In assigning priorities and prescribing investigative procedures based on the severity and immediacy of the alleged harm to a child under Section 261.301(d), the department shall establish an alternative [a flexible] response system to allow the department to make the most effective use of resources to investigate and respond to reported cases of abuse and neglect.

(d) In determining how to classify a reported case of abuse or neglect under the alternative [flexible] response system, the child's safety is the primary concern. The classification of a case may be changed as warranted by the circumstances.

SECTION 1.132. Section 261.302(b), Family Code, is amended to read as follows:

(b) The interview with and examination of the child may:

(1) be conducted at any reasonable time and place, including the child's home or the child's school;

(2) include the presence of persons the department [or designated agency] determines are necessary; and

(3) include transporting the child for purposes relating to the interview or investigation.

SECTION 1.133. Sections 261.303(a), (c), and (d), Family Code, are amended to read as follows:

(a) A person may not interfere with an investigation of a report of child abuse or neglect conducted by the department [or designated agency].

(c) If a parent or person responsible for the child's care does not consent to release of the child's prior medical, psychological, or psychiatric records or to a medical, psychological, or psychiatric examination of the child that is requested by the department [or designated agency], the court having family law jurisdiction shall, for good cause shown, order the records to be released or the examination to be made at the times and places designated by the court.

(d) A person, including a medical facility, that makes a report under Subchapter B shall release to the department [or designated agency], as part of the required report under Section 261.103, records that directly relate to the suspected abuse or neglect without requiring parental consent or a court order. If a child is transferred from a reporting medical facility to another medical facility to treat the injury or condition that formed the basis for the original report, the transferee medical facility shall, at the department's request, release to the department records relating to the injury or condition without requiring parental consent or a court order.

SECTION 1.134. Section 261.3031(a), Family Code, is amended to read as follows:

(a) If a parent or other person refuses to cooperate with the department's investigation of the alleged abuse or neglect of a child and the refusal poses a risk to the child's safety, the department shall seek assistance from the appropriate [county attorney or district attorney or criminal district] attorney with responsibility for representing the department as provided by Section 264.009 to obtain a court order as described by Section 261.303.

SECTION 1.135. Sections 261.305(b) and (d), Family Code, are amended to read as follows:

(b) If the parent or person does not consent to an examination or allow the department [or designated agency] to have access to medical or mental health records requested by the department [or agency], the court having family law jurisdiction, for good cause shown, shall order the examination to be made or that the department [or agency] be permitted to have access to the records under terms and conditions prescribed by the court.

(d) A parent or person responsible for the child's care is entitled to notice and a hearing when the department [or designated agency] seeks a court order to allow a medical, psychological, or psychiatric examination or access to medical or mental health records.

SECTION 1.136. Section 261.306, Family Code, is amended to read as follows:

Sec. 261.306. REMOVAL OF CHILD FROM STATE. (a) If the department [or designated agency] has reason to believe that a person responsible for the care, custody, or welfare of the child may remove the child from the state before the investigation is completed, the department [or designated agency] may file an application for a temporary restraining order in a district court without regard to continuing jurisdiction of the child as provided in Chapter 155.

(b) The court may render a temporary restraining order prohibiting the person from removing the child from the state pending completion of the investigation if the court:

(1) finds that the department [or designated agency] has probable cause to conduct the investigation; and

(2) has reason to believe that the person may remove the child from the state.

SECTION 1.137. Sections 261.308(a), (b), and (c), Family Code, are amended to read as follows:

(a) The department [or designated agency] shall make a complete written report of the investigation.

(b) If sufficient grounds for filing a suit exist, the department [or designated agency] shall submit the report, together with recommendations, to the court, the district attorney, and the appropriate law enforcement agency.

(c) On receipt of the report and recommendations, the court may direct the department [or designated agency] to file a petition requesting appropriate relief as provided in this title.

SECTION 1.138. Section 261.309(a), Family Code, is amended to read as follows:

(a) The executive commissioner [department] shall by rule establish policies and procedures to resolve complaints relating to and conduct reviews of child abuse or neglect investigations conducted by the department.

SECTION 1.139. Section 261.310(a), Family Code, is amended to read as follows:

(a) The executive commissioner [department] shall by rule develop and adopt standards for persons who investigate suspected child abuse or neglect at the state or local level. The standards shall encourage professionalism and consistency in the investigation of suspected child abuse or neglect.

SECTION 1.140. Sections 261.311(a) and (b), Family Code, are amended to read as follows:

(a) When during an investigation of a report of suspected child abuse or neglect a representative of the department [or the designated agency] conducts an interview with or an examination of a child, the department [or designated agency] shall make a reasonable effort before 24 hours after the time of the interview or examination to notify each parent of the child and the child's legal guardian, if one has been appointed, of the nature of the allegation and of the fact that the interview or examination was conducted.

(b) If a report of suspected child abuse or neglect is administratively closed by the department [or designated agency] as a result of a preliminary investigation that did not include an interview or examination of the child, the department [or designated agency] shall make a reasonable effort before the expiration of 24 hours after the time the investigation is closed to notify each parent and legal guardian of the child of the disposition of the investigation.

SECTION 1.141. Section 261.312(b), Family Code, is amended to read as follows:

(b) A review team consists of at least five members who serve staggered two-year terms. Review team members are appointed by the commissioner [director] of the department and consist of volunteers who live in and are broadly representative of the region in which the review team is established and have expertise in the prevention and treatment of child abuse and neglect. At least two members of a review team must be parents who have not been convicted of or indicted for an offense involving child abuse or neglect, have not been determined by the department to have engaged in child abuse or neglect, and are not under investigation by the department for child abuse or neglect. A member of a review team is a department volunteer for the purposes of Section 411.114, Government Code.

SECTION 1.142. Section 261.315(c), Family Code, is amended to read as follows:

(c) The executive commissioner [board] shall adopt rules necessary to administer this section.

SECTION 1.143. Sections 261.401(c) and (d), Family Code, are amended to read as follows:

(c) A state agency shall adopt rules relating to the investigation and resolution of reports received as provided by this subchapter. The executive commissioner [Health and Human Services Commission] shall review and approve the rules of agencies other than the Texas Department of Criminal Justice or the[,] Texas Juvenile Justice Department [Youth Commission, or Texas Juvenile Probation Commission] to ensure that those agencies implement appropriate standards for the conduct of investigations and that uniformity exists among agencies in the investigation and resolution of reports.

(d) The Texas School for the Blind and Visually Impaired and the Texas School for the Deaf shall adopt policies relating to the investigation and resolution of reports received as provided by this subchapter. The executive commissioner [Health and Human Services Commission] shall review and approve the policies to ensure that the Texas School for the Blind and Visually Impaired and the Texas School for the Deaf adopt those policies in a manner consistent with the minimum standards adopted by the executive commissioner [Health and Human Services Commission] under Section 261.407.

SECTION 1.144. Section 261.402(c), Family Code, is amended to read as follows:

(c) A state agency that licenses, certifies, or registers a facility in which children are located shall compile, maintain, and make available statistics on the incidence in the facility of child abuse, neglect, and exploitation that is investigated by the agency [in the facility].

SECTION 1.145. Section 261.403, Family Code, is amended to read as follows:

Sec. 261.403. COMPLAINTS. (a) If a state agency receives a complaint relating to an investigation conducted by the agency concerning a facility operated by that agency in which children are located, the agency shall refer the complaint to the agency's governing body [board].

(b) The governing body [board] of a state agency that operates a facility in which children are located shall ensure that the procedure for investigating abuse, neglect, and exploitation allegations and inquiries in the agency's facility is periodically reviewed under the agency's internal audit program required by Chapter 2102, Government Code.

SECTION 1.146. Section 261.404, Family Code, is amended to read as follows:

Sec. 261.404. INVESTIGATIONS REGARDING CERTAIN CHILDREN WITH MENTAL ILLNESS OR AN INTELLECTUAL DISABILITY [MENTAL RETARDATION]. (a) The department shall investigate a report of abuse, neglect, or exploitation of a child receiving services:

(1) in a facility operated by the Department of Aging and Disability Services or a mental health facility operated by the Department of State Health Services;

(2) in or from a community center, a local mental health authority, or a local intellectual and developmental disability [mental retardation] authority;

(3) through a program providing services to that child by contract with a facility operated by the Department of Aging and Disability Services, a mental health facility operated by the Department of State Health Services, a community center, a local mental health authority, or a local intellectual and developmental disability [mental retardation] authority;

(4) from a provider of home and community-based services who contracts with the Department of Aging and Disability Services; or

(5) in a facility licensed under Chapter 252, Health and Safety Code.

(b) The department shall investigate the report under rules developed by the executive commissioner [of the Health and Human Services Commission] with the advice and assistance of the department, the Department of Aging and Disability Services, and the Department of State Health Services.

(c) If a report under this section relates to a child with an intellectual disability [mental retardation] receiving services in a state supported living center or the ICF-IID [ICF-MR] component of the Rio Grande State Center, the department shall, within one hour of receiving the report, notify the facility in which the child is receiving services of the allegations in the report.

(d) If during the course of the department's investigation of reported abuse, neglect, or exploitation a caseworker of the department or the caseworker's supervisor has cause to believe that a child with an intellectual disability [mental retardation] described by Subsection (c) has been abused, neglected, or exploited by another person in a manner that constitutes a criminal offense under any law, including Section 22.04, Penal Code, the caseworker shall immediately notify the Health and Human Services Commission's office of inspector general and promptly provide the commission's office of inspector general with a copy of the department's investigation report.

(e) The definitions of "abuse" and "neglect" prescribed by Section 261.001 do not apply to an investigation under this section.

(f) In this section:

(1) "Community center," "local mental health authority," "local intellectual and developmental disability [mental retardation] authority," and "state supported living center" have the meanings assigned by Section 531.002, Health and Safety Code.

(2) "Provider" has the meaning assigned by Section 48.351, Human Resources Code.

SECTION 1.147. Section 261.405(a)(1), Family Code, is amended to read as follows:

(1) "Juvenile justice facility" means a facility operated wholly or partly by the juvenile board, by another governmental unit, or by a private vendor under a contract with the juvenile board, county, or other governmental unit that serves juveniles under juvenile court jurisdiction. The term includes:

(A) a public or private juvenile pre-adjudication secure detention facility, including a holdover facility;

(B) a public or private juvenile post-adjudication secure correctional facility except for a facility operated solely for children committed to the Texas Juvenile Justice Department [Youth Commission]; and

(C) a public or private non-secure juvenile post-adjudication residential treatment facility that is not licensed by the Department of Family and Protective [and Regulatory] Services or the Department of State Health Services [Texas Commission on Alcohol and Drug Abuse].

SECTION 1.148. Section 261.406(d), Family Code, is amended to read as follows:

(d) The executive commissioner [Board of Protective and Regulatory Services] shall adopt rules necessary to implement this section.

SECTION 1.149. Section 261.407, Family Code, is amended to read as follows:

Sec. 261.407. MINIMUM STANDARDS. (a) The executive commissioner [Health and Human Services Commission] by rule shall adopt minimum standards for the investigation under Section 261.401 of suspected child abuse, neglect, or exploitation in a facility.

(b) A rule or policy adopted by a state agency or institution under Section 261.401 must be consistent with the minimum standards adopted by the executive commissioner [Health and Human Services Commission].

(c) This section does not apply to a facility under the jurisdiction of the Texas Department of Criminal Justice or the[,] Texas Juvenile Justice Department [Youth Commission, or Texas Juvenile Probation Commission].

SECTION 1.150. Sections 261.408(a) and (c), Family Code, are amended to read as follows:

(a) The executive commissioner [Health and Human Services Commission] by rule shall adopt uniform procedures for collecting information under Section 261.401, including procedures for collecting information on deaths that occur in facilities.

(c) This section does not apply to a facility under the jurisdiction of the Texas Department of Criminal Justice or the[,] Texas Juvenile Justice Department [Youth Commission, or Texas Juvenile Probation Commission].

SECTION 1.151. Section 262.006(a), Family Code, is amended to read as follows:

(a) An authorized representative of the Department of Family and Protective [and Regulatory] Services may assume the care, control, and custody of a child born alive as the result of an abortion as defined by Chapter 161.

SECTION 1.152. Section 262.007(c), Family Code, is amended to read as follows:

(c) If a person entitled to possession of the child is not immediately available to take possession of the child, the law enforcement officer shall deliver the child to the Department of Family and Protective [and Regulatory] Services. Until a person entitled to possession of the child takes possession of the child, the department may, without a court order, retain possession of the child not longer than five days after the date the child is delivered to the department. While the department retains possession of a child under this subsection, the department may place the child in foster [home] care. If a parent or other person entitled to possession of the child does not take possession of the child before the sixth day after the date the child is delivered to the department, the department shall proceed under this chapter as if the law enforcement officer took possession of the child under Section 262.104.

SECTION 1.153. Section 262.008(a), Family Code, is amended to read as follows:

(a) An authorized representative of the Department of Family and Protective [and Regulatory] Services may assume the care, control, and custody of a child:

(1) who is abandoned without identification or a means for identifying the child; and

(2) whose identity cannot be ascertained by the exercise of reasonable diligence.

SECTION 1.154. Section 262.1015(a), Family Code, is amended to read as follows:

(a) If the Department of Family and Protective Services [department] determines after an investigation that child abuse has occurred and that the child would be protected in the child's home by the removal of the alleged perpetrator of the abuse, the department shall file a petition for the removal of the alleged perpetrator from the residence of the child rather than attempt to remove the child from the residence.

SECTION 1.155. Sections 262.102(a), (c), and (d), Family Code, are amended to read as follows:

(a) Before a court may, without prior notice and a hearing, issue a temporary order for the conservatorship of a child under Section 105.001(a)(1) or a temporary restraining order or attachment of a child authorizing a governmental entity to take possession of a child in a suit brought by a governmental entity, the court must find that:

(1) there is an immediate danger to the physical health or safety of the child or the child has been a victim of neglect or sexual abuse and that continuation in the home would be contrary to the child's welfare;

(2) there is no time, consistent with the physical health or safety of the child and the nature of the emergency, for a full adversary hearing under Subchapter C; and

(3) reasonable efforts, consistent with the circumstances and providing for the safety of the child, were made to prevent or eliminate the need for removal of the child.

(c) If, based on the recommendation of or a request by the Department of Family and Protective Services [department], the court finds that child abuse or neglect has occurred and that the child requires protection from family violence by a member of the child's family or household, the court shall render a temporary order under Title 4 [Chapter 71] for the protection of the child. In this subsection, "family violence" has the meaning assigned by Section 71.004.

(d) The temporary order, temporary restraining order, or attachment of a child rendered by the court under Subsection (a) must contain the following statement prominently displayed in boldface type, capital letters, or underlined:

"YOU HAVE THE RIGHT TO BE REPRESENTED BY AN ATTORNEY. IF YOU ARE INDIGENT AND UNABLE TO AFFORD AN ATTORNEY, YOU HAVE THE RIGHT TO REQUEST THE APPOINTMENT OF AN ATTORNEY BY CONTACTING THE COURT AT [ADDRESS], [TELEPHONE NUMBER]. IF YOU APPEAR IN OPPOSITION TO THE SUIT, CLAIM INDIGENCE, AND REQUEST THE APPOINTMENT OF AN ATTORNEY, THE COURT WILL REQUIRE YOU TO SIGN AN AFFIDAVIT OF INDIGENCE AND THE COURT MAY HEAR EVIDENCE TO DETERMINE IF YOU ARE INDIGENT. IF THE COURT DETERMINES YOU ARE INDIGENT AND ELIGIBLE FOR APPOINTMENT OF AN ATTORNEY, THE COURT WILL APPOINT AN ATTORNEY TO REPRESENT YOU."

SECTION 1.156. Section 262.103, Family Code, is amended to read as follows:

Sec. 262.103. DURATION OF TEMPORARY ORDER, TEMPORARY RESTRAINING ORDER, AND ATTACHMENT. A temporary order, temporary restraining order, or attachment of the child issued under Section 262.102(a) [this chapter] expires not later than 14 days after the date it is issued unless it is extended as provided by the Texas Rules of Civil Procedure or Section 262.201(a-3).

SECTION 1.157. Section 262.104(a), Family Code, is amended to read as follows:

(a) If there is no time to obtain a temporary order, temporary restraining order, or attachment under Section 262.102(a) before taking possession of a child consistent with the health and safety of that child, an authorized representative of the Department of Family and Protective Services, a law enforcement officer, or a juvenile probation officer may take possession of a child without a court order under the following conditions, only:

(1) on personal knowledge of facts that would lead a person of ordinary prudence and caution to believe that there is an immediate danger to the physical health or safety of the child;

(2) on information furnished by another that has been corroborated by personal knowledge of facts and all of which taken together would lead a person of ordinary prudence and caution to believe that there is an immediate danger to the physical health or safety of the child;

(3) on personal knowledge of facts that would lead a person of ordinary prudence and caution to believe that the child has been the victim of sexual abuse;

(4) on information furnished by another that has been corroborated by personal knowledge of facts and all of which taken together would lead a person of ordinary prudence and caution to believe that the child has been the victim of sexual abuse; or

(5) on information furnished by another that has been corroborated by personal knowledge of facts and all of which taken together would lead a person of ordinary prudence and caution to believe that the parent or person who has possession of the child is currently using a controlled substance as defined by Chapter 481, Health and Safety Code, and the use constitutes an immediate danger to the physical health or safety of the child.

SECTION 1.158. Section 262.105(b), Family Code, is amended to read as follows:

(b) If the Department of Family and Protective [and Regulatory] Services files a suit affecting the parent-child relationship required under Subsection (a)(1) seeking termination of the parent-child relationship, the department shall file the suit not later than the 45th day after the date the department assumes the care, control, and custody of a child under Section 262.303.

SECTION 1.159. Section 262.106(d), Family Code, is amended to read as follows:

(d) For the purpose of determining under Subsection (a) the first working day after the date the child is taken into possession, the child is considered to have been taken into possession by the Department of Family and Protective [and Regulatory] Services on the expiration of the five-day period permitted under Section 262.007(c) or 262.110(b), as appropriate.

SECTION 1.160. Section 262.109(a), Family Code, is amended to read as follows:

(a) The Department of Family and Protective Services [department] or other agency must give written notice as prescribed by this section to each parent of the child or to the child's conservator or legal guardian when a representative of the department [Department of Protective and Regulatory Services] or other agency takes possession of a child under this chapter.

SECTION 1.161. Section 262.110(a), Family Code, is amended to read as follows:

(a) An authorized representative of the Department of Family and Protective [and Regulatory] Services, a law enforcement officer, or a juvenile probation officer may take temporary possession of a child without a court order on discovery of a child in a situation of danger to the child's physical health or safety when the sole purpose is to deliver the child without unnecessary delay to the parent, managing conservator, possessory conservator, guardian, caretaker, or custodian who is presently entitled to possession of the child.

SECTION 1.162. Section 262.112(a), Family Code, is amended to read as follows:

(a) The Department of Family and Protective [and Regulatory] Services is entitled to an expedited hearing under this chapter in any proceeding in which a hearing is required if the department determines that a child should be removed from the child's home because of an immediate danger to the physical health or safety of the child.

SECTION 1.163. Sections 262.201(a-3) and (g), Family Code, are amended to read as follows:

(a-3) The court may, for good cause shown, postpone the full adversary hearing for not more than seven days from the date of the attorney's appointment to provide the attorney time to respond to the petition and prepare for the hearing. The court may shorten or lengthen the extension granted under this subsection if the parent and the appointed attorney agree in writing. If the court postpones the full adversary hearing, the court shall extend a temporary order, temporary restraining order, or attachment issued by the court under Section 262.102(a) for the protection of the child until the date of the rescheduled full adversary hearing.

(g) For the purpose of determining under Subsection (a) the 14th day after the date the child is taken into possession, a child is considered to have been taken into possession by the Department of Family and Protective Services [department] on the expiration of the five-day period permitted under Section 262.007(c) or 262.110(b), as appropriate.

SECTION 1.164. Sections 262.2015(a), (b), and (d), Family Code, are amended to read as follows:

(a) The court may waive the requirement of a service plan and the requirement to make reasonable efforts to return the child to a parent and may accelerate the trial schedule to result in a final order for a child under the care of the Department of Family and Protective Services [department] at an earlier date than provided by Subchapter D, Chapter 263, if the court finds that the parent has subjected the child to aggravated circumstances.

(b) The court may find under Subsection (a) that a parent has subjected the child to aggravated circumstances if:

(1) the parent abandoned the child without identification or a means for identifying the child;

(2) the child is a victim of serious bodily injury or sexual abuse inflicted by the parent or by another person with the parent's consent;

(3) the parent has engaged in conduct against the child that would constitute an offense under the following provisions of the Penal Code:

(A) Section 19.02 (murder);

(B) Section 19.03 (capital murder);

(C) Section 19.04 (manslaughter);

(D) Section 21.11 (indecency with a child);

(E) Section 22.011 (sexual assault);

(F) Section 22.02 (aggravated assault);

(G) Section 22.021 (aggravated sexual assault);

(H) Section 22.04 (injury to a child, elderly individual, or disabled individual);

(I) Section 22.041 (abandoning or endangering child);

(J) Section 25.02 (prohibited sexual conduct);

(K) Section 43.25 (sexual performance by a child);

(L) Section 43.26 (possession or promotion of child pornography);

(M) Section 21.02 (continuous sexual abuse of young child or children);

(N) Section 43.05(a)(2) (compelling prostitution); or

(O) Section 20A.02(a)(7) or (8) (trafficking of persons);

(4) the parent voluntarily left the child alone or in the possession of another person not the parent of the child for at least six months without expressing an intent to return and without providing adequate support for the child;

(5) the parent's parental rights with regard to another child have been involuntarily terminated based on a finding that the parent's conduct violated Section 161.001(b)(1)(D) [161.001(1)(D)] or (E) or a substantially equivalent provision of another state's law;

(6) the parent has been convicted for:

(A) the murder of another child of the parent and the offense would have been an offense under 18 U.S.C. Section 1111(a) if the offense had occurred in the special maritime or territorial jurisdiction of the United States;

(B) the voluntary manslaughter of another child of the parent and the offense would have been an offense under 18 U.S.C. Section 1112(a) if the offense had occurred in the special maritime or territorial jurisdiction of the United States;

(C) aiding or abetting, attempting, conspiring, or soliciting an offense under Paragraph [Subdivision] (A) or (B); or

(D) the felony assault of the child or another child of the parent that resulted in serious bodily injury to the child or another child of the parent; or

(7) the parent's parental rights with regard to two other children have been involuntarily terminated.

(d) The Department of Family and Protective [and Regulatory] Services shall make reasonable efforts to finalize the permanent placement of a child for whom the court has made the finding described by Subsection (c). The court shall set the suit for trial on the merits as required by Subchapter D, Chapter 263, in order to facilitate final placement of the child.

SECTION 1.165. Section 262.301(1), Family Code, is amended to read as follows:

(1) "Designated emergency infant care provider" means:

(A) an emergency medical services provider;

(B) a hospital; or

(C) a child-placing agency licensed by the Department of Family and Protective [and Regulatory] Services under Chapter 42, Human Resources Code, that:

(i) agrees to act as a designated emergency infant care provider under this subchapter; and

(ii) has on staff a person who is licensed as a registered nurse under Chapter 301, Occupations Code, or who provides emergency medical services under Chapter 773, Health and Safety Code, and who will examine and provide emergency medical services to a child taken into possession by the agency under this subchapter.

SECTION 1.166. Section 262.303(a), Family Code, is amended to read as follows:

(a) Not later than the close of the first business day after the date on which a designated emergency infant care provider takes possession of a child under Section 262.302, the provider shall notify the Department of Family and Protective [and Regulatory] Services that the provider has taken possession of the child.

SECTION 1.167. Section 262.304, Family Code, is amended to read as follows:

Sec. 262.304. FILING PETITION AFTER ACCEPTING POSSESSION OF ABANDONED CHILD. A child for whom the Department of Family and Protective [and Regulatory] Services assumes care, control, and custody under Section 262.303 shall be treated as a child taken into possession without a court order, and the department shall take action as required by Section 262.105 with regard to the child.

SECTION 1.168. Section 262.305(a), Family Code, is amended to read as follows:

(a) Immediately after assuming care, control, and custody of a child under Section 262.303, the Department of Family and Protective [and Regulatory] Services shall report the child to appropriate state and local law enforcement agencies as a potential missing child.

SECTION 1.169. Section 262.307, Family Code, is amended to read as follows:

Sec. 262.307. REIMBURSEMENT FOR CARE OF ABANDONED CHILD. The Department of Family and Protective Services [department] shall reimburse a designated emergency infant care provider that takes possession of a child under Section 262.302 for the cost to the provider of assuming the care, control, and custody of the child.

SECTION 1.170. Section 263.001(a)(4), Family Code, is amended to read as follows:

(4) "Substitute care" means the placement of a child who is in the conservatorship of the department [or an authorized agency] in care outside the child's home. The term includes foster care, institutional care, adoption, placement with a relative of the child, or commitment to the Texas Juvenile Justice Department [Youth Commission].

SECTION 1.171. Section 263.002, Family Code, is amended to read as follows:

Sec. 263.002. REVIEW OF PLACEMENTS BY COURT. In a suit affecting the parent-child relationship in which the department [or an authorized agency] has been appointed by the court or designated in an affidavit of relinquishment of parental rights as the temporary or permanent managing conservator of a child, the court shall hold a hearing to review:

(1) the conservatorship appointment and substitute care; and

(2) for a child committed to the Texas Juvenile Justice Department [Youth Commission], the child's commitment in the Texas Juvenile Justice Department [Youth Commission] or release under supervision by the Texas Juvenile Justice Department [Youth Commission].

SECTION 1.172. Section 263.008(a)(2), Family Code, is amended to read as follows:

(2) "Foster care" means the placement of a child who is in the conservatorship of the department [or an authorized agency] and in care outside the child's home in an agency foster group home, agency foster home, foster group home, foster home, or another facility licensed or certified under Chapter 42, Human Resources Code, in which care is provided for 24 hours a day.

SECTION 1.173. Section 263.101, Family Code, is amended to read as follows:

Sec. 263.101. DEPARTMENT TO FILE SERVICE PLAN. Not later than the 45th day after the date the court renders a temporary order appointing the department as temporary managing conservator of a child under Chapter 262, the department [or other agency appointed as the managing conservator of a child] shall file a service plan.

SECTION 1.174. Section 263.102(a), Family Code, is amended to read as follows:

(a) The service plan must:

(1) be specific;

(2) be in writing in a language that the parents understand, or made otherwise available;

(3) be prepared by the department [or other agency] in conference with the child's parents;

(4) state appropriate deadlines;

(5) state whether the goal of the plan is:

(A) return of the child to the child's parents;

(B) termination of parental rights and placement of the child for adoption; or

(C) because of the child's special needs or exceptional circumstances, continuation of the child's care out of the child's home;

(6) state steps that are necessary to:

(A) return the child to the child's home if the placement is in foster care;

(B) enable the child to remain in the child's home with the assistance of a service plan if the placement is in the home under the department's [or other agency's] supervision; or

(C) otherwise provide a permanent safe placement for the child;

(7) state the actions and responsibilities that are necessary for the child's parents to take to achieve the plan goal during the period of the service plan and the assistance to be provided to the parents by the department or other [authorized] agency toward meeting that goal;

(8) state any specific skills or knowledge that the child's parents must acquire or learn, as well as any behavioral changes the parents must exhibit, to achieve the plan goal;

(9) state the actions and responsibilities that are necessary for the child's parents to take to ensure that the child attends school and maintains or improves the child's academic compliance;

(10) state the name of the person with the department [or other agency] whom the child's parents may contact for information relating to the child if other than the person preparing the plan; and

(11) prescribe any other term or condition that the department [or other agency] determines to be necessary to the service plan's success.

SECTION 1.175. Sections 263.103(a), (a-1), (c), and (d), Family Code, are amended to read as follows:

(a) The original service plan shall be developed jointly by the child's parents and a representative of the department [or other authorized agency], including informing the parents of their rights in connection with the service plan process. If a parent is not able or willing to participate in the development of the service plan, it should be so noted in the plan.

(a-1) Before the original service plan is signed, the child's parents and the representative of the department [or other authorized agency] shall discuss each term and condition of the plan.

(c) If the department [or other authorized agency] determines that the child's parents are unable or unwilling to participate in the development of the original service plan or sign the plan, the department may file the plan without the parents' signatures.

(d) The original service plan takes effect when:

(1) the child's parents and the appropriate representative of the department [or other authorized agency] sign the plan; or

(2) the court issues an order giving effect to the plan without the parents' signatures.

SECTION 1.176. Section 263.104(b), Family Code, is amended to read as follows:

(b) The amended service plan supersedes the previously filed service plan and takes effect when:

(1) the child's parents and the appropriate representative of the department [or other authorized agency] sign the plan; or

(2) the department [or other authorized agency] determines that the child's parents are unable or unwilling to sign the amended plan and files it without the parents' signatures.

SECTION 1.177. Sections 263.202(a) and (b), Family Code, are amended to read as follows:

(a) If all persons entitled to citation and notice of a status hearing under this chapter were not served, the court shall make findings as to whether:

(1) the department [or other agency] has exercised due diligence to locate all necessary persons, including an alleged father of the child, regardless of whether the alleged father is registered with the registry of paternity under Section 160.402; and

(2) the child and each parent, alleged father, or relative of the child before the court have furnished to the department all available information necessary to locate an absent parent, alleged father, or relative of the child through exercise of due diligence.

(b) Except as otherwise provided by this subchapter, a status hearing shall be limited to matters related to the contents and execution of the service plan filed with the court. The court shall review the service plan that the department [or other agency] filed under this chapter for reasonableness, accuracy, and compliance with requirements of court orders and make findings as to whether:

(1) a plan that has the goal of returning the child to the child's parents adequately ensures that reasonable efforts are made to enable the child's parents to provide a safe environment for the child;

(2) the child's parents have reviewed and understand the plan and have been advised that unless the parents are willing and able to provide the child with a safe environment, even with the assistance of a service plan, within the reasonable period of time specified in the plan, the parents' parental and custodial duties and rights may be subject to restriction or to termination under this code or the child may not be returned to the parents;

(3) the plan is reasonably tailored to address any specific issues identified by the department [or other agency]; and

(4) the child's parents and the representative of the department [or other agency] have signed the plan.

SECTION 1.178. Section 263.301(c), Family Code, is amended to read as follows:

(c) If a person entitled to notice under Chapter 102 or this section has not been served, the court shall review the department's [or other agency's] efforts at attempting to locate all necessary persons and requesting service of citation and the assistance of a parent in providing information necessary to locate an absent parent.

SECTION 1.179. Section 263.303, Family Code, is amended to read as follows:

Sec. 263.303. PERMANENCY PROGRESS REPORT. (a) Not later than the 10th day before the date set for each permanency hearing other than the first permanency hearing, the department [or other authorized agency] shall file with the court and provide to each party, the child's attorney ad litem, the child's guardian ad litem, and the child's volunteer advocate a permanency progress report unless the court orders a different period for providing the report.

(b) The permanency progress report must:

(1) recommend that the suit be dismissed; or

(2) recommend that the suit continue, and:

(A) identify the date for dismissal of the suit under this chapter;

(B) provide:

(i) the name of any person entitled to notice under Chapter 102 who has not been served;

(ii) a description of the efforts by the department [or another agency] to locate and request service of citation; and

(iii) a description of each parent's assistance in providing information necessary to locate an unserved party;

(C) evaluate the parties' compliance with temporary orders and with the service plan;

(D) evaluate whether the child's placement in substitute care meets the child's needs and recommend other plans or services to meet the child's special needs or circumstances;

(E) describe the permanency plan for the child and recommend actions necessary to ensure that a final order consistent with that permanency plan, including the concurrent permanency goals contained in that plan, is rendered before the date for dismissal of the suit under this chapter;

(F) with respect to a child 16 years of age or older, identify the services needed to assist the child in the transition to adult life; and

(G) with respect to a child committed to the Texas Juvenile Justice Department [Youth Commission] or released under supervision by the Texas Juvenile Justice Department [Youth Commission]:

(i) evaluate whether the child's needs for treatment and education are being met;

(ii) describe, using information provided by the Texas Juvenile Justice Department [Youth Commission], the child's progress in any rehabilitation program administered by the Texas Juvenile Justice Department [Youth Commission]; and

(iii) recommend other plans or services to meet the child's needs.

(c) A parent whose parental rights are the subject of a suit affecting the parent-child relationship, the attorney for that parent, or the child's attorney ad litem or guardian ad litem may file a response to the department's [or other agency's] report filed under Subsection (b). A response must be filed not later than the third day before the date of the hearing.

SECTION 1.180. Section 263.306(a), Family Code, as amended by Chapters 191 (S.B. 352), 204 (H.B. 915), and 688 (H.B. 2619), Acts of the 83rd Legislature, Regular Session, 2013, is reenacted and amended to read as follows:

(a) At each permanency hearing the court shall:

(1) identify all persons or parties present at the hearing or those given notice but failing to appear;

(2) review the efforts of the department [or another agency] in:

(A) attempting to locate all necessary persons;

(B) requesting service of citation; and

(C) obtaining the assistance of a parent in providing information necessary to locate an absent parent, alleged father, or relative of the child;

(3) review the efforts of each custodial parent, alleged father, or relative of the child before the court in providing information necessary to locate another absent parent, alleged father, or relative of the child;

(4) review any visitation plan or amended plan required under Section 263.107 and render any orders for visitation the court determines necessary;

(5) return the child to the parent or parents if the child's parent or parents are willing and able to provide the child with a safe environment and the return of the child is in the child's best interest;

(6) place the child with a person or entity, other than a parent, entitled to service under Chapter 102 if the person or entity is willing and able to provide the child with a safe environment and the placement of the child is in the child's best interest;

(7) evaluate the department's efforts to identify relatives who could provide the child with a safe environment, if the child is not returned to a parent or another person or entity entitled to service under Chapter 102;

(8) evaluate the parties' compliance with temporary orders and the service plan;

(9) identify an education decision-maker for the child if one has not previously been identified;

(10) review the medical care provided to the child as required by Section 266.007;

(11) [(9)] ensure the child has been provided the opportunity, in a developmentally appropriate manner, to express the child's opinion on the medical care provided;

(12) [(10)] for a child receiving psychotropic medication, determine whether the child:

(A) has been provided appropriate psychosocial therapies, behavior strategies, and other non-pharmacological interventions; and

(B) has been seen by the prescribing physician, physician assistant, or advanced practice nurse at least once every 90 days for purposes of the review required by Section 266.011;

(13) [(11)] determine whether:

(A) the child continues to need substitute care;

(B) the child's current placement is appropriate for meeting the child's needs, including with respect to a child who has been placed outside of the state, whether that placement continues to be in the best interest of the child; and

(C) other plans or services are needed to meet the child's special needs or circumstances;

(14) [(12)] if the child is placed in institutional care, determine whether efforts have been made to ensure placement of the child in the least restrictive environment consistent with the best interest and special needs of the child;

(15) [(13)] if the child is 16 years of age or older, order services that are needed to assist the child in making the transition from substitute care to independent living if the services are available in the community;

(16) [(14)] determine plans, services, and further temporary orders necessary to ensure that a final order is rendered before the date for dismissal of the suit under this chapter;

(17) [(15)] if the child is committed to the Texas Juvenile Justice Department or released under supervision by the Texas Juvenile Justice Department, determine whether the child's needs for treatment, rehabilitation, and education are being met; and

(18) [(16)] determine the date for dismissal of the suit under this chapter and give notice in open court to all parties of:

(A) the dismissal date;

(B) the date of the next permanency hearing; and

(C) the date the suit is set for trial.

SECTION 1.181. Section 263.307(b), Family Code, is amended to read as follows:

(b) The following factors should be considered by the court and [,] the department[, and other authorized agencies] in determining whether the child's parents are willing and able to provide the child with a safe environment:

(1) the child's age and physical and mental vulnerabilities;

(2) the frequency and nature of out-of-home placements;

(3) the magnitude, frequency, and circumstances of the harm to the child;

(4) whether the child has been the victim of repeated harm after the initial report and intervention by the department [or other agency];

(5) whether the child is fearful of living in or returning to the child's home;

(6) the results of psychiatric, psychological, or developmental evaluations of the child, the child's parents, other family members, or others who have access to the child's home;

(7) whether there is a history of abusive or assaultive conduct by the child's family or others who have access to the child's home;

(8) whether there is a history of substance abuse by the child's family or others who have access to the child's home;

(9) whether the perpetrator of the harm to the child is identified;

(10) the willingness and ability of the child's family to seek out, accept, and complete counseling services and to cooperate with and facilitate an appropriate agency's close supervision;

(11) the willingness and ability of the child's family to effect positive environmental and personal changes within a reasonable period of time;

(12) whether the child's family demonstrates adequate parenting skills, including providing the child and other children under the family's care with:

(A) minimally adequate health and nutritional care;

(B) care, nurturance, and appropriate discipline consistent with the child's physical and psychological development;

(C) guidance and supervision consistent with the child's safety;

(D) a safe physical home environment;

(E) protection from repeated exposure to violence even though the violence may not be directed at the child; and

(F) an understanding of the child's needs and capabilities; and

(13) whether an adequate social support system consisting of an extended family and friends is available to the child.

SECTION 1.182. Sections 263.502(a) and (c), Family Code, are amended to read as follows:

(a) Not later than the 10th day before the date set for a placement review hearing, the department [or other authorized agency] shall file a placement review report with the court and provide a copy to each person entitled to notice under Section 263.501(d).

(c) The placement review report must identify the department's permanency goal for the child and must:

(1) evaluate whether the child's current placement is appropriate for meeting the child's needs;

(2) evaluate whether efforts have been made to ensure placement of the child in the least restrictive environment consistent with the best interest and special needs of the child if the child is placed in institutional care;

(3) contain a transition plan for a child who is at least 16 years of age that identifies the services and specific tasks that are needed to assist the child in making the transition from substitute care to adult living and describes the services that are being provided through the Transitional Living Services Program operated by the department;

(4) evaluate whether the child's current educational placement is appropriate for meeting the child's academic needs;

(5) identify other plans or services that are needed to meet the child's special needs or circumstances;

(6) describe the efforts of the department [or authorized agency] to place the child for adoption if parental rights to the child have been terminated and the child is eligible for adoption, including efforts to provide adoption promotion and support services as defined by 42 U.S.C. Section 629a and other efforts consistent with the federal Adoption and Safe Families Act of 1997 (Pub. L. No. 105-89);

(7) for a child for whom the department has been named managing conservator in a final order that does not include termination of parental rights, describe the efforts of the department to find a permanent placement for the child, including efforts to:

(A) work with the caregiver with whom the child is placed to determine whether that caregiver is willing to become a permanent placement for the child;

(B) locate a relative or other suitable individual to serve as permanent managing conservator of the child; and

(C) evaluate any change in a parent's circumstances to determine whether:

(i) the child can be returned to the parent; or

(ii) parental rights should be terminated;

(8) with respect to a child committed to the Texas Juvenile Justice Department or released under supervision by the Texas Juvenile Justice Department:

(A) evaluate whether the child's needs for treatment and education are being met;

(B) describe, using information provided by the Texas Juvenile Justice Department, the child's progress in any rehabilitation program administered by the Texas Juvenile Justice Department; and

(C) recommend other plans or services to meet the child's needs; and

(9) identify any placement changes that have occurred since the most recent court hearing concerning the child and describe any barriers to sustaining the child's placement, including any reason for which a substitute care provider has requested a placement change.

SECTION 1.183. Section 263.503(a), Family Code, as amended by Chapters 204 (H.B. 915) and 688 (H.B. 2619), Acts of the 83rd Legislature, Regular Session, 2013, is reenacted and amended to read as follows:

(a) At each placement review hearing, the court shall determine whether:

(1) the child's current placement is necessary, safe, and appropriate for meeting the child's needs, including with respect to a child placed outside of the state, whether the placement continues to be appropriate and in the best interest of the child;

(2) efforts have been made to ensure placement of the child in the least restrictive environment consistent with the best interest and special needs of the child if the child is placed in institutional care;

(3) the services that are needed to assist a child who is at least 16 years of age in making the transition from substitute care to independent living are available in the community;

(4) the child is receiving appropriate medical care;

(5) the child has been provided the opportunity, in a developmentally appropriate manner, to express the child's opinion on the medical care provided;

(6) for a child who is receiving psychotropic medication, the child:

(A) has been provided appropriate psychosocial therapies, behavior strategies, and other non-pharmacological interventions; and

(B) has been seen by the prescribing physician, physician assistant, or advanced practice nurse at least once every 90 days for purposes of the review required by Section 266.011;

(7) other plans or services are needed to meet the child's special needs or circumstances;

(8) the department [or authorized agency] has exercised due diligence in attempting to place the child for adoption if parental rights to the child have been terminated and the child is eligible for adoption;

(9) for a child for whom the department has been named managing conservator in a final order that does not include termination of parental rights, a permanent placement, including appointing a relative as permanent managing conservator or returning the child to a parent, is appropriate for the child;

(10) for a child whose permanency goal is another planned, permanent living arrangement, the department has:

(A) documented a compelling reason why adoption, permanent managing conservatorship with a relative or other suitable individual, or returning the child to a parent is not in the child's best interest; and

(B) identified a family or other caring adult who has made a permanent commitment to the child;

(11) the department [or authorized agency] has made reasonable efforts to finalize the permanency plan that is in effect for the child; [and]

(12) if the child is committed to the Texas Juvenile Justice Department or released under supervision by the Texas Juvenile Justice Department, the child's needs for treatment, rehabilitation, and education are being met;

(13) [(10)] an education decision-maker for the child has been identified; and

(14) [(11)] the child's education needs and goals have been identified and addressed.

SECTION 1.184. Section 264.0091, Family Code, is amended to read as follows:

Sec. 264.0091. USE OF TELECONFERENCING AND VIDEOCONFERENCING TECHNOLOGY. Subject to the availability of funds, the department, in cooperation with district and county courts, shall expand the use of teleconferencing and videoconferencing to facilitate participation by medical experts, children, and other individuals in court proceedings, including children for whom the department [, an authorized agency,] or a licensed child-placing agency has been appointed managing conservator and who are committed to the Texas Juvenile Justice Department [Youth Commission].

SECTION 1.185. Section 264.010(d), Family Code, is amended to read as follows:

(d) A child abuse prevention and protection plan must:

(1) specify the manner of communication between entities who are parties to the plan, including the department, the commission [Texas Department of Human Services], local law enforcement agencies, the county and district attorneys, members of the medical and social service community, foster parents, and child advocacy groups; and

(2) provide other information concerning the prevention and investigation of child abuse in the area for which the plan is adopted.

SECTION 1.186. Section 264.0111(e), Family Code, is amended to read as follows:

(e) The executive commissioner [department] may adopt rules to implement this section.

SECTION 1.187. Section 264.0145(b), Family Code, is amended to read as follows:

(b) The executive commissioner [department] by rule shall establish guidelines that prioritize requests to release case records, including those made by an adult previously in the department's managing conservatorship.

SECTION 1.188. Sections 264.101(b) and (d), Family Code, are amended to read as follows:

(b) The department may not pay the cost of protective foster care for a child for whom the department has been named managing conservator under an order rendered solely under Section 161.001(b)(1)(J) [161.001(1)(J)].

(d) The executive commissioner [of the Health and Human Services Commission] may adopt rules that establish criteria and guidelines for the payment of foster care, including medical care, for a child and for providing care for a child after the child becomes 18 years of age if the child meets the requirements for continued foster care under Subsection (a-1).

SECTION 1.189. Sections 264.107(a) and (b), Family Code, are amended to read as follows:

(a) The department shall use a system for the placement of children in contract residential care, including foster care, that conforms to the levels of care adopted [and maintained] by the executive commissioner [Health and Human Services Commission].

(b) The department shall use the standard application provided by the Health and Human Services Commission for the placement of children in contract residential care [as adopted and maintained by the Health and Human Services Commission].

SECTION 1.190. Section 264.1075(b), Family Code, is amended to read as follows:

(b) As soon as possible after a child begins receiving foster care under this subchapter, the department shall assess whether the child has a developmental or intellectual disability [or mental retardation]. The commission shall establish the procedures that the department must use in making an assessment under this subsection. The procedures may include screening or participation by:

(1) a person who has experience in childhood developmental or intellectual disabilities [or mental retardation];

(2) a local intellectual and developmental disability [mental retardation] authority; or

(3) a provider in a county with a local child welfare board.

SECTION 1.191. Section 264.108(f), Family Code, is amended to read as follows:

(f) The executive commissioner [department] by rule shall define what constitutes a delay under Subsections (b) and (d).

SECTION 1.192. Sections 264.110(b) and (g), Family Code, are amended to read as follows:

(b) A person registered under this section must satisfy requirements adopted by rule by the executive commissioner [department].

(g) The department may refuse to place a child with a person registered under this section only for a reason permitted under criteria adopted by the executive commissioner by [department] rule.

SECTION 1.193. Section 264.112(a), Family Code, is amended to read as follows:

(a) The department shall report the status for children in substitute care to the executive commissioner [Board of Protective and Regulatory Services] at least once every 12 months.

SECTION 1.194. Section 264.121(a), Family Code, is amended to read as follows:

(a) The department shall address the unique challenges facing foster children in the conservatorship of the department who must transition to independent living by:

(1) expanding efforts to improve transition planning and increasing the availability of transitional family group decision-making to all youth age 14 or older in the department's permanent managing conservatorship, including enrolling the youth in the Preparation for Adult Living Program before the age of 16;

(2) coordinating with the commission [Health and Human Services Commission] to obtain authority, to the extent allowed by federal law, the state Medicaid plan, the Title IV-E state plan, and any waiver or amendment to either plan, necessary to:

(A) extend foster care eligibility and transition services for youth up to age 21 and develop policy to permit eligible youth to return to foster care as necessary to achieve the goals of the Transitional Living Services Program; and

(B) extend Medicaid coverage for foster care youth and former foster care youth up to age 21 with a single application at the time the youth leaves foster care; and

(3) entering into cooperative agreements with the Texas Workforce Commission and local workforce development boards to further the objectives of the Preparation for Adult Living Program. The department, the Texas Workforce Commission, and the local workforce development boards shall ensure that services are prioritized and targeted to meet the needs of foster care and former foster care children and that such services will include, where feasible, referrals for short-term stays for youth needing housing.

SECTION 1.195. Section 264.124(b), Family Code, as added by Chapter 423 (S.B. 430), Acts of the 83rd Legislature, Regular Session, 2013, is amended to read as follows:

(b) The department, in accordance with department rules [executive commissioner rule], shall implement a process to verify that each foster parent who is seeking monetary assistance from the department for day care for a foster child has attempted to find appropriate day-care services for the foster child through community services, including Head Start programs, prekindergarten classes, and early education programs offered in public schools. The department shall specify the documentation the foster parent must provide to the department to demonstrate compliance with the requirements established under this subsection.

SECTION 1.196. Section 264.205(b), Family Code, is amended to read as follows:

(b) A swift adoption team shall consist of department personnel who shall operate under policies adopted by rule by the executive commissioner [department]. The department shall set priorities for the allocation of department resources to enable a swift adoption team to operate successfully under the policies adopted under this subsection.

SECTION 1.197. Section 264.506(b), Family Code, is amended to read as follows:

(b) To achieve its purpose, a review team shall:

(1) adapt and implement, according to local needs and resources, the model protocols developed by the department and the committee;

(2) meet on a regular basis to review child fatality cases and recommend methods to improve coordination of services and investigations between agencies that are represented on the team;

(3) collect and maintain data as required by the committee; and

(4) submit to the [bureau of] vital statistics unit data reports on deaths reviewed as specified by the committee.

SECTION 1.198. Section 264.507, Family Code, is amended to read as follows:

Sec. 264.507. DUTIES OF PRESIDING OFFICER. The presiding officer of a review team shall:

(1) send notices to the review team members of a meeting to review a child fatality;

(2) provide a list to the review team members of each child fatality to be reviewed at the meeting;

(3) submit data reports to the [bureau of] vital statistics unit not later than the 30th day after the date on which the review took place; and

(4) ensure that the review team operates according to the protocols developed by the department and the committee, as adapted by the review team.

SECTION 1.199. Section 264.514(a), Family Code, is amended to read as follows:

(a) A medical examiner or justice of the peace notified of a death of a child under Section 264.513 shall hold an inquest under Chapter 49, Code of Criminal Procedure, to determine whether the death is unexpected or the result of abuse or neglect. An inquest is not required under this subchapter if the child's death is expected and is due to a congenital or neoplastic disease. A death caused by an infectious disease may be considered an expected death if:

(1) the disease was not acquired as a result of trauma or poisoning;

(2) the infectious organism is identified using standard medical procedures; and

(3) the death is not reportable to the [Texas] Department of State Health Services under Chapter 81, Health and Safety Code.

SECTION 1.200. Section 264.614(d), Family Code, is amended to read as follows:

(d) The executive commissioner [of the Health and Human Services Commission] shall adopt rules necessary to implement this section.

SECTION 1.201. Section 264.753, Family Code, is amended to read as follows:

Sec. 264.753. EXPEDITED PLACEMENT. The department [or other authorized entity] shall expedite the completion of the background and criminal history check, the home study, and any other administrative procedure to ensure that the child is placed with a qualified relative or caregiver as soon as possible after the date the caregiver is identified.

SECTION 1.202. Section 264.755(d), Family Code, is amended to read as follows:

(d) The department, in accordance with department rules [executive commissioner rule], shall implement a process to verify that each relative and designated caregiver who is seeking monetary assistance or additional support services from the department for day care as defined by Section 264.124 for a child under this section has attempted to find appropriate day-care services for the child through community services, including Head Start programs, prekindergarten classes, and early education programs offered in public schools. The department shall specify the documentation the relative or designated caregiver must provide to the department to demonstrate compliance with the requirements established under this subsection. The department may not provide monetary assistance or additional support services to the relative or designated caregiver for the day care unless the department receives the required verification.

SECTION 1.203. The following provisions of the Family Code are repealed:

(1) Section 101.002;

(2) Section 161.002(c);

(3) Section 162.305;

(4) Sections 261.001(3) and (8);

(5) Section 262.008(c);

(6) Section 263.1015;

(7) Section 264.007;

(8) Section 264.105;

(9) Section 264.106;

(10) Section 264.1063;

(11) Section 264.107(f);

(12) Section 264.206;

(13) Sections 264.501(2) and (5); and

(14) Subchapter H, Chapter 264.

ARTICLE 2. GOVERNMENT CODE

SECTION 2.001. Section 403.1066(c), Government Code, is amended to read as follows:

(c) The available earnings of the fund may be appropriated to the [Texas] Department of State Health Services for the purpose of providing services at a public health hospital as defined by Section 13.033, Health and Safety Code, [the Texas Center for Infectious Disease] and grants, loans, or loan guarantees to public or nonprofit community hospitals with 125 beds or fewer located in an urban area of the state.

SECTION 2.002. Section 411.110(a), Government Code, is amended to read as follows:

(a) The Department of State Health Services is entitled to obtain from the department criminal history record information maintained by the department that relates to:

(1) a person who is:

(A) an applicant for a license or certificate under the Emergency Health Care [Medical Services] Act (Chapter 773, Health and Safety Code);

(B) an owner or manager of an applicant for an emergency medical services provider license under that Act; or

(C) the holder of a license or certificate under that Act;

(2) an applicant for a license or a license holder under Subchapter N, Chapter 431, Health and Safety Code;

(3) an applicant for a license, the owner or manager of an applicant for a massage establishment license, or a license holder under Chapter 455, Occupations Code;

(4) an applicant for employment at or current employee of:

(A) a public health hospital as defined by Section 13.033, Health and Safety Code [the Texas Center for Infectious Disease]; or

(B) the South Texas Health Care System; or

(5) an applicant for employment at, current employee of, or person who contracts or may contract to provide goods or services with:

(A) the vital statistics unit of the Department of State Health Services; or

(B) the Council on Sex Offender Treatment or other division or component of the Department of State Health Services that monitors sexually violent predators as described by Section 841.003(a), Health and Safety Code.

SECTION 2.003. Section 411.1131, Government Code, is amended to read as follows:

Sec. 411.1131. ACCESS TO CRIMINAL HISTORY RECORD INFORMATION: DEPARTMENT OF ASSISTIVE AND REHABILITATIVE SERVICES [TEXAS COMMISSION FOR THE DEAF AND HARD OF HEARING]. (a) The Department of Assistive and Rehabilitative Services [Texas Commission for the Deaf and Hard of Hearing] is entitled to obtain from the department criminal history record information maintained by the department that relates to a person who is an applicant for a staff position at an outdoor training program for children who are deaf or hard of hearing conducted by a private entity through a contract with the Department of Assistive and Rehabilitative Services [commission] in accordance with Section 81.013, Human Resources Code.

(b) Criminal history record information obtained by the Department of Assistive and Rehabilitative Services [Texas Commission for the Deaf and Hard of Hearing] under Subsection (a) may be used only to evaluate an applicant for a staff position at an outdoor training program for children who are deaf or hard of hearing. The Department of Assistive and Rehabilitative Services [Texas Commission for the Deaf and Hard of Hearing] may release or disclose the information to a private entity described by Subsection (a) for that purpose.

(c) The Department of Assistive and Rehabilitative Services [Texas Commission for the Deaf and Hard of Hearing] may not release or disclose information obtained under Subsection (a), except on court order or with the consent of the person who is the subject of the criminal history record information, and shall destroy all criminal history record information obtained under Subsection (a) after the information is used for its authorized purpose.

SECTION 2.004. Section 411.114(a)(3), Government Code, is amended to read as follows:

(3) The Department of Family and Protective Services is entitled to obtain from the department criminal history record information maintained by the department that relates to a person who is:

(A) a volunteer or applicant volunteer with a local affiliate in this state of Big Brothers/Big Sisters of America;

(B) a volunteer or applicant volunteer with the "I Have a Dream/Houston" program;

(C) a volunteer or applicant volunteer with an organization that provides court-appointed special advocates for abused or neglected children;

(D) a person providing, at the request of the child's parent, in-home care for a child who is the subject of a report alleging the child has been abused or neglected;

(E) a volunteer or applicant volunteer with a Texas chapter of the Make-a-Wish Foundation of America;

(F) a person providing, at the request of the child's parent, in-home care for a child only if the person gives written consent to the release and disclosure of the information;

(G) a child who is related to the caretaker, as determined under Section 42.002, Human Resources Code, and who resides in or is present in a child-care facility or family home, other than a child described by Subdivision (2)(C), or any other person who has unsupervised access to a child in the care of a child-care facility or family home;

(H) an applicant for a position with the Department of Family and Protective Services, other than a position described by Subdivision (2)(D), regardless of the duties of the position;

(I) a volunteer or applicant volunteer with the Department of Family and Protective Services, other than a registered volunteer, regardless of the duties to be performed;

(J) a person providing or applying to provide in-home, adoptive, or foster care for children to the extent necessary to comply with Subchapter B, Chapter 162, Family Code;

(K) a Department of Family and Protective Services employee, other than an employee described by Subdivision (2)(H), regardless of the duties of the employee's position;

(L) a relative of a child in the care of the Department of Family and Protective Services, to the extent necessary to comply with Section 162.007, Family Code;

(M) a person, other than an alleged perpetrator in a report described in Subdivision (2)(I), living in the residence in which the alleged victim of the report resides;

(N) [a contractor or an employee of a contractor who delivers services to a ward of the Department of Family and Protective Services under a contract with the estate of the ward;

[(O) a person who seeks unsupervised visits with a ward of the Department of Family and Protective Services, including a relative of the ward;

[(P)] an employee, volunteer, or applicant volunteer of a children's advocacy center under Subchapter E, Chapter 264, Family Code, including a member of the governing board of a center;

(O) [(Q)] an employee of, an applicant for employment with, or a volunteer or an applicant volunteer with an entity or person that contracts with the Department of Family and Protective Services and has access to confidential information in the department's records, if the employee, applicant, volunteer, or applicant volunteer has or will have access to that confidential information;

(P) [(R)] an employee of or volunteer at, or an applicant for employment with or to be a volunteer at, an entity that provides supervised independent living services to a young adult receiving extended foster care services from the Department of Family and Protective Services;

(Q) [(S)] a person 14 years of age or older who will be regularly or frequently working or staying in a host home that is providing supervised independent living services to a young adult receiving extended foster care services from the Department of Family and Protective Services; or

(R) [(T)] a person who volunteers to supervise visitation under Subchapter B, Chapter 263, Family Code.

SECTION 2.005. Sections 411.1386(a-1) and (a-3), Government Code, are amended to read as follows:

(a-1) The Department of Aging and Disability Services shall obtain from the Department of Public Safety criminal history record information maintained by the Department of Public Safety that relates to each individual who is or will be providing guardianship services to a ward of or referred by the Department of Aging and Disability Services, including:

(1) an employee of or an applicant selected for an employment position with the Department of Aging and Disability Services;

(2) a volunteer or an applicant selected to volunteer with the Department of Aging and Disability Services;

(3) an employee of or an applicant selected for an employment position with a business entity or other person that contracts with the Department of Aging and Disability Services to provide guardianship services to a ward referred by the department; [and]

(4) a volunteer or an applicant selected to volunteer with a business entity or person described by Subdivision (3); and

(5) a contractor or an employee of a contractor who provides services to a ward of the Department of Aging and Disability Services under a contract with the estate of the ward.

(a-3) The information in Subsection (a-1) regarding employees, contractors, or volunteers providing guardianship services must be obtained annually.

SECTION 2.006. Section 411.13861, Government Code, is amended by amending Subsection (a) and adding Subsection (e) to read as follows:

(a) The Department of Aging and Disability Services is entitled to obtain from the Department of Public Safety criminal history record information maintained by the Department of Public Safety that relates to a person:

(1) required to undergo a background and criminal history check under Chapter 248A, Health and Safety Code; or

(2) who seeks unsupervised visits with a ward of the department, including a relative of the ward.

(e) In this section, "ward" has the meaning assigned by Section 1002.030, Estates Code.

SECTION 2.007. Section 531.001, Government Code, is amended by amending Subdivisions (4-a) and (6) and adding Subdivision (4-b) to read as follows:

(4-a) "Home telemonitoring service" means a health service that requires scheduled remote monitoring of data related to a patient's health and transmission of the data to a licensed home and community support services [health] agency or a hospital, as those terms are defined by Section 531.02164(a).

(4-b) "Medicaid" means the medical assistance program established under Chapter 32, Human Resources Code.

(6) "Section 1915(c) waiver program" means a federally funded [Medicaid] program of the state under Medicaid that is authorized under Section 1915(c) of the federal Social Security Act (42 U.S.C. Section 1396n(c)).

SECTION 2.008. Section 531.0055(b), Government Code, is amended to read as follows:

(b) The commission shall:

(1) supervise the administration and operation of [the] Medicaid [program], including the administration and operation of the Medicaid managed care system in accordance with Section 531.021;

(2) perform information systems planning and management for health and human services agencies under Section 531.0273, with:

(A) the provision of information technology services at health and human services agencies considered to be a centralized administrative support service either performed by commission personnel or performed under a contract with the commission; and

(B) an emphasis on research and implementation on a demonstration or pilot basis of appropriate and efficient uses of new and existing technology to improve the operation of health and human services agencies and delivery of health and human services;

(3) monitor and ensure the effective use of all federal funds received by a health and human services agency in accordance with Section 531.028 and the General Appropriations Act;

(4) implement Texas Integrated Enrollment Services as required by Subchapter F, except that notwithstanding Subchapter F, determining eligibility for benefits under the following programs is the responsibility of and must be centralized by the commission:

(A) the child health plan program;

(B) the financial assistance program under Chapter 31, Human Resources Code;

(C) Medicaid [the medical assistance program under Chapter 32, Human Resources Code];

(D) the supplemental nutrition [nutritional] assistance program [programs] under Chapter 33, Human Resources Code;

(E) long-term care services, as defined by Section 22.0011, Human Resources Code;

(F) community-based support services identified or provided in accordance with Section 531.02481; and

(G) other health and human services programs, as appropriate; and

(5) implement programs intended to prevent family violence and provide services to victims of family violence.

SECTION 2.009. Subchapter A, Chapter 531, Government Code, is amended by adding Section 531.00551 to read as follows:

Sec. 531.00551. PROCEDURES FOR ADOPTING RULES AND POLICIES. (a) The executive commissioner shall develop procedures for adopting rules for the health and human services agencies. The procedures must specify the manner in which the health and human services agencies may participate in the rulemaking process.

(b) A health and human services agency shall assist the executive commissioner in the development of policies and guidelines needed for the administration of the agency's functions and shall submit any proposed policies and guidelines to the executive commissioner. The agency may implement a proposed policy or guideline only if the executive commissioner approves the policy or guideline.

SECTION 2.010. Section 531.006, Government Code, is amended to read as follows:

Sec. 531.006. ELIGIBILITY. (a) A person is not eligible for appointment as executive commissioner if the person or the person's spouse is an employee, officer, or paid consultant of a trade association in a field under the commission's jurisdiction.

(b) A person who is required to register as a lobbyist under Chapter 305 because of the person's activities for compensation in or on behalf of a profession related to a field under the commission's jurisdiction may not serve as executive commissioner.

(c) A person is not eligible for appointment as executive commissioner if the person has a financial interest in a corporation, organization, or association under contract with:

(1) the [Texas] Department of State Health Services, if the contract involves mental health services;

(2) the Department of Aging and Disability Services [Mental Health and Mental Retardation], if the contract involves intellectual and developmental disability services;

(3) a local mental health or intellectual and developmental disability [mental retardation] authority;[,] or

(4) a community center.

SECTION 2.011. Section 531.007, Government Code, is amended to read as follows:

Sec. 531.007. TERM. The executive commissioner serves a two-year term expiring February 1 of each odd-numbered year.

SECTION 2.012. Section 531.008(c), Government Code, is amended to read as follows:

(c) The executive commissioner shall establish the following divisions and offices within the commission:

(1) the eligibility services division to make eligibility determinations for services provided through the commission or a health and human services agency related to:

(A) the child health plan program;

(B) the financial assistance program under Chapter 31, Human Resources Code;

(C) Medicaid [the medical assistance program under Chapter 32, Human Resources Code];

(D) the supplemental nutrition [nutritional] assistance program [programs] under Chapter 33, Human Resources Code;

(E) long-term care services, as defined by Section 22.0011, Human Resources Code;

(F) community-based support services identified or provided in accordance with Section 531.02481; and

(G) other health and human services programs, as appropriate;

(2) the office of inspector general to perform fraud and abuse investigation and enforcement functions as provided by Subchapter C and other law;

(3) the office of the ombudsman to:

(A) provide dispute resolution services for the commission and the health and human services agencies; and

(B) perform consumer protection functions related to health and human services;

(4) a purchasing division as provided by Section 531.017; and

(5) an internal audit division to conduct a program of internal auditing in accordance with [Government Code,] Chapter 2102.

SECTION 2.013. Section 531.0081, Government Code, is amended to read as follows:

Sec. 531.0081. [OFFICE OF] MEDICAL TECHNOLOGY. [(a) In this section, "office" means the office of medical technology.]

(b) The commission shall [establish the office of medical technology within the commission. The office shall] explore and evaluate new developments in medical technology and propose implementing the technology in Medicaid [the medical assistance program under Chapter 32, Human Resources Code], if appropriate and cost-effective.

(c) Commission [Office] staff implementing this section must have skills and experience in research regarding health care technology.

SECTION 2.014. Section 531.0082(d), Government Code, is amended to read as follows:

(d) Not later than the 30th day following the end of each calendar quarter, the data analysis unit shall provide an update on the unit's activities and findings to the governor, the lieutenant governor, the speaker of the house of representatives, the chair of the Senate Finance Committee, the chair of the House Appropriations Committee, and the chairs of the standing committees of the senate and house of representatives having jurisdiction over [the] Medicaid [program].

SECTION 2.015. Sections 531.009(a), (b), (c), (d), (e), and (g), Government Code, are amended to read as follows:

(a) The executive commissioner shall employ a medical director to provide medical expertise to the executive commissioner and the commission and may employ other personnel necessary to administer the commission's duties.

(b) The executive commissioner [or the commissioner's designated representative] shall develop an intra-agency career ladder program, one part of which must require the intra-agency posting of all non-entry-level positions concurrently with any public posting.

(c) The executive commissioner [or the commissioner's designated representative] shall develop a system of annual performance evaluations based on measurable job tasks. All merit pay for commission employees must be based on the system established under this subsection.

(d) The executive commissioner shall provide to commission employees as often as is necessary information regarding their qualifications under this chapter and their responsibilities under applicable laws relating to standards of conduct for state employees.

(e) The executive commissioner [or the commissioner's designated representative] shall prepare and maintain a written policy statement that implements a program of equal employment opportunity to ensure that all personnel transactions are made without regard to race, color, disability, sex, religion, age, or national origin.

(g) The policy statement described by Subsection (e) must:

(1) be updated annually;

(2) be reviewed by the Texas Workforce Commission civil rights division [state Commission on Human Rights] for compliance with Subsection (f)(1); and

(3) be filed with the governor's office.

SECTION 2.016. Section 531.011(d), Government Code, is amended to read as follows:

(d) The executive commissioner by rule shall establish methods by which the public, consumers, and service recipients can be notified of the mailing addresses and telephone numbers of appropriate agency personnel for the purpose of directing complaints to the commission. The commission may provide for that notification:

(1) on each registration form, application, or written contract for services of a person regulated by the commission;

(2) on a sign prominently displayed in the place of business of each person regulated by the commission; or

(3) in a bill for service provided by a person regulated by the commission.

SECTION 2.017. Section 531.012, Government Code, is amended to read as follows:

Sec. 531.012. ADVISORY COMMITTEES. The executive commissioner may appoint advisory committees as needed.

SECTION 2.018. Section 531.020, Government Code, is amended to read as follows:

Sec. 531.020. OFFICE OF COMMUNITY ACCESS AND SERVICES [COLLABORATION]. The executive commissioner shall establish within the commission an office of community access and services [collaboration]. The office is responsible for:

(1) collaborating with community, state, and federal stakeholders to improve the elements of the health care system that are involved in the delivery of Medicaid services; and

(2) sharing with Medicaid providers, including hospitals, any best practices, resources, or other information regarding improvements to the health care system.

SECTION 2.019. Section 531.021, Government Code, is amended to read as follows:

Sec. 531.021. ADMINISTRATION OF MEDICAID [PROGRAM]. (a) The commission is the state agency designated to administer federal Medicaid [medical assistance] funds.

(b) The commission shall:

(1) plan and direct [the] Medicaid [program] in each agency that operates a portion of [the] Medicaid [program], including the management of the Medicaid managed care system and the development, procurement, management, and monitoring of contracts necessary to implement the Medicaid managed care system; and

(2) [adopt reasonable rules and standards governing the determination of fees, charges, and rates for medical assistance payments under Chapter 32, Human Resources Code, in consultation with the agencies that operate the Medicaid program; and

[(3)] establish requirements for and define the scope of the ongoing evaluation of the Medicaid managed care system conducted in conjunction with the Department of State Health Services [Texas Health Care Information Council] under Section 108.0065, Health and Safety Code.

(b-1) The executive commissioner shall adopt reasonable rules and standards governing the determination of fees, charges, and rates for Medicaid payments.

(c) The executive commissioner [commission] in the [its] adoption of reasonable rules and standards under Subsection (b-1) [(b)(2)] shall include financial performance standards that, in the event of a proposed rate reduction, provide private ICF-IID [ICF-MR] facilities and home and community-based services providers with flexibility in determining how to use Medicaid [medical assistance] payments to provide services in the most cost-effective manner while continuing to meet the state and federal requirements of [the] Medicaid [program].

(d) In adopting rules and standards required by Subsection (b-1) [(b)(2)], the executive commissioner [commission] may provide for payment of fees, charges, and rates in accordance with:

(1) formulas, procedures, or methodologies prescribed by the commission's rules;

(2) applicable state or federal law, policies, rules, regulations, or guidelines;

(3) economic conditions that substantially and materially affect provider participation in [the] Medicaid [program], as determined by the executive commissioner; or

(4) available levels of appropriated state and federal funds.

(e) Notwithstanding any other provision of Chapter 32, Human Resources Code, Chapter 533, or this chapter, the commission may adjust the fees, charges, and rates paid to Medicaid providers as necessary to achieve the objectives of [the] Medicaid [program] in a manner consistent with the considerations described by Subsection (d).

(f) In adopting rates for Medicaid [medical assistance] payments under Subsection (b-1) [(b)(2)], the executive commissioner may adopt reimbursement rates for appropriate nursing services provided to recipients with certain health conditions if those services are determined to provide a cost-effective alternative to hospitalization. A physician must certify that the nursing services are medically appropriate for the recipient for those services to qualify for reimbursement under this subsection.

(g) In adopting rates for Medicaid [medical assistance] payments under Subsection (b-1) [(b)(2)], the executive commissioner may adopt cost-effective reimbursement rates for group appointments with Medicaid [medical assistance] providers for certain diseases and medical conditions specified by rules of the executive commissioner.

SECTION 2.020. Sections 531.0211(a) and (c), Government Code, are amended to read as follows:

(a) In adopting rules to implement a managed care Medicaid program, the executive commissioner [commission] shall establish guidelines for, and require managed care organizations to provide, education programs for providers and clients using a variety of techniques and mediums.

(c) A client education program must present information in a manner that is easy to understand. A program must include information on:

(1) a client's rights and responsibilities under the bill of rights and the bill of responsibilities prescribed by Section 531.0212;

(2) how to access health care services;

(3) how to access complaint procedures and the client's right to bypass the managed care organization's internal complaint system and use the notice and appeal procedures otherwise required by [the] Medicaid [program];

(4) Medicaid policies, procedures, eligibility standards, and benefits;

(5) the policies and procedures of the managed care organization; and

(6) the importance of prevention, early intervention, and appropriate use of services.

SECTION 2.021. Sections 531.02111(a) and (b), Government Code, are amended to read as follows:

(a) The commission shall prepare a biennial Medicaid financial report covering each state agency that operates [administers] any part of [the state] Medicaid [program] and each component of [the] Medicaid [programs] operated [or administered] by those agencies.

(b) The report must include:

(1) for each state agency described by Subsection (a):

(A) a description of each of the components of Medicaid [programs administered or] operated by the agency; and

(B) an accounting of all funds related to [the state] Medicaid [program] received and disbursed by the agency during the period covered by the report, including:

(i) the amount of any federal Medicaid [medical assistance] funds allocated to the agency for the support of each of the Medicaid components [programs] operated [or administered] by the agency;

(ii) the amount of any funds appropriated by the legislature to the agency for each of those components [programs]; and

(iii) the amount of Medicaid [medical assistance] payments and related expenditures made by or in connection with each of those components [programs]; and

(2) for each Medicaid component [program] identified in the report:

(A) the amount and source of funds or other revenue received by or made available to the agency for the component [program]; and

(B) the information required by Section 531.02112(b).

SECTION 2.022. Sections 531.02112(a) and (b), Government Code, are amended to read as follows:

(a) The commission shall prepare a report, on a quarterly basis, regarding the Medicaid expenditures of each state agency that [administers or] operates a component of Medicaid [program].

(b) The report must identify each agency's expenditures by Medicaid component [program] and must include for each component [program]:

(1) the amount spent on each type of service or benefit provided by or under the component [program];

(2) the amount spent on [program] operations for that component, including eligibility determination, claims processing, and case management; and

(3) the amount spent on any other administrative costs.

SECTION 2.023. Sections 531.02115(a) and (c), Government Code, are amended to read as follows:

(a) A provider participating in [the] Medicaid or the child health plan program, including a provider participating in the network of a managed care organization that contracts with the commission to provide services under [the] Medicaid or the child health plan program, may not engage in any marketing activity, including any dissemination of material or other attempt to communicate, that:

(1) involves unsolicited personal contact, including by door-to-door solicitation, solicitation at a child-care facility or other type of facility, direct mail, or telephone, with a Medicaid client or a parent whose child is enrolled in [the] Medicaid or the child health plan program;

(2) is directed at the client or parent solely because the client or the parent's child is receiving benefits under [the] Medicaid or the child health plan program; and

(3) is intended to influence the client's or parent's choice of provider.

(c) Nothing in this section prohibits:

(1) a provider participating in [the] Medicaid or the child health plan program from:

(A) engaging in a marketing activity, including any dissemination of material or other attempt to communicate, that is intended to influence the choice of provider by a Medicaid client or a parent whose child is enrolled in [the] Medicaid or the child health plan program, if the marketing activity:

(i) is conducted at a community-sponsored educational event, health fair, outreach activity, or other similar community or nonprofit event in which the provider participates and does not involve unsolicited personal contact or promotion of the provider's practice; or

(ii) involves only the general dissemination of information, including by television, radio, newspaper, or billboard advertisement, and does not involve unsolicited personal contact;

(B) as permitted under the provider's contract, engaging in the dissemination of material or another attempt to communicate with a Medicaid client or a parent whose child is enrolled in [the] Medicaid or the child health plan program, including communication in person or by direct mail or telephone, for the purpose of:

(i) providing an appointment reminder;

(ii) distributing promotional health materials;

(iii) providing information about the types of services offered by the provider; or

(iv) coordinating patient care; or

(C) engaging in a marketing activity that has been submitted for review and obtained a notice of prior authorization from the commission under Subsection (d); or

(2) a provider participating in the [Medicaid] STAR + PLUS Medicaid managed care program from, as permitted under the provider's contract, engaging in a marketing activity, including any dissemination of material or other attempt to communicate, that is intended to educate a Medicaid client about available long-term care services and supports.

SECTION 2.024. Sections 531.0212(a) and (c), Government Code, are amended to read as follows:

(a) The executive commissioner [commission] by rule shall adopt a bill of rights and a bill of responsibilities for each person enrolled in [the] Medicaid [program].

(c) The bill of responsibilities must address a client's responsibility to:

(1) learn and understand each right the client has under [the] Medicaid [program];

(2) abide by the health plan and Medicaid policies and procedures;

(3) share information relating to the client's health status with the primary care provider and become fully informed about service and treatment options; and

(4) actively participate in decisions relating to service and treatment options, make personal choices, and take action to maintain the client's health.

SECTION 2.025. Section 531.0213(d), Government Code, is amended to read as follows:

(d) As a part of the support and information services required by this section, the commission or nonprofit organization shall:

(1) operate a statewide toll-free assistance telephone number that includes TDD lines and assistance for persons who speak Spanish;

(2) intervene promptly with the state Medicaid office, managed care organizations and providers, [the Texas Department of Health,] and any other appropriate entity on behalf of a person who has an urgent need for medical services;

(3) assist a person who is experiencing barriers in the Medicaid application and enrollment process and refer the person for further assistance if appropriate;

(4) educate persons so that they:

(A) understand the concept of managed care;

(B) understand their rights under [the] Medicaid [program], including grievance and appeal procedures; and

(C) are able to advocate for themselves;

(5) collect and maintain statistical information on a regional basis regarding calls received by the assistance lines and publish quarterly reports that:

(A) list the number of calls received by region;

(B) identify trends in delivery and access problems;

(C) identify recurring barriers in the Medicaid system; and

(D) indicate other problems identified with Medicaid managed care; and

(6) assist the state Medicaid office and[,] managed care organizations and providers[, and the Texas Department of Health] in identifying and correcting problems, including site visits to affected regions if necessary.

SECTION 2.026. Sections 531.0214(a), (c), and (e), Government Code, are amended to read as follows:

(a) The commission and each health and human services agency that administers a part of [the state] Medicaid [program] shall jointly develop a system to coordinate and integrate state Medicaid databases to:

(1) facilitate the comprehensive analysis of Medicaid data; and

(2) detect fraud perpetrated by a program provider or client.

(c) On the request of the executive commissioner, a state agency that administers any part of [the state] Medicaid [program] shall assist the commission in developing the system required by this section.

(e) The commission shall ensure that the database system is used each month to match [bureau of] vital statistics unit death records with a list of persons eligible for Medicaid [medical assistance under Chapter 32, Human Resources Code], and that each person who is deceased is promptly removed from the list of persons eligible for Medicaid [medical assistance].

SECTION 2.027. Section 531.02141(a), Government Code, is amended to read as follows:

(a) The commission shall make every effort to improve data analysis and integrate available information associated with [the] Medicaid [program]. The commission shall use the decision support system in the commission's center for strategic decision support for this purpose and shall modify or redesign the system to allow for the data collected by [the] Medicaid [program] to be used more systematically and effectively for Medicaid [program] evaluation and policy development. The commission shall develop or redesign the system as necessary to ensure that the system:

(1) incorporates program enrollment, utilization, and provider data that are currently collected;

(2) allows data manipulation and quick analysis to address a large variety of questions concerning enrollment and utilization patterns and trends within the program;

(3) is able to obtain consistent and accurate answers to questions;

(4) allows for analysis of multiple issues within the program to determine whether any programmatic or policy issues overlap or are in conflict;

(5) includes predefined data reports on utilization of high-cost services that allow program management to analyze and determine the reasons for an increase or decrease in utilization and immediately proceed with policy changes, if appropriate;

(6) includes any encounter data with respect to recipients that a managed care organization that contracts with the commission under Chapter 533 receives from a health care provider under the organization's provider network; and

(7) links Medicaid and non-Medicaid data sets, including data sets related to [the] Medicaid [program], the Temporary Assistance for Needy Families program, the Special Supplemental Nutrition Program for Women, Infants, and Children, vital statistics, and other public health programs.

SECTION 2.028. Section 531.0215, Government Code, is amended to read as follows:

Sec. 531.0215. COMPILATION OF STATISTICS RELATING TO FRAUD. The commission and each health and human services agency that administers a part of [the state] Medicaid [program] shall maintain statistics on the number, type, and disposition of fraudulent claims for benefits submitted under the part of the program the agency administers.

SECTION 2.029. Sections 531.0216(a), (d), and (f), Government Code, are amended to read as follows:

(a) The executive commissioner [commission] by rule shall develop and implement a system to reimburse providers of services under [the state] Medicaid [program] for services performed using telemedicine medical services or telehealth services.

(d) Subject to Section 153.004, Occupations Code, the executive commissioner [commission] may adopt rules as necessary to implement this section. In the rules adopted under this section, the executive commissioner [commission] shall:

(1) refer to the site where the patient is physically located as the patient site; and

(2) refer to the site where the physician or health professional providing the telemedicine medical service or telehealth service is physically located as the distant site.

(f) Not later than December 1 of each even-numbered year, the commission shall report to the speaker of the house of representatives and the lieutenant governor on the effects of telemedicine medical services, telehealth services, and home telemonitoring services on [the] Medicaid [program] in the state, including the number of physicians, health professionals, and licensed health care facilities using telemedicine medical services, telehealth services, or home telemonitoring services, the geographic and demographic disposition of the physicians and health professionals, the number of patients receiving telemedicine medical services, telehealth services, and home telemonitoring services, the types of services being provided, and the cost of utilization of telemedicine medical services, telehealth services, and home telemonitoring services to Medicaid [the program].

SECTION 2.030. Section 531.02161, Government Code, is amended to read as follows:

Sec. 531.02161. TELEMEDICINE, TELEHEALTH, AND HOME TELEMONITORING TECHNOLOGY STANDARDS. (b) The executive commissioner [commission and the Telecommunications Infrastructure Fund Board] by [joint] rule shall establish and adopt minimum standards for an operating system used in the provision of telemedicine medical services, telehealth services, or home telemonitoring services by a health care facility participating in [the state] Medicaid [program], including standards for electronic transmission, software, and hardware.

(c) In developing standards under this section, the executive commissioner [commission and the Telecommunications Infrastructure Fund Board] shall address:

(1) authentication and authorization of users;

(2) authentication of the origin of information;

(3) the prevention of unauthorized access to the system or information;

(4) system security, including the integrity of information that is collected, program integrity, and system integrity;

(5) maintenance of documentation about system and information usage;

(6) information storage, maintenance, and transmission; and

(7) synchronization and verification of patient profile data.

SECTION 2.031. Section 531.02162(b), Government Code, is amended to read as follows:

(b) The executive commissioner [commission] by rule shall establish policies that permit reimbursement under [the state] Medicaid and the child [children's] health plan [insurance] program for services provided through telemedicine medical services and telehealth services to children with special health care needs.

SECTION 2.032. Sections 531.02163(a), (c), and (d), Government Code, are amended to read as follows:

(a) In this section, "health professional" means an individual who:

(1) is licensed or certified in this state to perform health care services; and

(2) is not a physician, registered nurse, advanced practice registered nurse, or physician assistant.

(c) Notwithstanding Section 531.0217, the commission may provide reimbursement under [the state] Medicaid [program] for a telemedicine medical service initiated by a trained health professional who complies with the minimum standards adopted under this section.

(d) The commission shall provide reimbursement under [the state] Medicaid [program] to a physician for overseeing a telemedicine consultation at a telemedicine distant site if the telepresenter at the patient site is another physician or is an advanced practice registered nurse, registered nurse, or physician assistant acting under physician delegation and supervision throughout the consultation.

SECTION 2.033. Section 531.02164, Government Code, is amended to read as follows:

Sec. 531.02164. MEDICAID SERVICES PROVIDED THROUGH HOME TELEMONITORING SERVICES. (a) In this section:

(1) "Home and community support services [health] agency" means a person [facility] licensed under Chapter 142, Health and Safety Code, to provide home health, hospice, or personal assistance services as defined by Section 142.001, Health and Safety Code.

(2) "Hospital" means a hospital licensed under Chapter 241, Health and Safety Code.

(b) If the commission determines that establishing a statewide program that permits reimbursement under [the state] Medicaid [program] for home telemonitoring services would be cost-effective and feasible, the executive commissioner by rule shall establish the program as provided under this section.

(c) The program required under this section must:

(1) provide that home telemonitoring services are available only to persons who:

(A) are diagnosed with one or more of the following conditions:

(i) pregnancy;

(ii) diabetes;

(iii) heart disease;

(iv) cancer;

(v) chronic obstructive pulmonary disease;

(vi) hypertension;

(vii) congestive heart failure;

(viii) mental illness or serious emotional disturbance;

(ix) asthma;

(x) myocardial infarction; or

(xi) stroke; and

(B) exhibit two or more of the following risk factors:

(i) two or more hospitalizations in the prior 12-month period;

(ii) frequent or recurrent emergency room admissions;

(iii) a documented history of poor adherence to ordered medication regimens;

(iv) a documented history of falls in the prior six-month period;

(v) limited or absent informal support systems;

(vi) living alone or being home alone for extended periods of time; and

(vii) a documented history of care access challenges;

(2) ensure that clinical information gathered by a home and community support services [health] agency or hospital while providing home telemonitoring services is shared with the patient's physician; and

(3) ensure that the program does not duplicate disease management program services provided under Section 32.057, Human Resources Code.

(d) If, after implementation, the commission determines that the program established under this section is not cost-effective, the commission may discontinue the program and stop providing reimbursement under [the state] Medicaid [program] for home telemonitoring services, notwithstanding Section 531.0216 or any other law.

(e) The commission shall determine whether the provision of home telemonitoring services to persons who are eligible to receive benefits under both [the] Medicaid and the Medicare program [programs] achieves cost savings for the Medicare program.

SECTION 2.034. Sections 531.0217(b), (c-1), (c-3), (d), (h), (i), (i-1), and (j), Government Code, are amended to read as follows:

(b) The executive commissioner [commission] by rule shall require each health and human services agency that administers a part of [the] Medicaid [program] to provide Medicaid reimbursement for a telemedicine medical service initiated or provided by a physician.

(c-1) Notwithstanding Subsection (b) or (c), the commission shall provide for reimbursement under [the] Medicaid [program] for an office visit provided through telemedicine by a physician who is assessing and evaluating the patient from a distant site if:

(1) a health professional acting under the delegation and supervision of that physician is present with the patient at the time of the visit; and

(2) the medical condition, illness, or injury for which the patient is receiving the service is not likely, within a reasonable degree of medical certainty, to undergo material deterioration within the 30-day period following the date of the visit.

(c-3) In adopting rules developed under Subsection (c-2), the executive commissioner [commission] shall confer with the Centers for Medicare and Medicaid Services on the legality of allocating reimbursement or establishing a facility fee as described in that subsection. Rules adopted by the executive commissioner [commission] under this subsection or Subsection (c-2) must reflect a policy to build capacity in medically underserved areas of this state.

(d) The commission shall require reimbursement for a telemedicine medical service at the same rate as [the] Medicaid [program] reimburses for a comparable in-person medical service. A request for reimbursement may not be denied solely because an in-person medical service between a physician and a patient did not occur.

(h) The commission in consultation with the Texas Medical Board [State Board of Medical Examiners] shall monitor and regulate the use of telemedicine medical services to ensure compliance with this section. In addition to any other method of enforcement, the commission may use a corrective action plan to ensure compliance with this section.

(i) The Texas Medical Board [State Board of Medical Examiners], in consultation with the commission, as appropriate, may adopt rules as necessary to:

(1) ensure that appropriate care, including quality of care, is provided to patients who receive telemedicine medical services;

(2) prevent abuse and fraud through the use of telemedicine medical services, including rules relating to filing of claims and records required to be maintained in connection with telemedicine; and

(3) define those situations when a face-to-face consultation with a physician is required after a telemedicine medical service.

(i-1) The Texas Medical Board [State Board of Medical Examiners], in consultation with the commission and the Department of State Health Services, as appropriate, shall adopt rules to establish supervisory requirements for a physician delegating a service to be performed by an individual who is not a physician, registered nurse, advanced practice registered nurse, or physician assistant, including a health professional who is authorized to be a telepresenter under Section 531.02163. This section may not be construed as authorizing the Texas Medical Board [State Board of Medical Examiners] to regulate another licensed or certified health care provider.

(j) The executive commissioner shall establish an advisory committee to coordinate state telemedicine efforts and assist the commission in:

(1) evaluating policies for telemedicine medical services under Section 531.0216 and this section;

(2) monitoring the types of programs receiving reimbursement under this section; and

(3) coordinating the activities of state agencies interested in the use of telemedicine medical services.

SECTION 2.035. Sections 531.02172(b) and (c), Government Code, are amended to read as follows:

(b) The advisory committee must include:

(1) representatives of health and human services agencies and other state agencies concerned with the use of telemedical and telehealth consultations and home telemonitoring services in [the] Medicaid [program] and the state child health plan program, including representatives of:

(A) the commission;

(B) the Department of State Health Services;

(C) the Office [Texas Department] of Rural Affairs;

(D) the Texas Department of Insurance;

(E) the Texas Medical Board;

(F) the Texas Board of Nursing; and

(G) the Texas State Board of Pharmacy;

(2) representatives of health science centers in this state;

(3) experts on telemedicine, telemedical consultation, and telemedicine medical services or telehealth services;

(4) representatives of consumers of health services provided through telemedical consultations and telemedicine medical services or telehealth services; and

(5) representatives of providers of telemedicine medical services, telehealth services, and home telemonitoring services.

(c) A member of the advisory committee serves at the will of the executive commissioner.

SECTION 2.036. Section 531.02173, Government Code, is amended to read as follows:

Sec. 531.02173. ALIGNMENT OF MEDICAID TELEMEDICINE REIMBURSEMENT POLICIES WITH MEDICARE REIMBURSEMENT POLICIES. (a) The commission shall periodically review policies regarding reimbursement under [the] Medicaid [program] for telemedicine medical services to identify variations between permissible reimbursement under that program and reimbursement available to providers under the Medicare program.

(b) To the extent practicable, and notwithstanding any other state law, after [conducting] a review conducted under Subsection (a) the executive commissioner [commission] may modify rules and procedures applicable to reimbursement under [the] Medicaid [program] for telemedicine medical services as necessary to provide for a reimbursement system that is comparable to the reimbursement system for those services under the Medicare program.

(c) The commission and executive commissioner shall perform the [its] duties under this section with assistance from the telemedicine and telehealth advisory committee established under Section 531.02172.

SECTION 2.037. Section 531.02174, Government Code, is amended to read as follows:

Sec. 531.02174. ADDITIONAL AUTHORITY REGARDING TELEMEDICINE MEDICAL SERVICES. (a) In addition to the authority granted by other law regarding telemedicine medical services, the executive commissioner [commission] may review rules and procedures applicable to reimbursement of telemedicine medical services provided through any government-funded health program subject to the commission's oversight.

(b) The executive commissioner [commission] may modify rules and procedures described by Subsection (a) as necessary to ensure that reimbursement for telemedicine medical services is provided in a cost-effective manner and only in circumstances in which the provision of those services is clinically effective.

(c) This section does not affect the commission's authority or duties under other law regarding reimbursement of telemedicine medical services under [the] Medicaid [program].

SECTION 2.038. Sections 531.02175(b) and (c), Government Code, are amended to read as follows:

(b) Subject to the requirements of this subsection, the executive commissioner by rule may require the commission and each health and human services agency that administers a part of [the] Medicaid [program] to provide Medicaid reimbursement for a medical consultation that is provided by a physician or other health care professional using the Internet as a cost-effective alternative to an in-person consultation. The executive commissioner may require the commission or a health and human services agency to provide the reimbursement described by this subsection only if the Centers for Medicare and Medicaid Services develop an appropriate Current Procedural Terminology code for medical services provided using the Internet.

(c) The executive commissioner may develop and implement a pilot program in one or more sites chosen by the executive commissioner under which Medicaid reimbursements are paid for medical consultations provided by physicians or other health care professionals using the Internet. The pilot program must be designed to test whether an Internet medical consultation is a cost-effective alternative to an in-person consultation under [the] Medicaid [program]. The executive commissioner may modify the pilot program as necessary throughout its implementation to maximize the potential cost-effectiveness of Internet medical consultations. If the executive commissioner determines from the pilot program that Internet medical consultations are cost-effective, the executive commissioner may expand the pilot program to additional sites or may implement Medicaid reimbursements for Internet medical consultations statewide.

SECTION 2.039. Section 531.02176, Government Code, is amended to read as follows:

Sec. 531.02176. EXPIRATION OF MEDICAID REIMBURSEMENT FOR PROVISION OF HOME TELEMONITORING SERVICES. Notwithstanding any other law, the commission may not reimburse providers under [the] Medicaid [program] for the provision of home telemonitoring services on or after September 1, 2015.

SECTION 2.040. Section 531.0218(b), Government Code, is amended to read as follows:

(b) Subsection (a) does not apply to functions of a Section 1915(c) waiver program that is operated in conjunction with a federally funded [Medicaid] program of the state under Medicaid that is authorized under Section 1915(b) of the federal Social Security Act (42 U.S.C. Section 1396n(b)).

SECTION 2.041. Sections 531.022(a), (b), (d), and (e), Government Code, are amended to read as follows:

(a) The executive commissioner shall develop a coordinated, six-year strategic plan for health and human services in this state and shall update the plan biennially.

(b) The executive commissioner shall submit each biennial update of the plan to the governor, the lieutenant governor, and the speaker of the house of representatives not later than October 1 of each even-numbered year.

(d) In developing a plan and plan updates under this section, the executive commissioner shall consider:

(1) existing strategic plans of health and human services agencies;

(2) health and human services priorities and plans submitted by governmental entities under Subsection (e);

(3) facilitation of pending reorganizations or consolidations of health and human services agencies and programs;

(4) public comment, including comment documented through public hearings conducted under Section 531.036; and

(5) budgetary issues, including projected agency needs and projected availability of funds.

(e) The executive commissioner shall identify the governmental entities that coordinate the delivery of health and human services in regions, counties, and municipalities and request that each entity:

(1) identify the health and human services priorities in the entity's jurisdiction and the most effective ways to deliver and coordinate services in that jurisdiction;

(2) develop a coordinated plan for the delivery of health and human services in the jurisdiction, including transition services that prepare special education students for adulthood; and

(3) make the information requested under Subdivisions (1) and (2) available to the commission.

SECTION 2.042. Sections 531.0223(b), (e), and (o), Government Code, are amended to read as follows:

(b) The executive commissioner shall appoint an advisory committee to develop a strategic plan for eliminating the disparities between the Texas-Mexico border region and other areas of the state in:

(1) capitation rates under Medicaid managed care and the child health plan program for services provided to persons younger than 19 years of age;

(2) fee-for-service per capita expenditures under [the] Medicaid [program] and the child health plan program for inpatient and outpatient hospital services for services provided to persons younger than 19 years of age; and

(3) total professional services expenditures per Medicaid recipient younger than 19 years of age or per child enrolled in the child health plan program.

(e) The executive commissioner shall appoint nine members to the advisory committee in a manner that ensures that the committee:

(1) represents the spectrum of geographic areas included in the Texas-Mexico border region;

(2) includes persons who are knowledgeable regarding [the] Medicaid [program], including Medicaid managed care, and the child health plan program; and

(3) represents the interests of physicians, hospitals, patients, managed care organizations, state agencies involved in the management and delivery of medical resources of any kind, affected communities, and other areas of the state.

(o) The commission shall:

(1) measure changes occurring from September 1, 2002, to August 31, 2014, in the number of health care providers participating in [the] Medicaid [program] or the child health plan program in the Texas-Mexico border region and resulting effects on consumer access to health care and consumer utilization;

(2) determine:

(A) the effects, if any, of the changes in rates and expenditures required by Subsection (k); and

(B) if funding available and used for changes in rates and expenditures was sufficient to produce measurable effects;

(3) make a recommendation regarding whether Medicaid rate increases should be expanded to include Medicaid services provided to adults in the Texas-Mexico border region; and

(4) not later than December 1, 2014, submit a report to the legislature.

SECTION 2.043. Section 531.0224, Government Code, is amended to read as follows:

Sec. 531.0224. PLANNING AND POLICY DIRECTION OF TEMPORARY ASSISTANCE FOR NEEDY FAMILIES PROGRAM. (a) The commission shall:

(1) plan and direct the financial assistance program under Chapter 31, Human Resources Code, including the procurement, management, and monitoring of contracts necessary to implement the program; and

(2) [adopt rules and standards governing the financial assistance program under Chapter 31, Human Resources Code; and

[(3)] establish requirements for and define the scope of the ongoing evaluation of the financial assistance program under Chapter 31, Human Resources Code.

(b) The executive commissioner shall adopt rules and standards governing the financial assistance program under Chapter 31, Human Resources Code.

SECTION 2.044. Section 531.0226(a), Government Code, is amended to read as follows:

(a) If feasible and cost-effective, the commission may apply for a waiver from the federal Centers for Medicare and Medicaid Services or another appropriate federal agency to more efficiently leverage the use of state and local funds in order to maximize the receipt of federal Medicaid matching funds by providing benefits under [the] Medicaid [program] to individuals who:

(1) meet established income and other eligibility criteria; and

(2) are eligible to receive services through the county for chronic health conditions.

SECTION 2.045. Sections 531.0235(a) and (c), Government Code, are amended to read as follows:

(a) The executive commissioner shall direct and require the Texas [Planning] Council for Developmental Disabilities and the Office for the Prevention of Developmental Disabilities to prepare a joint biennial report on the state of services to persons with disabilities in this state. The Texas [Planning] Council for Developmental Disabilities will serve as the lead agency in convening working meetings and in coordinating and completing the report. Not later than December 1 of each even-numbered year, the agencies shall submit the report to the executive commissioner, governor, lieutenant governor, and speaker of the house of representatives.

(c) The commission[, Texas Department of Human Services,] and other health and human services agencies shall cooperate with the agencies required to prepare the report under Subsection (a).

SECTION 2.046. Section 531.024(a-1), Government Code, is amended to read as follows:

(a-1) To the extent permitted under applicable federal law and notwithstanding any provision of Chapter 191 or 192, Health and Safety Code, the commission and other health and human services agencies shall share data to facilitate patient care coordination, quality improvement, and cost savings in [the] Medicaid [program], the child health plan program, and other health and human services programs funded using money appropriated from the general revenue fund.

SECTION 2.047. Section 531.0241, Government Code, is amended to read as follows:

Sec. 531.0241. STREAMLINING DELIVERY OF SERVICES. To integrate and streamline service delivery and facilitate access to services, the executive commissioner may request a health and human services agency to take a specific action and may recommend the manner in which the streamlining is to be accomplished, including requesting each health and human services agency to:

(1) simplify agency procedures;

(2) automate agency procedures;

(3) coordinate service planning and management tasks between and among health and human services agencies;

(4) reallocate staff resources;

(5) [adopt rules;

[(6) amend,] waive[, or repeal] existing rules; or

(6) [(7)] take other necessary actions.

SECTION 2.048. Section 531.02411, Government Code, is amended to read as follows:

Sec. 531.02411. STREAMLINING ADMINISTRATIVE PROCESSES. The commission shall make every effort using the commission's existing resources to reduce the paperwork and other administrative burdens placed on Medicaid recipients and providers and other participants in [the] Medicaid [program] and shall use technology and efficient business practices to decrease those burdens. In addition, the commission shall make every effort to improve the business practices associated with the administration of [the] Medicaid [program] by any method the commission determines is cost-effective, including:

(1) expanding the utilization of the electronic claims payment system;

(2) developing an Internet portal system for prior authorization requests;

(3) encouraging Medicaid providers to submit their program participation applications electronically;

(4) ensuring that the Medicaid provider application is easy to locate on the Internet so that providers may conveniently apply to the program;

(5) working with federal partners to take advantage of every opportunity to maximize additional federal funding for technology in [the] Medicaid [program]; and

(6) encouraging the increased use of medical technology by providers, including increasing their use of:

(A) electronic communications between patients and their physicians or other health care providers;

(B) electronic prescribing tools that provide up-to-date payer formulary information at the time a physician or other health care practitioner writes a prescription and that support the electronic transmission of a prescription;

(C) ambulatory computerized order entry systems that facilitate physician and other health care practitioner orders at the point of care for medications and laboratory and radiological tests;

(D) inpatient computerized order entry systems to reduce errors, improve health care quality, and lower costs in a hospital setting;

(E) regional data-sharing to coordinate patient care across a community for patients who are treated by multiple providers; and

(F) electronic intensive care unit technology to allow physicians to fully monitor hospital patients remotely.

SECTION 2.049. Section 531.024115, Government Code, is amended to read as follows:

Sec. 531.024115. SERVICE DELIVERY AREA ALIGNMENT. Notwithstanding Section 533.0025(e) or any other law, to the extent possible, the commission shall align service delivery areas under [the] Medicaid and the child health plan program [programs].

SECTION 2.050. Section 531.02412, Government Code, is amended to read as follows:

Sec. 531.02412. SERVICE DELIVERY AUDIT MECHANISMS. (a) The commission shall make every effort to ensure the integrity of [the] Medicaid [program]. To ensure that integrity, the commission shall:

(1) perform risk assessments of every element of the [Medicaid] program and audit those elements of the program that are determined to present the greatest risks;

(2) ensure that sufficient oversight is in place for the Medicaid medical transportation program;

(3) ensure that a quality review assessment of the Medicaid medical transportation program occurs; and

(4) evaluate [the] Medicaid [program] with respect to use of the metrics developed through the Texas Health Steps performance improvement plan to guide changes and improvements to the program.

SECTION 2.051. Sections 531.02413(a-1) and (b), Government Code, are amended to read as follows:

(a-1) If cost-effective and feasible, the commission shall contract to expand the Medicaid billing coordination system described by Subsection (a) to process claims for all other health care services provided through [the] Medicaid [program] in the manner claims for acute care services are processed by the system under Subsection (a). This subsection does not apply to claims for health care services provided through [the] Medicaid [program] if, before September 1, 2009, those claims were being processed by an alternative billing coordination system.

(b) If cost-effective, the executive commissioner shall adopt rules for the purpose of enabling the system described by Subsection (a) to identify an entity with primary responsibility for paying a claim that is processed by the system under Subsection (a) and establish reporting requirements for any entity that may have a contractual responsibility to pay for the types of services that are provided under [the] Medicaid [program] and the claims for which are processed by the system under Subsection (a).

SECTION 2.052. Section 531.024131(a), Government Code, is amended to read as follows:

(a) If cost-effective, the commission may:

(1) contract to expand all or part of the billing coordination system established under Section 531.02413 to process claims for services provided through other benefits programs administered by the commission or a health and human services agency;

(2) expand any other billing coordination tools and resources used to process claims for health care services provided through [the] Medicaid [program] to process claims for services provided through other benefits programs administered by the commission or a health and human services agency; and

(3) expand the scope of persons about whom information is collected under Section 32.042, Human Resources Code, to include recipients of services provided through other benefits programs administered by the commission or a health and human services agency.

SECTION 2.053. Section 531.02414(a)(1), Government Code, is amended to read as follows:

(1) "Medical transportation program" means the program that provides nonemergency transportation services to and from covered health care services, based on medical necessity, to recipients under [the] Medicaid [program], the children with special health care needs program, and the transportation for indigent cancer patients program, who have no other means of transportation.

SECTION 2.054. The heading to Section 531.024161, Government Code, is amended to read as follows:

Sec. 531.024161. REIMBURSEMENT CLAIMS FOR CERTAIN MEDICAID OR CHILD HEALTH PLAN [CHIP] SERVICES INVOLVING SUPERVISED PROVIDERS.

SECTION 2.055. Section 531.024161(a), Government Code, is amended to read as follows:

(a) If a provider, including a nurse practitioner or physician assistant, under [the] Medicaid or the child health plan program provides a referral for or orders health care services for a recipient or enrollee, as applicable, at the direction or under the supervision of another provider, and the referral or order is based on the supervised provider's evaluation of the recipient or enrollee, the names and associated national provider identifier numbers of the supervised provider and the supervising provider must be included on any claim for reimbursement submitted by a provider based on the referral or order. For purposes of this section, "national provider identifier" means the national provider identifier required under Section 1128J(e), Social Security Act (42 U.S.C. Section 1320a-7k(e)).

SECTION 2.056. Section 531.02418, Government Code, is amended to read as follows:

Sec. 531.02418. MEDICAID AND CHILD HEALTH PLAN PROGRAM ELIGIBILITY DETERMINATIONS FOR CERTAIN INDIVIDUALS. (a) The commission shall enter into a memorandum of understanding with the Texas Juvenile Justice Department [Youth Commission] to ensure that each individual who is committed, placed, or detained under Title 3, Family Code, is assessed by the commission for eligibility for Medicaid [the medical assistance program under Chapter 32, Human Resources Code,] and the child health plan program before that individual's release from commitment,[.

[(b) The commission shall enter into a memorandum of understanding with the Texas Juvenile Probation Commission to ensure that each individual who is placed or detained under Title 3, Family Code, is assessed by the commission for eligibility for the medical assistance program under Chapter 32, Human Resources Code, and the child health plan program before the individual's release from] placement, or detention. Local juvenile probation departments are subject to the requirements of the memorandum.

(c) The [Each] memorandum of understanding entered into as required by this section must specify:

(1) the information that must be provided to the commission;

(2) the process by which and time frame within which the information must be provided; and

(3) the roles and responsibilities of all parties to the memorandum, which must include a requirement that the commission pursue the actions needed to complete eligibility applications as necessary.

(d) The [Each] memorandum of understanding required by Subsection (a) [or (b)] must be tailored to achieve the goal of ensuring that an individual described by Subsection (a) [or (b)] who is determined eligible by the commission for coverage under Medicaid [the medical assistance program under Chapter 32, Human Resources Code,] or the child health plan program[,] is enrolled in the program for which the individual is eligible and may begin receiving services through the program as soon as possible after the eligibility determination is made and, if possible, to achieve the goal of ensuring that the individual may begin receiving those services on the date of the individual's release from placement, detention, or commitment.

(e) The executive commissioner may adopt rules as necessary to implement this section.

SECTION 2.057. Section 531.024181(a), Government Code, is amended to read as follows:

(a) This section applies only with respect to the following benefits programs:

(1) the child health plan program under Chapter 62, Health and Safety Code;

(2) the financial assistance program under Chapter 31, Human Resources Code;

(3) Medicaid [the medical assistance program under Chapter 32, Human Resources Code]; and

(4) the supplemental nutrition [nutritional] assistance program under Chapter 33, Human Resources Code.

SECTION 2.058. Section 531.024182(b), Government Code, is amended to read as follows:

(b) If, at the time of application for benefits, a person stated that the person is a sponsored alien, the commission may, to the extent allowed by federal law, verify information relating to the sponsorship, using an automated system or systems where available, after the person is determined eligible for and begins receiving benefits under any of the following benefits programs:

(1) the child health plan program under Chapter 62, Health and Safety Code;

(2) the financial assistance program under Chapter 31, Human Resources Code;

(3) Medicaid [the medical assistance program under Chapter 32, Human Resources Code]; or

(4) the supplemental nutrition [nutritional] assistance program under Chapter 33, Human Resources Code.

SECTION 2.059. Sections 531.0244(c) and (g), Government Code, are amended to read as follows:

(c) For purposes of developing the strategies required by Subsection (b)(4), a person with a mental illness who is admitted to a facility of the [Texas] Department of State Health Services [Mental Health and Mental Retardation] for inpatient mental health services three or more times during a 180-day period is presumed to be in imminent risk of requiring placement in an institution. The strategies must be developed in a manner that presumes the person's eligibility for and the appropriateness of intensive community-based services and support.

(g) Not later than December 1 of each even-numbered year, the executive commissioner shall submit to the governor and the legislature a report on the status of the implementation of the plan required by Subsection (a). The report must include recommendations on any statutory or other action necessary to implement the plan.

SECTION 2.060. Sections 531.02441(a), (b), (c), (d), (e), (g), and (i), Government Code, are amended to read as follows:

(a) The executive commissioner shall establish an interagency task force to assist the commission and appropriate health and human services agencies in developing a comprehensive, effectively working plan to ensure appropriate care settings for persons with disabilities.

(b) The executive commissioner shall determine the number of members of the task force. The executive commissioner shall appoint as members of the task force:

(1) representatives of appropriate health and human services agencies, including the [Texas] Department of Aging and Disability [Human] Services and the [Texas] Department of State Health Services [Mental Health and Mental Retardation];

(2) representatives of related work groups, including representatives of the work group [groups] established under Section [Sections 22.034 and] 22.035, Human Resources Code;

(3) representatives of consumer and family advocacy groups; and

(4) representatives of service providers for persons with disabilities.

(c) The executive commissioner shall designate a member of the task force to serve as presiding officer. The members of the task force shall elect any other necessary officers.

(d) The task force shall meet at the call of the executive commissioner.

(e) A member of the task force serves at the will of the executive commissioner.

(g) The task force shall study and make recommendations to the commission on[:

[(1)] developing the comprehensive, effectively working plan required by Section 531.0244(a) to ensure appropriate care settings for persons with disabilities[; and

[(2) identifying appropriate components of the pilot program established under Section 22.037, Human Resources Code, for coordination and integration among the Texas Department of Human Services, the Texas Department of Mental Health and Mental Retardation, and the Department of Protective and Regulatory Services].

(i) Not later than September 1 of each year, the task force shall submit a report to the executive commissioner on its findings and recommendations required by Subsection (g).

SECTION 2.061. Section 531.02442, Government Code, is amended to read as follows:

Sec. 531.02442. COMMUNITY LIVING OPTIONS INFORMATION PROCESS FOR CERTAIN PERSONS WITH AN INTELLECTUAL DISABILITY [MENTAL RETARDATION]. (a) In this section:

(1) "Department" means the Department of Aging and Disability Services.

(1-a) "Institution" means:

(A) a residential care facility operated or maintained by the department [Texas Department of Mental Health and Mental Retardation] to provide 24-hour services, including residential services, to persons with an intellectual disability [mental retardation]; or

(B) an ICF-IID [ICF-MR], as defined by Section 531.002, Health and Safety Code.

(2) "Legally authorized representative" has the meaning assigned by Section 241.151, Health and Safety Code.

(3) "Local intellectual and developmental disability [mental retardation] authority" has the meaning assigned by Section 531.002, Health and Safety Code.

(b) In addition to providing information regarding care and support options as required by Section 531.042, the department [Texas Department of Mental Health and Mental Retardation] shall implement a community living options information process in each institution to inform persons with an intellectual disability [mental retardation] who reside in the institution and their legally authorized representatives of alternative community living options.

(c) The department shall provide the information required by Subsection (b) through the community living options information process at least annually. The department shall also provide the information at any other time on request by a person with an intellectual disability [mental retardation] who resides in an institution or the person's legally authorized representative.

(d) If a person with an intellectual disability [mental retardation] residing in an institution or the person's legally authorized representative indicates a desire to pursue an alternative community living option after receiving the information provided under this section, the department shall refer the person or the person's legally authorized representative to the local intellectual and developmental disability [mental retardation] authority. The local intellectual and developmental disability [mental retardation] authority shall place the person in an alternative community living option, subject to the availability of funds, or on a waiting list for those options if the options are not available to the person for any reason on or before the 30th day after the date the person or the person's legally authorized representative is referred to the local intellectual and developmental disability [mental retardation] authority.

(e) The department shall document in the records of each person with an intellectual disability [mental retardation] who resides in an institution the information provided to the person or the person's legally authorized representative through the community living options information process and the results of that process.

SECTION 2.062. Section 531.02443, Government Code, is amended to read as follows:

Sec. 531.02443. IMPLEMENTATION OF COMMUNITY LIVING OPTIONS INFORMATION PROCESS AT STATE INSTITUTIONS FOR CERTAIN ADULT RESIDENTS. (a) In this section:

(1) "Adult resident" means a person with an intellectual disability [mental retardation] who:

(A) is at least 22 years of age; and

(B) resides in a state supported living center [school].

(2) "Department" means the Department of Aging and Disability Services.

(3) "Legally authorized representative" has the meaning assigned by Section 241.151, Health and Safety Code.

(4) "Local intellectual and developmental disability [mental retardation] authority" has the meaning assigned by Section 531.002, Health and Safety Code.

(5) "State supported living center [school]" has the meaning assigned by Section 531.002, Health and Safety Code.

(b) This section applies only to the community living options information process for an adult resident.

(c) The department shall contract with local intellectual and developmental disability [mental retardation] authorities to implement the community living options information process required by Section 531.02442 for an adult resident.

(d) The contract with the local intellectual and developmental disability [mental retardation] authority must:

(1) delegate to the local intellectual and developmental disability [mental retardation] authority the department's duties under Section 531.02442 with regard to the implementation of the community living options information process at a state supported living center [school];

(2) include performance measures designed to assist the department in evaluating the effectiveness of a local intellectual and developmental disability [mental retardation] authority in implementing the community living options information process; and

(3) ensure that the local intellectual and developmental disability [mental retardation] authority provides service coordination and relocation services to an adult resident who chooses, is eligible for, and is recommended by the interdisciplinary team for a community living option to facilitate a timely, appropriate, and successful transition from the state supported living center [school] to the community living option.

(e) The department, with the advice and assistance of the interagency task force on ensuring appropriate care settings for persons with disabilities and representatives of family members or legally authorized representatives of adult residents, persons with an intellectual disability [mental retardation], state supported living centers [schools], and local intellectual and developmental disability [mental retardation] authorities, shall:

(1) develop an effective community living options information process;

(2) create uniform procedures for the implementation of the community living options information process; and

(3) minimize any potential conflict of interest regarding the community living options information process between a state supported living center [school] and an adult resident, an adult resident's legally authorized representative, or a local intellectual and developmental disability [mental retardation] authority.

(f) A state supported living center [school] shall:

(1) allow a local intellectual and developmental disability [mental retardation] authority to participate in the interdisciplinary planning process involving the consideration of community living options for an adult resident;

(2) to the extent not otherwise prohibited by state or federal confidentiality laws, provide a local intellectual and developmental disability [mental retardation] authority with access to an adult resident and an adult resident's records to assist the authority in implementing the community living options information process; and

(3) provide the adult resident or the adult resident's legally authorized representative with accurate information regarding the risks of moving the adult resident to a community living option.

SECTION 2.063. Section 531.02444, Government Code, as amended by Chapter 34 (S.B. 187), Acts of the 81st Legislature, Regular Session, 2009, is reenacted and amended to read as follows:

Sec. 531.02444. MEDICAID BUY-IN PROGRAMS FOR CERTAIN PERSONS WITH DISABILITIES. (a) The executive commissioner shall develop and implement:

(1) a Medicaid buy-in program for persons with disabilities as authorized by the Ticket to Work and Work Incentives Improvement Act of 1999 (Pub. L. No. 106-170) or the Balanced Budget Act of 1997 (Pub. L. No. 105-33); and

(2) as authorized by the Deficit Reduction Act of 2005 (Pub. L. No. 109-171), a Medicaid buy-in program for [disabled] children with disabilities that is described by 42 U.S.C. Section 1396a(cc)(1) whose family incomes do not exceed 300 percent of the applicable federal poverty level.

(b) The executive commissioner shall adopt rules in accordance with federal law that provide for:

(1) eligibility requirements for each program described by Subsection (a); and

(2) requirements for participants in the program to pay premiums or cost-sharing payments, subject to Subsection (c).

(c) Rules adopted by the executive commissioner under Subsection (b) with respect to the program for [disabled] children with disabilities described by Subsection (a)(2) must require a participant to pay monthly premiums according to a sliding scale that is based on family income, subject to the requirements of 42 U.S.C. Sections 1396o(i)(2) and (3).

SECTION 2.064. Section 531.0246, Government Code, is amended to read as follows:

Sec. 531.0246. REGIONAL MANAGEMENT OF HEALTH AND HUMAN SERVICES AGENCIES. (a) The [Subject to Section 531.0055(c), the] commission may require a health and human services agency, under the direction of the commission, to:

(1) [locate all or a portion of the agency's employees and programs in the same building as another health and human services agency or at a location near or adjacent to the location of another health and human services agency;

[(2)] ensure that the agency's location is accessible to [disabled] employees with disabilities and agency clients with disabilities; and

(2) [(3)] consolidate agency support services, including clerical and administrative support services and information resources support services, with support services provided to or by another health and human services agency.

(b) The executive commissioner may require a health and human services agency, under the direction of the executive commissioner, to locate all or a portion of the agency's employees and programs in the same building as another health and human services agency or at a location near or adjacent to the location of another health and human services agency.

SECTION 2.065. Section 531.0247, Government Code, is amended to read as follows:

Sec. 531.0247. ANNUAL BUSINESS PLAN. The [Subject to Section 531.0055(c), the] commission shall develop and implement an annual business services plan for each health and human services region that establishes performance objectives for all health and human services agencies providing services in the region and measures agency effectiveness and efficiency in achieving those objectives.

SECTION 2.066. Section 531.0248(d), Government Code, is amended to read as follows:

(d) In implementing this section, the commission shall consider models used in other service delivery systems, including the mental health and intellectual disability [mental retardation] service delivery systems [system].

SECTION 2.067. Sections 531.02481(a), (e), and (f), Government Code, are amended to read as follows:

(a) The commission[, the Texas Department of Human Services,] and the Department of Aging and Disability Services [Texas Department on Aging] shall assist communities in this state in developing comprehensive, community-based support and service delivery systems for long-term care services. At the request of a community-based organization or combination of community-based organizations, the commission may provide a grant to the organization or combination of organizations in accordance with Subsection (g). At the request of a community, the commission shall provide resources and assistance to the community to enable the community to:

(1) identify and overcome institutional barriers to developing more comprehensive community support systems, including barriers that result from the policies and procedures of state health and human services agencies;

(2) develop a system of blended funds, consistent with the requirements of federal law and the General Appropriations Act, to allow the community to customize services to fit individual community needs; and

(3) develop a local system of access and assistance to aid clients in accessing the full range of long-term care services.

(e) The executive commissioner shall assure the maintenance of no fewer than 28 area agencies on aging in order to assure the continuation of a local system of access and assistance that is sensitive to the aging population.

(f) A community-based organization or a combination of organizations may make a proposal under this section. A community-based organization includes:

(1) an area agency on aging;

(2) an independent living center;

(3) a municipality, county, or other local government;

(4) a nonprofit or for-profit organization; or

(5) a community mental health and intellectual disability [mental retardation] center.

SECTION 2.068. Section 531.02491, Government Code, is amended to read as follows:

Sec. 531.02491. JOINT TRAINING FOR CERTAIN CASEWORKERS. (a) The executive commissioner shall provide for joint training for health and human services caseworkers whose clients are children, including caseworkers employed by:

(1) the commission [Texas Department of Health];

(2) the [Texas] Department of Aging and Disability [Human] Services; [and]

(3) the [Texas] Department of State Health Services;

(4) [Mental Health and Mental Retardation,] a local mental health authority; and[, or]

(5) a local intellectual and developmental disability [mental retardation] authority.

(b) Training provided under this section must be designed to increase a caseworker's knowledge and awareness of the services available to children at each health and human services agency or local mental health or intellectual and developmental disability [mental retardation] authority, including long-term care programs and services available under a Section 1915(c) waiver program.

SECTION 2.069. Section 531.02492, Government Code, is amended to read as follows:

Sec. 531.02492. DELIVERY OF HEALTH AND HUMAN SERVICES TO YOUNG TEXANS. [(a) The executive head of each health and human services agency shall report annually to the governing body of that agency on that agency's efforts to provide health and human services to children younger than six years of age, including the development of any new programs or the enhancement of existing programs. The agency shall submit a copy of the report to the commission.]

(b) The commission shall electronically publish on the commission's Internet website a biennial report and, on or before the date the report is due, shall notify the governor, the lieutenant governor, the speaker of the house of representatives, the comptroller, the Legislative Budget Board, and the appropriate legislative committees that the report is available on the commission's Internet website. The report must address the efforts of the health and human services agencies to provide health and human services to children younger than six years of age. The report may contain recommendations by the commission to better coordinate state agency programs relating to the delivery of health and human services to children younger than six years of age and may propose joint agency collaborative programs.

[(c) The commissioner shall adopt rules relating to the reports required by Subsection (a), including rules specifying when and in what manner a health and human services agency must report and the information to be included in the report. Each agency shall follow the rules adopted by the commissioner under this section.]

SECTION 2.070. Section 531.0271, Government Code, is amended to read as follows:

Sec. 531.0271. HEALTH AND HUMAN SERVICES AGENCIES OPERATING BUDGETS. The commission may, within the limits established by and subject to the General Appropriations Act, transfer amounts appropriated to health and human services agencies among the agencies to:

(1) enhance the receipt of federal money under the federal money [funds] management system established under Section 531.028;

(2) achieve efficiencies in the administrative support functions of the agencies; and

(3) perform the functions assigned to the executive commissioner under Section 531.0055.

SECTION 2.071. Section 531.0273, Government Code, is amended to read as follows:

Sec. 531.0273. INFORMATION RESOURCES PLANNING AND MANAGEMENT[; ADVISORY COMMITTEE]. (a) The commission is responsible for strategic planning for information resources at each health and human services agency and shall direct the management of information resources at each health and human services agency. The commission shall:

(1) develop a coordinated strategic plan for information resources management that:

(A) covers a five-year period;

(B) defines objectives for information resources management at each health and human services agency;

(C) prioritizes information resources projects and implementation of new technology for all health and human services agencies;

(D) integrates planning and development of each information resources system used by a health and human services agency into a coordinated information resources management planning and development system established by the commission;

(E) establishes standards for information resources system security and that promotes the ability of information resources systems to operate with each other;

(F) achieves economies of scale and related benefits in purchasing for health and human services information resources systems; and

(G) is consistent with the state strategic plan for information resources developed under Chapter 2054;

(2) establish information resources management policies, procedures, and technical standards and ensure compliance with those policies, procedures, and standards; and

(3) review and approve the information resources deployment review and biennial operating plan of each health and human services agency.

(c) A health and human services agency may not submit its plans to the Department of Information Resources or the Legislative Budget Board under Subchapter E, Chapter 2054, until those plans are approved by the commission.

[(d) The commission shall appoint an advisory committee composed of:

[(1) information resources managers for state agencies and for private employers; and

[(2) the directors, executive directors, and commissioners of health and human services agencies.

[(e) The advisory committee appointed under Subsection (d) shall advise the commission with respect to the implementation of the commission's duties under Subsection (a)(1) and:

[(1) shall advise the commission about:

[(A) overall goals and objectives for information resources management for all health and human services agencies;

[(B) coordination of agency information resources management plans;

[(C) development of short-term and long-term strategies for:

[(i) implementing information resources management policies, procedures, and technical standards; and

[(ii) ensuring compatibility of information resources systems across health and human services agencies as technology changes;

[(D) information resources training and skill development for health and human services agency employees and policies to facilitate recruitment and retention of trained employees;

[(E) standards for determining:

[(i) the circumstances in which obtaining information resources services under contract is appropriate;

[(ii) the information resources services functions that must be performed by health and human services agency information resources services employees; and

[(iii) the information resources services skills that must be maintained by health and human services agency information resources services employees;

[(F) optimization of the use of information resources technology that is in place at health and human services agencies; and

[(G) existing and potential future information resources technologies and practices and the usefulness of those technologies and practices to health and human services agencies; and

[(2) shall review and make recommendations to the commission relating to the consolidation and improved efficiency of information resources management functions, including:

[(A) cooperative leasing of information resources systems equipment;

[(B) consolidation of data centers;

[(C) improved network operations;

[(D) technical support functions, including help desk services, call centers, and data warehouses;

[(E) administrative applications;

[(F) purchases of standard software;

[(G) joint training efforts;

[(H) recruitment and retention of trained agency employees;

[(I) video conferencing; and

[(J) other related opportunities for improved efficiency.

[(f) A member of the advisory committee may not receive compensation, but is entitled to reimbursement of the travel expenses incurred by the member while conducting the business of the committee, as provided by the General Appropriations Act.

[(g) The advisory committee is not subject to Chapter 2110.]

SECTION 2.072. Section 531.028(b), Government Code, is amended to read as follows:

(b) The executive commissioner shall establish a federal money management system to coordinate and monitor the use of federal money that is received by health and human services agencies to ensure that the money is spent in the most efficient manner and shall:

(1) establish priorities for use of federal money by all health and human services agencies, in coordination with the coordinated strategic plan established under Section 531.022 and the budget prepared under Section 531.026;

(2) coordinate and monitor the use of federal money for health and human services to ensure that the money is spent in the most cost-effective manner throughout the health and human services system;

(3) review and approve all federal funding plans for health and human services in this state;

(4) estimate available federal money, including earned federal money, and monitor unspent money;

(5) ensure that the state meets federal requirements relating to receipt of federal money for health and human services, including requirements relating to state matching money and maintenance of effort;

(6) transfer appropriated amounts as described by Section 531.0271; and

(7) ensure that each governmental entity identified under Section 531.022(e) has access to complete and timely information about all sources of federal money for health and human services programs and that technical assistance is available to governmental entities seeking grants of federal money to provide health and human services.

SECTION 2.073. Section 531.031, Government Code, is amended to read as follows:

Sec. 531.031. MANAGEMENT INFORMATION AND COST ACCOUNTING SYSTEM. The executive commissioner shall establish a management information system and a cost accounting system for all health and human services that is compatible with and meets the requirements of the uniform statewide accounting project.

SECTION 2.074. (a) Section 531.0312(b), Government Code, as amended by Chapters 50 (S.B. 397) and 1460 (H.B. 2641), Acts of the 76th Legislature, Regular Session, 1999, and Chapter 937 (H.B. 3560), Acts of the 80th Legislature, Regular Session, 2007, is reenacted to read as follows:

(b) The commission shall cooperate with the Records Management Interagency Coordinating Council and the comptroller to establish a single method of categorizing information about health and human services to be used by the Records Management Interagency Coordinating Council and the Texas Information and Referral Network. The network, in cooperation with the council and the comptroller, shall ensure that:

(1) information relating to health and human services is included in each residential telephone directory published by a for-profit publisher and distributed to the public at minimal or no cost; and

(2) the single method of categorizing information about health and human services is used in a residential telephone directory described by Subdivision (1).

(b) Section 531.0312(c), Government Code, as added by Chapter 1460 (H.B. 2641), Acts of the 76th Legislature, Regular Session, 1999, is reenacted to incorporate amendments made to Section 531.0312(b), Government Code, by Chapter 50 (S.B. 397), Acts of the 76th Legislature, Regular Session, 1999, and amended to read as follows:

(c) A health and human services agency or a public or private entity receiving state-appropriated funds to provide health and human services shall provide the Texas Information and Referral Network and the Records Management Interagency Coordinating Council with information about the health and human services provided by the agency or entity for inclusion in the statewide information and referral network, residential telephone directories described by Subsection (b), and any other materials produced under the direction of the network or the council. The agency or entity shall provide the information in the format required by the Texas Information and Referral Network or the Records Management Interagency Coordinating Council [a form determined by the commissioner] and shall update the information at least quarterly or as required by the network or the council.

(c) Section 531.0312(d), Government Code, is amended to read as follows:

(d) The Texas Department of Housing and Community Affairs shall provide the Texas Information and Referral Network with information regarding the department's housing and community affairs programs for inclusion in the statewide information and referral network. The department shall provide the information in a form determined by the commission [commissioner] and shall update the information at least quarterly.

SECTION 2.075. Section 531.0317(c), Government Code, is amended to read as follows:

(c) The Internet site must:

(1) contain information that is:

(A) in a concise and easily understandable and accessible format; and

(B) organized by the type of service provided rather than by the agency or provider delivering the service;

(2) contain eligibility criteria for each agency program;

(3) contain application forms for each of the public assistance programs administered by health and human services agencies, including application forms for:

(A) financial assistance under Chapter 31, Human Resources Code;

(B) Medicaid [medical assistance under Chapter 32, Human Resources Code]; and

(C) nutritional assistance under Chapter 33, Human Resources Code;

(4) to avoid duplication of functions and efforts, provide a link that provides access to a site maintained by the Texas Information and Referral Network under Section 531.0313;

(5) contain the telephone number and, to the extent available, the electronic mail address for each health and human services agency and local provider of health and human services;

(6) be designed in a manner that allows a member of the public to send questions about each agency's programs or services electronically and receive responses to the questions from the agency electronically; and

(7) be updated at least quarterly.

SECTION 2.076. Sections 531.0318(b) and (c), Government Code, are amended to read as follows:

(b) The information for consumers required by this section must:

(1) be presented in a manner that is easily accessible to, and understandable by, a consumer; and

(2) allow a consumer to make informed choices concerning long-term care services and include:

(A) an explanation of the manner in which long-term care service delivery is administered in different counties through different programs operated by the commission and by the Department of Aging and Disability Services, so that an individual can easily understand the service options available in the area in which that individual lives; and

(B) for the [Medicaid] Star + Plus Medicaid managed care [pilot] program, information that allows a consumer to evaluate the performance of each participating plan issuer, including for each issuer, in an accessible format such as a table:

(i) the enrollment in each county;

(ii) additional "value-added" services provided;

(iii) a summary of the financial statistical report required under Subchapter A, Chapter 533;

(iv) complaint information;

(v) any sanction or penalty imposed by any state agency, including a sanction or penalty imposed by the commission or the Texas Department of Insurance;

(vi) information concerning consumer satisfaction; and

(vii) other data, including relevant data from reports of external quality review organizations, that may be used by the consumer to evaluate the quality of the services provided.

(c) In addition to providing the information required by this section through the Internet, the commission or the Department of Aging and Disability Services shall, on request by a consumer without Internet access, provide the consumer with a printed copy of the information from the website. The commission or department may charge a reasonable fee for printing the information. The executive commissioner shall establish the fee by rule.

SECTION 2.077. Section 531.033, Government Code, is amended to read as follows:

Sec. 531.033. RULES. The executive commissioner shall adopt rules necessary to carry out the commission's duties under this chapter.

SECTION 2.078. Section 531.0335(b), Government Code, is amended to read as follows:

(b) The executive commissioner by rule shall prohibit a health and human services agency from taking a punitive action against a person responsible for a child's care, custody, or welfare for failure of the person to ensure that the child receives the immunization series prescribed by Section 161.004, Health and Safety Code.

SECTION 2.079. Section 531.035, Government Code, is amended to read as follows:

Sec. 531.035. DISPUTE ARBITRATION. The executive commissioner shall arbitrate and render the final decision on interagency disputes.

SECTION 2.080. The heading to Section 531.0381, Government Code, is amended to read as follows:

Sec. 531.0381. CERTAIN GIFTS AND GRANTS TO HEALTH AND HUMAN SERVICES AGENCIES.

SECTION 2.081. Sections 531.0381(b) and (c), Government Code, are amended to read as follows:

(b) Acceptance of a gift or grant under this section is subject to the written approval of the executive commissioner. Chapter 575 does not apply to a gift or grant under this section.

(c) The executive commissioner may adopt rules and procedures to implement this section. The rules must ensure that acceptance of a gift or grant under this section is consistent with any applicable federal law or regulation and does not adversely affect federal financial participation in any state program, including [the state] Medicaid [program].

SECTION 2.082. Section 531.0392(a), Government Code, is amended to read as follows:

(a) In this section, "dually eligible individual" means an individual who is eligible to receive health care benefits under both [the] Medicaid and the Medicare program [programs].

SECTION 2.083. Section 531.041, Government Code, is amended to read as follows:

Sec. 531.041. GENERAL POWERS AND DUTIES. The executive commissioner and the commission have [has] all the powers and duties necessary to administer this chapter.

SECTION 2.084. Section 531.042(a), Government Code, is amended to read as follows:

(a) The executive commissioner by rule shall require each health and human services agency to provide to each patient or client of the agency and to at least one family member of the patient or client, if possible, information regarding all care and support options available to the patient or client, including community-based services appropriate to the needs of the patient or client, before the agency allows the patient or client to be placed in a care setting, including a nursing facility [home], intermediate care facility for individuals with an intellectual disability [the mentally retarded], or general residential operation for children with an intellectual disability that is [institution for the mentally retarded] licensed [or operated] by the Department of Family and Protective [and Regulatory] Services, to receive care or services provided by the agency or by a person under an agreement with the agency.

SECTION 2.085. Section 531.043(a), Government Code, is amended to read as follows:

(a) In conjunction with the appropriate state agencies, the executive commissioner shall develop a plan for access to individualized long-term care services for persons with functional limitations or medical needs and their families that assists those persons in achieving and maintaining the greatest possible independence, autonomy, and quality of life.

SECTION 2.086. Section 531.044, Government Code, is amended to read as follows:

Sec. 531.044. FINANCIAL ASSISTANCE [AFDC] RECIPIENTS ELIGIBLE FOR FEDERAL PROGRAMS. [(a)] The commission shall assist recipients of financial assistance under Chapter 31, Human Resources Code, who are eligible for assistance under federal programs to apply for benefits under those federal programs. The commission may delegate this responsibility to a health and human services [service] agency, contract with a unit of local government, or use any other cost-effective method to assist financial assistance recipients who are eligible for federal programs.

[(b) The commission shall organize a planning group involving the Texas Department of Human Services, the Texas Education Agency, and the Texas Rehabilitation Commission to:

[(1) improve workload coordination between those agencies as necessary to administer this section; and

[(2) provide information and help train employees to correctly screen applicants under this section as requested by the commission.]

SECTION 2.087. Sections 531.045(b) and (g), Government Code, are amended to read as follows:

(b) The task force is composed of:

(1) a representative of:

(A) the attorney general's office, appointed by the attorney general;

(B) the comptroller's office, appointed by the comptroller;

(C) the commission, appointed by the executive commissioner;

(D) the [Texas] Department of State Health Services, appointed by the commissioner of state health services [public health];

(E) the [Texas] Department of Aging and Disability [Human] Services, appointed by the commissioner of aging and disability [human] services;

(F) the Texas Workforce Commission, appointed by the executive director of that agency; and

(G) the Department of Assistive and Rehabilitative Services [Texas Rehabilitation Commission], appointed by the commissioner of assistive and rehabilitative services [that agency]; and

(2) two representatives of each of the following groups, appointed by the comptroller:

(A) retailers who maintain electronic benefits transfer point-of-sale equipment;

(B) banks or owners of automatic teller machines; and

(C) consumer or client advocacy organizations.

(g) The task force shall:

(1) serve as this state's counterpoint to the federal electronic benefits transfer task force;

(2) identify benefit programs that merit addition to this state's electronic benefits transfer system;

(3) identify and address problems that may occur if a program is added;

(4) pursue state-federal partnerships to facilitate the development and expansion of this state's electronic benefits transfer system;

(5) track and distribute federal legislation and information from other states that relate to electronic benefits transfer systems;

(6) ensure efficiency and planning coordination in relation to this state's electronic benefits transfer system;

(7) [develop a plan using the experience and expertise of appropriate state agencies for the use of a photograph or other imaging technology on all electronic benefits transfer cards and, if proven to be effective in reducing fraud and misuse, begin using the new cards starting with replacement cards for cards that were used in the program on June 13, 1995;

[(8)] review current and potential fraud problems with electronic benefits transfer and propose methods to prevent or deter fraud;

[(9) evaluate the feasibility of adding the Medicaid program to the state's electronic benefits transfer system;] and

(8) [(10)] develop a plan to assist beneficiaries of public programs to obtain bank accounts.

SECTION 2.088. Section 531.047(a), Government Code, is amended to read as follows:

(a) The executive commissioner [commission], after consulting with representatives from the Department of Family and Protective [and Regulatory] Services, the Texas Juvenile Justice Department [Probation Commission], the Department of Aging and Disability Services, and the [Texas] Department of State Health Services [Mental Health and Mental Retardation], shall by rule adopt result-oriented standards that a provider of substitute care services for children under the care of the state must achieve.

SECTION 2.089. Section 531.048, Government Code, is amended to read as follows:

Sec. 531.048. CASELOAD STANDARDS. (a) The executive [After considering the recommendations of the caseload standards advisory committees under Section 531.049(e), the] commissioner may establish caseload standards and other standards relating to caseloads for each category of caseworker employed by the [Texas Department of Human Services or the] Department of Family and Protective [and Regulatory] Services.

(b) In establishing standards under this section, the executive commissioner shall:

(1) ensure the standards are based on the actual duties of the caseworker;

(2) ensure the caseload standards are reasonable and achievable;

(3) ensure the standards are consistent with existing professional caseload standards;

(4) consider standards developed by other states for caseworkers in similar positions of employment; and

(5) ensure the standards are consistent with existing caseload standards of other state agencies.

(c) Subject to the availability of funds appropriated by the legislature, [the commissioner of human services and] the commissioner [executive director] of the Department of Family and Protective [and Regulatory] Services shall use the standards established by the executive commissioner under this section to determine the number of personnel to assign as caseworkers for the department [their respective agencies].

(d) Subject to the availability of funds appropriated by the legislature, the [Texas Department of Human Services and the] Department of Family and Protective [and Regulatory] Services shall use the standards established by the executive commissioner to assign caseloads to individual caseworkers employed by the department [those agencies].

[(e) The commissioner shall include a recommendation made to the commissioner by a caseload standards advisory committee under Section 531.049(e) in the strategic plan of the agency that is the subject of the recommendation.]

(f) Nothing in this section may be construed to create a cause of action.

[(g) The executive commissioner shall develop and, subject to the availability of funds, implement a caseload management reduction plan to reduce, not later than January 1, 2011, caseloads for caseworkers employed by the adult protective services division of the Department of Family and Protective Services to a level that does not exceed professional caseload standards by more than five cases per caseworker. The plan must provide specific annual targets for caseload reduction.]

SECTION 2.090. Section 531.050, Government Code, is amended to read as follows:

Sec. 531.050. MINIMUM COLLECTION GOAL. (a) Before August 31 of each year, the executive commissioner [commission, after consulting with the Texas Department of Human Services,] by rule shall set a minimum goal for the commission [Texas Department of Human Services] that specifies the percentage of the amount of benefits granted by the commission [department] in error under the supplemental nutrition assistance [food stamp] program or the program of financial assistance under Chapter 31, Human Resources Code, that the commission [department] should recover. The executive commissioner [commission] shall set the percentage based on comparable recovery rates reported by other states or other appropriate factors identified by the executive commissioner [commission and the department].

(b) If the commission [department] fails to meet the goal set under Subsection (a) for the fiscal year, the executive commissioner shall notify the comptroller, and the comptroller shall reduce the commission's [department's] general revenue appropriation by an amount equal to the difference between the amount of state funds the commission [department] would have collected had the commission [department] met the goal and the amount of state funds the commission [department] actually collected.

(c) The executive commissioner [commission], the governor, and the Legislative Budget Board shall monitor the commission's [department's] performance in meeting the goal set under this section. The commission [department] shall cooperate by providing to [the commission,] the governor[,] and the Legislative Budget Board, on request, information concerning the commission's [department's] collection efforts.

SECTION 2.091. Section 531.051(c), Government Code, is amended to read as follows:

(c) In adopting rules for the consumer direction models, the executive commissioner [commission] shall:

(1) with assistance from the work group established under Section 531.052, determine which services are appropriate and suitable for delivery through consumer direction;

(2) ensure that each consumer direction model is designed to comply with applicable federal and state laws;

(3) maintain procedures to ensure that a potential consumer or the consumer's legally authorized representative has adequate and appropriate information, including the responsibilities of a consumer or representative under each service delivery option, to make an informed choice among the types of consumer direction models;

(4) require each consumer or the consumer's legally authorized representative to sign a statement acknowledging receipt of the information required by Subdivision (3);

(5) maintain procedures to monitor delivery of services through consumer direction to ensure:

(A) adherence to existing applicable program standards;

(B) appropriate use of funds; and

(C) consumer satisfaction with the delivery of services;

(6) ensure that authorized program services that are not being delivered to a consumer through consumer direction are provided by a provider agency chosen by the consumer or the consumer's legally authorized representative; and

(7) work in conjunction with the work group established under Section 531.052 to set a timetable to complete the implementation of the consumer direction models.

SECTION 2.092. Sections 531.055(a) and (e), Government Code, are amended to read as follows:

(a) Each health and human services agency, the Texas Correctional Office [Council] on Offenders with Medical or Mental Impairments, the Texas Department of Criminal Justice, the Texas Department of Housing and Community Affairs, the Texas Education Agency, the Texas Workforce Commission, and the Texas Juvenile Justice Department [Youth Commission] shall enter into [adopt] a joint memorandum of understanding to promote a system of local-level interagency staffing groups to coordinate services for persons needing multiagency services.

(e) The agencies shall ensure that a state-level interagency staffing group provides a biennial report to the administrative head [executive director] of each agency, the legislature, and the governor that includes:

(1) the number of persons served through the local-level interagency staffing groups and the outcomes of the services provided;

(2) a description of any barriers identified to the state's ability to provide effective services to persons needing multiagency services; and

(3) any other information relevant to improving the delivery of services to persons needing multiagency services.

SECTION 2.093. Section 531.056, Government Code, is amended to read as follows:

Sec. 531.056. REVIEW OF SURVEY PROCESS IN CERTAIN INSTITUTIONS AND FACILITIES. (a) The commission shall adopt procedures to review:

(1) citations or penalties assessed for a violation of a rule or law against an institution or facility licensed under Chapter 242, 247, or 252, Health and Safety Code, or certified to participate in Medicaid administered in accordance with Chapter 32, Human Resources Code, considering:

(A) the number of violations by geographic region;

(B) the patterns of violations in each region; and

(C) the outcomes following the assessment of a penalty or citation; and

(2) the performance of duties by employees and agents of a [the Texas Department of Human Services or another] state agency responsible for licensing, inspecting, surveying, or investigating institutions and facilities licensed under Chapter 242, 247, or 252, Health and Safety Code, or certified to participate in Medicaid administered in accordance with Chapter 32, Human Resources Code, related to:

(A) complaints received by the commission; or

(B) any standards or rules violated by an employee or agent of a state agency.

SECTION 2.094. Section 531.057, Government Code, is amended to read as follows:

Sec. 531.057. VOLUNTEER ADVOCATE PROGRAM FOR THE ELDERLY. (a) In this section:

(1) "Designated caregiver" means:

(A) a person designated as a caregiver by an elderly individual receiving services from or under the direction of the commission or a health and human services agency; or

(B) a court-appointed guardian of an elderly individual receiving services from or under the direction of the commission or a health and human services agency.

(2) "Elderly" means individuals who are at least 60 years of age.

(3) "Program" means the volunteer advocate program created under this section for the elderly receiving services from or under the direction of the commission or a health and human services agency [created under this section].

(4) "Volunteer advocate" means a person who successfully completes the volunteer advocate curriculum described by Subsection (c)(2).

[(b) The executive commissioner shall coordinate with the advisory committee established under Section 531.0571 to develop a volunteer advocate program for the elderly receiving services from or under the direction of the commission or a health and human services agency.]

(c) The [In developing the] program[, the executive commissioner and the advisory committee] shall adhere to the following principles:

(1) the intent of the program is to evaluate, through operation of pilot projects, whether providing the services of a trained volunteer advocate selected by an elderly individual or the individual's designated caregiver is effective in achieving the following goals:

(A) extend the time the elderly individual can remain in an appropriate home setting;

(B) maximize the efficiency of services delivered to the elderly individual by focusing on services needed to sustain family caregiving;

(C) protect the elderly individual by providing a knowledgeable third party to review the quality of care and services delivered to the individual and the care options available to the individual and the individual's family; and

(D) facilitate communication between the elderly individual or the individual's designated caregiver and providers of health care and other services;

(2) a volunteer advocate curriculum must be maintained [established] that incorporates best practices as determined and recognized by a professional organization recognized in the elder health care field;

(3) the use of pro bono assistance from qualified professionals must be maximized in modifying [developing] the volunteer advocate curriculum and [designing] the program;

(4) trainers must be certified on the ability to deliver training;

(5) training shall be offered through multiple community-based organizations; and

(6) participation in the program is voluntary and must be initiated by the elderly individual or the individual's designated caregiver.

(d) The executive commissioner may enter into agreements with appropriate nonprofit organizations for the provision of services under the program. A nonprofit organization is eligible to provide services under the program if the organization:

(1) has significant experience in providing services to elderly individuals;

(2) has the capacity to provide training and supervision for individuals interested in serving as volunteer advocates; and

(3) meets any other criteria prescribed by the executive commissioner.

(e) The commission shall fund the program, including the design and evaluation of pilot projects, modification [development] of the volunteer advocate curriculum, and training of volunteers, through existing appropriations to the commission.

(f) Notwithstanding Subsection (e), the commission may accept gifts, grants, or donations for the program from any public or private source to:

(1) carry out the design of the program;

(2) develop criteria for evaluation of any proposed pilot projects operated under the program;

(3) modify [develop] a volunteer advocate training curriculum;

(4) conduct training for volunteer advocates; and

(5) develop a request for offers to conduct any proposed pilot projects under the program.

(g) The executive commissioner may adopt rules as necessary to implement the program.

SECTION 2.095. Sections 531.0571(a) and (b), Government Code, are amended to read as follows:

(a) The executive commissioner shall appoint an advisory committee composed of the following members:

(1) a representative of the Department of Aging and Disability Services;

(2) a representative of the Department of Assistive and Rehabilitative Services;

(3) a representative of the Department of State Health Services;

(4) a representative of the Texas Silver-Haired Legislature;

(5) a representative of an area agency on aging;

(6) a representative of United Ways of Texas;

(7) a home health provider;

(8) an assisted living provider;

(9) a nursing facility [home] provider;

(10) a representative of Texas CASA;

(11) a licensed gerontologist; and

(12) a representative of AARP.

(b) The advisory committee shall advise the executive commissioner on [the development of] the volunteer advocate program for the elderly [developed] under Section 531.057, including reviewing and commenting on:

(1) program design and selection of any pilot sites operated under the program;

(2) the volunteer advocate training curriculum;

(3) requests for oversight requirements for any pilot projects operated under the program;

(4) evaluation of any pilot projects operated under the program;

(5) requirements for periodic reports to the elderly individual or the individual's designated caregiver and providers of health care or other services; and

(6) other issues as requested by the executive commissioner.

SECTION 2.096. Sections 531.058(a), (b), and (d), Government Code, are amended to read as follows:

(a) The executive commissioner [commission] by rule shall establish an informal dispute resolution process in accordance with this section. The process must provide for adjudication by an appropriate disinterested person of disputes relating to a proposed enforcement action or related proceeding of the commission [Texas Department of Human Services] under Section 32.021(d), Human Resources Code, or the Department of Aging and Disability Services under Chapter 242, 247, or 252, Health and Safety Code. The informal dispute resolution process must require:

(1) an institution or facility to request informal dispute resolution not later than the 10th calendar day after notification by the commission or department, as applicable, of the violation of a standard or standards; and

(2) the commission to complete the process not later than:

(A) the 30th calendar day after receipt of a request from an institution or facility, other than an assisted living facility, for informal dispute resolution; or

(B) the 90th calendar day after receipt of a request from an assisted living facility for informal dispute resolution.

(b) The executive commissioner [commission] shall adopt rules to adjudicate claims in contested cases.

(d) The executive commissioner [commission] shall use a negotiated rulemaking process and engage a qualified impartial third party as provided by Section 2009.053, with the goal of the executive commissioner adopting rules that are fair and impartial to all parties not later than January 1, 2015. This subsection expires September 1, 2015.

SECTION 2.097. Section 531.059, Government Code, is amended to read as follows:

Sec. 531.059. VOUCHER PROGRAM FOR TRANSITIONAL LIVING ASSISTANCE FOR PERSONS WITH DISABILITIES. (a) In this section:

(1) "Institutional housing" means:

(A) an ICF-IID [ICF-MR], as defined by Section 531.002, Health and Safety Code;

(B) a nursing facility;

(C) a state hospital, state supported living center [school], or state center maintained and managed by the [Texas] Department of State Health Services or the Department of Aging and Disability Services [Mental Health and Mental Retardation];

(D) a general residential operation for children with an intellectual disability that is [an institution for the mentally retarded] licensed [or operated] by the Department of Family and Protective Services; or

(E) a general residential operation, as defined by Section 42.002, Human Resources Code.

(2) "Integrated housing" means housing in which a person with a disability resides or may reside that is found in the community but that is not exclusively occupied by persons with disabilities and their care providers.

(b) Subject to the availability of funds, the commission shall coordinate with the [Texas Department of Human Services, the] Texas Department of Housing and Community Affairs, the Department of State Health Services, and the [Texas] Department of Aging and Disability Services [Mental Health and Mental Retardation] to develop a housing assistance program to assist persons with disabilities in moving from institutional housing to integrated housing. In developing the program, the agencies shall address:

(1) eligibility requirements for assistance;

(2) the period during which a person with a disability may receive assistance;

(3) the types of housing expenses to be covered under the program; and

(4) the locations at which the program will be operated.

(c) Subject to the availability of funds, the Department of Aging and Disability Services [commission] shall [require the Texas Department of Human Services to implement and] administer the housing assistance program under this section. The department shall coordinate with the Texas Department of Housing and Community Affairs in [implementing and] administering the program, determining the availability of funding from the United States Department of Housing and Urban Development, and obtaining those funds.

(d) The [Texas Department of Human Services and the] Texas Department of Housing and Community Affairs and the Department of Aging and Disability Services shall provide information to the commission as necessary to facilitate the administration [development and implementation] of the housing assistance program.

SECTION 2.098. Sections 531.060(c)(3) and (4), Government Code, are amended to read as follows:

(3) "Institution" means any congregate care facility, including:

(A) a nursing facility [home];

(B) an ICF-IID [ICF-MR facility], as defined by Section 531.002, Health and Safety Code;

(C) a group home operated by the [Texas] Department of Aging and Disability Services [Mental Health and Mental Retardation]; and

(D) a general residential operation for children with an intellectual disability that is [an institution for the mentally retarded] licensed by the Department of Family and Protective [and Regulatory] Services.

(4) "Waiver services" means services provided under:

(A) the Medically Dependent Children Program (MDCP);

(B) the Community Living Assistance and Support Services (CLASS) waiver program [Program];

(C) the Home and Community-based [Waiver] Services (HCS) waiver program [Program, including the HCS-OBRA Program];

(D) [the Mental Retardation-Local Authority Pilot Project (MRLA);

[(E)] the Deaf Blind with Multiple Disabilities (DBMD) waiver program [Deaf, Blind, and Multiply Disabled Program]; and

(E) [(F)] any other Section 1915(c) waiver program that provides long-term care services for children.

SECTION 2.099. Sections 531.062(a) and (b), Government Code, are amended to read as follows:

(a) Notwithstanding any other law, the commission may establish one or more pilot projects through which reimbursement under Medicaid [the medical assistance program under Chapter 32, Human Resources Code,] is made to demonstrate the applications of technology in providing services under that program.

(b) A pilot project established under this section may relate to providing rehabilitation services, services for the aging or persons with disabilities [disabled], or long-term care services, including community care services and support.

SECTION 2.100. Sections 531.063(a) and (i), Government Code, are amended to read as follows:

(a) The executive commissioner [commission,] by rule[,] shall establish at least one but not more than four call centers for purposes of determining and certifying or recertifying a person's eligibility and need for services related to the programs listed under Section 531.008(c), if cost-effective. [The commission must conduct a public hearing before establishing the initial call center.]

(i) Notwithstanding Subsection (a), the executive commissioner shall develop and implement policies that provide an applicant for services related to the programs listed under Section 531.008(c) with an opportunity to appear in person to establish initial eligibility or to comply with periodic eligibility recertification requirements if the applicant requests a personal interview. In implementing the policies, the commission shall maintain offices to serve applicants who request a personal interview. This subsection does not affect a law or rule that requires an applicant to appear in person to establish initial eligibility or to comply with periodic eligibility recertification requirements.

SECTION 2.101. Section 531.064(a), Government Code, is amended to read as follows:

(a) In this section, "vaccines for children program" means the program operated by the [Texas] Department of State Health Services under authority of 42 U.S.C. Section 1396s, as amended.

SECTION 2.102. Sections 531.067(a), (b), (d), and (g), Government Code, are amended to read as follows:

(a) The commission shall appoint a Public Assistance Health Benefit Review and Design Committee. The committee consists of nine representatives of health care providers participating in [the] Medicaid [program] or the child health plan program, or both. The committee membership must include at least three representatives from each program.

(b) The executive commissioner shall designate one member to serve as presiding officer for a term of two years.

(d) The committee shall review and provide recommendations to the commission regarding health benefits and coverages provided under [the state] Medicaid [program], the child health plan program, and any other income-based health care program administered by the commission or a health and human services agency. In performing its duties under this subsection, the committee must:

(1) review benefits provided under each of the programs; and

(2) review procedures for addressing high utilization of benefits by recipients.

(g) In performing the duties under this section, the commission may design and implement a program to improve and monitor clinical and functional outcomes of a recipient of services under Medicaid or the state child health plan [or medical assistance] program. The program may use financial, clinical, and other criteria based on pharmacy, medical services, and other claims data related to Medicaid or the child health plan [or the state medical assistance] program. The commission must report to the committee on the fiscal impact, including any savings associated with the strategies utilized under this section.

SECTION 2.103. Section 531.068, Government Code, is amended to read as follows:

Sec. 531.068. MEDICAID OR OTHER HEALTH BENEFIT COVERAGE. In adopting rules or standards governing [the state] Medicaid [program] or rules or standards for the development or implementation of health benefit coverage for a program administered by the commission or a health and human services agency, the executive commissioner [commission and each health and human services agency, as appropriate,] may take into consideration any recommendation made with respect to health benefits provided under [their respective programs or the state] Medicaid or another of those programs [program] by the Public Assistance Health Benefit Review and Design Committee established under Section 531.067.

SECTION 2.104. Section 531.0691(a)(1), Government Code, is amended to read as follows:

(1) "Medicaid Drug Utilization Review Program" means the program operated by the vendor drug program to improve the quality of pharmaceutical care under [the] Medicaid [program].

SECTION 2.105. Section 531.0693(a), Government Code, is amended to read as follows:

(a) The commission shall monitor and analyze prescription drug use and expenditure patterns in [the] Medicaid [program]. The commission shall identify the therapeutic prescription drug classes and individual prescription drugs that are most often prescribed to patients or that represent the greatest expenditures.

SECTION 2.106. Section 531.0694, Government Code, is amended to read as follows:

Sec. 531.0694. PERIOD OF VALIDITY FOR PRESCRIPTION. In the [its] rules and standards governing the vendor drug program, the executive commissioner [commission], to the extent allowed by federal law and laws regulating the writing and dispensing of prescription medications, shall ensure that a prescription written by an authorized health care provider under [the] Medicaid [program] is valid for the lesser of the period for which the prescription is written or one year. This section does not apply to a prescription for a controlled substance, as defined by Chapter 481, Health and Safety Code.

SECTION 2.107. Section 531.0697(a), Government Code, is amended to read as follows:

(a) This section applies to:

(1) the vendor drug program for [the] Medicaid and the child health plan program [programs];

(2) the kidney health care program;

(3) the children with special health care needs program; and

(4) any other state program administered by the commission that provides prescription drug benefits.

SECTION 2.108. Sections 531.070(b), (c), and (m), Government Code, are amended to read as follows:

(b) For purposes of this section, the term "supplemental rebates" means cash rebates paid by a manufacturer to the state on the basis of appropriate quarterly health and human services program utilization data relating to the manufacturer's products, pursuant to a state supplemental rebate agreement negotiated with the manufacturer and, if necessary, approved by the federal government under Section 1927 of the federal Social Security Act (42 U.S.C. Section 1396r-8).

(c) The commission may enter into a written agreement with a manufacturer to accept certain program benefits in lieu of supplemental rebates, as defined by this section, only if:

(1) the program benefit yields savings that are at least equal to the amount the manufacturer would have provided under a state supplemental rebate agreement during the current biennium as determined by the written agreement;

(2) the manufacturer posts a performance bond guaranteeing savings to the state, and agrees that if the savings are not achieved in accordance with the written agreement, the manufacturer will forfeit the bond to the state less any savings that were achieved; and

(3) the program benefit is in addition to other program benefits currently offered by the manufacturer to recipients of Medicaid [medical assistance] or related programs.

(m) In negotiating terms for a supplemental rebate, the commission shall use the average manufacturer price (AMP), as defined in 42 U.S.C. Section 1396r-8(k)(1) [Section 1396r-8(k)(1) of the Omnibus Budget Reconciliation Act of 1990], as the cost basis for the product.

SECTION 2.109. Section 531.071(a), Government Code, is amended to read as follows:

(a) Notwithstanding any other state law, information obtained or maintained by the commission regarding prescription drug rebate negotiations or a supplemental Medicaid [medical assistance] or other rebate agreement, including trade secrets, rebate amount, rebate percentage, and manufacturer or labeler pricing, is confidential and not subject to disclosure under Chapter 552.

SECTION 2.110. Sections 531.073(a), (a-1), (c), and (d), Government Code, are amended to read as follows:

(a) The executive commissioner [commission], in the [its] rules and standards governing the Medicaid vendor drug program and the child health plan program, shall require prior authorization for the reimbursement of a drug that is not included in the appropriate preferred drug list adopted under Section 531.072, except for any drug exempted from prior authorization requirements by federal law. The executive commissioner [commission] may require prior authorization for the reimbursement of a drug provided through any other state program administered by the commission or a state health and human services agency, including a community mental health center and a state mental health hospital if the commission adopts preferred drug lists under Section 531.072 that apply to those facilities and the drug is not included in the appropriate list. The executive commissioner [commission] shall require that the prior authorization be obtained by the prescribing physician or prescribing practitioner.

(a-1) Until the commission has completed a study evaluating the impact of a requirement of prior authorization on recipients of certain drugs, the executive commissioner [commission] shall delay requiring prior authorization for drugs that are used to treat patients with illnesses that:

(1) are life-threatening;

(2) are chronic; and

(3) require complex medical management strategies.

(c) The commission shall ensure that a prescription drug prescribed before implementation of a prior authorization requirement for that drug for a recipient under the child health plan program, [the] Medicaid [program], or another state program administered by the commission or a health and human services agency or for a person who becomes eligible under the child health plan program, [the] Medicaid [program], or another state program administered by the commission or a health and human services agency is not subject to any requirement for prior authorization under this section unless the recipient has exhausted all the prescription, including any authorized refills, or a period prescribed by the commission has expired, whichever occurs first.

(d) The commission shall implement procedures to ensure that a recipient under the child health plan program, [the] Medicaid [program], or another state program administered by the commission or a person who becomes eligible under the child health plan program, [the] Medicaid [program], or another state program administered by the commission or a health and human services agency receives continuity of care in relation to certain prescriptions identified by the commission.

SECTION 2.111. Sections 531.074(b), (c), (f), (i), and (i-1), Government Code, are amended to read as follows:

(b) The committee consists of the following members appointed by the governor:

(1) six physicians licensed under Subtitle B, Title 3, Occupations Code, and participating in [the] Medicaid [program], at least one of whom is a licensed physician who is actively engaged in mental health providing care and treatment to persons with severe mental illness and who has practice experience in the state Medicaid plan; and

(2) five pharmacists licensed under Subtitle J, Title 3, Occupations Code, and participating in the Medicaid vendor drug program.

(c) In making appointments to the committee under Subsection (b), the governor shall ensure that the committee includes physicians and pharmacists who:

(1) represent different specialties and provide services to all segments of the [Medicaid program's] diverse population served by Medicaid;

(2) have experience in either developing or practicing under a preferred drug list; and

(3) do not have contractual relationships, ownership interests, or other conflicts of interest with a pharmaceutical manufacturer or labeler or with an entity engaged by the commission to assist in the development of the preferred drug lists or the administration of the prior authorization system.

(f) The [committee shall meet at least monthly during the six-month period following establishment of the committee to enable the committee to develop recommendations for the initial preferred drug lists. After that period, the] committee shall meet at least quarterly and at other times at the call of the presiding officer or a majority of the committee members.

(i) The executive commissioner [commission] shall adopt rules governing the operation of the committee, including rules governing the procedures used by the committee for providing notice of a meeting and rules prohibiting the committee from discussing confidential information described by Section 531.071 in a public meeting. The committee shall comply with the rules adopted under this subsection and Subsection (i-1).

(i-1) In addition to the rules under Subsection (i), the executive commissioner [commission] by rule shall require the committee or the committee's designee to present a summary of any clinical efficacy and safety information or analyses regarding a drug under consideration for a preferred drug list that is provided to the committee by a private entity that has contracted with the commission to provide the information. The committee or the committee's designee shall provide the summary in electronic form before the public meeting at which consideration of the drug occurs. Confidential information described by Section 531.071 must be omitted from the summary. The summary must be posted on the commission's Internet website.

SECTION 2.112. The heading to Section 531.077, Government Code, is amended to read as follows:

Sec. 531.077. RECOVERY OF CERTAIN [MEDICAL] ASSISTANCE.

SECTION 2.113. Section 531.077(a), Government Code, is amended to read as follows:

(a) The executive commissioner shall ensure that [the state] Medicaid [program] implements 42 U.S.C. Section 1396p(b)(1).

SECTION 2.114. Section 531.078(a), Government Code, is amended to read as follows:

(a) In this section, "gross receipts" means money received as compensation for services under an intermediate care facility [facilities] for individuals with an intellectual disability [the mentally retarded] waiver program such as a home and community ] waiver program such as a home and community services waiver or a community living assistance and support services waiver. The term does not include a charitable contribution, revenues received for services or goods other than waivers, or any money received from consumers or their families as reimbursement for services or goods not normally covered by the waivers.

SECTION 2.115. Section 531.079, Government Code, is amended to read as follows:

Sec. 531.079. WAIVER PROGRAM QUALITY ASSURANCE FEE ACCOUNT. (a) The waiver program quality assurance fee account is a dedicated account in the general revenue fund. The account is exempt from the application of Section 403.095. [Interest earned on money in the account shall be credited to the account.]

(b) The account consists of fees collected under Section 531.078 [and interest earned on money in the account].

(c) Subject to legislative appropriation and state and federal law, money in the account may be appropriated only to the Department of Aging and Disability Services to increase reimbursement rates paid under the home and community services waiver program or the community living assistance and support services waiver program or to offset allowable expenses under [the state] Medicaid [program].

SECTION 2.116. Section 531.081, Government Code, is amended to read as follows:

Sec. 531.081. INVALIDITY; FEDERAL FUNDS. If any portion of Sections 531.078-531.080 is held invalid by a final order of a court that is not subject to appeal, or if the commission determines that the imposition of the quality assurance fee and the expenditure of the money collected as provided by those sections will not entitle this state to receive additional federal money under [the] Medicaid [program], the commission shall:

(1) stop collection of the quality assurance fee; and

(2) not later than the 30th day after the date the collection of the quality assurance fee is stopped, return any money collected under Section 531.078, but not spent under Section 531.080, to the persons who paid the fees in proportion to the total amount paid by those persons.

SECTION 2.117. Section 531.084(a), Government Code, is amended to read as follows:

(a) The commission shall make every effort to achieve cost efficiencies within the Medicaid long-term care program. To achieve those efficiencies, the commission shall:

(1) establish a fee schedule for reimbursable incurred medical expenses for dental services controlled in long-term care facilities;

(2) implement a fee schedule for reimbursable incurred medical expenses for durable medical equipment in nursing facilities and ICF-IID [ICF-MR] facilities;

(3) implement a durable medical equipment fee schedule action plan;

(4) establish a system for private contractors to secure and coordinate the collection of Medicare funds for recipients who are dually eligible for Medicare and Medicaid;

(5) create additional partnerships with pharmaceutical companies to obtain discounted prescription drugs for Medicaid recipients; and

(6) develop and implement a system for auditing the Medicaid hospice care system that provides services in long-term care facilities to ensure correct billing for pharmaceuticals.

SECTION 2.118. Section 531.085, Government Code, is amended to read as follows:

Sec. 531.085. HOSPITAL EMERGENCY ROOM USE REDUCTION INITIATIVES. The commission shall develop and implement a comprehensive plan to reduce the use of hospital emergency room services by recipients under Medicaid [the medical assistance program]. The plan may include:

(1) a pilot program designed to facilitate program participants in accessing an appropriate level of health care, which may include as components:

(A) providing program participants access to bilingual health services providers; and

(B) giving program participants information on how to access primary care physicians, advanced practice registered nurses, and local health clinics;

(2) a pilot program under which health care providers, other than hospitals, are given financial incentives for treating recipients outside of normal business hours to divert those recipients from hospital emergency rooms;

(3) payment of a nominal referral fee to hospital emergency rooms that perform an initial medical evaluation of a recipient and subsequently refer the recipient, if medically stable, to an appropriate level of health care, such as care provided by a primary care physician, advanced practice registered nurse, or local clinic;

(4) a program under which the commission or a managed care organization that enters into a contract with the commission under Chapter 533 contacts, by telephone or mail, a recipient who accesses a hospital emergency room three times during a six-month period and provides the recipient with information on ways the recipient may secure a medical home to avoid unnecessary treatment at hospital emergency rooms;

(5) a health care literacy program under which the commission develops partnerships with other state agencies and private entities to:

(A) assist the commission in developing materials that:

(i) contain basic health care information for parents of young children who are recipients under Medicaid [the medical assistance program] and who are participating in public or private child-care or prekindergarten programs, including federal Head Start programs; and

(ii) are written in a language understandable to those parents and specifically tailored to be applicable to the needs of those parents;

(B) distribute the materials developed under Paragraph (A) to those parents; and

(C) otherwise teach those parents about the health care needs of their children and ways to address those needs; and

(6) other initiatives developed and implemented in other states that have shown success in reducing the incidence of unnecessary treatment in hospital emergency rooms.

SECTION 2.119. Sections 531.0861(a) and (b), Government Code, are amended to read as follows:

(a) If cost-effective, the executive commissioner by rule shall establish a physician incentive program designed to reduce the use of hospital emergency room services for non-emergent conditions by recipients under Medicaid [the medical assistance program].

(b) In establishing the physician incentive program under Subsection (a), the executive commissioner may include only the program components identified as cost-effective in the study conducted under former Section 531.086.

SECTION 2.120. Section 531.087(a), Government Code, is amended to read as follows:

(a) The commission shall ensure that educational materials relating to the federal earned income tax credit are provided in accordance with this section to each person receiving assistance or benefits under:

(1) the child health plan program;

(2) the financial assistance program under Chapter 31, Human Resources Code;

(3) Medicaid [the medical assistance program under Chapter 32, Human Resources Code];

(4) the supplemental nutrition assistance [food stamp] program under Chapter 33, Human Resources Code; or

(5) another appropriate health and human services program.

SECTION 2.121. Section 531.089(b), Government Code, is amended to read as follows:

(b) The executive commissioner [of the Health and Human Services Commission] may adopt rules as necessary to implement this section.

SECTION 2.122. Section 531.090(a), Government Code, is amended to read as follows:

(a) Subject to Subsection (b), the commission and each health and human services agency authorized by the executive commissioner may enter into an agreement with one or more other states for the joint bulk purchasing of prescription drugs and other medications to be used in [the] Medicaid [program], the state child health plan, or another program under the authority of the commission.

SECTION 2.123. Section 531.091(b), Government Code, is amended to read as follows:

(b) The method may:

(1) provide for the use of a single integrated benefits issuance card or multiple cards capable of integrating benefits issuance or other program functions;

(2) incorporate a fingerprint image identifier to enable personal identity verification at a point of service and reduce fraud [as permitted by Section 531.1063];

(3) enable immediate electronic verification of recipient eligibility; and

(4) replace multiple forms, cards, or other methods used for fraud reduction or provision of health and human services benefits, including:

(A) electronic benefits transfer cards; and

(B) smart cards used in [the] Medicaid [program].

SECTION 2.124. Section 531.097, Government Code, is amended to read as follows:

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 developed under this section must increase the state's flexibility with respect to the state's use of Medicaid funding and may not reduce the benefits available under the Medicaid state plan to any Medicaid recipient population.

(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 if, before September 1, 2007:

[(1) a federal waiver was requested to implement the package of benefits;

[(2) the package of benefits is being developed, as directed by the legislature; or

[(3) the package of benefits has been implemented.]

SECTION 2.125. Sections 531.099(a) and (b), Government Code, are amended to read as follows:

(a) The commission shall review forms and requirements under [the] Medicaid [program] regarding written orders for diabetic equipment and supplies to identify variations between permissible ordering procedures under that program and ordering procedures available to providers under the Medicare program.

(b) To the extent practicable, and in conformity with Chapter 157, Occupations Code, and Chapter 483, Health and Safety Code, after conducting a review under Subsection (a) the commission or executive commissioner, as appropriate, shall modify only forms, rules, and procedures applicable to orders for diabetic equipment and supplies under [the] Medicaid [program] to provide for an ordering system that is comparable to the ordering system for diabetic equipment and supplies under the Medicare program. The ordering system must permit a diabetic equipment or supplies supplier to complete the forms by hand or to enter by electronic format medical information or supply orders into any form as necessary to provide the information required to dispense diabetic equipment or supplies.

SECTION 2.126. Section 531.0995(a), Government Code, is amended to read as follows:

(a) This section applies to individuals receiving benefits under:

(1) the financial assistance program under Chapter 31, Human Resources Code;

(2) Medicaid [the medical assistance program under Chapter 32, Human Resources Code]; or

(3) the supplemental nutrition assistance program under Chapter 33, Human Resources Code.

SECTION 2.127. Section 531.0996(a), Government Code, is amended to read as follows:

(a) The commission shall develop and implement a pilot program in Harris County to create pregnancy medical homes that provide coordinated evidence-based maternity care management to women who reside in the pilot program area and are recipients of Medicaid [medical assistance] through a Medicaid managed care model or arrangement under Chapter 533.

SECTION 2.128. Section 531.0998(e), Government Code, is amended to read as follows:

(e) Not later than October 1 of each year, the commission, the Texas Veterans Commission, the Veterans' Land Board, and the Department of Aging and Disability Services collectively shall submit to the legislature, the governor, and the Legislative Budget Board a report describing:

(1) interagency progress in identifying and obtaining United States Department of Veterans Affairs benefits for veterans receiving Medicaid and other public benefit programs;

(2) the number of veterans benefits claims awarded, the total dollar amount of veterans benefits claims awarded, and the costs to the state that were avoided as a result of state agencies' use of the system;

(3) efforts to expand the use of the system and improve the effectiveness of shifting veterans from Medicaid and other public benefits to United States Department of Veterans Affairs benefits, including any barriers and how state agencies have addressed those barriers; and

(4) the extent to which the Texas Veterans Commission has targeted specific populations of veterans, including populations in rural counties and in specific age and service-connected disability categories, in order to maximize benefits for veterans and savings to the state.

SECTION 2.129. Sections 531.101(a) and (b), Government Code, are amended to read as follows:

(a) The commission may grant an award to an individual who reports activity that constitutes fraud or abuse of funds in [the state] Medicaid [program] or reports overcharges in Medicaid [the program] if the commission determines that the disclosure results in the recovery of an administrative penalty imposed under Section 32.039, Human Resources Code. The commission may not grant an award to an individual in connection with a report if the commission or attorney general had independent knowledge of the activity reported by the individual.

(b) The commission shall determine the amount of an award. The award may not exceed five percent of the amount of the administrative penalty imposed under Section 32.039, Human Resources Code, that resulted from the individual's disclosure. In determining the amount of the award, the commission shall consider how important the disclosure is in ensuring the fiscal integrity of Medicaid [the program]. The commission may also consider whether the individual participated in the fraud, abuse, or overcharge.

SECTION 2.130. Sections 531.1011(1), (6), (9), and (10), Government Code, are amended to read as follows:

(1) "Abuse" means:

(A) a practice by a provider that is inconsistent with sound fiscal, business, or medical practices and that results in:

(i) an unnecessary cost to [the] Medicaid [program]; or

(ii) the reimbursement of services that are not medically necessary or that fail to meet professionally recognized standards for health care; or

(B) a practice by a recipient that results in an unnecessary cost to [the] Medicaid [program].

(6) "Payment hold" means the temporary denial of reimbursement under [the] Medicaid [program] for items or services furnished by a specified provider.

(9) "Program exclusion" means the suspension of a provider from being authorized under [the] Medicaid [program] to request reimbursement of items or services furnished by that specific provider.

(10) "Provider" means a person, firm, partnership, corporation, agency, association, institution, or other entity that was or is approved by the commission to:

(A) provide Medicaid services [medical assistance] under a contract or provider agreement with the commission; or

(B) provide third-party billing vendor services under a contract or provider agreement with the commission.

SECTION 2.131. Sections 531.102(e), (f), (m), and (n), Government Code, are amended to read as follows:

(e) The executive commissioner [commission], in consultation with the inspector general, by rule shall set specific claims criteria that, when met, require the office to begin an investigation.

(f)(1) If the commission receives a complaint or allegation of Medicaid fraud or abuse from any source, the office must conduct a preliminary investigation as provided by Section 531.118(c) to determine whether there is a sufficient basis to warrant a full investigation. A preliminary investigation must begin not later than the 30th day after the date the commission receives a complaint or allegation or has reason to believe that fraud or abuse has occurred. A preliminary investigation shall be completed not later than the 90th day after it began.

(2) If the findings of a preliminary investigation give the office reason to believe that an incident of fraud or abuse involving possible criminal conduct has occurred in [the] Medicaid [program], the office must take the following action, as appropriate, not later than the 30th day after the completion of the preliminary investigation:

(A) if a provider is suspected of fraud or abuse involving criminal conduct, the office must refer the case to the state's Medicaid fraud control unit, provided that the criminal referral does not preclude the office from continuing its investigation of the provider, which investigation may lead to the imposition of appropriate administrative or civil sanctions; or

(B) if there is reason to believe that a recipient has defrauded [the] Medicaid [program], the office may conduct a full investigation of the suspected fraud, subject to Section 531.118(c).

(m) The office shall employ a dental director who is a licensed dentist under Subtitle D, Title 3, Occupations Code, and the rules adopted under that subtitle by the State Board of Dental Examiners, and who preferably has significant knowledge of [the] Medicaid [program]. The dental director shall ensure that any investigative findings based on the necessity of dental services or the quality of dental care have been reviewed by a qualified expert as described by the Texas Rules of Evidence before the office imposes a payment hold or seeks recoupment of an overpayment, damages, or penalties.

(n) To the extent permitted under federal law, the executive commissioner, on behalf of the office, [acting through the commission,] shall adopt rules establishing the criteria for initiating a full-scale fraud or abuse investigation, conducting the investigation, collecting evidence, accepting and approving a provider's request to post a surety bond to secure potential recoupments in lieu of a payment hold or other asset or payment guarantee, and establishing minimum training requirements for Medicaid provider fraud or abuse investigators.

SECTION 2.132. Section 531.102(l), Government Code, as added by Chapter 622 (S.B. 1803), Acts of the 83rd Legislature, Regular Session, 2013, is amended to read as follows:

(l) The office shall employ a medical director who is a licensed physician under Subtitle B, Title 3, Occupations Code, and the rules adopted under that subtitle by the Texas Medical Board, and who preferably has significant knowledge of [the] Medicaid [program]. The medical director shall ensure that any investigative findings based on medical necessity or the quality of medical care have been reviewed by a qualified expert as described by the Texas Rules of Evidence before the office imposes a payment hold or seeks recoupment of an overpayment, damages, or penalties.

SECTION 2.133. Subsection (l), Section 531.102, Government Code, as added by Chapter 1311 (S.B. 8), Acts of the 83rd Legislature, Regular Session, 2013, is redesignated as Subsection (o), Section 531.102, Government Code, to read as follows:

(o) [(l)] Nothing in this section limits the authority of any other state agency or governmental entity.

SECTION 2.134. Section 531.1021(a), Government Code, is amended to read as follows:

(a) The office of inspector general may request that the executive commissioner or the executive commissioner's designee approve the issuance by the office of a subpoena in connection with an investigation conducted by the office. If the request is approved, the office may issue a subpoena to compel the attendance of a relevant witness or the production, for inspection or copying, of relevant evidence that is in this state.

SECTION 2.135. Section 531.1022(a), Government Code, is amended to read as follows:

(a) The commission's office of inspector general shall employ and commission not more than five peace officers at any given time for the purpose of assisting the office in carrying out the duties of the office relating to the investigation of fraud, waste, and abuse in [the] Medicaid [program].

SECTION 2.136. Sections 531.103(a) and (c), Government Code, are amended to read as follows:

(a) The commission, acting through the commission's office of inspector general, and the office of the attorney general shall enter into a memorandum of understanding to develop and implement joint written procedures for processing cases of suspected fraud, waste, or abuse, as those terms are defined by state or federal law, or other violations of state or federal law under [the state] Medicaid [program] or another [other] program administered by the commission or a health and human services agency, including the financial assistance program under Chapter 31, Human Resources Code, the supplemental nutrition [a nutritional] assistance program under Chapter 33, Human Resources Code, and the child health plan program. The memorandum of understanding shall require:

(1) the office of inspector general and the office of the attorney general to set priorities and guidelines for referring cases to appropriate state agencies for investigation, prosecution, or other disposition to enhance deterrence of fraud, waste, abuse, or other violations of state or federal law, including a violation of Chapter 102, Occupations Code, in the programs and maximize the imposition of penalties, the recovery of money, and the successful prosecution of cases;

(1-a) the office of inspector general to refer each case of suspected provider fraud, waste, or abuse to the office of the attorney general not later than the 20th business day after the date the office of inspector general determines that the existence of fraud, waste, or abuse is reasonably indicated;

(1-b) the office of the attorney general to take appropriate action in response to each case referred to the attorney general, which action may include direct initiation of prosecution, with the consent of the appropriate local district or county attorney, direct initiation of civil litigation, referral to an appropriate United States attorney, a district attorney, or a county attorney, or referral to a collections agency for initiation of civil litigation or other appropriate action;

(2) the office of inspector general to keep detailed records for cases processed by that office or the office of the attorney general, including information on the total number of cases processed and, for each case:

(A) the agency and division to which the case is referred for investigation;

(B) the date on which the case is referred; and

(C) the nature of the suspected fraud, waste, or abuse;

(3) the office of inspector general to notify each appropriate division of the office of the attorney general of each case referred by the office of inspector general;

(4) the office of the attorney general to ensure that information relating to each case investigated by that office is available to each division of the office with responsibility for investigating suspected fraud, waste, or abuse;

(5) the office of the attorney general to notify the office of inspector general of each case the attorney general declines to prosecute or prosecutes unsuccessfully;

(6) representatives of the office of inspector general and of the office of the attorney general to meet not less than quarterly to share case information and determine the appropriate agency and division to investigate each case; and

(7) the office of inspector general and the office of the attorney general to submit information requested by the comptroller about each resolved case for the comptroller's use in improving fraud detection.

(c) The commission and the office of the attorney general shall jointly prepare and submit an annual report to the governor, lieutenant governor, and speaker of the house of representatives concerning the activities of those agencies in detecting and preventing fraud, waste, and abuse under [the state] Medicaid [program] or another [other] program administered by the commission or a health and human services agency. The report may be consolidated with any other report relating to the same subject matter the commission or office of the attorney general is required to submit under other law.

SECTION 2.137. Section 531.1031(a)(2), Government Code, is amended to read as follows:

(2) "Participating agency" means:

(A) the Medicaid fraud enforcement divisions of the office of the attorney general;

(B) each board or agency with authority to license, register, regulate, or certify a health care professional or managed care organization that may participate in [the state] Medicaid [program]; and

(C) the commission's office of inspector general.

SECTION 2.138. Section 531.1031(b), Government Code, is amended to read as follows:

(b) This section applies only to criminal history record information held by a participating agency that relates to a health care professional and information held by a participating agency that relates to a health care professional or managed care organization that is the subject of an investigation by a participating agency for alleged fraud or abuse under [the state] Medicaid [program].

SECTION 2.139. Section 531.105, Government Code, is amended to read as follows:

Sec. 531.105. FRAUD DETECTION TRAINING. (a) The commission shall develop and implement a program to provide annual training to contractors who process Medicaid claims and to appropriate staff of the health and human services agencies [Texas Department of Health and the Texas Department of Human Services] in identifying potential cases of fraud, waste, or abuse under [the state] Medicaid [program]. The training provided to the contractors and staff must include clear criteria that specify:

(1) the circumstances under which a person should refer a potential case to the commission; and

(2) the time by which a referral should be made.

(b) The health and human services agencies [Texas Department of Health and the Texas Department of Human Services], in cooperation with the commission, shall periodically set a goal of the number of potential cases of fraud, waste, or abuse under [the state] Medicaid [program] that each agency will attempt to identify and refer to the commission. The commission shall include information on the agencies' goals and the success of each agency in meeting the agency's goal in the report required by Section 531.103(c).

SECTION 2.140. Sections 531.106(a), (d), (f), and (g), Government Code, are amended to read as follows:

(a) The commission shall use learning or neural network technology to identify and deter fraud in [the] Medicaid [program] throughout this state.

(d) The commission shall require each health and human services agency that performs any aspect of [the state] Medicaid [program] to participate in the implementation and use of the technology.

(f) The commission shall refer cases identified by the technology to the commission's office of inspector general [investigations and enforcement] or the office of the attorney general, as appropriate.

(g) Each month, the learning or neural network technology implemented under this section must match [bureau of] vital statistics unit death records with Medicaid claims filed by a provider. If the commission determines that a provider has filed a claim for services provided to a person after the person's date of death, as determined by the [bureau of] vital statistics unit death records, the commission shall refer the case for investigation to the commission's office of inspector general [investigations and enforcement].

SECTION 2.141. Sections 531.1061(a) and (c), Government Code, are amended to read as follows:

(a) The commission shall use an automated fraud investigation tracking system through the commission's office of inspector general [investigations and enforcement] to monitor the progress of an investigation of suspected fraud, abuse, or insufficient quality of care under [the state] Medicaid [program].

(c) The commission shall require each health and human services agency that performs any aspect of [the state] Medicaid [program] to participate in the implementation and use of the automated fraud investigation tracking system.

SECTION 2.142. Section 531.1062(a), Government Code, is amended to read as follows:

(a) The commission shall use an automated recovery monitoring system to monitor the collections process for a settled case of fraud, abuse, or insufficient quality of care under [the state] Medicaid [program].

SECTION 2.143. Sections 531.107(a), (b), and (f), Government Code, are amended to read as follows:

(a) The Medicaid and Public Assistance Fraud Oversight Task Force advises and assists the commission and the commission's office of inspector general [investigations and enforcement] in improving the efficiency of fraud investigations and collections.

(b) The task force is composed of a representative of the:

(1) attorney general's office, appointed by the attorney general;

(2) comptroller's office, appointed by the comptroller;

(3) Department of Public Safety, appointed by the public safety director;

(4) state auditor's office, appointed by the state auditor;

(5) commission, appointed by the executive commissioner [of health and human services];

(6) [Texas] Department of Aging and Disability [Human] Services, appointed by the commissioner of aging and disability [human] services;

(7) Texas Department of Insurance, appointed by the commissioner of insurance; [and]

(8) [Texas] Department of State Health Services, appointed by the commissioner of state [public] health services; and

(9) commission's office of inspector general, appointed by the executive commissioner.

(f) At least once each fiscal quarter, the commission's office of inspector general [investigations and enforcement] shall provide to the task force:

(1) information detailing:

(A) the number of fraud referrals made to the office and the origin of each referral;

(B) the time spent investigating each case;

(C) the number of cases investigated each month, by program and region;

(D) the dollar value of each fraud case that results in a criminal conviction; and

(E) the number of cases the office rejects and the reason for rejection, by region; and

(2) any additional information the task force requires.

SECTION 2.144. Sections 531.108(a) and (b), Government Code, are amended to read as follows:

(a) The commission's office of inspector general [investigations and enforcement] shall compile and disseminate accurate information and statistics relating to:

(1) fraud prevention; and

(2) post-fraud referrals received and accepted or rejected from the commission's case management system or the case management system of a health and human services agency.

(b) The commission shall:

(1) aggressively publicize successful fraud prosecutions and fraud-prevention programs through all available means, including the use of statewide press releases [issued in coordination with the Texas Department of Human Services]; and

(2) ensure that a toll-free hotline for reporting suspected fraud in programs administered by the commission or a health and human services agency is maintained and promoted, either by the commission or by a health and human services agency.

SECTION 2.145. Section 531.109(a), Government Code, is amended to read as follows:

(a) The commission shall annually select and review a random, statistically valid sample of all claims for reimbursement under [the state] Medicaid [program], including under the vendor drug program, for potential cases of fraud, waste, or abuse.

SECTION 2.146. Sections 531.110(a), (b), (c), and (e), Government Code, are amended to read as follows:

(a) The commission shall conduct electronic data matches for a Medicaid recipient [of assistance under the state Medicaid program] at least quarterly to verify the identity, income, employment status, and other factors that affect the eligibility of the recipient.

(b) To verify eligibility of a recipient for [assistance under the state] Medicaid [program], the electronic data matching must match information provided by the recipient with information contained in databases maintained by appropriate federal and state agencies.

(c) The health and human services agencies [Texas Department of Human Services] shall cooperate with the commission by providing data or any other assistance necessary to conduct the electronic data matches required by this section.

(e) The executive commissioner shall establish procedures by which the commission, or a health and human services agency designated by the commission, verifies [by rule shall establish procedures to verify] the electronic data matches conducted by the commission under this section. Not later than the 20th day after the date the electronic data match is verified, the commission [Texas Department of Human Services] shall remove from eligibility a recipient who is determined to be ineligible for [assistance under the state] Medicaid [program].

SECTION 2.147. Section 531.111, Government Code, is amended to read as follows:

Sec. 531.111. FRAUD DETECTION TECHNOLOGY. The commission may contract with a contractor who specializes in developing technology capable of identifying patterns of fraud exhibited by Medicaid recipients to:

(1) develop and implement the fraud detection technology; and

(2) determine if a pattern of fraud by Medicaid recipients is present in the recipients' eligibility files maintained by the commission [Texas Department of Human Services].

SECTION 2.148. Section 531.1112(a), Government Code, is amended to read as follows:

(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.

SECTION 2.149. Section 531.112(a)(1), Government Code, is amended to read as follows:

(1) "Chemical dependency" has the meaning assigned by Section 461A.002 [461.002], Health and Safety Code.

SECTION 2.150. Section 531.112(b), Government Code, is amended to read as follows:

(b) Following the final conviction of a chemical dependency treatment provider for an offense, an element of which involves submitting a fraudulent claim for reimbursement for services under [the state] Medicaid [program], the commission or other health and human services agency that operates a portion of [the state] Medicaid [program] shall expunge or provide for the expunction of a diagnosis of chemical dependency in a child that has been made by the treatment provider and entered in any:

(1) appropriate official record of the commission or agency;

(2) applicable medical record that is in the commission's or agency's custody; and

(3) applicable record of a company that the commission contracts with for the processing and payment of claims under [the state] Medicaid [program].

SECTION 2.151. Sections 531.113(a) and (e), Government Code, are amended to read as follows:

(a) Each managed care organization that provides or arranges for the provision of health care services to an individual under a government-funded program, including [the] Medicaid [program] and the child health plan program, shall:

(1) establish and maintain a special investigative unit within the managed care organization to investigate fraudulent claims and other types of program abuse by recipients and service providers; or

(2) contract with another entity for the investigation of fraudulent claims and other types of program abuse by recipients and service providers.

(e) The executive commissioner shall adopt rules as necessary to accomplish the purposes of this section.

SECTION 2.152. Section 531.1131(a), Government Code, is amended to read as follows:

(a) If a managed care organization's special investigative unit under Section 531.113(a)(1) or the entity with which the managed care organization contracts under Section 531.113(a)(2) discovers fraud or abuse in [the] Medicaid [program] or the child health plan program, the unit or entity shall:

(1) immediately and contemporaneously notify the commission's office of inspector general and the office of the attorney general;

(2) subject to Subsection (b), begin payment recovery efforts; and

(3) ensure that any payment recovery efforts in which the organization engages are in accordance with applicable rules adopted by the executive commissioner.

SECTION 2.153. Section 531.114(g), Government Code, is amended to read as follows:

(g) The executive commissioner [commission] shall adopt rules as necessary to implement this section.

SECTION 2.154. Section 531.116, Government Code, is amended to read as follows:

Sec. 531.116. COMPLIANCE WITH LAW PROHIBITING SOLICITATION. A provider who furnishes services under [the] Medicaid [program] or the child health plan program is subject to Chapter 102, Occupations Code, and the provider's compliance with that chapter is a condition of the provider's eligibility to participate as a provider under those programs.

SECTION 2.155. Section 531.117, Government Code, is amended to read as follows:

Sec. 531.117. RECOVERY AUDIT CONTRACTORS. To the extent required under Section 1902(a)(42), Social Security Act (42 U.S.C. Section 1396a(a)(42)), the commission shall establish a program under which the commission contracts with one or more recovery audit contractors for purposes of identifying underpayments and overpayments under [the] Medicaid [program] and recovering the overpayments.

SECTION 2.156. Sections 531.121(2), (4), and (6), Government Code, are amended to read as follows:

(2) "Guardian" has the meaning assigned by Section 1002.012, Estates [601, Texas Probate] Code.

(4) "Incapacitated individual" means an incapacitated person as defined by Section 1002.017, Estates [601, Texas Probate] Code.

(6) "Statutory probate court" has the meaning assigned by Section 1002.008(b), Estates [601, Texas Probate] Code.

SECTION 2.157. Sections 531.122(c) and (f), Government Code, are amended to read as follows:

(c) To be eligible for an appointment under this section, an individual must have demonstrated experience working with:

(1) a guardianship program;

(2) an organization that advocates on behalf of or in the interest of elderly individuals or individuals with mental illness or an intellectual disability [mental retardation]; or

(3) incapacitated individuals.

(f) Sections 2110.002 and 2110.008 [2 and 8, Article 6252-33, Revised Statutes,] do not apply to the advisory board.

SECTION 2.158. Section 531.125(a), Government Code, is amended to read as follows:

(a) The commission in accordance with commission rules [by rule] may award grants to:

(1) a local guardianship program, subject to the requirements of this section; and

(2) a local legal guardianship program to enable low-income family members and friends to have legal representation in court if they are willing and able to be appointed guardians of proposed wards who are indigent.

SECTION 2.159. Section 531.151(3), Government Code, is amended to read as follows:

(3) "Institution" means:

(A) an ICF-IID [ICF-MR], as defined by Section 531.002, Health and Safety Code;

(B) a group home operated under the authority of the [Texas] Department of Aging and Disability Services [Mental Health and Mental Retardation], including a residential service provider under a Medicaid waiver program authorized under Section 1915(c) of the federal Social Security Act (42 U.S.C. Section 1396n), as amended, that provides services at a residence other than the child's home or foster home;

(C) a foster group home or an agency foster group home as defined by Section 42.002, Human Resources Code;

(D) a nursing facility;

(E) a general residential operation for children with an intellectual disability that is [an institution for the mentally retarded] licensed by the Department of Family and Protective [and Regulatory] Services; or

(F) another residential arrangement other than a foster home as defined by Section 42.002, Human Resources Code, that provides care to four or more children who are unrelated to each other.

SECTION 2.160. Sections 531.1521(a) and (b), Government Code, are amended to read as follows:

(a) The executive commissioner by rule shall develop and implement a system by which the Department of Aging and Disability Services ensures that, for each child with respect to whom the department or a local intellectual and developmental disability [mental retardation] authority is notified of a request for placement in an institution, the child's parent or guardian is fully informed before the child is placed in the institution of all community-based services and any other service and support options for which the child may be eligible. The system must be designed to ensure that the department provides the information through:

(1) a local intellectual and developmental disability [mental retardation] authority;

(2) any private entity that has knowledge and expertise regarding the needs of and full spectrum of care options available to children with disabilities as well as the philosophy and purpose of permanency planning; or

(3) a department employee.

(b) An institution in which a child's parent or guardian is considering placing the child may provide information required under Subsection (a), but the information must also be provided by a local intellectual and developmental disability [mental retardation] authority, private entity, or employee of the Department of Aging and Disability Services as required by Subsection (a).

SECTION 2.161. Sections 531.153(b), (d), (d-1), and (e), Government Code, are amended to read as follows:

(b) The Department of Family and Protective [and Regulatory] Services shall develop a permanency plan as required by this subchapter for each child who resides in an institution in this state for whom the department has been appointed permanent managing conservator. The department is not required to develop a permanency plan under this subchapter for a child for whom the department has been appointed temporary managing conservator, but may incorporate the requirements of this subchapter in a permanency plan developed for the child under Section 263.3025, Family Code.

(d) In implementing permanency planning procedures under Subsection (a) to develop a permanency plan for each child, the Department of Aging and Disability Services shall:

(1) delegate the department's duty to develop a permanency plan to a local intellectual and developmental disability [mental retardation] authority, as defined by Section 531.002, Health and Safety Code, or enter into a memorandum of understanding with the local intellectual and developmental disability [mental retardation] authority to develop the permanency plan for each child who resides in an institution in this state or with respect to whom the department is notified in advance that institutional care is sought;

(2) contract with a private entity, other than an entity that provides long-term institutional care, to develop a permanency plan for a child who resides in an institution in this state or with respect to whom the department is notified in advance that institutional care is sought; or

(3) perform the department's duties regarding permanency planning procedures using department personnel.

(d-1) A contract or memorandum of understanding under Subsection (d) must include performance measures by which the Department of Aging and Disability Services may evaluate the effectiveness of a local intellectual and developmental disability [mental retardation] authority's or private entity's permanency planning efforts.

(e) The commission, the Department of Aging and Disability Services, [Texas Department of Human Services, the Texas Department of Mental Health and Mental Retardation,] and the Department of Family and Protective [and Regulatory] Services may solicit and accept gifts, grants, and donations to support the development of permanency plans for children residing in institutions by individuals or organizations not employed by or affiliated with those institutions.

SECTION 2.162. Section 531.1531, Government Code, is amended to read as follows:

Sec. 531.1531. ASSISTANCE WITH PERMANENCY PLANNING EFFORTS. An institution in which a child resides shall assist with providing effective permanency planning for the child by:

(1) cooperating with the health and human services agency, local intellectual and developmental disability [mental retardation] authority, or private entity responsible for developing the child's permanency plan; and

(2) participating in meetings to review the child's permanency plan as requested by a health and human services agency, local intellectual and developmental disability [mental retardation] authority, or private entity responsible for developing the child's permanency plan.

SECTION 2.163. Section 531.154, Government Code, is amended to read as follows:

Sec. 531.154. NOTIFICATION REQUIRED. (a) Not later than the third day after the date a child is initially placed in an institution, the institution shall notify:

(1) the Department of Aging and Disability Services [Texas Department of Human Services], if the child is placed in a nursing facility [home];

(2) the local intellectual and developmental disability [mental retardation] authority, as defined by Section 531.002, Health and Safety Code, where the institution is located, if the child:

(A) is placed in an ICF-IID [ICF-MR], as defined by Section 531.002, Health and Safety Code; or

(B) is placed by a [state or local] child protective services agency in a general residential operation for children with an intellectual disability that is [an institution for the mentally retarded] licensed by the Department of Family and Protective [and Regulatory] Services;

(3) the community resource coordination group in the county of residence of a parent or guardian of the child;

(4) if the child is at least three years of age, the school district for the area in which the institution is located; and

(5) if the child is less than three years of age, the local early childhood intervention program for the area in which the institution is located.

(b) The [Texas] Department of Aging and Disability [Human] Services shall notify the local intellectual and developmental disability [mental retardation] authority, as defined by Section 531.002, Health and Safety Code, of a child's placement in a nursing facility [home] if the child is known or suspected to have an intellectual disability [suffer from mental retardation] or another disability for which the child may receive services through the [Texas] Department of Aging and Disability Services [Mental Health and Mental Retardation].

SECTION 2.164. Section 531.156, Government Code, is amended to read as follows:

Sec. 531.156. DESIGNATION OF ADVOCATE. (a) The Department of Aging and Disability Services [Except as provided by Subsection (b), the Texas Department of Human Services] shall designate a person, including a member of a community-based organization, to serve as a volunteer advocate for a child residing in an institution to assist in developing a permanency plan for the child if:

(1) the child's parent or guardian requests the assistance of an advocate; [or]

(2) the institution in which the child is placed cannot locate the child's parent or guardian; or[.]

(3) [(b) The Texas Department of Mental Health and Mental Retardation shall designate the person to serve as a volunteer advocate for a child in accordance with Subsection (a) if] the child resides in an institution operated by the department.

(b) [(c)] The person designated [by the Texas Department of Human Services or the Texas Department of Mental Health and Mental Retardation] to serve as the child's volunteer advocate under this section may be:

(1) a person selected by the child's parent or guardian, except that the person may not be employed by or under a contract with the institution in which the child resides;

(2) an adult relative of the child; or

(3) a representative of a child advocacy group.

(c) [(d)] The [Texas Department of Human Services or the Texas] Department of Aging and Disability Services [Mental Health and Mental Retardation, as appropriate,] shall provide to each person designated to serve as a child's volunteer advocate information regarding permanency planning under this subchapter.

SECTION 2.165. Sections 531.159(b), (c), (d), (e), and (f), Government Code, are amended to read as follows:

(b) The chief executive officer of each appropriate health and human services agency or the officer's designee must approve the placement of a child in an institution. The initial placement of the child in the institution is temporary and may not exceed six months unless the appropriate chief executive officer or the officer's designee approves an extension of an additional six months after conducting a review of documented permanency planning efforts to unite the child with a family in a permanent living arrangement. After the initial six-month extension of a child's placement in an institution approved under this subsection, the chief executive officer or the officer's designee shall conduct a review of the child's placement in the institution at least semiannually to determine whether a continuation of that placement is warranted. If, based on the review, the chief executive officer or the officer's designee determines that an additional extension is warranted, the officer or the officer's designee shall recommend to the executive commissioner that the child continue residing in the institution.

(c) On receipt of a recommendation made under Subsection (b) for an extension of a child's placement, the executive commissioner, the executive commissioner's designee, or another person with whom the commission contracts shall conduct a review of the child's placement. Based on the results of the review, the executive commissioner or the executive commissioner's designee may approve a six-month extension of the child's placement if the extension is appropriate.

(d) The child may continue residing in the institution after the six-month extension approved under Subsection (c) only if the chief executive officer of the appropriate health and human services agency or the officer's designee makes subsequent recommendations as provided by Subsection (b) for each additional six-month extension and the executive commissioner or the executive commissioner's designee approves each extension as provided by Subsection (c).

(e) The executive commissioner or the executive commissioner's designee shall conduct a semiannual review of data received from health and human services agencies regarding all children who reside in institutions in this state. The executive commissioner, the executive commissioner's designee, or a person with whom the commission contracts shall also review the recommendations of the chief executive officers of each appropriate health and human services agency or the officer's designee if the officer or the officer's designee repeatedly recommends that children continue residing in an institution.

(f) The executive commissioner [commission] by rule shall develop procedures by which to conduct the reviews required by Subsections (c), (d), and (e). In developing the procedures, the commission may seek input from the work group on children's long-term services, health services, and mental health services established under Section 22.035, Human Resources Code.

SECTION 2.166. Section 531.160, Government Code, is amended to read as follows:

Sec. 531.160. INSPECTIONS. As part of each inspection, survey, or investigation of an institution, including a nursing facility [home], general residential operation for children with an intellectual disability that is [institution for the mentally retarded] licensed by the Department of Family and Protective [and Regulatory] Services, or ICF-IID [ICF-MR], as defined by Section 531.002, Health and Safety Code, in which a child resides, the agency or the agency's designee shall determine the extent to which the nursing facility [home], general residential operation [institution], or ICF-IID [ICF-MR] is complying with the permanency planning requirements under this subchapter.

SECTION 2.167. Section 531.161, Government Code, is amended to read as follows:

Sec. 531.161. ACCESS TO RECORDS. Each institution in which a child resides shall allow the following to have access to the child's records to assist in complying with the requirements of this subchapter:

(1) the commission;

(2) appropriate health and human services agencies; and

(3) to the extent not otherwise prohibited by state or federal confidentiality laws, a local intellectual and developmental disability [mental retardation] authority or private entity that enters into a contract or memorandum of understanding under Section 531.153(d) to develop a permanency plan for the child.

SECTION 2.168. Section 531.162(b), Government Code, is amended to read as follows:

(b) The executive commissioner shall submit a semiannual report to the governor and the committees of each house of the legislature that have primary oversight jurisdiction over health and human services agencies regarding:

(1) the number of children residing in institutions in this state and, of those children, the number for whom a recommendation has been made for a transition to a community-based residence but who have not yet made that transition;

(2) the circumstances of each child described by Subdivision (1), including the type of institution and name of the institution in which the child resides, the child's age, the residence of the child's parents or guardians, and the length of time in which the child has resided in the institution;

(3) the number of permanency plans developed for children residing in institutions in this state, the progress achieved in implementing those plans, and barriers to implementing those plans;

(4) the number of children who previously resided in an institution in this state and have made the transition to a community-based residence;

(5) the number of children who previously resided in an institution in this state and have been reunited with their families or placed with alternate families;

(6) the community supports that resulted in the successful placement of children described by Subdivision (5) with alternate families; and

(7) the community supports that are unavailable but necessary to address the needs of children who continue to reside in an institution in this state after being recommended to make a transition from the institution to an alternate family or community-based residence.

SECTION 2.169. Sections 531.164(b), (e), (f), (g), and (h), Government Code, are amended to read as follows:

(b) An institution described by Section 531.151(3)(A) or (B) shall notify the local intellectual and developmental disability [mental retardation] authority for the region in which the institution is located of a request for placement of a child in the institution. An institution described by Section 531.151(3)(D) shall notify the Department of Aging and Disability Services of a request for placement of a child in the institution.

(e) Except as otherwise provided by Subsection (f):

(1) an ICF-IID [ICF-MR] must:

(A) attempt to notify the parent or guardian of a child who resides in the ICF-IID [ICF-MR] in writing of a periodic permanency planning meeting or annual service plan review and reauthorization meeting not later than the 21st day before the date the meeting is scheduled to be held; and

(B) request a response from the parent or guardian; and

(2) a nursing facility must:

(A) attempt to notify the parent or guardian of a child who resides in the facility in writing of an annual service plan review and reauthorization meeting not later than the 21st day before the date the meeting is scheduled to be held; and

(B) request a response from the parent or guardian.

(f) If an emergency situation involving a child residing in an ICF-IID [ICF-MR] or nursing facility occurs, the ICF-IID [ICF-MR] or nursing facility, as applicable, must:

(1) attempt to notify the child's parent or guardian as soon as possible; and

(2) request a response from the parent or guardian.

(g) If a child's parent or guardian does not respond to a notice under Subsection (e) or (f), the ICF-IID [ICF-MR] or nursing facility, as applicable, must attempt to locate the parent or guardian by contacting another person whose information was provided by the parent or guardian under Section 531.1533(1)(B).

(h) Not later than the 30th day after the date an ICF-IID [ICF-MR] or nursing facility determines that it is unable to locate a child's parent or guardian for participation in activities listed under Subsection (e)(1) or (2), the ICF-IID [ICF-MR] or nursing facility must notify the Department of Aging and Disability Services of that determination and request that the department initiate a search for the child's parent or guardian.

SECTION 2.170. Section 531.171, Government Code, is amended to read as follows:

Sec. 531.171. COMMITTEE DUTIES. (a) The standing or other committees of the house of representatives and the senate that have jurisdiction over the commission [Health and Human Services Commission] and other agencies relating to implementation of this chapter, as identified by the speaker of the house of representatives and the lieutenant governor, shall:

(1) monitor the commission's implementation of Section 531.0055 and the commission's other duties in consolidating and integrating health and human services to ensure implementation consistent with law;

(2) recommend, as needed, adjustments to the implementation of Section 531.0055 and the commission's other duties in consolidating and integrating health and human services; and

(3) review the rulemaking process used by the commission, including the commission's plan for obtaining public input.

(b) The commission shall provide copies of all required reports to the committees and shall provide the committees with copies of proposed rules before the rules are published in the Texas Register. At the request of a committee or the executive commissioner, a health and human services agency shall provide other information to the committee, including information relating to the health and human services system, and shall report on agency progress in implementing statutory directives identified by the committee and the directives of the commission.

SECTION 2.171. Section 531.191(a), Government Code, is amended to read as follows:

(a) The commission, subject to the approval of the governor and the Legislative Budget Board, shall develop and implement a plan for the integration of services and functions relating to eligibility determination and service delivery by health and human services agencies, the Texas Workforce Commission, and other agencies. The plan must include a reengineering of eligibility determination business processes, streamlined service delivery, a unified and integrated process for the transition from welfare to work, and improved access to benefits and services for clients. In developing and implementing the plan, the commission:

(1) shall give priority to the design and development of computer hardware and software for and provide technical support relating to the integrated eligibility determination system;

(2) shall consult with agencies whose programs are included in the plan, including the [Texas] Department of Aging and Disability [Human] Services, the Department of State Health Services [Texas Department of Health], and the Texas Workforce Commission;

(3) may contract for appropriate professional and technical assistance; and

(4) may use the staff and resources of agencies whose programs are included in the plan.

SECTION 2.172. Sections 531.251(a-1) and (a-2), Government Code, are amended to read as follows:

(a-1) The consortium must include:

(1) representatives of the Department of State Health Services, Department of Family and Protective Services, commission's [Health and Human Services Commission's] Medicaid program, Texas Education Agency, Texas Juvenile Justice Department, and Texas Correctional Office on Offenders with Medical or Mental Impairments; and

(2) one member who is:

(A) a youth or young adult who has a serious emotional disturbance and has received mental health services and supports; or

(B) [(3)] a family member of a youth or young adult described by Paragraph (A) [Subdivision (2)].

(a-2) The consortium may coordinate with the Children's Policy Council for the purposes of including the representation required by Subsection [Subsections] (a-1)(2) [and (3)].

SECTION 2.173. The heading to Subchapter H, Chapter 531, Government Code, is amended to read as follows:

SUBCHAPTER H. OFFICE OF HEALTH [EARLY CHILDHOOD] COORDINATION AND

CONSUMER SERVICES

SECTION 2.174. Section 531.281, Government Code, is amended to read as follows:

Sec. 531.281. DEFINITION [DEFINITIONS]. In this chapter, "office"[:

[(1) "Office"] means the Office of Health [Early Childhood] Coordination and Consumer Services.

[(2) "Advisory committee" means the Office of Early Childhood Coordination Advisory Committee.]

SECTION 2.175. Sections 531.282(a) and (b), Government Code, are amended to read as follows:

(a) The Office of Health [Early Childhood] Coordination and Consumer Services is an office within the commission.

(b) The executive commissioner shall employ staff as needed to carry out the duties of the office.

SECTION 2.176. Section 531.284(b), Government Code, is amended to read as follows:

(b) In developing the statewide strategic plan, the office shall:

(1) consider existing programs and models to serve children younger than six years of age, including:

(A) community resource coordination groups;

(B) the Texas System of Care [Integrated Funding Initiative];

(C) the Texas Information and Referral Network; and

(D) efforts to create a 2-1-1 telephone number for access to human services;

(2) attempt to maximize federal funds and local existing infrastructure and funds; and

(3) provide for local participation to the greatest extent possible.

SECTION 2.177. Section 531.285(a), Government Code, is amended to read as follows:

(a) The office shall identify:

(1) gaps in early childhood services by functional area and geographical area;

(2) state policies, rules, and service procedures that prevent or inhibit children younger than six years of age from accessing available services;

(3) sources of funds for early childhood services, including federal, state, and private-public ventures;

(4) opportunities for collaboration between the Texas Education Agency and health and human services agencies to better serve the needs of children younger than six years of age;

(5) methods for coordinating the provision of early childhood services provided by the Texas Head Start State [Start-State] Collaboration Office [Project], the Texas Education Agency, and the Texas Workforce Commission;

(6) quantifiable benchmarks for success within early childhood service delivery; and

(7) national best practices in early care and educational delivery models.

SECTION 2.178. Sections 531.301(a) and (b), Government Code, are amended to read as follows:

(a) The commission shall develop and implement a state prescription drug program that operates in the same manner as the vendor drug program operates in providing prescription drug benefits to Medicaid recipients [of medical assistance under Chapter 32, Human Resources Code].

(b) A person is eligible for prescription drug benefits under the state program if the person is:

(1) a qualified Medicare beneficiary, as defined by 42 U.S.C. Section 1396d(p)(1), as amended;

(2) a specified low-income Medicare beneficiary who is eligible for [medical] assistance under Medicaid for Medicare cost-sharing payments under 42 U.S.C. Section 1396a(a)(10)(E)(iii), as amended;

(3) a qualified disabled and working individual, as defined by 42 U.S.C. Section 1396d(s), as amended; or

(4) a qualifying individual who is eligible for that assistance under 42 U.S.C. Section 1396a(a)(10)(E)(iv) [1396a(a)(10)(E)(iv)(I), as amended; or

[(5) a qualifying individual who is eligible for that assistance under 42 U.S.C. Section 1396a(a)(10)(E)(iv)(II), as amended].

SECTION 2.179. Section 531.302, Government Code, is amended to read as follows:

Sec. 531.302. RULES. (a) The executive commissioner [commission] shall adopt all rules necessary for implementation of the state prescription drug program.

(b) In adopting rules for the state prescription drug program, the executive commissioner [commission] may:

(1) require a person who is eligible for prescription drug benefits to pay a cost-sharing payment;

(2) authorize the use of a prescription drug formulary to specify which prescription drugs the state program will cover;

(3) to the extent possible, require clinically appropriate prior authorization for prescription drug benefits in the same manner as prior authorization is required under the vendor drug program; and

(4) establish a drug utilization review program to ensure the appropriate use of prescription drugs under the state program.

(c) In adopting rules for the state prescription drug program, the executive commissioner [commission] shall consult with an advisory panel composed of an equal number of physicians, pharmacists, and pharmacologists appointed by the executive commissioner.

SECTION 2.180. Section 531.303, Government Code, is amended to read as follows:

Sec. 531.303. GENERIC EQUIVALENT AUTHORIZED. In adopting rules under the state program, the executive commissioner [commission] may require that, unless the practitioner's signature on a prescription clearly indicates that the prescription must be dispensed as written, the pharmacist may select a generic equivalent of the prescribed drug.

SECTION 2.181. Section 531.304, Government Code, is amended to read as follows:

Sec. 531.304. PROGRAM FUNDING PRIORITIES. If money available for the state prescription drug program is insufficient to provide prescription drug benefits to all persons who are eligible under Section 531.301(b), the commission shall limit the number of enrollees based on available funding and shall provide the prescription drug benefits to eligible persons in the following order of priority:

(1) persons eligible under Section 531.301(b)(1);

(2) persons eligible under Section 531.301(b)(2); and

(3) persons eligible under Sections 531.301(b)(3) and [,] (4)[, and (5)].

SECTION 2.182. Section 531.402(b), Government Code, is amended to read as follows:

(b) The council is composed of nine members of the public appointed by the governor with the advice and consent of the senate. To be eligible for appointment to the council, a person must have demonstrated an interest in and knowledge of problems and available services related to Medicaid, the child health plan program, the financial assistance program under Chapter 31, Human Resources Code, [the medical assistance program under Chapter 32, Human Resources Code,] or the supplemental nutrition assistance program [nutritional assistance programs] under Chapter 33, Human Resources Code.

SECTION 2.183. Sections 531.421(1), (2), and (3), Government Code, are amended to read as follows:

(1) "Children with severe emotional disturbances" includes:

(A) children who are at risk of incarceration or placement in a residential mental health facility;

(B) children for whom a court may appoint the Department of Family and Protective [and Regulatory] Services as managing conservator;

(C) children who are students in a special education program under Subchapter A, Chapter 29, Education Code; and

(D) children who have a substance abuse disorder or a developmental disability.

(2) "Community resource coordination group" means a coordination group established under a memorandum of understanding adopted under Section 531.055[, as added by Chapter 114, Acts of the 77th Legislature, Regular Session, 2001].

(3) "Consortium" means the Texas System of Care Consortium established under Subchapter G-1 [consortium that oversees the Texas Integrated Funding Initiative under Subchapter G, Chapter 531, as added by Chapter 446, Acts of the 76th Legislature, Regular Session, 1999].

SECTION 2.184. The heading to Section 531.423, Government Code, is amended to read as follows:

Sec. 531.423. SUMMARY REPORT BY [TEXAS INTEGRATED FUNDING INITIATIVE] CONSORTIUM.

SECTION 2.185. Section 531.423(c), Government Code, is amended to read as follows:

(c) The consortium may include in the report created under this section recommendations for the statewide expansion of sites participating in the Texas System of Care [Integrated Funding Initiative under Subchapter G, Chapter 531, as added by Chapter 446, Acts of the 76th Legislature, Regular Session, 1999,] and the integration of services provided at those sites with services provided by community resource coordination groups.

SECTION 2.186. Section 531.424, Government Code, is amended to read as follows:

Sec. 531.424. AGENCY IMPLEMENTATION OF RECOMMENDATIONS. As appropriate, the person or entity responsible for adopting rules for an [An] agency described by Section 531.423(a) shall[, as appropriate,] adopt rules, and the agency shall implement policy changes[,] and enter into memoranda of understanding with other agencies, to implement the recommendations in the report created under Section 531.423.

SECTION 2.187. Section 531.551(a), Government Code, is amended to read as follows:

(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 a [the] 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 [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.

SECTION 2.188. The heading to Section 531.652, Government Code, is amended to read as follows:

Sec. 531.652. OPERATION [ESTABLISHMENT] OF NURSE-FAMILY PARTNERSHIP COMPETITIVE GRANT PROGRAM.

SECTION 2.189. Section 531.652(a), Government Code, is amended to read as follows:

(a) The commission shall operate [establish] a nurse-family partnership competitive grant program through which the commission will award grants for the implementation of nurse-family partnership programs, or the expansion of existing programs, and for the operation of those programs for a period of not less than two years.

SECTION 2.190. Section 531.659(a), Government Code, is amended to read as follows:

(a) The commission, with the assistance of the Nurse-Family Partnership National Service Office, shall:

(1) adopt performance indicators that are designed to measure a grant recipient's performance with respect to the partnership program standards adopted by the executive commissioner [commission] under Section 531.656;

(2) use the performance indicators to continuously monitor and formally evaluate on an annual basis the performance of each grant recipient; and

(3) prepare and submit an annual report, not later than December 1 of each year, to the Senate Health and Human Services Committee, or its successor, and the House Human Services Committee, or its successor, regarding the performance of each grant recipient during the preceding state fiscal year with respect to providing partnership program services.

SECTION 2.191. Section 531.706(c), Government Code, is amended to read as follows:

(c) The advisory committee shall:

(1) develop strategies for implementing the regulation of health care interpreters and health care translators;

(2) make recommendations to the commission for any legislation necessary to establish and enforce qualifications for health care interpreters and health care translators or for the adoption of rules by or for state agencies regulating health care practitioners, hospitals, physician offices, and health care facilities that hire health care interpreters or health care translators; and

(3) perform other activities assigned by the commission related to health care interpreters or health care translators.

SECTION 2.192. Section 531.754, Government Code, is amended to read as follows:

Sec. 531.754. TRAINING PROGRAM. The commission shall develop and administer a training program for navigators. The program must include training on:

(1) how to complete an online application for public assistance benefits through the Texas Integrated Eligibility Redesign System (TIERS);

(2) the importance of maintaining the confidentiality of information handled by a navigator;

(3) the importance of obtaining and submitting complete and accurate information when completing an application for public assistance benefits online through the Texas Integrated Eligibility Redesign System (TIERS);

(4) the financial assistance program, the supplemental nutrition assistance program, Medicaid [the medical assistance program], the child health plan program, and any other public assistance benefits program for which an individual may complete an online application through the Texas Integrated Eligibility Redesign System (TIERS); and

(5) how an individual may apply for other public assistance benefits for which an individual may not complete an online application through the Texas Integrated Eligibility Redesign System (TIERS).

SECTION 2.193. Sections 531.802(c), (d), and (g), Government Code, are amended to read as follows:

(c) Subject to Subsection (d), the council is composed of the following:

(1) the executive commissioner;

(2) the commissioner of state health services;

(3) the commissioner of the Department of Family and Protective Services;

(4) the commissioner of aging and disability services;

(5) the commissioner of assistive and rehabilitative services;

(6) the commissioner of education;

(7) the executive director of the Texas Juvenile Justice Department [Probation Commission];

(8) [the executive commissioner of the Texas Youth Commission;

[(9)] the executive director of the Texas Workforce Commission;

(9) [(10)] the director of the Texas Correctional Office on Offenders with Medical or Mental Impairments;

(10) [(11)] two public representatives who are parents of children who have received services from an agency represented on the council, appointed by the executive commissioner; and

(11) [(12)] two representatives who are young adults or adolescents who have received services from an agency represented on the council, appointed by the executive commissioner.

(d) An individual listed in Subsections (c)(1)-(9) [(c)(1)-(10)] may designate another individual as having authority to act on behalf of the individual at council meetings and with respect to council functions.

(g) The council is administratively attached to the commission but is independent of direction by the commission or the executive commissioner. The commission, through the commission's Office of Health [Program] Coordination and Consumer Services [for Children and Youth], shall provide administrative support and resources to the council as necessary to enable the council to perform its duties.

SECTION 2.194. The heading to Subchapter U, Chapter 531, Government Code, is amended to read as follows:

SUBCHAPTER U. MORTALITY REVIEW FOR CERTAIN INDIVIDUALS WITH AN

INTELLECTUAL OR DEVELOPMENTAL DISABILITY [DISABILITIES]

SECTION 2.195. Section 531.8501, Government Code, is amended to read as follows:

Sec. 531.8501. DEFINITION. In this subchapter, "contracted organization" means an entity that contracts with the commission [Health and Human Services Commission] for the provision of services as described by Section 531.851(c).

SECTION 2.196. Sections 531.851(a), (c), and (e), Government Code, are amended to read as follows:

(a) The executive commissioner shall establish an independent mortality review system to review the death of a person with an intellectual or developmental disability who, at the time of the person's death or at any time during the 24-hour period before the person's death:

(1) resided in or received services from:

(A) an ICF-IID [intermediate care facility for persons with an intellectual or developmental disability (ICF/IID)] operated or licensed by the Department of Aging and Disability Services or a community center; or

(B) the ICF-IID [ICF/IID] component of the Rio Grande State Center; or

(2) received services through a Section 1915(c) waiver program for individuals who are eligible for ICF-IID [ICF/IID] services.

(c) The executive commissioner shall contract with an institution of higher education or a health care organization or association with experience in conducting research-based mortality studies to conduct independent mortality reviews of persons with an intellectual or developmental disability. The contract must require the contracted organization to form a review team consisting of:

(1) a physician with expertise regarding the medical treatment of individuals with an intellectual or developmental disability [disabilities];

(2) a registered nurse with expertise regarding the medical treatment of individuals with an intellectual or developmental disability [disabilities];

(3) a clinician or other professional with expertise in the delivery of services and supports for individuals with an intellectual or developmental disability [disabilities]; and

(4) any other appropriate person as provided by the executive commissioner.

(e) To ensure consistency across mortality review systems, a review under this section must collect information consistent with the information required to be collected by any other independent mortality review process established specifically for persons with an intellectual or developmental disability [disabilities].

SECTION 2.197. Section 531.854(a), Government Code, is amended to read as follows:

(a) The commission may use or publish information under this subchapter only to advance statewide practices regarding the treatment and care of individuals with an intellectual or [and] developmental disability [disabilities]. A summary of the data in the contracted organization's reports or a statistical compilation of data reports may be released by the commission for general publication if the summary or statistical compilation does not contain any information that would permit the identification of an individual or that is confidential or privileged under this subchapter or other state or federal law.

SECTION 2.198. Section 531.901(4), Government Code, is amended to read as follows:

(4) "Local or regional health information exchange" means a health information exchange operating in this state that securely exchanges electronic health information, including information for patients receiving services under the child health plan program or Medicaid [program], among hospitals, clinics, physicians' offices, and other health care providers that are not owned by a single entity or included in a single operational unit or network.

SECTION 2.199. Sections 531.903(a) and (c), Government Code, are amended to read as follows:

(a) The commission shall develop an electronic health information exchange system to improve the quality, safety, and efficiency of health care services provided under the child health plan program and Medicaid [programs]. In developing the system, the commission shall ensure that:

(1) the confidentiality of patients' health information is protected and the privacy of those patients is maintained in accordance with applicable federal and state law, including:

(A) Section 1902(a)(7), Social Security Act (42 U.S.C. Section 1396a(a)(7));

(B) the Health Insurance Portability and Accountability Act of 1996 (Pub. L. No. 104-191);

(C) Chapter 552 [, Government Code];

(D) Subchapter G, Chapter 241, Health and Safety Code;

(E) Section 12.003, Human Resources Code; and

(F) federal and state rules and regulations, including:

(i) 42 C.F.R. Part 431, Subpart F; and

(ii) 45 C.F.R. Part 164;

(2) appropriate information technology systems used by the commission and health and human services agencies are interoperable;

(3) the system and external information technology systems are interoperable in receiving and exchanging appropriate electronic health information as necessary to enhance:

(A) the comprehensive nature of the information contained in electronic health records; and

(B) health care provider efficiency by supporting integration of the information into the electronic health record used by health care providers;

(4) the system and other health information systems not described by Subdivision (3) and data warehousing initiatives are interoperable; and

(5) the system has the elements described by Subsection (b).

(c) The commission shall implement the health information exchange system in stages as described by this chapter [Sections 531.905 through 531.908], except that the commission may deviate from those stages if technological advances make a deviation advisable or more efficient.

SECTION 2.200. Section 531.904(b), Government Code, is amended to read as follows:

(b) The executive commissioner shall appoint to the advisory committee at least 12 and not more than 16 members who have an interest in health information technology and who have experience in serving persons receiving health care through the child health plan program and Medicaid [programs].

SECTION 2.201. Sections 531.906(a) and (d), Government Code, are amended to read as follows:

(a) In stage one of implementing the health information exchange system, the commission shall support and coordinate electronic prescribing tools used by health care providers and health care facilities under the child health plan program and Medicaid [programs].

(d) The commission shall apply for and actively pursue any waiver to the child health plan program or the state Medicaid plan from the federal Centers for Medicare and Medicaid Services or any other federal agency as necessary to remove an identified impediment to supporting and implementing electronic prescribing tools under this section, including the requirement for handwritten certification of certain drugs under 42 C.F.R. Section 447.512. If the commission, with assistance from the Legislative Budget Board, determines that the implementation of operational modifications in accordance with a waiver obtained as required by this subsection has resulted in cost increases in the child health plan program or Medicaid [program], the commission shall take the necessary actions to reverse the operational modifications.

SECTION 2.202. Section 531.907(a), Government Code, is amended to read as follows:

(a) Based on the recommendations of the advisory committee established under Section 531.904 and feedback provided by interested parties, the commission in stage two of implementing the health information exchange system may expand the system by:

(1) providing an electronic health record for each child enrolled in the child health plan program;

(2) including state laboratory results information in an electronic health record, including the results of newborn screenings and tests conducted under the Texas Health Steps program, based on the system developed for the health passport under Section 266.006, Family Code;

(3) improving data-gathering capabilities for an electronic health record so that the record may include basic health and clinical information in addition to available claims information, as determined by the executive commissioner;

(4) using evidence-based technology tools to create a unique health profile to alert health care providers regarding the need for additional care, education, counseling, or health management activities for specific patients; and

(5) continuing to enhance the electronic health record created for each Medicaid recipient [under Section 531.905] as technology becomes available and interoperability capabilities improve.

SECTION 2.203. Section 531.911, Government Code, is amended to read as follows:

Sec. 531.911. RULES. The executive commissioner may adopt rules to implement Sections 531.903 through 531.909 [531.910].

SECTION 2.204. Sections 531.912(a), (b), and (c), Government Code, are amended to read as follows:

(a) In this section, "nursing facility" means a convalescent or nursing home or related institution licensed under Chapter 242, Health and Safety Code, that provides long-term care services, as defined by Section 22.0011, Human Resources Code, to Medicaid [medical assistance] recipients.

(b) If feasible, the executive commissioner by rule may establish an incentive payment program for nursing facilities that choose to participate. The program must be designed to improve the quality of care and services provided to Medicaid [medical assistance] recipients. Subject to Subsection (f), the program may provide incentive payments in accordance with this section to encourage facilities to participate in the program.

(c) In establishing an incentive payment program under this section, the executive commissioner shall, subject to Subsection (d), adopt common performance measures to be used in evaluating nursing facilities that are related to structure, process, and outcomes that positively correlate to nursing facility quality and improvement. The common performance measures:

(1) must be:

(A) recognized by the executive commissioner as valid indicators of the overall quality of care received by Medicaid [medical assistance] recipients; and

(B) designed to encourage and reward evidence-based practices among nursing facilities; and

(2) may include measures of:

(A) quality of care, as determined by clinical performance ratings published by the federal Centers for Medicare and Medicaid Services, the Agency for Healthcare Research and Quality, or another federal agency;

(B) direct-care staff retention and turnover;

(C) recipient satisfaction, including the satisfaction of recipients who are short-term and long-term residents of facilities, and family satisfaction, as determined by the Nursing Home Consumer Assessment of Healthcare [Health] Providers and Systems surveys [survey] relied upon by the federal Centers for Medicare and Medicaid Services;

(D) employee satisfaction and engagement;

(E) the incidence of preventable acute care emergency room services use;

(F) regulatory compliance;

(G) level of person-centered care; and

(H) direct-care staff training, including a facility's utilization of independent distance learning programs for the continuous training of direct-care staff.

SECTION 2.205. The heading to Section 531.982, Government Code, is amended to read as follows:

Sec. 531.982. IMPLEMENTATION [ESTABLISHMENT] OF TEXAS HOME VISITING PROGRAM.

SECTION 2.206. Section 531.982(a), Government Code, is amended to read as follows:

(a) The commission shall maintain [create] a strategic plan to serve at-risk pregnant women and families with children under the age of six through home visiting programs that improve outcomes for parents and families.

SECTION 2.207. Section 531.988, Government Code, is amended to read as follows:

Sec. 531.988. RULES. The executive commissioner [commission] may adopt rules as necessary to implement this subchapter.

SECTION 2.208. The heading to Chapter 533, Government Code, is amended to read as follows:

CHAPTER 533. [IMPLEMENTATION OF] MEDICAID MANAGED CARE PROGRAM

SECTION 2.209. Sections 533.001(2) and (6), Government Code, are amended to read as follows:

(2) "Executive commissioner" ["Commissioner"] means the executive commissioner of the Health and Human Services Commission [health and human services].

(6) "Recipient" means a recipient of Medicaid [medical assistance under Chapter 32, Human Resources Code].

SECTION 2.210. Section 533.002, Government Code, is amended to read as follows:

Sec. 533.002. PURPOSE. The commission shall implement the Medicaid managed care program [as part of the health care delivery system developed under Chapter 532] by contracting with managed care organizations in a manner that, to the extent possible:

(1) improves the health of Texans by:

(A) emphasizing prevention;

(B) promoting continuity of care; and

(C) providing a medical home for recipients;

(2) ensures that each recipient receives high quality, comprehensive health care services in the recipient's local community;

(3) encourages the training of and access to primary care physicians and providers;

(4) maximizes cooperation with existing public health entities, including local departments of health;

(5) provides incentives to managed care organizations to improve the quality of health care services for recipients by providing value-added services; and

(6) reduces administrative and other nonfinancial barriers for recipients in obtaining health care services.

SECTION 2.211. Sections 533.0025(b), (c), (d), (e), (f), and (h), Government Code, are amended to read as follows:

(b) Except as otherwise provided by this section and notwithstanding any other law, the commission shall provide Medicaid [medical assistance for] acute care services through the most cost-effective model of Medicaid capitated managed care as determined by the commission. The commission shall require mandatory participation in a Medicaid capitated managed care program for all persons eligible for Medicaid acute care [medical assistance] benefits, but may implement alternative models or arrangements, including a traditional fee-for-service arrangement, if the commission determines the alternative would be more cost-effective or efficient.

(c) In determining whether a model or arrangement described by Subsection (b) is more cost-effective, the executive commissioner must consider:

(1) the scope, duration, and types of health benefits or services to be provided in a certain part of this state or to a certain population of recipients;

(2) administrative costs necessary to meet federal and state statutory and regulatory requirements;

(3) the anticipated effect of market competition associated with the configuration of Medicaid service delivery models determined by the commission; and

(4) the gain or loss to this state of a tax collected under Chapter 222, Insurance Code.

(d) If the commission determines that it is not more cost-effective to use a Medicaid managed care model to provide certain types of Medicaid [medical assistance for] acute care in a certain area or to certain [medical assistance] recipients as prescribed by this section, the commission shall provide Medicaid [medical assistance for] acute care through a traditional fee-for-service arrangement.

(e) The commission shall determine the most cost-effective alignment of managed care service delivery areas. The executive commissioner may consider the number of lives impacted, the usual source of health care services for residents in an area, and other factors that impact the delivery of health care services in the area.

(f) The commission shall:

(1) conduct a study to evaluate the feasibility of automatically enrolling applicants determined eligible for benefits under Medicaid [the medical assistance program] in a Medicaid managed care plan chosen by the applicant; and

(2) report the results of the study to the legislature not later than December 1, 2014.

(h) If the commission determines that it is feasible, the commission may, notwithstanding any other law, implement an automatic enrollment process under which applicants determined eligible for Medicaid [medical assistance] benefits are automatically enrolled in a Medicaid managed care plan chosen by the applicant. The commission may elect to implement the automatic enrollment process as to certain populations of recipients [under the medical assistance program].

SECTION 2.212. Section 533.00251(a)(3), Government Code, is amended to read as follows:

(3) "Nursing facility" means a convalescent or nursing home or related institution licensed under Chapter 242, Health and Safety Code, that provides long-term services and supports to [Medicaid] recipients.

SECTION 2.213. Sections 533.00251(b), (c), and (d), Government Code, are amended to read as follows:

(b) Subject to Section 533.0025, the commission shall expand the STAR + PLUS Medicaid managed care program to all areas of this state to serve individuals eligible for acute care services and long-term services and supports under Medicaid [the medical assistance program].

(c) Subject to Section 533.0025 and notwithstanding any other law, the commission, in consultation with the advisory committee, shall provide benefits under Medicaid [the medical assistance program] to recipients who reside in nursing facilities through the STAR + PLUS Medicaid managed care program. In implementing this subsection, the commission shall ensure:

(1) that the commission is responsible for setting the minimum reimbursement rate paid to a nursing facility under the managed care program, including the staff rate enhancement paid to a nursing facility that qualifies for the enhancement;

(2) that a nursing facility is paid not later than the 10th day after the date the facility submits a clean claim;

(3) the appropriate utilization of services consistent with criteria established [adopted] by the commission;

(4) a reduction in the incidence of potentially preventable events and unnecessary institutionalizations;

(5) that a managed care organization providing services under the managed care program provides discharge planning, transitional care, and other education programs to physicians and hospitals regarding all available long-term care settings;

(6) that a managed care organization providing services under the managed care program:

(A) assists in collecting applied income from recipients; and

(B) provides payment incentives to nursing facility providers that reward reductions in preventable acute care costs and encourage transformative efforts in the delivery of nursing facility services, including efforts to promote a resident-centered care culture through facility design and services provided;

(7) the establishment of a portal that is in compliance with state and federal regulations, including standard coding requirements, through which nursing facility providers participating in the STAR + PLUS Medicaid managed care program may submit claims to any participating managed care organization;

(8) that rules and procedures relating to the certification and decertification of nursing facility beds under Medicaid [the medical assistance program] are not affected; and

(9) that a managed care organization providing services under the managed care program, to the greatest extent possible, offers nursing facility providers access to:

(A) acute care professionals; and

(B) telemedicine, when feasible and in accordance with state law, including rules adopted by the Texas Medical Board.

(d) Subject to Subsection (e), the commission shall ensure that a nursing facility provider authorized to provide services under Medicaid [the medical assistance program] on September 1, 2013, is allowed to participate in the STAR + PLUS Medicaid managed care program through August 31, 2017.

SECTION 2.214. Section 533.002515(a), Government Code, is amended to read as follows:

(a) The commission shall develop a plan in preparation for implementing the requirement under Section 533.00251(c) that the commission provide benefits under Medicaid [the medical assistance program] to recipients who reside in nursing facilities through the STAR + PLUS Medicaid managed care program. The plan required by this section must be completed in two phases as follows:

(1) phase one: contract planning phase; and

(2) phase two: initial testing phase.

SECTION 2.215. Section 533.00252(a), Government Code, is amended to read as follows:

(a) The STAR + PLUS Nursing Facility Advisory Committee is established to advise the commission on the implementation of and other activities related to the provision of Medicaid [medical assistance] benefits to recipients who reside in nursing facilities through the STAR + PLUS Medicaid managed care program under Section 533.00251, including advising the commission regarding its duties with respect to:

(1) developing quality-based outcomes and process measures for long-term services and supports provided in nursing facilities;

(2) developing quality-based long-term care payment systems and quality initiatives for nursing facilities;

(3) transparency of information received from managed care organizations;

(4) the reporting of outcome and process measures;

(5) the sharing of data among health and human services agencies; and

(6) patient care coordination, quality of care improvement, and cost savings.

SECTION 2.216. Section 533.00253(a)(2), Government Code, is amended to read as follows:

(2) "Health home" means a primary care provider practice, or, if appropriate, a specialty care provider practice, incorporating several features, including comprehensive care coordination, family-centered care, and data management, that are focused on improving outcome-based quality of care and increasing patient and provider satisfaction under Medicaid [the medical assistance program].

SECTION 2.217. Sections 533.00253(b), (d), and (e), Government Code, are amended to read as follows:

(b) Subject to Section 533.0025, the commission shall, in consultation with the advisory committee and the Children's Policy Council established under Section 22.035, Human Resources Code, establish a mandatory STAR Kids capitated managed care program tailored to provide Medicaid [medical assistance] benefits to children with disabilities. The managed care program developed under this section must:

(1) provide Medicaid [medical assistance] benefits that are customized to meet the health care needs of recipients under the program through a defined system of care;

(2) better coordinate care of recipients under the program;

(3) improve the health outcomes of recipients;

(4) improve recipients' access to health care services;

(5) achieve cost containment and cost efficiency;

(6) reduce the administrative complexity of delivering Medicaid [medical assistance] benefits;

(7) reduce the incidence of unnecessary institutionalizations and potentially preventable events by ensuring the availability of appropriate services and care management;

(8) require a health home; and

(9) coordinate and collaborate with long-term care service providers and long-term care management providers, if recipients are receiving long-term services and supports outside of the managed care organization.

(d) The commission shall provide Medicaid [medical assistance] benefits through the STAR Kids managed care program established under this section to children who are receiving benefits under the medically dependent children (MDCP) waiver program. The commission shall ensure that the STAR Kids managed care program provides all of the benefits provided under the medically dependent children (MDCP) waiver program to the extent necessary to implement this subsection.

(e) The commission shall ensure that there is a plan for transitioning the provision of Medicaid [program] benefits to recipients 21 years of age or older from under the STAR Kids program to under the STAR + PLUS Medicaid managed care program that protects continuity of care. The plan must ensure that coordination between the programs begins when a recipient reaches 18 years of age.

SECTION 2.218. Section 533.0026(a), Government Code, is amended to read as follows:

(a) Notwithstanding any other law, the commission shall ensure that a managed care plan offered by a managed care organization that contracts with the commission under this chapter and any other Medicaid managed care model or arrangement implemented under this chapter allow a [Medicaid] recipient who receives services through the plan or other model or arrangement to, in the manner and to the extent required by Section 32.072, Human Resources Code:

(1) select an in-network ophthalmologist or therapeutic optometrist in the managed care network to provide eye health care services, other than surgery; and

(2) have direct access to the selected in-network ophthalmologist or therapeutic optometrist for the provision of the nonsurgical services.

SECTION 2.219. Section 533.0028, Government Code, is amended to read as follows:

Sec. 533.0028. EVALUATION OF CERTAIN STAR + PLUS MEDICAID MANAGED CARE PROGRAM SERVICES. The external quality review organization shall periodically conduct studies and surveys to assess the quality of care and satisfaction with health care services provided to enrollees in the STAR + PLUS Medicaid managed care program who are eligible to receive health care benefits under both [the] Medicaid and the Medicare program [programs].

SECTION 2.220. Section 533.00281(d), Government Code, is amended to read as follows:

(d) In conjunction with the commission's office of contract management, the commission shall provide a report to the standing committees of the senate and house of representatives with jurisdiction over [the] Medicaid [program] not later than December 1 of each year. The report must:

(1) summarize the results of the utilization reviews conducted under this section during the preceding fiscal year;

(2) provide analysis of errors committed by each reviewed managed care organization; and

(3) extrapolate those findings and make recommendations for improving the efficiency of the program.

SECTION 2.221. Section 533.003(b), Government Code, is amended to read as follows:

(b) The commission, in considering approval of a subcontract between a managed care organization and a pharmacy benefit manager for the provision of prescription drug benefits under [the] Medicaid [program], shall review and consider whether the pharmacy benefit manager has been in the preceding three years:

(1) convicted of an offense involving a material misrepresentation or an act of fraud or of another violation of state or federal criminal law;

(2) adjudicated to have committed a breach of contract; or

(3) assessed a penalty or fine in the amount of $500,000 or more in a state or federal administrative proceeding.

SECTION 2.222. Section 533.005(a), Government Code, is amended to read as follows:

(a) A contract between a managed care organization and the commission for the organization to provide health care services to recipients must contain:

(1) procedures to ensure accountability to the state for the provision of health care services, including procedures for financial reporting, quality assurance, utilization review, and assurance of contract and subcontract compliance;

(2) capitation rates that ensure the cost-effective provision of quality health care;

(3) a requirement that the managed care organization provide ready access to a person who assists recipients in resolving issues relating to enrollment, plan administration, education and training, access to services, and grievance procedures;

(4) a requirement that the managed care organization provide ready access to a person who assists providers in resolving issues relating to payment, plan administration, education and training, and grievance procedures;

(5) a requirement that the managed care organization provide information and referral about the availability of educational, social, and other community services that could benefit a recipient;

(6) procedures for recipient outreach and education;

(7) a requirement that the managed care organization make payment to a physician or provider for health care services rendered to a recipient under a managed care plan on any claim for payment that is received with documentation reasonably necessary for the managed care organization to process the claim:

(A) not later than:

(i) the 10th day after the date the claim is received if the claim relates to services provided by a nursing facility, intermediate care facility, or group home;

(ii) the 30th day after the date the claim is received if the claim relates to the provision of long-term services and supports not subject to Subparagraph (i); and

(iii) the 45th day after the date the claim is received if the claim is not subject to Subparagraph (i) or (ii); or

(B) within a period, not to exceed 60 days, specified by a written agreement between the physician or provider and the managed care organization;

(7-a) a requirement that the managed care organization demonstrate to the commission that the organization pays claims described by Subdivision (7)(A)(ii) on average not later than the 21st day after the date the claim is received by the organization;

(8) a requirement that the commission, on the date of a recipient's enrollment in a managed care plan issued by the managed care organization, inform the organization of the recipient's Medicaid certification date;

(9) a requirement that the managed care organization comply with Section 533.006 as a condition of contract retention and renewal;

(10) a requirement that the managed care organization provide the information required by Section 533.012 and otherwise comply and cooperate with the commission's office of inspector general and the office of the attorney general;

(11) a requirement that the managed care organization's usages of out-of-network providers or groups of out-of-network providers may not exceed limits for those usages relating to total inpatient admissions, total outpatient services, and emergency room admissions determined by the commission;

(12) if the commission finds that a managed care organization has violated Subdivision (11), a requirement that the managed care organization reimburse an out-of-network provider for health care services at a rate that is equal to the allowable rate for those services, as determined under Sections 32.028 and 32.0281, Human Resources Code;

(13) a requirement that, notwithstanding any other law, including Sections 843.312 and 1301.052, Insurance Code, the organization:

(A) use advanced practice registered nurses and physician assistants in addition to physicians as primary care providers to increase the availability of primary care providers in the organization's provider network; and

(B) treat advanced practice registered nurses and physician assistants in the same manner as primary care physicians with regard to:

(i) selection and assignment as primary care providers;

(ii) inclusion as primary care providers in the organization's provider network; and

(iii) inclusion as primary care providers in any provider network directory maintained by the organization;

(14) a requirement that the managed care organization reimburse a federally qualified health center or rural health clinic for health care services provided to a recipient outside of regular business hours, including on a weekend day or holiday, at a rate that is equal to the allowable rate for those services as determined under Section 32.028, Human Resources Code, if the recipient does not have a referral from the recipient's primary care physician;

(15) a requirement that the managed care organization develop, implement, and maintain a system for tracking and resolving all provider appeals related to claims payment, including a process that will require:

(A) a tracking mechanism to document the status and final disposition of each provider's claims payment appeal;

(B) the contracting with physicians who are not network providers and who are of the same or related specialty as the appealing physician to resolve claims disputes related to denial on the basis of medical necessity that remain unresolved subsequent to a provider appeal;

(C) the determination of the physician resolving the dispute to be binding on the managed care organization and provider; and

(D) the managed care organization to allow a provider with a claim that has not been paid before the time prescribed by Subdivision (7)(A)(ii) to initiate an appeal of that claim;

(16) a requirement that a medical director who is authorized to make medical necessity determinations is available to the region where the managed care organization provides health care services;

(17) a requirement that the managed care organization ensure that a medical director and patient care coordinators and provider and recipient support services personnel are located in the South Texas service region, if the managed care organization provides a managed care plan in that region;

(18) a requirement that the managed care organization provide special programs and materials for recipients with limited English proficiency or low literacy skills;

(19) a requirement that the managed care organization develop and establish a process for responding to provider appeals in the region where the organization provides health care services;

(20) a requirement that the managed care organization:

(A) develop and submit to the commission, before the organization begins to provide health care services to recipients, a comprehensive plan that describes how the organization's provider network will provide recipients sufficient access to:

(i) preventive care;

(ii) primary care;

(iii) specialty care;

(iv) after-hours urgent care;

(v) chronic care;

(vi) long-term services and supports;

(vii) nursing services; and

(viii) therapy services, including services provided in a clinical setting or in a home or community-based setting; and

(B) regularly, as determined by the commission, submit to the commission and make available to the public a report containing data on the sufficiency of the organization's provider network with regard to providing the care and services described under Paragraph (A) and specific data with respect to Paragraphs (A)(iii), (vi), (vii), and (viii) on the average length of time between:

(i) the date a provider makes a referral for the care or service and the date the organization approves or denies the referral; and

(ii) the date the organization approves a referral for the care or service and the date the care or service is initiated;

(21) a requirement that the managed care organization demonstrate to the commission, before the organization begins to provide health care services to recipients, that:

(A) the organization's provider network has the capacity to serve the number of recipients expected to enroll in a managed care plan offered by the organization;

(B) the organization's provider network includes:

(i) a sufficient number of primary care providers;

(ii) a sufficient variety of provider types;

(iii) a sufficient number of providers of long-term services and supports and specialty pediatric care providers of home and community-based services; and

(iv) providers located throughout the region where the organization will provide health care services; and

(C) health care services will be accessible to recipients through the organization's provider network to a comparable extent that health care services would be available to recipients under a fee-for-service or primary care case management model of Medicaid managed care;

(22) a requirement that the managed care organization develop a monitoring program for measuring the quality of the health care services provided by the organization's provider network that:

(A) incorporates the National Committee for Quality Assurance's Healthcare Effectiveness Data and Information Set (HEDIS) measures;

(B) focuses on measuring outcomes; and

(C) includes the collection and analysis of clinical data relating to prenatal care, preventive care, mental health care, and the treatment of acute and chronic health conditions and substance abuse;

(23) subject to Subsection (a-1), a requirement that the managed care organization develop, implement, and maintain an outpatient pharmacy benefit plan for its enrolled recipients:

(A) that exclusively employs the vendor drug program formulary and preserves the state's ability to reduce waste, fraud, and abuse under [the] Medicaid [program];

(B) that adheres to the applicable preferred drug list adopted by the commission under Section 531.072;

(C) that includes the prior authorization procedures and requirements prescribed by or implemented under Sections 531.073(b), (c), and (g) for the vendor drug program;

(D) for purposes of which the managed care organization:

(i) may not negotiate or collect rebates associated with pharmacy products on the vendor drug program formulary; and

(ii) may not receive drug rebate or pricing information that is confidential under Section 531.071;

(E) that complies with the prohibition under Section 531.089;

(F) under which the managed care organization may not prohibit, limit, or interfere with a recipient's selection of a pharmacy or pharmacist of the recipient's choice for the provision of pharmaceutical services under the plan through the imposition of different copayments;

(G) that allows the managed care organization or any subcontracted pharmacy benefit manager to contract with a pharmacist or pharmacy providers separately for specialty pharmacy services, except that:

(i) the managed care organization and pharmacy benefit manager are prohibited from allowing exclusive contracts with a specialty pharmacy owned wholly or partly by the pharmacy benefit manager responsible for the administration of the pharmacy benefit program; and

(ii) the managed care organization and pharmacy benefit manager must adopt policies and procedures for reclassifying prescription drugs from retail to specialty drugs, and those policies and procedures must be consistent with rules adopted by the executive commissioner and include notice to network pharmacy providers from the managed care organization;

(H) under which the managed care organization may not prevent a pharmacy or pharmacist from participating as a provider if the pharmacy or pharmacist agrees to comply with the financial terms and conditions of the contract as well as other reasonable administrative and professional terms and conditions of the contract;

(I) under which the managed care organization may include mail-order pharmacies in its networks, but may not require enrolled recipients to use those pharmacies, and may not charge an enrolled recipient who opts to use this service a fee, including postage and handling fees;

(J) under which the managed care organization or pharmacy benefit manager, as applicable, must pay claims in accordance with Section 843.339, Insurance Code; and

(K) under which the managed care organization or pharmacy benefit manager, as applicable:

(i) to place a drug on a maximum allowable cost list, must ensure that:

(a) the drug is listed as "A" or "B" rated in the most recent version of the United States Food and Drug Administration's Approved Drug Products with Therapeutic Equivalence Evaluations, also known as the Orange Book, has an "NR" or "NA" rating or a similar rating by a nationally recognized reference; and

(b) the drug is generally available for purchase by pharmacies in the state from national or regional wholesalers and is not obsolete;

(ii) must provide to a network pharmacy provider, at the time a contract is entered into or renewed with the network pharmacy provider, the sources used to determine the maximum allowable cost pricing for the maximum allowable cost list specific to that provider;

(iii) must review and update maximum allowable cost price information at least once every seven days to reflect any modification of maximum allowable cost pricing;

(iv) must, in formulating the maximum allowable cost price for a drug, use only the price of the drug and drugs listed as therapeutically equivalent in the most recent version of the United States Food and Drug Administration's Approved Drug Products with Therapeutic Equivalence Evaluations, also known as the Orange Book;

(v) must establish a process for eliminating products from the maximum allowable cost list or modifying maximum allowable cost prices in a timely manner to remain consistent with pricing changes and product availability in the marketplace;

(vi) must:

(a) provide a procedure under which a network pharmacy provider may challenge a listed maximum allowable cost price for a drug;

(b) respond to a challenge not later than the 15th day after the date the challenge is made;

(c) if the challenge is successful, make an adjustment in the drug price effective on the date the challenge is resolved, and make the adjustment applicable to all similarly situated network pharmacy providers, as determined by the managed care organization or pharmacy benefit manager, as appropriate;

(d) if the challenge is denied, provide the reason for the denial; and

(e) report to the commission every 90 days the total number of challenges that were made and denied in the preceding 90-day period for each maximum allowable cost list drug for which a challenge was denied during the period;

(vii) must notify the commission not later than the 21st day after implementing a practice of using a maximum allowable cost list for drugs dispensed at retail but not by mail; and

(viii) must provide a process for each of its network pharmacy providers to readily access the maximum allowable cost list specific to that provider;

(24) a requirement that the managed care organization and any entity with which the managed care organization contracts for the performance of services under a managed care plan disclose, at no cost, to the commission and, on request, the office of the attorney general all discounts, incentives, rebates, fees, free goods, bundling arrangements, and other agreements affecting the net cost of goods or services provided under the plan; and

(25) a requirement that the managed care organization not implement significant, nonnegotiated, across-the-board provider reimbursement rate reductions unless:

(A) subject to Subsection (a-3), the organization has the prior approval of the commission to make the reduction; or

(B) the rate reductions are based on changes to the Medicaid fee schedule or cost containment initiatives implemented by the commission.

SECTION 2.223. Section 533.0051(d), Government Code, is amended to read as follows:

(d) Subject to Subsection (f), the commission shall assess the feasibility and cost-effectiveness of including provisions in a contract described by Subsection (a) that require the health maintenance organization to provide to the providers in the organization's provider network pay-for-performance opportunities that support quality improvements in the care of [Medicaid] recipients. Pay-for-performance opportunities may include incentives for providers to provide care after normal business hours and to participate in the early and periodic screening, diagnosis, and treatment program and other activities that improve [Medicaid] recipients' access to care. If the commission determines that the provisions are feasible and may be cost-effective, the commission shall develop and implement a pilot program in at least one health care service region under which the commission will include the provisions in contracts with health maintenance organizations offering managed care plans in the region.

SECTION 2.224. Section 533.0055(b), Government Code, is amended to read as follows:

(b) The provider protection plan required under this section must provide for:

(1) prompt payment and proper reimbursement of providers by managed care organizations;

(2) prompt and accurate adjudication of claims through:

(A) provider education on the proper submission of clean claims and on appeals;

(B) acceptance of uniform forms, including HCFA Forms 1500 and UB-92 and subsequent versions of those forms, through an electronic portal; and

(C) the establishment of standards for claims payments in accordance with a provider's contract;

(3) adequate and clearly defined provider network standards that are specific to provider type, including physicians, general acute care facilities, and other provider types defined in the commission's network adequacy standards in effect on January 1, 2013, and that ensure choice among multiple providers to the greatest extent possible;

(4) a prompt credentialing process for providers;

(5) uniform efficiency standards and requirements for managed care organizations for the submission and tracking of preauthorization requests for services provided under [the] Medicaid [program];

(6) establishment of an electronic process, including the use of an Internet portal, through which providers in any managed care organization's provider network may:

(A) submit electronic claims, prior authorization requests, claims appeals and reconsiderations, clinical data, and other documentation that the managed care organization requests for prior authorization and claims processing; and

(B) obtain electronic remittance advice, explanation of benefits statements, and other standardized reports;

(7) the measurement of the rates of retention by managed care organizations of significant traditional providers;

(8) the creation of a work group to review and make recommendations to the commission concerning any requirement under this subsection for which immediate implementation is not feasible at the time the plan is otherwise implemented, including the required process for submission and acceptance of attachments for claims processing and prior authorization requests through an electronic process under Subdivision (6) and, for any requirement that is not implemented immediately, recommendations regarding the expected:

(A) fiscal impact of implementing the requirement; and

(B) timeline for implementation of the requirement; and

(9) any other provision that the commission determines will ensure efficiency or reduce administrative burdens on providers participating in a Medicaid managed care model or arrangement.

SECTION 2.225. Section 533.006, Government Code, is amended to read as follows:

Sec. 533.006. PROVIDER NETWORKS. (a) The commission shall require that each managed care organization that contracts with the commission to provide health care services to recipients in a region:

(1) seek participation in the organization's provider network from:

(A) each health care provider in the region who has traditionally provided care to [Medicaid] recipients;

(B) each hospital in the region that has been designated as a disproportionate share hospital under [the state] Medicaid [program]; and

(C) each specialized pediatric laboratory in the region, including those laboratories located in children's hospitals; and

(2) include in its provider network for not less than three years:

(A) each health care provider in the region who:

(i) previously provided care to Medicaid and charity care recipients at a significant level as prescribed by the commission;

(ii) agrees to accept the prevailing provider contract rate of the managed care organization; and

(iii) has the credentials required by the managed care organization, provided that lack of board certification or accreditation by The [the] Joint Commission [on Accreditation of Healthcare Organizations] may not be the sole ground for exclusion from the provider network;

(B) each accredited primary care residency program in the region; and

(C) each disproportionate share hospital designated by the commission as a statewide significant traditional provider.

(b) A contract between a managed care organization and the commission for the organization to provide health care services to recipients in a health care service region that includes a rural area must require that the organization include in its provider network rural hospitals, physicians, home and community support services agencies, and other rural health care providers who:

(1) are sole community providers;

(2) provide care to Medicaid and charity care recipients at a significant level as prescribed by the commission;

(3) agree to accept the prevailing provider contract rate of the managed care organization; and

(4) have the credentials required by the managed care organization, provided that lack of board certification or accreditation by The [the] Joint Commission [on Accreditation of Healthcare Organizations] may not be the sole ground for exclusion from the provider network.

SECTION 2.226. Sections 533.007(b), (d), and (e), Government Code, are amended to read as follows:

(b) Each managed care organization that contracts with the commission to provide health care services to recipients in a health care service region shall submit an implementation plan not later than the 90th day before the date on which the managed care organization [commission] plans to begin to provide health care services to recipients in that region through managed care. The implementation plan must include:

(1) specific staffing patterns by function for all operations, including enrollment, information systems, member services, quality improvement, claims management, case management, and provider and recipient training; and

(2) specific time frames for demonstrating preparedness for implementation before the date on which the managed care organization [commission] plans to begin to provide health care services to recipients in that region through managed care.

(d) Each managed care organization that contracts with the commission to provide health care services to recipients in a region shall submit status reports on the implementation plan not later than the 60th day and the 30th day before the date on which the managed care organization [commission] plans to begin to provide health care services to recipients in that region through managed care and every 30th day after that date until the 180th day after that date.

(e) The commission shall conduct a compliance and readiness review of each managed care organization that contracts with the commission not later than the 15th day before the date on which the process of enrolling recipients in a managed care plan issued by the managed care organization is to begin [commission plans to begin the enrollment process] in a region and again not later than the 15th day before the date on which the managed care organization [commission] plans to begin to provide health care services to recipients in that region through managed care. The review must include an on-site inspection and tests of service authorization and claims payment systems, including the ability of the managed care organization to process claims electronically, complaint processing systems, and any other process or system required by the contract.

SECTION 2.227. Section 533.0075, Government Code, is amended to read as follows:

Sec. 533.0075. RECIPIENT ENROLLMENT. The commission shall:

(1) encourage recipients to choose appropriate managed care plans and primary health care providers by:

(A) providing initial information to recipients and providers in a region about the need for recipients to choose plans and providers not later than the 90th day before the date on which a managed care organization [the commission] plans to begin to provide health care services to recipients in that region through managed care;

(B) providing follow-up information before assignment of plans and providers and after assignment, if necessary, to recipients who delay in choosing plans and providers; and

(C) allowing plans and providers to provide information to recipients or engage in marketing activities under marketing guidelines established by the commission under Section 533.008 after the commission approves the information or activities;

(2) consider the following factors in assigning managed care plans and primary health care providers to recipients who fail to choose plans and providers:

(A) the importance of maintaining existing provider-patient and physician-patient relationships, including relationships with specialists, public health clinics, and community health centers;

(B) to the extent possible, the need to assign family members to the same providers and plans; and

(C) geographic convenience of plans and providers for recipients;

(3) retain responsibility for enrollment and disenrollment of recipients in managed care plans, except that the commission may delegate the responsibility to an independent contractor who receives no form of payment from, and has no financial ties to, any managed care organization;

(4) develop and implement an expedited process for determining eligibility for and enrolling pregnant women and newborn infants in managed care plans; and

(5) ensure immediate access to prenatal services and newborn care for pregnant women and newborn infants enrolled in managed care plans, including ensuring that a pregnant woman may obtain an appointment with an obstetrical care provider for an initial maternity evaluation not later than the 30th day after the date the woman applies for Medicaid.

SECTION 2.228. Section 533.009(c), Government Code, is amended to read as follows:

(c) The executive commissioner, by rule, shall prescribe the minimum requirements that a managed care organization, in providing a disease management program, must meet to be eligible to receive a contract under this section. The managed care organization must, at a minimum, be required to:

(1) provide disease management services that have performance measures for particular diseases that are comparable to the relevant performance measures applicable to a provider of disease management services under Section 32.057 [32.059], Human Resources Code[, as added by Chapter 208, Acts of the 78th Legislature, Regular Session, 2003]; and

(2) show evidence of ability to manage complex diseases in the Medicaid population.

SECTION 2.229. Section 533.012(c), Government Code, is amended to read as follows:

(c) The commission's office of inspector general [investigations and enforcement] or the office of the attorney general, as applicable, shall review the information submitted under this section as appropriate in the investigation of fraud in the Medicaid managed care program.

SECTION 2.230. Sections 533.013(a) and (b), Government Code, are amended to read as follows:

(a) In determining premium payment rates paid to a managed care organization under a managed care plan, the commission shall consider:

(1) the regional variation in costs of health care services;

(2) the range and type of health care services to be covered by premium payment rates;

(3) the number of managed care plans in a region;

(4) the current and projected number of recipients in each region, including the current and projected number for each category of recipient;

(5) the ability of the managed care plan to meet costs of operation under the proposed premium payment rates;

(6) the applicable requirements of the federal Balanced Budget Act of 1997 and implementing regulations that require adequacy of premium payments to managed care organizations participating in [the state] Medicaid [program];

(7) the adequacy of the management fee paid for assisting enrollees of Supplemental Security Income (SSI) (42 U.S.C. Section 1381 et seq.) who are voluntarily enrolled in the managed care plan;

(8) the impact of reducing premium payment rates for the category of recipients who are pregnant; and

(9) the ability of the managed care plan to pay under the proposed premium payment rates inpatient and outpatient hospital provider payment rates that are comparable to the inpatient and outpatient hospital provider payment rates paid by the commission under a primary care case management model or a partially capitated model.

(b) In determining the maximum premium payment rates paid to a managed care organization that is licensed under Chapter 843, Insurance Code, the commission shall consider and adjust for the regional variation in costs of services under the traditional fee-for-service component of [the state] Medicaid [program], utilization patterns, and other factors that influence the potential for cost savings. For a service area with a service area factor of .93 or less, or another appropriate service area factor, as determined by the commission, the commission may not discount premium payment rates in an amount that is more than the amount necessary to meet federal budget neutrality requirements for projected fee-for-service costs unless:

(1) a historical review of managed care financial results among managed care organizations in the service area served by the organization demonstrates that additional savings are warranted;

(2) a review of Medicaid fee-for-service delivery in the service area served by the organization has historically shown a significant overutilization by recipients of certain services covered by the premium payment rates in comparison to utilization patterns throughout the rest of the state; or

(3) a review of Medicaid fee-for-service delivery in the service area served by the organization has historically shown an above-market cost for services for which there is substantial evidence that Medicaid managed care delivery will reduce the cost of those services.

SECTION 2.231. Section 533.01315(a), Government Code, is amended to read as follows:

(a) This section applies only to a recipient receiving benefits [medical assistance] through any Medicaid managed care model or arrangement.

SECTION 2.232. Sections 533.014(a) and (b), Government Code, are amended to read as follows:

(a) The executive commissioner [commission] shall adopt rules regarding the sharing of profits earned by a managed care organization through a managed care plan providing health care services under a contract with the commission under this chapter.

(b) Except as provided by Subsection (c), any amount received by the state under this section shall be deposited in the general revenue fund [for the purpose of funding the state Medicaid program].

SECTION 2.233. Section 533.015, Government Code, is amended to read as follows:

Sec. 533.015. COORDINATION OF EXTERNAL OVERSIGHT ACTIVITIES. To the extent possible, the commission shall coordinate all external oversight activities to minimize duplication of oversight of managed care plans under [the state] Medicaid [program] and disruption of operations under those plans.

SECTION 2.234. Section 533.020(a), Government Code, is amended to read as follows:

(a) The Texas Department of Insurance, in conjunction with the commission, shall establish fiscal solvency standards and complaint system guidelines for managed care organizations that serve [Medicaid] recipients.

SECTION 2.235. Section 533.021, Government Code, is amended to read as follows:

Sec. 533.021. MEDICAID MANAGED CARE ADVISORY COMMITTEES [APPOINTMENT]. A [Not later than the 180th day before the date the commission plans to begin to provide health care services to recipients in a health care service region through managed care, the commission, in consultation with health and human services agencies, shall appoint a] Medicaid managed care advisory committee exists for each health care service [for that] region. The commission, in consultation with health and human services agencies, appoints the committee members.

SECTION 2.236. Section 533.023, Government Code, is amended to read as follows:

Sec. 533.023. PRESIDING OFFICER; SUBCOMMITTEES. The executive commissioner or the executive commissioner's designated representative serves as the presiding officer of a committee. The presiding officer may appoint subcommittees as necessary.

SECTION 2.237. Section 533.028, Government Code, is amended to read as follows:

Sec. 533.028. OTHER LAW. Except as provided by this chapter, a committee is subject to Chapter 2110 [Article 6252-33, Revised Statutes].

SECTION 2.238. Sections 533.041(a) and (d), Government Code, are amended to read as follows:

(a) The executive commissioner shall appoint a state Medicaid managed care advisory committee. The advisory committee consists of representatives of:

(1) hospitals;

(2) managed care organizations and participating health care providers;

(3) primary care providers and specialty care providers;

(4) state agencies;

(5) low-income recipients or consumer advocates representing low-income recipients;

(6) recipients with disabilities, including recipients with an intellectual or [and] developmental disability [disabilities] or with physical disabilities, or consumer advocates representing those recipients;

(7) parents of children who are recipients;

(8) rural providers;

(9) advocates for children with special health care needs;

(10) pediatric health care providers, including specialty providers;

(11) long-term services and supports providers, including nursing facility providers and direct service workers;

(12) obstetrical care providers;

(13) community-based organizations serving low-income children and their families;

(14) community-based organizations engaged in perinatal services and outreach;

(15) recipients who are 65 years of age or older;

(16) recipients with mental illness;

(17) nonphysician mental health providers participating in the Medicaid managed care program; and

(18) entities with responsibilities for the delivery of long-term services and supports or other Medicaid [program] service delivery, including:

(A) independent living centers;

(B) area agencies on aging;

(C) aging and disability resource centers established under the Aging and Disability Resource Center initiative funded in part by the federal Administration on Aging and the Centers for Medicare and Medicaid Services;

(D) community mental health and intellectual disability centers; and

(E) the NorthSTAR Behavioral Health Program provided under Chapter 534, Health and Safety Code.

(d) To the greatest extent possible, the executive commissioner shall appoint members of the advisory committee who reflect the geographic diversity of the state and include members who represent rural [Medicaid program] recipients.

SECTION 2.239. Section 533.045(b), Government Code, is amended to read as follows:

(b) A member of the advisory committee who is a [Medicaid program] recipient or the relative of a [Medicaid program] recipient is entitled to a per diem allowance and reimbursement at rates established in the General Appropriations Act.

SECTION 2.240. The heading to Chapter 534, Government Code, is amended to read as follows:

CHAPTER 534. SYSTEM REDESIGN FOR DELIVERY OF MEDICAID ACUTE CARE

SERVICES AND LONG-TERM SERVICES AND SUPPORTS TO PERSONS WITH AN

INTELLECTUAL OR [AND] DEVELOPMENTAL DISABILITY [DISABILITIES]

SECTION 2.241. Sections 534.001(6), (7), (8), and (11), Government Code, are amended to read as follows:

(6) "ICF-IID" means the [Medicaid] program under Medicaid serving individuals with an intellectual or [and] developmental disability [disabilities] who receive care in intermediate care facilities other than a state supported living center.

(7) "ICF-IID program" means a program under [the] Medicaid [program] serving individuals with an intellectual or [and] developmental disability [disabilities] who reside in and receive care from:

(A) intermediate care facilities licensed under Chapter 252, Health and Safety Code; or

(B) community-based intermediate care facilities operated by local intellectual and developmental disability authorities.

(8) "Local intellectual and developmental disability authority" has the meaning assigned [means an authority defined] by Section 531.002 [Section 531.002(11)], Health and Safety Code.

(11) "Medicaid waiver program" means only the following programs that are authorized under Section 1915(c) of the federal Social Security Act (42 U.S.C. Section 1396n(c)) for the provision of services to persons with an intellectual or [and] developmental disability [disabilities]:

(A) the community living assistance and support services (CLASS) waiver program;

(B) the home and community-based services (HCS) waiver program;

(C) the deaf-blind with multiple disabilities (DBMD) waiver program; and

(D) the Texas home living (TxHmL) waiver program.

SECTION 2.242. Section 534.051, Government Code, is amended to read as follows:

Sec. 534.051. ACUTE CARE SERVICES AND LONG-TERM SERVICES AND SUPPORTS SYSTEM FOR INDIVIDUALS WITH AN INTELLECTUAL OR [AND] DEVELOPMENTAL DISABILITY [DISABILITIES]. In accordance with this chapter, the commission and the department shall jointly design and implement an acute care services and long-term services and supports system for individuals with an intellectual or [and] developmental disability [disabilities] that supports the following goals:

(1) provide Medicaid services to more individuals in a cost-efficient manner by providing the type and amount of services most appropriate to the individuals' needs;

(2) improve individuals' access to services and supports by ensuring that the individuals receive information about all available programs and services, including employment and least restrictive housing assistance, and how to apply for the programs and services;

(3) improve the assessment of individuals' needs and available supports, including the assessment of individuals' functional needs;

(4) promote person-centered planning, self-direction, self-determination, community inclusion, and customized, integrated, competitive employment;

(5) promote individualized budgeting based on an assessment of an individual's needs and person-centered planning;

(6) promote integrated service coordination of acute care services and long-term services and supports;

(7) improve acute care and long-term services and supports outcomes, including reducing unnecessary institutionalization and potentially preventable events;

(8) promote high-quality care;

(9) provide fair hearing and appeals processes in accordance with applicable federal law;

(10) ensure the availability of a local safety net provider and local safety net services;

(11) promote independent service coordination and independent ombudsmen services; and

(12) ensure that individuals with the most significant needs are appropriately served in the community and that processes are in place to prevent inappropriate institutionalization of individuals.

SECTION 2.243. Section 534.052, Government Code, is amended to read as follows:

Sec. 534.052. IMPLEMENTATION OF SYSTEM REDESIGN. The commission and department shall, in consultation with the advisory committee, jointly implement the acute care services and long-term services and supports system for individuals with an intellectual or [and] developmental disability [disabilities] in the manner and in the stages described in this chapter.

SECTION 2.244. Sections 534.053(a), (b), and (e), Government Code, are amended to read as follows:

(a) The Intellectual and Developmental Disability System Redesign Advisory Committee shall [is established to] advise the commission and the department on the implementation of the acute care services and long-term services and supports system redesign under this chapter. Subject to Subsection (b), the executive commissioner and the commissioner of aging and disability services [the department] shall jointly appoint members of the advisory committee who are stakeholders from the intellectual and developmental disabilities community, including:

(1) individuals with an intellectual or [and] developmental disability [disabilities] who are recipients of services under the Medicaid waiver programs, individuals with an intellectual or [and] developmental disability [disabilities] who are recipients of services under the ICF-IID program, and individuals who are advocates of those recipients, including at least three representatives from intellectual and developmental disability advocacy organizations;

(2) representatives of Medicaid managed care and nonmanaged care health care providers, including:

(A) physicians who are primary care providers and physicians who are specialty care providers;

(B) nonphysician mental health professionals; and

(C) providers of long-term services and supports, including direct service workers;

(3) representatives of entities with responsibilities for the delivery of Medicaid long-term services and supports or other Medicaid [program] service delivery, including:

(A) representatives of aging and disability resource centers established under the Aging and Disability Resource Center initiative funded in part by the federal Administration on Aging and the Centers for Medicare and Medicaid Services;

(B) representatives of community mental health and intellectual disability centers;

(C) representatives of and service coordinators or case managers from private and public home and community-based services providers that serve individuals with an intellectual or [and] developmental disability [disabilities]; and

(D) representatives of private and public ICF-IID providers; and

(4) representatives of managed care organizations contracting with the state to provide services to individuals with an intellectual or [and] developmental disability [disabilities].

(b) To the greatest extent possible, the executive commissioner and the commissioner of aging and disability services [the department] shall appoint members of the advisory committee who reflect the geographic diversity of the state and include members who represent rural Medicaid [program] recipients.

(e) A member of the advisory committee serves without compensation. A member of the advisory committee who is a Medicaid [program] recipient or the relative of a Medicaid [program] recipient is entitled to a per diem allowance and reimbursement at rates established in the General Appropriations Act.

SECTION 2.245. Section 534.054(a), Government Code, is amended to read as follows:

(a) Not later than September 30 of each year, the commission shall submit a report to the legislature regarding:

(1) the implementation of the system required by this chapter, including appropriate information regarding the provision of acute care services and long-term services and supports to individuals with an intellectual or [and] developmental disability [disabilities] under [the] Medicaid [program]; and

(2) recommendations, including recommendations regarding appropriate statutory changes to facilitate the implementation.

SECTION 2.246. Section 534.055(a), Government Code, is amended to read as follows:

(a) The commission and department shall submit a report to the legislature not later than December 1, 2014, that includes the following information:

(1) the percentage of services provided by each local intellectual and developmental disability authority to individuals receiving ICF-IID or Medicaid waiver program services, compared to the percentage of those services provided by private providers;

(2) the types of evidence provided by local intellectual and developmental disability authorities to the department to demonstrate the lack of available private providers in areas of the state where local authorities provide services to more than 40 percent of the Texas home living (TxHmL) waiver program clients or 20 percent of the home and community-based services (HCS) waiver program clients;

(3) the types and amounts of services received by clients from local intellectual and developmental disability authorities compared to the types and amounts of services received by clients from private providers;

(4) the provider capacity of each local intellectual and developmental disability authority as determined under Section 533A.0355(d) [Section 533.0355(d)], Health and Safety Code;

(5) the number of individuals served above or below the applicable provider capacity by each local intellectual and developmental disability authority; and

(6) if a local intellectual and developmental disability authority is serving clients over the authority's provider capacity, the length of time the local authority has served clients above the authority's approved provider capacity.

SECTION 2.247. Section 534.101(2), Government Code, is amended to read as follows:

(2) "Provider" means a person with whom the commission contracts for the provision of long-term services and supports under [the] Medicaid [program] to a specific population based on capitation.

SECTION 2.248. Section 534.102, Government Code, is amended to read as follows:

Sec. 534.102. PILOT PROGRAMS TO TEST MANAGED CARE STRATEGIES BASED ON CAPITATION. The commission and the department may develop and implement pilot programs in accordance with this subchapter to test one or more service delivery models involving a managed care strategy based on capitation to deliver long-term services and supports under [the] Medicaid [program] to individuals with an intellectual or [and] developmental disability [disabilities].

SECTION 2.249. Sections 534.104(a) and (f), Government Code, are amended to read as follows:

(a) The department shall identify private services providers that are good candidates to develop a service delivery model involving a managed care strategy based on capitation and to test the model in the provision of long-term services and supports under [the] Medicaid [program] to individuals with an intellectual or [and] developmental disability [disabilities] through a pilot program established under this subchapter.

(f) For each pilot program service provider, the department shall develop and implement a pilot program. Under a pilot program, the pilot program service provider shall provide long-term services and supports under [the] Medicaid [program] to persons with an intellectual or [and] developmental disability [disabilities] to test its managed care strategy based on capitation.

SECTION 2.250. Section 534.107, Government Code, is amended to read as follows:

Sec. 534.107. COORDINATING SERVICES. In providing long-term services and supports under [the] Medicaid [program] to individuals with an intellectual or [and] developmental disability [disabilities], a pilot program service provider shall:

(1) coordinate through the pilot program institutional and community-based services available to the individuals, including services provided through:

(A) a facility licensed under Chapter 252, Health and Safety Code;

(B) a Medicaid waiver program; or

(C) a community-based ICF-IID operated by local authorities;

(2) collaborate with managed care organizations to provide integrated coordination of acute care services and long-term services and supports, including discharge planning from acute care services to community-based long-term services and supports;

(3) have a process for preventing inappropriate institutionalizations of individuals; and

(4) accept the risk of inappropriate institutionalizations of individuals previously residing in community settings.

SECTION 2.251. Section 534.109, Government Code, is amended to read as follows:

Sec. 534.109. PERSON-CENTERED PLANNING. The commission, in cooperation with the department, shall ensure that each individual with an intellectual or developmental disability who receives services and supports under [the] Medicaid [program] through a pilot program established under this subchapter, or the individual's legally authorized representative, has access to a facilitated, person-centered plan that identifies outcomes for the individual and drives the development of the individualized budget. The consumer direction model, as defined by Section 531.051, may be an outcome of the plan.

SECTION 2.252. Section 534.110, Government Code, is amended to read as follows:

Sec. 534.110. TRANSITION BETWEEN PROGRAMS. The commission shall ensure that there is a comprehensive plan for transitioning the provision of Medicaid [program] benefits between a Medicaid waiver program or an ICF-IID program and a pilot program under this subchapter to protect continuity of care.

SECTION 2.253. Section 534.151, Government Code, is amended to read as follows:

Sec. 534.151. DELIVERY OF ACUTE CARE SERVICES FOR INDIVIDUALS WITH AN INTELLECTUAL OR [AND] DEVELOPMENTAL DISABILITY [DISABILITIES]. Subject to Section 533.0025, the commission shall provide acute care Medicaid [program] benefits to individuals with an intellectual or [and] developmental disability [disabilities] through the STAR + PLUS Medicaid managed care program or the most appropriate integrated capitated managed care program delivery model and monitor the provision of those benefits.

SECTION 2.254. Sections 534.152(a), (b), (c), (e), and (f), Government Code, are amended to read as follows:

(a) The commission shall:

(1) implement the most cost-effective option for the delivery of basic attendant and habilitation services for individuals with an intellectual or [and] developmental disability [disabilities] under the STAR + PLUS Medicaid managed care program that maximizes federal funding for the delivery of services for that program and other similar programs; and

(2) provide voluntary training to individuals receiving services under the STAR + PLUS Medicaid managed care program or their legally authorized representatives regarding how to select, manage, and dismiss personal attendants providing basic attendant and habilitation services under the program.

(b) The commission shall require that each managed care organization that contracts with the commission for the provision of basic attendant and habilitation services under the STAR + PLUS Medicaid managed care program in accordance with this section:

(1) include in the organization's provider network for the provision of those services:

(A) home and community support services agencies licensed under Chapter 142, Health and Safety Code, with which the department has a contract to provide services under the community living assistance and support services (CLASS) waiver program; and

(B) persons exempted from licensing under Section 142.003(a)(19), Health and Safety Code, with which the department has a contract to provide services under:

(i) the home and community-based services (HCS) waiver program; or

(ii) the Texas home living (TxHmL) waiver program;

(2) review and consider any assessment conducted by a local intellectual and developmental disability authority providing intellectual and developmental disability service coordination under Subsection (c); and

(3) enter into a written agreement with each local intellectual and developmental disability authority in the service area regarding the processes the organization and the authority will use to coordinate the services of individuals with an intellectual or [and] developmental disability [disabilities].

(c) The department shall contract with and make contract payments to local intellectual and developmental disability authorities to conduct the following activities under this section:

(1) provide intellectual and developmental disability service coordination to individuals with an intellectual or [and] developmental disability [disabilities] under the STAR + PLUS Medicaid managed care program by assisting those individuals who are eligible to receive services in a community-based setting, including individuals transitioning to a community-based setting;

(2) provide an assessment to the appropriate managed care organization regarding whether an individual with an intellectual or developmental disability needs attendant or habilitation services, based on the individual's functional need, risk factors, and desired outcomes;

(3) assist individuals with an intellectual or [and] developmental disability [disabilities] with developing the individuals' plans of care under the STAR + PLUS Medicaid managed care program, including with making any changes resulting from periodic reassessments of the plans;

(4) provide to the appropriate managed care organization and the department information regarding the recommended plans of care with which the authorities provide assistance as provided by Subdivision (3), including documentation necessary to demonstrate the need for care described by a plan; and

(5) on an annual basis, provide to the appropriate managed care organization and the department a description of outcomes based on an individual's plan of care.

(e) During the first three years basic attendant and habilitation services are provided to individuals with an intellectual or [and] developmental disability [disabilities] under the STAR + PLUS Medicaid managed care program in accordance with this section, providers eligible to participate in the home and community-based services (HCS) waiver program, the Texas home living (TxHmL) waiver program, or the community living assistance and support services (CLASS) waiver program on September 1, 2013, are considered significant traditional providers.

(f) A local intellectual and developmental disability authority with which the department contracts under Subsection (c) may subcontract with an eligible person, including a nonprofit entity, to coordinate the services of individuals with an intellectual or [and] developmental disability [disabilities] under this section. The executive commissioner by rule shall establish minimum qualifications a person must meet to be considered an "eligible person" under this subsection.

SECTION 2.255. Sections 534.201(a), (b), (e), and (f), Government Code, are amended to read as follows:

(a) This section applies to individuals with an intellectual or [and] developmental disability [disabilities] who are receiving long-term services and supports under the Texas home living (TxHmL) waiver program on the date the commission implements the transition described by Subsection (b).

(b) Not later than September 1, 2017, the commission shall transition the provision of Medicaid [program] benefits to individuals to whom this section applies to the STAR + PLUS Medicaid managed care program delivery model or the most appropriate integrated capitated managed care program delivery model, as determined by the commission based on cost-effectiveness and the experience of the STAR + PLUS Medicaid managed care program in providing basic attendant and habilitation services and of the pilot programs established under Subchapter C, subject to Subsection (c)(1).

(e) The commission shall ensure that there is a comprehensive plan for transitioning the provision of Medicaid [program] benefits under this section that protects the continuity of care provided to individuals to whom this section applies.

(f) In addition to the requirements of Section 533.005, a contract between a managed care organization and the commission for the organization to provide Medicaid [program] benefits under this section must contain a requirement that the organization implement a process for individuals with an intellectual or [and] developmental disability [disabilities] that:

(1) ensures that the individuals have a choice among providers;

(2) to the greatest extent possible, protects those individuals' continuity of care with respect to access to primary care providers, including the use of single-case agreements with out-of-network providers; and

(3) provides access to a member services phone line for individuals or their legally authorized representatives to obtain information on and assistance with accessing services through network providers, including providers of primary, specialty, and other long-term services and supports.

SECTION 2.256. Sections 534.202(a), (b), (e), (f), and (i), Government Code, are amended to read as follows:

(a) This section applies to individuals with an intellectual or [and] developmental disability [disabilities] who, on the date the commission implements the transition described by Subsection (b), are receiving long-term services and supports under:

(1) a Medicaid waiver program other than the Texas home living (TxHmL) waiver program; or

(2) an ICF-IID program.

(b) After implementing the transition required by Section 534.201 but not later than September 1, 2020, the commission shall transition the provision of Medicaid [program] benefits to individuals to whom this section applies to the STAR + PLUS Medicaid managed care program delivery model or the most appropriate integrated capitated managed care program delivery model, as determined by the commission based on cost-effectiveness and the experience of the transition of Texas home living (TxHmL) waiver program recipients to a managed care program delivery model under Section 534.201, subject to Subsections (c)(1) and (g).

(e) The commission shall ensure that there is a comprehensive plan for transitioning the provision of Medicaid [program] benefits under this section that protects the continuity of care provided to individuals to whom this section applies.

(f) Before transitioning the provision of Medicaid [program] benefits for children under this section, a managed care organization providing services under the managed care program delivery model selected by the commission must demonstrate to the satisfaction of the commission that the organization's network of providers has experience and expertise in the provision of services to children with an intellectual or [and] developmental disability [disabilities]. Before transitioning the provision of Medicaid [program] benefits for adults with an intellectual or [and] developmental disability [disabilities] under this section, a managed care organization providing services under the managed care program delivery model selected by the commission must demonstrate to the satisfaction of the commission that the organization's network of providers has experience and expertise in the provision of services to adults with an intellectual or [and] developmental disability [disabilities].

(i) In addition to the requirements of Section 533.005, a contract between a managed care organization and the commission for the organization to provide Medicaid [program] benefits under this section must contain a requirement that the organization implement a process for individuals with an intellectual or [and] developmental disability [disabilities] that:

(1) ensures that the individuals have a choice among providers;

(2) to the greatest extent possible, protects those individuals' continuity of care with respect to access to primary care providers, including the use of single-case agreements with out-of-network providers; and

(3) provides access to a member services phone line for individuals or their legally authorized representatives to obtain information on and assistance with accessing services through network providers, including providers of primary, specialty, and other long-term services and supports.

SECTION 2.257. Section 535.051(b), Government Code, is amended to read as follows:

(b) The chief administrative officer of each of the following state agencies, in consultation with the governor, shall designate one employee from the agency to serve as a liaison for faith- and community-based organizations:

(1) [the Texas Department of Rural Affairs;

[(2)] the Texas Commission on Environmental Quality;

(2) [(3)] the Texas Department of Criminal Justice;

(3) [(4)] the Texas Department of Housing and Community Affairs;

(4) [(5)] the Texas Juvenile Justice Department;

(5) [(6)] the Texas Veterans Commission;

(6) [(7)] the Texas Workforce Commission;

(7) [(8)] the office of the governor;

(8) [(9)] the Department of Public Safety;

(9) [(10)] the Texas Department of Insurance;

(10) [(11)] the Public Utility Commission of Texas;

(11) [(12)] the office of the attorney general;

(12) [(13)] the Department of Agriculture;

(13) [(14)] the office of the comptroller;

(14) [(15)] the Department of Information Resources;

(15) [(16)] the Office of State-Federal Relations;

(16) [(17)] the office of the secretary of state; and

(17) [(18)] other state agencies as determined by the governor.

SECTION 2.258. Section 535.103(b), Government Code, is amended to read as follows:

(b) The account consists of:

(1) all money appropriated for the purposes of this subchapter; and

(2) any gifts, grants, or donations received for the purposes of this subchapter[; and

[(3) interest earned on money in the account].

SECTION 2.259. The heading to Chapter 536, Government Code, is amended to read as follows:

CHAPTER 536. MEDICAID AND THE CHILD HEALTH PLAN PROGRAM [PROGRAMS]:

QUALITY-BASED OUTCOMES AND PAYMENTS

SECTION 2.260. Section 536.002(a), Government Code, is amended to read as follows:

(a) The Medicaid and CHIP Quality-Based Payment Advisory Committee advises [is established to advise] the commission on establishing, for purposes of the child health plan program and Medicaid [programs administered by the commission or a health and human services agency]:

(1) reimbursement systems used to compensate physicians or other health care providers under those programs that reward the provision of high-quality, cost-effective health care and quality performance and quality of care outcomes with respect to health care services;

(2) standards and benchmarks for quality performance, quality of care outcomes, efficiency, and accountability by managed care organizations and physicians and other health care providers;

(3) programs and reimbursement policies that encourage high-quality, cost-effective health care delivery models that increase appropriate provider collaboration, promote wellness and prevention, and improve health outcomes; and

(4) outcome and process measures under Section 536.003.

SECTION 2.261. Sections 536.003(a), (b), (d), and (e), Government Code, are amended to read as follows:

(a) The commission, in consultation with the advisory committee, shall develop quality-based outcome and process measures that promote the provision of efficient, quality health care and that can be used in the child health plan program and Medicaid [programs] to implement quality-based payments for acute care services and long-term services and supports across all delivery models and payment systems, including fee-for-service and managed care payment systems. Subject to Subsection (a-1), the commission, in developing outcome and process measures under this section, must include measures that are based on potentially preventable events and that advance quality improvement and innovation. The commission may change measures developed:

(1) to promote continuous system reform, improved quality, and reduced costs; and

(2) to account for managed care organizations added to a service area.

(b) To the extent feasible, the commission shall develop outcome and process measures:

(1) consistently across all child health plan program and Medicaid [program] delivery models and payment systems;

(2) in a manner that takes into account appropriate patient risk factors, including the burden of chronic illness on a patient and the severity of a patient's illness;

(3) that will have the greatest effect on improving quality of care and the efficient use of services, including acute care services and long-term services and supports;

(4) that are similar to outcome and process measures used in the private sector, as appropriate;

(5) that reflect effective coordination of acute care services and long-term services and supports;

(6) that can be tied to expenditures; and

(7) that reduce preventable health care utilization and costs.

(d) The executive commissioner by rule may require managed care organizations and physicians and other health care providers participating in the child health plan program and Medicaid [programs] to report to the commission in a format specified by the executive commissioner information necessary to develop outcome and process measures under this section.

(e) If the commission increases physician and other health care provider reimbursement rates under the child health plan program or Medicaid [program] as a result of an increase in the amounts appropriated for the programs for a state fiscal biennium as compared to the preceding state fiscal biennium, the commission shall, to the extent permitted under federal law and to the extent otherwise possible considering other relevant factors, correlate the increased reimbursement rates with the quality-based outcome and process measures developed under this section.

SECTION 2.262. Sections 536.004(a), (c), and (e), Government Code, are amended to read as follows:

(a) Using quality-based outcome and process measures developed under Section 536.003 and subject to this section, the commission, after consulting with the advisory committee and other appropriate stakeholders with an interest in the provision of acute care and long-term services and supports under the child health plan program and Medicaid [programs], shall develop quality-based payment systems, and require managed care organizations to develop quality-based payment systems, for compensating a physician or other health care provider participating in the child health plan program or Medicaid [program] that:

(1) align payment incentives with high-quality, cost-effective health care;

(2) reward the use of evidence-based best practices;

(3) promote the coordination of health care;

(4) encourage appropriate physician and other health care provider collaboration;

(5) promote effective health care delivery models; and

(6) take into account the specific needs of the child health plan program enrollee and Medicaid recipient populations.

(c) In developing quality-based payment systems under this chapter, the commission shall examine and consider implementing:

(1) an alternative payment system;

(2) any existing performance-based payment system used under the Medicare program that meets the requirements of this chapter, modified as necessary to account for programmatic differences, if implementing the system would:

(A) reduce unnecessary administrative burdens; and

(B) align quality-based payment incentives for physicians and other health care providers with the Medicare program; and

(3) alternative payment methodologies within the system that are used in the Medicare program, modified as necessary to account for programmatic differences, and that will achieve cost savings and improve quality of care in the child health plan program and Medicaid [programs].

(e) The commission may modify a quality-based payment system developed under this chapter to account for programmatic differences between the child health plan program and Medicaid [programs] and delivery systems under those programs.

SECTION 2.263. Sections 536.005(a) and (c), Government Code, are amended to read as follows:

(a) To the extent possible, the commission shall convert hospital reimbursement systems under the child health plan program and Medicaid [programs] to a diagnosis-related groups (DRG) methodology that will allow the commission to more accurately classify specific patient populations and account for severity of patient illness and mortality risk.

(c) Notwithstanding Subsection (a) and to the extent possible, the commission shall convert outpatient hospital reimbursement systems under the child health plan program and Medicaid [programs] to an appropriate prospective payment system that will allow the commission to:

(1) more accurately classify the full range of outpatient service episodes;

(2) more accurately account for the intensity of services provided; and

(3) motivate outpatient service providers to increase efficiency and effectiveness.

SECTION 2.264. Section 536.051(a), Government Code, is amended to read as follows:

(a) Subject to Section 1903(m)(2)(A), Social Security Act (42 U.S.C. Section 1396b(m)(2)(A)), and other applicable federal law, the commission shall base a percentage of the premiums paid to a managed care organization participating in the child health plan program or Medicaid [program] on the organization's performance with respect to outcome and process measures developed under Section 536.003 that address potentially preventable events. The percentage of the premiums paid may increase each year.

SECTION 2.265. Sections 536.052(a) and (d), Government Code, are amended to read as follows:

(a) The commission may allow a managed care organization participating in the child health plan program or Medicaid [program] increased flexibility to implement quality initiatives in a managed care plan offered by the organization, including flexibility with respect to financial arrangements, in order to:

(1) achieve high-quality, cost-effective health care;

(2) increase the use of high-quality, cost-effective delivery models;

(3) reduce the incidence of unnecessary institutionalization and potentially preventable events; and

(4) increase the use of alternative payment systems, including shared savings models, in collaboration with physicians and other health care providers.

(d) In awarding contracts to managed care organizations under the child health plan program and Medicaid [programs], the commission shall, in addition to considerations under Section 533.003 of this code and Section 62.155, Health and Safety Code, give preference to an organization that offers a managed care plan that successfully implements quality initiatives under Subsection (a) as determined by the commission based on data or other evidence provided by the organization or meets quality of care and cost-efficiency benchmarks under Subsection (b).

SECTION 2.266. Section 536.101(1), Government Code, is amended to read as follows:

(1) "Health home" means a primary care provider practice or, if appropriate, a specialty care provider practice, incorporating several features, including comprehensive care coordination, family-centered care, and data management, that are focused on improving outcome-based quality of care and increasing patient and provider satisfaction under the child health plan program and Medicaid [programs].

SECTION 2.267. Section 536.151(b), Government Code, is amended to read as follows:

(b) The commission shall establish a program to provide a confidential report to each hospital in this state that participates in the child health plan program or Medicaid [program] regarding the hospital's performance with respect to each potentially preventable event described under Subsection (a). To the extent possible, a report provided under this section should include all potentially preventable events across all child health plan program and Medicaid [program] payment systems. A hospital shall distribute the information contained in the report to physicians and other health care providers providing services at the hospital.

SECTION 2.268. Section 536.203(c), Government Code, is amended to read as follows:

(c) The commission may limit a payment initiative to:

(1) one or more regions in this state;

(2) one or more organized networks of physicians and other health care providers; or

(3) specified types of services provided under the child health plan program or Medicaid [program], or specified types of enrollees or recipients under those programs.

SECTION 2.269. Section 536.253(b), Government Code, is amended to read as follows:

(b) The commission shall establish a program to provide a report to each Medicaid long-term services and supports provider in this state regarding the provider's performance with respect to potentially preventable admissions, potentially preventable readmissions, and potentially preventable emergency room visits. To the extent possible, a report provided under this section should include applicable potentially preventable events information across all Medicaid [program] payment systems.

SECTION 2.270. Section 537.002(b), Government Code, is amended to read as follows:

(b) The waiver under this section must be designed to achieve the following objectives regarding [the] Medicaid [program] and alternatives to Medicaid [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 2.271. Section 538.002, Government Code, is amended to read as follows:

Sec. 538.002. EFFECT OF CHAPTER; AUTHORITY OF COMMISSION. This chapter does not affect or give the commission additional authority to:

(1) affect any individual health care treatment decision for a Medicaid recipient;

(2) replace or affect the process of determining Medicaid benefits, including the approval process for receiving benefits for durable medical equipment, or any applicable approval process required for reimbursement for services or other equipment under [the] Medicaid [program];

(3) implement a clinical initiative or associated rule or program policy that is otherwise prohibited under state or federal law; or

(4) implement any initiative that would expand eligibility for benefits under [the] Medicaid [program].

SECTION 2.272. Section 538.051, Government Code, is amended to read as follows:

Sec. 538.051. MEDICAID QUALITY IMPROVEMENT PROCESS. The commission shall, according to the provisions of this chapter, develop and implement a quality improvement process by which the commission:

(1) receives suggestions for clinical initiatives designed to improve:

(A) the quality of care provided under [the] Medicaid [program]; and

(B) the cost-effectiveness of [the] Medicaid [program];

(2) conducts a preliminary review under Section 538.053(4) of each suggestion received under Section 538.052 to determine whether the suggestion warrants further consideration and analysis; and

(3) conducts an analysis under Section 538.054 of clinical initiative suggestions that are selected for analysis under Subdivision (2) [and of required clinical initiatives under Section 538.0521].

SECTION 2.273. Section 538.052(a), Government Code, is amended to read as follows:

(a) Subject to Subsection (b), the commission shall solicit and accept suggestions for clinical initiatives, in either written or electronic form, from:

(1) a member of the state legislature;

(2) the executive commissioner;

(3) the commissioner of aging and disability services [the Department of Aging and Disability Services];

(4) the commissioner of state health services [the Department of State Health Services];

(5) the commissioner of the Department of Family and Protective Services;

(6) the commissioner of assistive and rehabilitative services [the Department of Assistive and Rehabilitative Services];

(7) the medical care advisory committee established under Section 32.022, Human Resources Code;

(8) the physician payment advisory committee created under Section 32.022(d), Human Resources Code; and

(9) the Electronic Health Information Exchange System Advisory Committee established under Section 531.904.

SECTION 2.274. Section 538.054, Government Code, is amended to read as follows:

Sec. 538.054. ANALYSIS OF CLINICAL INITIATIVES. The commission shall conduct an analysis of each clinical initiative selected by the commission after having conducted the commission's preliminary review under Section 538.053(4). The analysis required under this section must include a review of:

(1) any public comments and submitted research relating to the initiative;

(2) the available clinical research and historical utilization information relating to the initiative;

(3) published medical literature relating to the initiative;

(4) any adoption of the initiative by medical societies or other clinical groups;

(5) whether the initiative has been implemented under:

(A) the Medicare program;

(B) another state medical assistance program; or

(C) a state-operated health care program, including the child health plan program;

(6) the results of reports, research, pilot programs, or clinical studies relating to the initiative conducted by:

(A) institutions of higher education, including related medical schools;

(B) governmental entities and agencies; and

(C) private and nonprofit think tanks and research groups;

(7) the impact that the initiative would have on [the] Medicaid [program] if the initiative were implemented in this state, including:

(A) an estimate of the number of recipients under [the] Medicaid [program] that would be impacted by implementation of the initiative; and

(B) a description of any potential cost savings to the state that would result from implementation of the initiative; and

(8) any statutory barriers to implementation of the initiative.

SECTION 2.275. Section 538.055, Government Code, is amended to read as follows:

Sec. 538.055. FINAL REPORT ON CLINICAL INITIATIVE. The commission shall prepare a final report based on the commission's analysis of a clinical initiative under Section 538.054. The final report must include:

(1) a final determination of:

(A) the feasibility of implementing the initiative;

(B) the likely impact implementing the initiative would have on the quality of care provided under [the] Medicaid [program]; and

(C) the anticipated cost savings to the state that would result from implementing the initiative;

(2) a summary of the public comments, including a description of any opposition to the initiative;

(3) an identification of any statutory barriers to implementation of the initiative; and

(4) if the initiative is not implemented, an explanation of the decision not to implement the initiative.

SECTION 2.276. Section 538.057, Government Code, is amended to read as follows:

Sec. 538.057. ACTION ON CLINICAL INITIATIVE BY COMMISSION. After the commission conducts an analysis of a clinical initiative under Section 538.054:

(1) if the commission has determined that the initiative is cost-effective and will improve the quality of care under [the] Medicaid [program], the commission may:

(A) implement the initiative if implementation of the initiative is not otherwise prohibited by law; or

(B) if implementation requires a change in law, submit a copy of the final report together with recommendations relating to the initiative's implementation to the standing committees of the senate and house of representatives having jurisdiction over [the] Medicaid [program]; and

(2) if the commission has determined that the initiative is not cost-effective or will not improve quality of care under [the] Medicaid [program], the commission may not implement the initiative.

SECTION 2.277. Section 539.001, Government Code, is amended to read as follows:

Sec. 539.001. DEFINITION [DEFINITIONS]. In this chapter, "department" [:

[(1) "Department"] means the Department of State Health Services.

[(2) "Executive commissioner" means the executive commissioner of the Health and Human Services Commission.]

SECTION 2.278. Sections 2105.001(1) and (4), Government Code, are amended to read as follows:

(1) "Agency" means:

(A) the Health and Human Services Commission [Texas Department of Human Services];

(B) the [Texas] Department of State Health Services;

(C) the Texas Department of Housing and Community Affairs;

(D) the Texas Education Agency;

(E) the [Texas] Department of Aging and Disability Services [Mental Health and Mental Retardation]; or

(F) [the Texas Department on Aging; or

[(G)] any other commission, board, department, or state agency designated to receive block grant funds.

(4) "Provider" means a public or private organization that receives block grant funds or may be eligible to receive block grant funds to provide services or benefits to the public, including:

(A) a local government unit;

(B) a council of government;

(C) a community action agency; or

(D) a private new community developer or nonprofit community association in a community originally established as a new community development program under the former Urban Growth and New Community Development Act of 1970 (42 U.S.C. Section 4511 et seq.).

SECTION 2.279. Section 2105.002, Government Code, is amended to read as follows:

Sec. 2105.002. COMBINATION OF PROGRAMS NOT INTENDED TO REDUCE SERVICES. The process of combining categorical federal assistance programs into block grants should not have an overall effect of reducing the relative proportion of services and benefits made available to low-income individuals, elderly individuals, [disabled] individuals with disabilities, and migrant and seasonal agricultural workers.

SECTION 2.280. Section 2105.005(c), Government Code, is amended to read as follows:

(c) To the extent consistent with the purpose of the block grant, an agency's rules [agency by rule] shall ensure that providers use block grant funds to the maximum benefit of low-income recipients and intended recipients.

SECTION 2.281. Section 2105.009, Government Code, is amended to read as follows:

Sec. 2105.009. PRIMARY CARE BLOCK GRANT. (a) The [Texas] Department of State Health Services shall administer a [the] primary care block grant if that grant is authorized and if the department satisfies federal requirements relating to the designation of an agency to administer the grant.

(b) In administering the primary care block grant, the department may:

(1) receive the primary care block grant funds on behalf of the state;

(2) spend primary care block grant funds and state funds specifically appropriated by the legislature to match funds received under a primary care block grant;

(3) make grants to, advance funds to, contract with, and take other actions through community health centers that meet the requirements of 42 U.S.C. Section 254c(e)(3) to provide for the delivery of primary and supplemental health services to medically underserved populations of the state; and

(4) [adopt necessary rules; and

[(5)] perform other activities necessary to administer the primary care block grant.

(b-1) The executive commissioner of the Health and Human Services Commission may adopt necessary rules for administering the primary care block grant.

(c) In this section:

(1) "Community health center" has the meaning assigned by 42 U.S.C. Section 254c(a), as that law existed on April 23, 1986.

(2) "Medically underserved population," "primary health services," and "supplemental health services" have the meanings assigned by 42 U.S.C. Section 254c(b), as that law existed on April 23, 1986.

SECTION 2.282. Section 2105.058(d), Government Code, is amended to read as follows:

(d) An agency's rules [agency by rule] may require a provider to undertake other reasonable efforts to seek public participation.

SECTION 2.283. Section 2105.152, Government Code, is amended to read as follows:

Sec. 2105.152. HEALTH AND [DEPARTMENT OF] HUMAN SERVICES COMMISSION PROCEDURES FOR FAIR HEARING. The Health and Human Services Commission [Texas Department of Human Services] shall use procedures for conducting a fair hearing under this subchapter.

SECTION 2.284. Section 2105.202(a), Government Code, is amended to read as follows:

(a) The individual or entity responsible for adopting rules for an [An] agency shall adopt specific rules for the agency that define [defining] good cause for nonrenewal of a provider's contract or reduction of a provider's funding.

SECTION 2.285. Section 2165.301, Government Code, is amended by amending Subdivision (2) and adding Subdivision (2-a) to read as follows:

(2) "Department" means the [Texas] Department of State Health Services.

(2-a) "Executive commissioner" means the executive commissioner of the Health and Human Services Commission.

SECTION 2.286. Sections 2165.302(a), (d), and (e), Government Code, are amended to read as follows:

(a) Except as provided by Section 2165.303:

(1) the commission shall refer matters related to the investigation and testing of indoor air quality in state buildings under the charge and control of the commission to the department [Texas Department of Health]; and

(2) the department shall conduct any necessary investigation and testing of indoor air quality in state buildings, on request or referral of an entity with charge and control of the state building.

(d) The executive commissioner by rule [department] may establish a system of charges for indoor air quality investigation and testing in state buildings. A system established by the executive commissioner [department] shall ensure that the department is reimbursed for the cost of providing the services by the agency or agencies occupying the portions of a building that are investigated or tested.

(e) The executive commissioner [department] shall adopt rules and procedures relating to the investigation and testing of indoor air quality in state buildings.

SECTION 2.287. The following provisions of the Government Code are repealed:

(1) Section 531.02131;

(2) Section 531.0222;

(3) Section 531.0249;

(4) Section 531.030;

(5) Section 531.0314;

(6) Section 531.046;

(7) Section 531.049;

(8) Section 531.065;

(9) Section 531.0993;

(10) Section 531.1063;

(11) Section 531.286;

(12) Section 531.552;

(13) Section 531.902;

(14) Section 531.905;

(15) Section 533.0025(a);

(16) Subchapter D, Chapter 533;

(17) Section 534.001(10);

(18) Sections 536.001(4) and (13);

(19) Section 537.001; and

(20) Section 538.001.

ARTICLE 3. HEALTH AND SAFETY CODE

SECTION 3.0001. The heading to Subtitle A, Title 2, Health and Safety Code, is amended to read as follows:

SUBTITLE A. [TEXAS] DEPARTMENT OF STATE HEALTH SERVICES

SECTION 3.0002. The heading to Chapter 11, Health and Safety Code, is amended to read as follows:

CHAPTER 11. GENERAL PROVISIONS [ORGANIZATION OF TEXAS DEPARTMENT

OF HEALTH]

SECTION 3.0003. Section 11.001, Health and Safety Code, is amended to read as follows:

Sec. 11.001. DEFINITIONS. In this title:

(1) "Commission" means the Health and Human Services Commission ["Board" means the Texas Board of Health].

(2) "Commissioner" means the commissioner of state [public] health services.

(3) "Department" means the [Texas] Department of State Health Services.

(4) "Executive commissioner" means the executive commissioner of the Health and Human Services Commission.

SECTION 3.0004. Sections 11.003(b) and (c), Health and Safety Code, are amended to read as follows:

(b) In the review of the department [Department of State Health Services] by the Sunset Advisory Commission, as required by [this section and] Section 1001.003, the sunset commission shall review the powers and duties exercised by the department under Chapter 108 and determine whether the department, under that chapter, is:

(1) achieving the legislature's intent of empowering consumers with information to make informed health care decisions;

(2) maintaining appropriate privacy and security standards for patient information; and

(3) limiting the patient information the department collects to the information necessary for performing the department's duties under Chapter 108.

(c) The Sunset Advisory Commission shall report its findings to the legislature in the report required by Section 325.010, Government Code. This section expires [subsection and Subsection (b) expire] September 1, 2015.

SECTION 3.0005. (a) Section 11.004(b), Health and Safety Code, is transferred to Section 1001.071, Health and Safety Code, redesignated as Section 1001.071(a), Health and Safety Code, and amended to read as follows:

(a) [(b)] The department is the state agency with primary responsibility to administer or provide [for providing] health services, including:

(1) disease prevention;

(2) health promotion;

(3) indigent health care;

(4) certain acute care services;

(5) [health care facility regulation, excluding long-term care facilities;

[(6)] licensing of certain health professions; and

(6) [(7)] other health-related services as provided by law.

(b) Section 1001.071, Health and Safety Code, is amended to read as follows:

Sec. 1001.071. GENERAL POWERS AND DUTIES OF DEPARTMENT RELATED TO HEALTH CARE. (b) The department is responsible for administering human services programs regarding the public health, including:

(1) implementing the state's public health care delivery programs under the authority of the department;

(2) administering state health facilities, hospitals, and health care systems;

(3) developing and providing health care services, as directed by law;

(4) providing for the prevention and control of communicable diseases;

(5) providing public education on health-related matters, as directed by law;

(6) compiling and reporting health-related information, as directed by law;

(7) acting as the lead agency for implementation of state policies regarding the human immunodeficiency virus and acquired immunodeficiency syndrome and administering programs related to the human immunodeficiency virus and acquired immunodeficiency syndrome;

(8) investigating the causes of injuries and methods of prevention;

(9) administering a grant program to provide appropriated money to counties, municipalities, public health districts, and other political subdivisions for their use to provide or pay for essential public health services;

(10) administering the registration of vital statistics;

(11) licensing, inspecting, and enforcing regulations regarding health facilities, other than long-term care facilities regulated by the Department of Aging and Disability Services;

(12) implementing established standards and procedures for the management and control of sanitation and for health protection measures;

(13) enforcing regulations regarding radioactive materials;

(14) enforcing regulations regarding food, bottled and vended drinking water, drugs, cosmetics, and health devices;

(15) enforcing regulations regarding food service establishments, retail food stores, mobile food units, and roadside food vendors;

(16) enforcing regulations controlling hazardous substances in households and workplaces; and

(17) implementing a mental health program for veterans.

SECTION 3.0006. Sections 11.012(a), (b), (c), (d), and (f), Health and Safety Code, are transferred to Section 1001.051, Health and Safety Code, redesignated respectively as Sections 1001.051(a-1), (a-2), (a-3), (a-4), and (b-1), Health and Safety Code, and amended to read as follows:

(a-1) [(a)] The executive commissioner [of health and human services] shall employ the commissioner in accordance with Section 531.0056, Government Code.

(a-2) [(b)] Except as provided in Subsection (a-3) [(c)], the commissioner must:

(1) have at least five years of experience in the administration of public health systems; and

(2) be a person licensed to practice medicine in this state.

(a-3) [(c)] The executive commissioner [of health and human services] may, based on the qualifications and experience in administering public health systems, employ a person other than a physician as the commissioner.

(a-4) [(d)] If the executive commissioner [of health and human services] employs a person as commissioner who is not a physician, then the executive commissioner [board] shall designate a person licensed to practice medicine in this state as chief medical executive.

(b-1) [(f)] The executive commissioner [board] may supplement the salary of the commissioner with the approval of the governor. The salary may not exceed 1.5 times the salary of the governor, from funds appropriated to the department. The use of funds from other sources are not limited by this subsection.

SECTION 3.0007. Section 11.014, Health and Safety Code, is transferred to Subchapter B, Chapter 1001, Health and Safety Code, redesignated as Section 1001.034, Health and Safety Code, and amended to read as follows:

Sec. 1001.034 [11.014]. INVESTIGATION OF DEPARTMENT. The executive commissioner [board] shall investigate the conduct of the work of the department. For that purpose, the executive commissioner [board] shall have access at any time to all department books and records and may require an officer or employee of the department to furnish written or oral information.

SECTION 3.0008. Section 11.016, Health and Safety Code, is transferred to Subchapter B, Chapter 1001, Health and Safety Code, redesignated as Section 1001.035, Health and Safety Code, and amended to read as follows:

Sec. 1001.035 [11.016]. ADVISORY COMMITTEES. (a) The executive commissioner [board] may appoint advisory committees to assist the executive commissioner and department [board] in performing [its] duties related to department functions.

(b) If the executive commissioner appoints [The board shall appoint] an advisory committee under this section, the appointment must be made in a manner that provides for:

(1) a balanced representation of persons with knowledge and interest in the committee's field of work;

(2) the inclusion on the committee of at least two members who represent the interests of the public; and

(3) a balanced representation of the geographic regions of the state.

(d) A [Except as otherwise provided by law and contingent on the availability of department funds for this purpose, a] member of an advisory committee appointed under this section may [by the board is entitled to] receive reimbursement for[, with regard to] travel expenses as provided by Section 2110.004, Government Code[, the per diem and travel allowance authorized by the General Appropriations Act for state employees].

(e) The executive commissioner [board] shall specify each committee's purpose, powers, and duties, and shall require each committee to report to the executive commissioner or department [board] in the manner specified by the executive commissioner [board] concerning the committee's activities and the results of its work.

(f) The executive commissioner [board] shall establish procedures for receiving reports relating to the activities and accomplishments of an advisory committee established by statute to advise the [board or] department or executive commissioner on matters related to department functions. The executive commissioner [board] may appoint additional members to those advisory committees and may establish additional duties of those committees as the executive commissioner [board] determines to be necessary.

(g) The executive commissioner [board] shall adopt rules to implement this section.

SECTION 3.0009. The heading to Chapter 12, Health and Safety Code, is amended to read as follows:

CHAPTER 12. POWERS AND DUTIES OF [TEXAS] DEPARTMENT OF

STATE HEALTH SERVICES

SECTION 3.0010. Subchapter A, Chapter 12, Health and Safety Code, is amended to read as follows:

SUBCHAPTER A. GENERAL POWERS AND DUTIES [OF BOARD]

Sec. 12.0001. COMMISSIONER'S POWERS AND DUTIES; EFFECT OF CONFLICT WITH OTHER LAW [OF COMMISSIONER OF HEALTH AND HUMAN SERVICES]. [The commissioner of health and human services has the powers and duties relating to the board and commissioner as provided by Section 531.0055, Government Code.] To the extent a power or duty given to the [board or] commissioner by this title or another law conflicts with Section 531.0055, Government Code, Section 531.0055 controls.

Sec. 12.001. GENERAL POWERS AND DUTIES OF EXECUTIVE COMMISSIONER. (a) The executive commissioner [board] has general supervision and control over all matters relating to the health of the citizens of this state.

(b) The executive commissioner [board] shall[:

[(1)] adopt rules for [its procedure and for] the performance of each duty imposed by law on the executive commissioner [board], the department, or the commissioner and file a copy of those rules with the department.

Sec. 12.0011. INVESTIGATIONS IN GENERAL. Subject to the oversight of the executive commissioner, the department shall[; and

[(2)] examine, investigate, enter, and inspect any public place or public building as the department [board] determines necessary for the discovery and suppression of disease and the enforcement of any health or sanitation law of this state.

[(c) The board has all the powers, duties, and functions granted by law to:

[(1) the Texas Board of Health;

[(2) the state commissioner of health;

[(3) the Texas Department of Health;

[(4) the Texas Board of Health Resources; and

[(5) the Texas Department of Health Resources.]

Sec. 12.002. CERTAIN PROCEDURES FOR [BOARD] INVESTIGATIONS. (a) The commissioner or the commissioner's designee [A member of the board] may administer oaths, summon witnesses, and compel the attendance of witnesses in any matter proper for [board] investigation by the department, subject to the executive commissioner's oversight, including the determination of nuisances and the investigation of:

(1) public water supplies;

(2) sanitary conditions;

(3) the existence of infection; or

(4) any matter that requires the department [board] to exercise its discretionary powers and that is within the general scope of its authority under this subchapter.

(b) Each district court shall aid the department [board] in its investigations and in compelling compliance with this subchapter. If a witness summoned by the commissioner or the commissioner's designee [board] is disobedient or disrespectful to the department's [board's] lawful authority, the district court of the county in which the witness is summoned to appear shall punish the witness in the manner provided for contempt of court.

Sec. 12.003. LEGAL REPRESENTATION. (a) A suit brought by the department [board] must be brought in the name of the state.

(b) The attorney general shall assign a special assistant to attend to the department's [board's] legal matters, and on the department's [board's] request shall furnish necessary assistance to the department [board] relating to its legal requirements.

[Sec. 12.004. DEVELOPMENT OF PROPOSED RULES. (a) This section applies to the process by which the department develops proposed rules for the board's consideration before the proposed rules are published in the Texas Register and before the board, commissioner, or department complies with the rulemaking requirements of the administrative procedure law, Chapter 2001, Government Code. This section does not affect the duty of the board, commissioner, or department to comply with the rulemaking requirements of that law.

[(b) The board shall require the department to establish a checklist of methods that, to the extent appropriate, the department will follow to obtain early in the rule development process the advice and opinions of the public and of persons who will be most affected by a proposed rule. The checklist must include methods for identifying persons who will be most affected and for soliciting at a minimum the advice and opinions of affected local health departments, of recipients and providers of affected services, and of advocates for affected recipients or providers.

[(c) The checklist may include negotiated rulemaking, informal conferences, advisory committees, and any other appropriate method.

[(d) A rule adopted by the board may not be challenged on the grounds that the board, commissioner, or department did not comply with this section. If the department was unable to solicit a significant amount of advice and opinion from the public or from affected persons early in the rule development process, the department shall state in writing to the board the reasons why the department was unable to do so.

[Sec. 12.005. MEDICAL DIRECTOR: MEDICAID MANAGED CARE AND CHIPS PROGRAMS. (a) In addition to any other medical director employed by the department, the board shall require the department to employ a separate medical director whose duties consist of acting as the medical director for the children's health insurance program created under Title XXI of the Social Security Act (42 U.S.C. Section 1397aa et seq.) and also as the medical director for the Medicaid managed care program, to the extent that those programs are administered by the department.

[(b) The medical director shall be primarily responsible for implementing and maintaining policies and systems for the programs that relate to clinical and professional medical issues, including clinical oversight.

[(c) The medical director must be a physician licensed to practice medicine in this state.]

SECTION 3.0011. Sections 12.0111(b) and (c), Health and Safety Code, are amended to read as follows:

(b) Notwithstanding other law, the executive commissioner by rule shall adopt and the department shall collect [charge] a fee for issuing or renewing a license that is in an amount designed to allow the department to recover from its license holders all of the department's direct and indirect costs in administering and enforcing the applicable licensing program.

(c) Notwithstanding other law, each regulatory board or other agency that is under the jurisdiction of the department or administratively attached to the department and that issues licenses shall adopt by rule and collect [charge] a fee for issuing or renewing a license that is in an amount designed to allow the department and the regulatory board or agency to recover from the license holders all of the direct and indirect costs to the department and to the regulatory board or agency in administering and enforcing the applicable licensing program.

SECTION 3.0012. Sections 12.0115(a), (e), and (h), Health and Safety Code, are amended to read as follows:

(a) In this section, "health care delivery programs" includes the department's primary health care services program, its program to improve maternal and infant health, its services program for [chronically ill and disabled] children with special health care needs, any aspects of health care delivery under the state Medicaid program assigned to the department by law or by the commission [Health and Human Services Commission], and the part of any other department program concerned with the department's responsibility for the delivery of health care services.

(e) One of the primary goals of the department in integrating the administration of [its] contracts entered into by the executive commissioner or the executive commissioner's designee on behalf of the department with providers of health care services shall be designing an integrated contract administration system that reduces the administrative and paperwork burden on providers while still providing the department with the information it needs to effectively administer the contracts. The department's integration of contract administration must include:

(1) the integration of the initial procurement process within and across programs, at least in part by efficiently combining requests for bids or proposals within or across programs to the extent it reduces the administrative burden for providers;

(2) the establishment of uniform contract terms, including:

(A) contract terms that require information from providers, or that prescribe performance standards for providers, that could be made uniform within or across programs while remaining effective as contract terms;

(B) the establishment of a procedure under which a contractor or a person responding to a request for bids or proposals may supply the department with requested information whenever possible by referencing current and correct information previously supplied to and on file with the department; and

(C) contract terms regarding incentives for contractors to meet or exceed contract requirements;

(3) the integration of contract monitoring, particularly with regard to monitoring providers that deliver health services for the department under more than one contract or under more than one department program; and

(4) the integration of reimbursement methods:

(A) particularly for a provider that delivers health services for the department under more than one contract or under more than one department program; and

(B) including the application across programs of the most effective and efficient reimbursement technologies or methods that are available to the department under any of its programs.

(h) The department may not integrate health care delivery programs under this section in a way that affects the single state agency status of another state agency for federal purposes without obtaining the approval of the commission [Health and Human Services Commission] and any necessary federal approval.

SECTION 3.0013. Sections 12.0121(b) and (d), Health and Safety Code, are amended to read as follows:

(b) The executive commissioner [board] by rule shall adopt a list of categories of licensed, certified, registered, or otherwise authorized providers to whom the department may award a grant for professional services under this section or with whom the department may contract or otherwise engage to perform professional services under this section.

(d) The department may award a grant, enter into a contract, or otherwise engage an individual or a group or association of individuals to perform professional services without complying with Subsection (c) if the executive commissioner by order [ratified by the board at its next regular meeting] determines that an emergency exists that necessitates the use of different procedures. A grant, contract, or engagement under this subsection is effective only for the period specified by the executive commissioner's order.

SECTION 3.0014. Section 12.0122(d), Health and Safety Code, is amended to read as follows:

(d) The executive commissioner [department] by rule may establish fees that the department may collect [charges] for the sale of laboratory services.

SECTION 3.0015. Section 12.01221, Health and Safety Code, is transferred to Subchapter B, Chapter 33, Health and Safety Code, redesignated as Section 33.0165, Health and Safety Code, and amended to read as follows:

Sec. 33.0165 [12.01221]. MUTUAL AID AGREEMENT FOR NEWBORN SCREENING LABORATORY SERVICES. (a) In this section, "newborn screening laboratory services" means the performance of tests to analyze specimens collected as part of the newborn screenings performed under this subchapter [Subchapter B, Chapter 33].

(b) Notwithstanding Section 12.0122 or other law, the department may enter into a mutual aid agreement to provide newborn screening laboratory services to another state and to receive newborn screening laboratory services from another state in the event of an unexpected interruption of service, including an interruption caused by a disaster.

(c) Each mutual aid agreement under Subsection (b) shall include provisions:

(1) to address the confidentiality of the identity of the newborn child and the newborn child's family; and

(2) to ensure the return of blood specimens and related records to the state that received the newborn screening laboratory services.

SECTION 3.0016. Section 12.0123, Health and Safety Code, as added by Chapter 1411 (H.B. 2085), Acts of the 76th Legislature, Regular Session, 1999, is transferred to Subchapter B, Chapter 32, Human Resources Code, redesignated as Section 32.0705, Human Resources Code, amended to conform to Section 12.0123, Health and Safety Code, as added by Chapters 1447 (H.B. 2896) and 1460 (H.B. 2641), Acts of the 76th Legislature, Regular Session, 1999, and further amended to read as follows:

Sec. 32.0705 [12.0123]. EXTERNAL AUDITS OF CERTAIN MEDICAID CONTRACTORS BASED ON RISK. (a) In this section, "Medicaid contractor" means an entity that:

(1) is not a health and human services agency as defined by Section 531.001, Government Code; and

(2) under a contract with the commission or otherwise on behalf of the commission [department], performs one or more administrative services in relation to the commission's [department's] operation of [a part of the state] Medicaid [program], such as claims processing, utilization review, client enrollment, provider enrollment, quality monitoring, or payment of claims.

(b) The commission [department] shall contract with an independent auditor to perform annual independent external financial and performance audits of any Medicaid contractor used [by the department] in the commission's [department's] operation of [a part of the state] Medicaid [program]. The commission [department] regularly shall review the [its] Medicaid contracts and ensure that:

(1) the frequency and extent of audits of a Medicaid contractor under this section are based on the amount of risk to the state involved in the administrative services being performed by the contractor;

(2) audit procedures related to financial audits and performance audits are used consistently in audits under this section; and

(3) to the extent possible, audits under this section are completed in a timely manner.

(c) If another state agency succeeds to the commission's [department's] operation of a part of [the state] Medicaid [program] for which the commission [department] used a Medicaid contractor, the successor agency shall comply with this section with regard to the Medicaid contractor, including the requirement to contract with an independent auditor to perform the external financial and performance audits required by this section.

(d) An audit required by this section must be completed before the end of the fiscal year immediately following the fiscal year for which the audit is performed.

SECTION 3.0017. Section 12.0124, Health and Safety Code, is transferred to Subchapter B, Chapter 32, Human Resources Code, redesignated as Section 32.0316, Human Resources Code, and amended to read as follows:

Sec. 32.0316 [12.0124]. ELECTRONIC TRANSACTIONS; [STATE] MEDICAID [PROGRAM]. The executive commissioner shall adopt and the commission [department or the department's successor in function in relation to the department's operation of a part of the state Medicaid program] shall implement policies that encourage the use of electronic transactions in Medicaid. The policies shall require payment to Medicaid [service] providers by electronic funds transfer, including electronic remittance and status reports. The policies shall also include the establishment of incentives to submit claims electronically and of disincentives to submit claims on paper that are reasonably based on the higher administrative costs to process claims submitted on paper.

SECTION 3.0018. Sections 12.0125(a) and (c), Health and Safety Code, are amended to read as follows:

(a) The department shall develop a voluntary drug manufacturer rebate program for drugs purchased by or on behalf of a client of the Kidney Health Care Program or the Children with Special Health Care Needs [Chronically Ill and Disabled Children's] Services Program for which rebates are not available under the Medicaid drug manufacturer rebate program.

(c) Amounts received by the department under the drug rebate program established under this section may be appropriated only for the Kidney Health Care Program or the Children with Special Health Care Needs [Chronically Ill and Disabled Children's] Services Program.

SECTION 3.0019. Section 12.0128, Health and Safety Code, is amended to read as follows:

Sec. 12.0128. HEALTH ALERT NETWORK. The department shall include local health officials [the Texas Association of Local Health Officials], the Texas Association of Community Health Centers, and the Texas Organization of Rural and Community Hospitals in the department's Texas Health Alert Network to the extent federal funds for bioterrorism preparedness are available for that purpose.

SECTION 3.0020. Section 12.014(b), Health and Safety Code, is amended to read as follows:

(b) The executive commissioner [board] by rule may adopt reasonable registration fees to cover the costs of establishing and maintaining a registry and may adopt other rules as necessary to administer this section.

SECTION 3.0021. Sections 12.0145(a), (d), and (g), Health and Safety Code, are amended to read as follows:

(a) The department shall publish and provide information in accordance with this section regarding each final enforcement action taken by the department or[,] commissioner[, or board] against a person or facility regulated by the department in which any kind of sanction is imposed, including:

(1) the imposition of a reprimand, a period of probation, a monetary penalty, or a condition on a person's continued practice or a facility's continued operation; and

(2) the refusal to renew or the suspension, probation, or revocation of a license or other form of permission to engage in an activity.

(d) The department shall publish and provide the information promptly after the sanction has been imposed or, when applicable, promptly after the period during which the sanction is imposed has begun. The executive commissioner [department] by rule shall establish the length of time during which the required information will be published and provided under this section based on the executive commissioner's [department's] determination regarding the types of services provided by regulated entities and the length of time for which information about a category of enforcement actions is useful to a member of the public.

(g) A determination that the department is not required to publish and provide information under this section does not affect a determination regarding whether the information is subject to required disclosure under the open records law, Chapter 552, Government Code. The executive commissioner's [department's] determination regarding the length of the period during which information should continue to be published and provided under this section does not affect a determination regarding the period for which the information must be preserved under Chapter 441, Government Code, or under another law.

SECTION 3.0022. Section 12.015(a), Health and Safety Code, is amended to read as follows:

(a) If the department determines that a person is not eligible for a level of care in a nursing facility [home], the department shall inform the person that community services might be available under a [the] community care for the aged and disabled program administered by the [Texas] Department of Aging and Disability [Human] Services.

SECTION 3.0023. Section 12.016(d), Health and Safety Code, is amended to read as follows:

(d) An applicant for a license, permit, registration, or similar form of permission required by law to be obtained from the department may not amend the application after the 31st day before the date on which a public hearing on the application is scheduled to begin. If an amendment of an application would be necessary within that period, the applicant shall resubmit the application to the department and must again comply with notice requirements and any other requirements of law or department [board] rule as though the application were originally submitted to the department on that date.

SECTION 3.0024. Section 12.019(a), Health and Safety Code, is amended to read as follows:

(a) The executive commissioner by rule may set a fee to be collected by the department [may charge] for providing genetic counseling services. The fee may not exceed the actual cost of providing the services.

SECTION 3.0025. Section 12.020(e), Health and Safety Code, is amended to read as follows:

(e) The executive commissioner shall institute intellectual property policies for the department that establish minimum standards for:

(1) the public disclosure or availability of products, technology, and scientific information, including inventions, discoveries, trade secrets, and computer software;

(2) review by the department of products, technology, and scientific information, including consideration of ownership and appropriate legal protection;

(3) the licensing of products, technology, and scientific information;

(4) the identification of ownership and licensing responsibilities for each class of intellectual property; and

(5) royalty participation by inventors and the department.

SECTION 3.0026. Section 12.032, Health and Safety Code, is amended to read as follows:

Sec. 12.032. FEES FOR PUBLIC HEALTH SERVICES. (a) The executive commissioner [board] by rule may adopt [charge] fees to be collected by the department from [to] a person who receives public health services from the department.

(b) The executive commissioner [board] by rule may require department contractors to collect [charge] fees for public health services provided by department contractors participating in the department's programs. A department contractor shall retain a fee collected under this subsection and shall use the fee in accordance with the contract provisions.

(c) The amount of a fee collected [charged] for a public health service may not exceed the cost to the department of providing the service.

(d) The executive commissioner by rule [board] may establish a fee schedule. In establishing the schedule, the executive commissioner [board] shall consider a person's ability to pay the entire amount of a fee.

(e) The executive commissioner [board] may not deny public health services to a person because of the person's inability to pay for the services.

SECTION 3.0027. Sections 12.033(a), (b), and (c), Health and Safety Code, are amended to read as follows:

(a) Except as otherwise provided by this section, the executive commissioner [board] by rule shall adopt [charge] fees to be collected by the department for the distribution and administration of vaccines and sera provided under:

(1) Section 38.001, Education Code;

(2) Section 42.043, Human Resources Code;

(3) Chapter 826 (Rabies Control Act of 1981);

(4) Chapter 81 (Communicable Disease Prevention and Control Act); and

(5) Section 161.005.

(b) Except as otherwise provided by this section, the executive commissioner [board] by rule may require a department contractor to collect [charge] fees for public health services provided by a contractor participating in a department program under the laws specified by Subsection (a).

(c) Provided the executive commissioner [board] finds that the monetary savings of this subsection are greater than any costs associated with administering it, the executive commissioner [board] by rule shall establish a fee schedule for fees under this section. In establishing the fee schedule, the executive commissioner [board] shall consider a person's financial ability to pay all or part of the fee, including the availability of health insurance coverage. In the event the fee schedule conflicts with any federal law or regulation, the executive commissioner [board] shall seek a waiver from the applicable federal law or regulation to permit the fee schedule. In the event the waiver is denied, the fee schedule shall not go into effect.

SECTION 3.0028. Sections 12.034(a), (c), and (d), Health and Safety Code, are amended to read as follows:

(a) The executive commissioner [board] shall establish procedures for the collection of fees for public health services. The procedures shall be used by the department and by those department contractors required by the executive commissioner [board] to collect [charge] fees.

(c) The department shall make a reasonable effort to collect fees billed after services are performed. However, the executive commissioner [board] by rule may waive the collection procedures if the administrative costs exceed the fees to be collected.

(d) If the executive commissioner [board] elects to require cash payments by program participants, the money received shall be deposited locally at the end of each day and retained by the department for not more than seven days. At the end of that time, the money shall be deposited in the state treasury.

SECTION 3.0029. Section 12.035, Health and Safety Code, is amended to read as follows:

Sec. 12.035. PUBLIC HEALTH SERVICES FEE ACCOUNT [FUND]. (a) The department shall deposit all money collected for fees and charges collected under Sections 12.0122(d) and 12.032(a) in the state treasury to the credit of the [Texas Department of Health] public health services fee account in the general revenue fund.

(b) The department shall maintain proper accounting records to allocate the money [fund] among the state and federal programs generating the fees and administrative costs incurred in collecting the fees.

[(c) The public health services fee fund is exempt from Section 403.095(b), Government Code.]

SECTION 3.0030. Sections 12.036(c) and (d), Health and Safety Code, are amended to read as follows:

(c) The executive commissioner [board] or the executive commissioner's [board's] designee may waive the department's right of subrogation in whole or in part if the executive commissioner [board] or the designee determines that:

(1) enforcement of the right would tend to defeat the purpose of the department's program; or

(2) the administrative expense of the enforcement would be greater than the expected recovery.

(d) The executive commissioner [board] may adopt rules for the enforcement of the department's right of subrogation.

SECTION 3.0031. Section 12.037(b), Health and Safety Code, is amended to read as follows:

(b) The executive commissioner [board] by rule shall prescribe the criteria for department action under this section.

SECTION 3.0032. Section 12.038, Health and Safety Code, is amended to read as follows:

Sec. 12.038. RULES. The executive commissioner [board] may adopt rules necessary to implement this subchapter.

SECTION 3.0033. Sections 12.055(b) and (d), Health and Safety Code, are amended to read as follows:

(b) A state agency or local unit of government under Subsection (a)(3) shall acquire goods or services by any procurement method approved by the commission [Health and Human Services Commission] that provides the best value to the state agency or local unit of government. The state agency or local unit of government shall document that the state agency or local unit of government considered all relevant factors under Subsection (c) in making the acquisition.

(d) If a state agency to which this section applies acquires goods or services with a value that exceeds $100,000, the state agency shall consult with and receive approval from the commission [Health and Human Services Commission] before considering factors other than price and meeting specifications.

SECTION 3.0034. Subchapter F, Chapter 12, Health and Safety Code, is amended to read as follows:

SUBCHAPTER F. OFFICE OF BORDER [TEXAS-MEXICO] HEALTH

[AND ENVIRONMENTAL ISSUES]

Sec. 12.071. OFFICE OF BORDER [TEXAS-MEXICO] HEALTH [AND ENVIRONMENTAL ISSUES]. The department shall establish and maintain an office in the department to coordinate and promote health and environmental issues between this state and Mexico.

SECTION 3.0035. Section 12.091, Health and Safety Code, is amended to read as follows:

Sec. 12.091. DEFINITION [DEFINITIONS]. In this subchapter, "panel"[:

[(1) "Medical standards division" means the Medical Standards on Motor Vehicle Operations Division of the department.

[(2) "Panel"] means a panel of the medical advisory board.

SECTION 3.0036. Section 12.092(a), Health and Safety Code, is amended to read as follows:

(a) The commissioner shall appoint the medical advisory board members from:

(1) persons licensed to practice medicine in this state, including physicians who are board certified in internal medicine, psychiatry, neurology, physical medicine, or ophthalmology and who are jointly recommended by the department [Texas Department of Health] and the Texas Medical Association; and

(2) persons licensed to practice optometry in this state who are jointly recommended by the department and the Texas Optometric Association.

SECTION 3.0037. Section 12.093, Health and Safety Code, is amended to read as follows:

Sec. 12.093. ADMINISTRATION[; RULES]. (a) The medical advisory board is administratively attached to the department [medical standards division].

(b) The department [medical standards division]:

(1) shall provide administrative support for the medical advisory board and panels of the medical advisory board; and

(2) may collect and maintain the individual medical records necessary for use by the medical advisory board and the panels under this section from a physician, hospital, or other health care provider.

SECTION 3.0038. Section 12.094(a), Health and Safety Code, is amended to read as follows:

(a) The executive commissioner [board]:

(1) may adopt rules to govern the activities of the medical advisory board;

(2) by rule may establish a reasonable fee to pay a member of the medical advisory board for the member's professional consultation services; and

(3) if appropriate, may authorize reimbursement for [per diem and] travel expenses as provided by Section 2110.004, Government Code, [allowances] for each meeting a member attends[, not to exceed the amounts authorized for state employees by the General Appropriations Act].

SECTION 3.0039. Section 12.097(b), Health and Safety Code, is amended to read as follows:

(b) In a subsequent proceeding under Subchapter H, Chapter 411, Government Code, or Subchapter N, Chapter 521, Transportation Code, the department [medical standards division] may provide a copy of the report of the medical advisory board or panel and a medical record or report relating to an applicant or license holder to:

(1) the Department of Public Safety of the State of Texas;

(2) the applicant or license holder; and

(3) the officer who presides at the hearing.

SECTION 3.0040. Section 12.113(a), Health and Safety Code, is amended to read as follows:

(a) Volunteers recruited under this subchapter may include students in high school or an institution of higher education, senior citizens, participants in the TANF [AFDC] job opportunities and basic skills (JOBS) training program, VISTA and AmeriCorps volunteers, and volunteers from business and community networks.

SECTION 3.0041. Section 12.133(b), Health and Safety Code, is amended to read as follows:

(b) Subject to the approval of the advisory committee, the executive commissioner [board] shall adopt rules governing the collection of information under Subsection (a). The rules may provide for regular audits of randomly selected political subdivisions and may govern the manner in which a political subdivision is selected for an audit and the selection of an auditor.

SECTION 3.0042. Section 12.134(a), Health and Safety Code, is amended to read as follows:

(a) Subject to the approval of the advisory committee, the executive commissioner [board] shall adopt rules under which a political subdivision or agency of this state may dispute information submitted by a political subdivision under Section 12.133.

SECTION 3.0043. Section 12.136(a), Health and Safety Code, is amended to read as follows:

(a) If the department, pursuant to rules adopted by the executive commissioner, [board] finds, after an audit conducted under Section 12.133 or 12.134, that a political subdivision has overstated unreimbursed health care expenditures in the information submitted under Section 12.133 for any year, the department shall report that fact to the comptroller and shall reduce that political subdivision's percentage of the subsequent annual distribution of the earnings from the account appropriately.

SECTION 3.0044. Sections 12.137(a) and (b), Health and Safety Code, are amended to read as follows:

(a) The tobacco settlement permanent trust account administration advisory committee shall advise the department [board] on the implementation of the department's duties under this subchapter.

(b) The advisory committee is composed of 11 members appointed as follows:

(1) one member appointed by the executive commissioner [board] to represent a public hospital or hospital district located in a county with a population of 50,000 or less or a public hospital owned or maintained by a municipality;

(2) one member appointed by the political subdivision that, in the year preceding the appointment, received the largest annual distribution paid from the account;

(3) one member appointed by the political subdivision that, in the year preceding the appointment, received the second largest annual distribution paid from the account;

(4) four members appointed by the Texas Conference of Urban Counties from nominations received from political subdivisions that in the year preceding the appointment, received the 3rd, 4th, 5th, 6th, 7th, 8th, 9th, 10th, 11th, or 12th largest annual distribution paid from the account;

(5) one member appointed by the County Judges and Commissioners Association of Texas;

(6) one member appointed by the North and East Texas County Judges and Commissioners Association;

(7) one member appointed by the South Texas County Judges and Commissioners Association; and

(8) one member appointed by the West Texas County Judges and Commissioners Association.

SECTION 3.0045. Section 12.138, Health and Safety Code, is amended to read as follows:

Sec. 12.138. APPROVAL OF RULES. A rule to be adopted by the executive commissioner [board] relating to certification of a percentage of an annual distribution under Section 12.132 or collection of information under Sections 12.132, 12.133, and 12.134 must be submitted to the advisory committee and may not become effective before the rule is approved by the advisory committee. If the advisory committee disapproves a proposed rule, the advisory committee shall provide the executive commissioner [board] the specific reasons that the rule was disapproved.

SECTION 3.0046. Section 12.139, Health and Safety Code, is amended to read as follows:

Sec. 12.139. ANNUAL REVIEW. The advisory committee shall annually:

(1) review the results of any audit conducted under this subchapter and the results of any dispute filed under Section 12.134; and

(2) review the rules adopted by the executive commissioner [board] under this subchapter and propose any amendments to the rules the advisory committee considers necessary.

SECTION 3.0047. The heading to Chapter 13, Health and Safety Code, is amended to read as follows:

CHAPTER 13. [HEALTH] DEPARTMENT HOSPITALS AND RESPIRATORY

FACILITIES

SECTION 3.0048. The heading to Subchapter A, Chapter 13, Health and Safety Code, is amended to read as follows:

SUBCHAPTER A. CARE AND TREATMENT IN [HEALTH] DEPARTMENT HOSPITALS

SECTION 3.0049. Sections 13.002(a), (c), and (d), Health and Safety Code, are amended to read as follows:

(a) The department [board] may admit to any hospital under its supervision a patient who:

(1) is eligible to receive patient services under a department program; and

(2) will benefit from hospitalization.

(c) The executive commissioner [board] may adopt rules and the department may enter into contracts as necessary to implement this section.

(d) This section does not require the executive commissioner [board] or department to:

(1) admit a patient to a particular hospital;

(2) guarantee the availability of space at any hospital; or

(3) provide treatment for a particular medical need at any hospital.

SECTION 3.0050. Section 13.003(b), Health and Safety Code, is amended to read as follows:

(b) The department [board] may establish at the Rio Grande State Center:

(1) cancer screening;

(2) diagnostic services;

(3) educational services;

(4) obstetrical services;

(5) gynecological services;

(6) other inpatient health care services; and

(7) outpatient health care services, including diagnostic, treatment, disease management, and supportive care services.

SECTION 3.0051. The heading to Section 13.004, Health and Safety Code, is amended to read as follows:

Sec. 13.004. TREATMENT OF CERTAIN PERSONS WITH MENTAL ILLNESS OR AN INTELLECTUAL DISABILITY [MENTALLY ILL OR MENTALLY RETARDED PERSONS].

SECTION 3.0052. Section 13.004(a), Health and Safety Code, is amended to read as follows:

(a) The department or the Department of Aging and Disability Services, as appropriate, [Texas Department of Mental Health and Mental Retardation] may transfer a [mentally ill or mentally retarded] person with mental illness or an intellectual disability who is infected with tuberculosis to a public health hospital as defined by Section 13.033 [the Texas Center for Infectious Disease].

SECTION 3.0053. Section 13.005, Health and Safety Code, is amended to read as follows:

Sec. 13.005. CARE AND TREATMENT OF CERTAIN PATIENTS. (a) The department [board] shall fully develop essential services needed for the control of tuberculosis. To provide those services, the department [board] may contract for the support, maintenance, care, and treatment of tuberculosis patients:

(1) admitted to facilities under the department's [board's] jurisdiction; or

(2) otherwise subject to the department's [board's] jurisdiction.

(b) The department [board] may contract with:

(1) municipal, county, or state hospitals;

(2) private physicians;

(3) licensed nursing facilities [homes] and hospitals; and

(4) hospital districts.

(c) The department [board] may contract for diagnostic and other services available in a community or region as necessary to prevent further spread of tuberculosis.

(d) A contract may not include the assignment of any lien accruing to the state.

(e) The department [board] may establish and operate outpatient clinics as necessary to provide follow-up treatment on discharged patients. A person who receives treatment as an outpatient is financially liable in the manner provided for inpatients.

SECTION 3.0054. Sections 13.033(3) and (5), Health and Safety Code, are amended to read as follows:

(3) "Physician" means a person licensed by the Texas [State Board of] Medical Board [Examiners] to practice medicine in this state.

(5) "Public health [State chest] hospital" means a hospital operated by the department to provide services under this subchapter, including the Texas Center for Infectious Disease [and the Rio Grande State Center].

SECTION 3.0055. Section 13.034, Health and Safety Code, is amended to read as follows:

Sec. 13.034. [BOARD] DUTIES OF EXECUTIVE COMMISSIONER AND DEPARTMENT. (a) The executive commissioner [board] shall adopt rules [and bylaws] relating to:

(1) the management of public health [state chest] hospitals;

(2) the duties of officers and employees of those hospitals; and

(3) the enforcement of necessary discipline and restraint of patients.

(a-1) The executive commissioner may adopt rules as necessary for the proper and efficient hospitalization of tuberculosis patients.

(b) The department [board] shall supply each hospital with the necessary personnel for the operation and maintenance of the hospital.

(c) The department [board] may:

(1) prescribe the form and content of applications, certificates, records, and reports provided for under this subchapter;

(2) require reports from the administrator of a public health [state chest] hospital relating to the admission, examination, diagnosis, release, or discharge of a patient;

(3) visit each hospital regularly to review admitting procedures and the care and treatment of all new patients admitted since the last visit; and

(4) investigate by personal visit a complaint made by a patient or by another person on behalf of a patient[; and

[(5) adopt rules as necessary for the proper and efficient hospitalization of tuberculosis patients].

[(d) The board may delegate a power or duty of the board to an employee. The delegation does not relieve the board from its responsibility.]

SECTION 3.0056. Section 13.035(a), Health and Safety Code, is amended to read as follows:

(a) The department shall employ a qualified hospital administrator for each public health [state chest] hospital.

SECTION 3.0057. Sections 13.036(a) and (c), Health and Safety Code, are amended to read as follows:

(a) A resident of this state who has tuberculosis may be admitted to a public health [state chest] hospital. A person who is not a resident of this state and who has tuberculosis may be admitted to a public health [state chest] hospital in accordance with Section 13.046.

(c) An application for admission to a public health [state chest] hospital shall be accompanied by a certificate issued by a physician stating that the physician has thoroughly examined the applicant and that the applicant has tuberculosis. In the case of an applicant who is not a resident of this state, the certificate may be issued by a physician who holds a license to practice medicine in the state of residence of the applicant.

SECTION 3.0058. Section 13.038(a), Health and Safety Code, is amended to read as follows:

(a) A patient admitted to a public health [state chest] hospital is a public patient and classified as indigent, nonindigent, or nonresident.

SECTION 3.0059. Section 13.039(b), Health and Safety Code, is amended to read as follows:

(b) The action shall be brought on the written request of the public health [state chest] hospital administrator, accompanied by a certificate as to the amount owed to the state. In any action, the certificate is sufficient evidence of the amount owed to the state for the support of that patient.

SECTION 3.0060. Sections 13.041(a) and (c), Health and Safety Code, are amended to read as follows:

(a) The department [board] may:

(1) return a nonresident patient admitted to a public health [state chest] hospital to the proper agency of the state of the patient's residence; and

(2) permit the return of a resident of this state who has been admitted to a tuberculosis hospital in another state.

(c) The department [board] may enter into reciprocal agreements with the proper agencies of other states to facilitate the return to the states of their residence of nonresident patients admitted to tuberculosis [state chest] hospitals in other states.

SECTION 3.0061. Section 13.042, Health and Safety Code, is amended to read as follows:

Sec. 13.042. DISCRIMINATION PROHIBITED. (a) A public health [state chest] hospital may not discriminate against a patient.

(b) Each patient is entitled to equal facilities, attention, and treatment. However, a public health [state chest] hospital may provide different care and treatment of patients because of differences in the condition of the individual patients.

SECTION 3.0062. Sections 13.043(a) and (c), Health and Safety Code, are amended to read as follows:

(a) A patient in a public health [state chest] hospital may not offer an officer, agent, or employee of the hospital a tip, payment, or reward of any kind.

(c) The department [board] shall strictly enforce this section.

SECTION 3.0063. Sections 13.044(a), (d), and (e), Health and Safety Code, are amended to read as follows:

(a) On the request of any charitable organization in this state, the department [board] may permit the erection, furnishing, and maintenance by the charitable organization of accommodations on the grounds of a public health [state chest] hospital for persons who have tuberculosis and who are:

(1) members of the charitable organization;

(2) members of the families of persons who are members of the charitable organization; or

(3) surviving spouses or minor children of deceased persons who are members of the charitable organization.

(d) The officers or a board or committee of the charitable organization and the department [board] must enter into a written agreement relating to the location, construction, style, and character, and terms of existence of buildings, and other questions arising in connection with the grant of permission to erect and maintain private accommodations. The department must maintain as a record a copy of the written agreement [must be recorded in the minutes of the board].

(e) Except for the preferential right to occupy vacant accommodations erected by the person's charitable organization, a person described by Subsection (a) shall be classified in the same manner as other public health [state chest] hospital patients and shall be admitted, maintained, cared for, and treated in those hospitals in the same manner and under the same conditions and rules that apply to other patients.

SECTION 3.0064. Section 13.045(a), Health and Safety Code, is amended to read as follows:

(a) A county may donate and convey land to the state in consideration of the establishment of a public health [state chest] hospital by the executive commissioner [board].

SECTION 3.0065. Section 13.046, Health and Safety Code, is amended to read as follows:

Sec. 13.046. ADMISSION OF NONRESIDENT PATIENTS. (a) The department may enter into an agreement with an agency of another state responsible for the care of residents of that state who have tuberculosis under which:

(1) residents of the other state who have tuberculosis may be admitted to a public health [state chest] hospital, subject to the availability of appropriate space after the needs of eligible tuberculosis and chronic respiratory disease patients who are residents of this state have been met; and

(2) the other state is responsible for paying all costs of the hospitalization and treatment of patients admitted under the agreement.

(b) Section 13.041 does not apply to the return of a nonresident patient admitted to a public health [state chest] hospital in accordance with an agreement entered into under this section. The return of that patient to the state of residence is governed by the agreement.

SECTION 3.0066. Section 31.002(a)(3), Health and Safety Code, is amended to read as follows:

(3) "Other benefit" means a benefit, other than a benefit provided under this chapter, to which an individual is entitled for payment of the costs of primary health care services, including benefits available from:

(A) an insurance policy, group health plan, or prepaid medical care plan;

(B) Title XVIII or XIX of the Social Security Act (42 U.S.C. Section 1395 et seq. or Section 1396 et seq.);

(C) the United States Department of Veterans Affairs [Administration];

(D) the TRICARE program of the United States Department of Defense [Civilian Health and Medical Program of the Uniformed Services];

(E) workers' compensation or any other compulsory employers' insurance program;

(F) a public program created by federal or state law, or by an ordinance or rule of a municipality or political subdivision of the state, excluding benefits created by the establishment of a municipal or county hospital, a joint municipal-county hospital, a county hospital authority, a hospital district, or the facilities of a publicly supported medical school; or

(G) a cause of action for medical, facility, or medical transportation expenses, or a settlement or judgment based on the cause of action, if the expenses are related to the need for services provided under this chapter.

SECTION 3.0067. Section 31.002(b), Health and Safety Code, is amended to read as follows:

(b) The executive commissioner [board] by rule may define a word or term not defined by Subsection (a) as necessary to administer this chapter. The executive commissioner [board] may not define a word or term so that the word or term is inconsistent or in conflict with the purposes of this chapter, or is in conflict with the definition and conditions of practice governing a provider who is required to be licensed, registered, certified, identified, or otherwise sanctioned under the laws of this state.

SECTION 3.0068. Sections 31.003(a), (b), (c), (d), (e), and (g), Health and Safety Code, are amended to read as follows:

(a) The executive commissioner [board] may establish a program in the department to provide primary health care services to eligible individuals.

(b) If the program is established, the executive commissioner [board] shall adopt rules relating to:

(1) the type, amount, and duration of services to be provided under this chapter; and

(2) the determination by the department of the services needed in each service area.

(c) If budgetary limitations exist, the executive commissioner [board] by rule shall establish a system of priorities relating to the types of services provided, geographic areas covered, or classes of individuals eligible for services.

(d) The executive commissioner [board] shall adopt rules under Subsection (c) relating to the geographic areas covered and the classes of individuals eligible for services according to a statewide determination of the need for services.

(e) The executive commissioner [board] shall adopt rules under Subsection (c) relating to the types of services provided according to the set of service priorities established under this subsection. Initial service priorities shall focus on the funding of, provision of, and access to:

(1) diagnosis and treatment;

(2) emergency services;

(3) family planning services;

(4) preventive health services, including immunizations;

(5) health education; and

(6) laboratory, X-ray, nuclear medicine, or other appropriate diagnostic services.

(g) The executive commissioner [board] should require that the services provided under this chapter be reserved to the greatest extent possible for low-income individuals who are not eligible for similar services through any other publicly funded program.

SECTION 3.0069. Sections 31.004(a) and (b), Health and Safety Code, are amended to read as follows:

(a) The executive commissioner [board] shall adopt rules necessary to administer this chapter, and the department shall administer the program in accordance with those [board] rules.

(b) The executive commissioner [With the advice and assistance of the commissioner and the department, the board] by rule shall:

(1) establish the administrative structure of the program;

(2) establish a plan of areawide administration to provide authorized services;

(3) designate, if possible, local public and private resources as providers; and

(4) prevent duplication by coordinating authorized primary health care services with existing federal, state, and local programs.

SECTION 3.0070. Sections 31.005(a), (b), (c), and (e), Health and Safety Code, are amended to read as follows:

(a) The executive commissioner [board] shall adopt rules relating to the department's determination of whether program services are to be provided through a network of approved providers, directly by the department, or by a combination of the department and approved providers as prescribed by this section.

(b) The department shall provide services only as prescribed by department [board] rule.

(c) The department may provide primary health care services directly to eligible individuals to the extent that the department [board] determines that existing private or public providers or other resources in the service area are unavailable or unable to provide those services. In making that determination, the department shall:

(1) initially determine the proposed need for services in the service area;

(2) notify existing private and public providers and other resources in the service area of the department's initial determination of need and the services the department proposes to provide directly to eligible individuals;

(3) provide existing private and public providers and other resources in the service area a reasonable opportunity to comment on the department's initial determination of need and the availability and ability of existing private or public providers or other resources in the service area to satisfy the need;

(4) provide existing private and public providers and other resources in the service area a reasonable opportunity to obtain approval as providers under the program; and

(5) eliminate, reduce, or otherwise modify the proposed scope or type of services the department proposes to provide directly to the extent that those services may be provided by existing private or public providers or other resources in the service area that meet the executive commissioner's [board's] criteria for approval as providers.

(e) If after a review the department [board] determines that a private or public provider or other resource is available to provide services and has been approved as a provider, the department shall, immediately after approving the provider, eliminate, reduce, or modify the scope and type of services the department provides directly to the extent the private or public provider or other resource is available and able to provide the service.

SECTION 3.0071. Sections 31.006(a), (b), (d), (f), and (i), Health and Safety Code, are amended to read as follows:

(a) The executive commissioner [board] shall adopt rules relating to:

(1) the selection and expedited selection of providers, including physicians, registered nurses, and facilities; and

(2) the denial, modification, suspension, and termination of program participation.

(b) The department shall select and approve providers to participate in the program according to the criteria and following the procedures prescribed by department [board] rules.

(d) The executive commissioner [board] may not adopt facility approval criteria that discriminate against a facility solely because it is operated for profit.

(f) The department [board] shall provide a due process hearing procedure in accordance with department rules for the resolution of conflicts between the department and a provider. Chapter 2001, Government Code, does [do] not apply to conflict resolution procedures adopted under this section.

(i) The notice and hearing required by this section do not apply if a grant or contract:

(1) is canceled by the department because of exhaustion of funds or because insufficient funds require the executive commissioner [board] to adopt service priorities; or

(2) expires according to its terms.

SECTION 3.0072. Sections 31.007(a), (c), (d), and (e), Health and Safety Code, are amended to read as follows:

(a) The executive commissioner [board] shall adopt rules relating to application procedures for admission to the program.

(c) The application form must be accompanied by:

(1) a statement by the applicant, or by the person with a legal obligation to provide for the applicant's support, that the applicant or person is financially unable to pay for all or part of the cost of the necessary services; and

(2) any other assurances from the applicant or any documentary evidence required by department rules [the board] that is necessary to support the applicant's eligibility.

(d) Except as permitted by department [program] rules, the department may not provide services or authorize payment for services delivered to an individual before the eligibility date assigned to the individual by the department.

(e) The department shall determine or cause to be determined the eligibility date in accordance with department [board] rules. The date may not be later than the date on which the individual submits a properly completed application form and all supporting documents required by this chapter or department [board] rules.

SECTION 3.0073. Section 31.008, Health and Safety Code, is amended to read as follows:

Sec. 31.008. ELIGIBILITY FOR SERVICES. (a) The executive commissioner [board] shall adopt rules relating to eligibility criteria for an individual to receive services under the program, including health, medical, and financial criteria. The department shall determine or cause to be determined an applicant's eligibility in accordance with this chapter and department [board] rules.

(b) Except as modified by other rules adopted under this chapter, the executive commissioner [board] by rule shall provide that to be eligible to receive services, the individual must be a resident of this state.

SECTION 3.0074. Sections 31.009(c), (d), and (f), Health and Safety Code, are amended to read as follows:

(c) The executive commissioner [board] by rule shall provide criteria for action by the department under this section.

(d) Chapter 2001, Government Code, does [do] not apply to the granting, denial, modification, suspension, or termination of services. The department shall conduct hearings in accordance with the department's [board's] due process hearing rules.

(f) The notice and hearing required by this section do not apply if the department restricts program services to conform to budgetary limitations that require the executive commissioner [board] to establish service priorities.

SECTION 3.0075. Sections 31.010(b) and (e), Health and Safety Code, are amended to read as follows:

(b) Except as provided by department [board] rules, an individual is not eligible to receive services under this chapter to the extent that the individual, or a person with a legal obligation to support the individual, is eligible for some other benefit that would pay for all or part of the services.

(e) The department [commissioner] may waive enforcement of Subsections (b)-(d) [of this section] as prescribed by department [board] rules in certain individually considered cases in which enforcement will deny services to a class of otherwise eligible individuals because of conflicting federal, state, or local laws or rules.

SECTION 3.0076. Section 31.012, Health and Safety Code, is amended to read as follows:

Sec. 31.012. FEES. (a) The department [board] may charge fees for the services provided directly by the department or through approved providers in accordance with Subchapter D, Chapter 12.

(b) The executive commissioner by rule [board] shall adopt standards and procedures to develop and implement a schedule of allowable charges for program services.

SECTION 3.0077. Section 31.013(a), Health and Safety Code, is amended to read as follows:

(a) Except as provided by this chapter or by other law, the department [board] may seek, receive, and spend funds received through an appropriation, grant, donation, or reimbursement from any public or private source to administer this chapter.

SECTION 3.0078. Sections 31.015(b) and (d), Health and Safety Code, are amended to read as follows:

(b) The executive commissioner [board] shall adopt rules relating to the information a provider is required to report to the department and shall adopt procedures to prevent unnecessary and duplicative reporting of data.

(d) The report required under Subsection (c) must include:

(1) the number of individuals receiving care under this chapter;

(2) the total cost of the program, including a delineation of the total administrative costs and the total cost for each service authorized under Section 31.003(e);

(3) the average cost per recipient of services;

(4) the number of individuals who received services in each public health region; and

(5) any other information required by the executive commissioner [board].

SECTION 3.0079. Section 32.002(a)(8), Health and Safety Code, is amended to read as follows:

(8) "Other benefit" means a benefit, other than a benefit provided under this chapter, to which an individual is entitled for payment of the costs of maternal and infant health improvement services, ancillary services, educational services, or transportation services, including benefits available from:

(A) an insurance policy, group health plan, or prepaid medical care plan;

(B) Title XVIII of the Social Security Act (42 U.S.C. Section 1395 et seq.);

(C) the United States Department of Veterans Affairs [Administration];

(D) the TRICARE program of the United States Department of Defense [Civilian Health and Medical Program of the Uniformed Services];

(E) workers' compensation or any other compulsory employers' insurance program;

(F) a public program created by federal or state law, other than Title XIX of the Social Security Act (42 U.S.C. Section 1396 et seq.), or by an ordinance or rule of a municipality or political subdivision of the state, excluding benefits created by the establishment of a municipal or county hospital, a joint municipal-county hospital, a county hospital authority, a hospital district, or the facilities of a publicly supported medical school; or

(G) a cause of action for medical, facility, or medical transportation expenses, or a settlement or judgment based on the cause of action, if the expenses are related to the need for services provided under this chapter.

SECTION 3.0080. Section 32.002(b), Health and Safety Code, is amended to read as follows:

(b) The executive commissioner [board] by rule may define a word or term not defined by Subsection (a) as necessary to administer this chapter. The executive commissioner [board] may not define a word or term so that the word or term is inconsistent or in conflict with the purposes of this chapter, or is in conflict with the definition and conditions of practice governing a provider who is required to be licensed, registered, certified, identified, or otherwise sanctioned under the laws of this state.

SECTION 3.0081. Section 32.003, Health and Safety Code, is amended to read as follows:

Sec. 32.003. MATERNAL AND INFANT HEALTH IMPROVEMENT SERVICES PROGRAM. (a) The executive commissioner [board] may establish a maternal and infant health improvement services program in the department to provide comprehensive maternal and infant health improvement services and ancillary services to eligible women and infants.

(b) If the program is established, the executive commissioner [board] shall adopt rules relating to:

(1) the type, amount, and duration of services to be provided under this chapter; and

(2) the determination by the department of the services needed in each service area.

(c) If budgetary limitations exist, the executive commissioner [board] by rule shall establish a system of priorities relating to the types of services provided, geographic areas covered, or classes of individuals eligible for services.

(d) The executive commissioner [board] shall adopt the rules according to a statewide determination of the need for services.

(e) In structuring the program and adopting rules, the department and executive commissioner [board] shall attempt to maximize the amount of federal matching funds available for maternal and infant health improvement services while continuing to serve targeted populations.

(f) If necessary, the executive commissioner [board] by rule may coordinate services and other parts of the program with the medical assistance program. However, the executive commissioner [board] may not adopt rules relating to the services under either program that would:

(1) cause the program established under this chapter not to conform with federal law to the extent that federal matching funds would not be available; or

(2) affect the status of the single state agency to administer the medical assistance program.

SECTION 3.0082. Section 32.006(a), Health and Safety Code, is amended to read as follows:

(a) The executive commissioner [board] shall adopt rules necessary to administer this chapter, and the department shall administer the program in accordance with those [board] rules.

SECTION 3.0083. Sections 32.011(b), (c), (d), and (e), Health and Safety Code, are amended to read as follows:

(b) The executive commissioner [board] by rule shall provide criteria for action by the department under this section.

(c) Chapter 2001, Government Code, does not apply to the granting, denial, modification, suspension, or termination of services. The department shall provide [conduct] hearings in accordance with the department's [board's] due process hearing rules.

(d) The department shall render the final administrative decision following [in] a due process hearing to deny, modify, suspend, or terminate the receipt of services.

(e) The notice and hearing required by this section do not apply if the department restricts program services to conform to budgetary limitations that require the executive commissioner [board] to establish service priorities.

SECTION 3.0084. Sections 32.012(b) and (e), Health and Safety Code, are amended to read as follows:

(b) Except as provided by department [board] rules, an individual is not eligible to receive services under this chapter to the extent that the individual or a person with a legal obligation to support the individual is eligible for some other benefit that would pay for all or part of the services.

(e) The department [commissioner] may waive enforcement of Subsections (b)-(d) [of this section] as prescribed by department [board] rules in certain individually considered cases in which enforcement will deny services to a class of otherwise eligible individuals because of conflicting federal, state, or local laws or rules.

SECTION 3.0085. Section 32.014, Health and Safety Code, is amended to read as follows:

Sec. 32.014. FEES. (a) Except as prohibited by federal law or regulation, the department [board] may collect [charge] fees for the services provided directly by the department or through approved providers in accordance with Subchapter D, Chapter 12.

(b) The executive commissioner by rule [board] shall adopt standards and procedures to develop and implement a schedule of allowable charges for program services.

SECTION 3.0086. Section 32.015(a), Health and Safety Code, is amended to read as follows:

(a) Except as provided by this chapter or by other law, the department [board] may seek, receive, and spend funds received through an appropriation, grant, donation, or reimbursement from any public or private source to administer this chapter.

SECTION 3.0087. Section 32.017(b), Health and Safety Code, is amended to read as follows:

(b) The executive commissioner [board] shall adopt rules relating to the information a provider is required to report to the department and shall adopt procedures to prevent unnecessary and duplicative reporting of data.

SECTION 3.0088. The heading to Section 32.021, Health and Safety Code, is amended to read as follows:

Sec. 32.021. REQUIREMENTS REGARDING THE WOMEN, INFANTS, AND CHILDREN PROGRAM.

SECTION 3.0089. Section 32.021(a), Health and Safety Code, is amended to read as follows:

(a) An agency, organization, or other entity that contracts with the Special Supplemental Nutrition Program for Women, Infants, and Children shall each month provide the clinical and nutritional services supported by that program during extended hours, as defined by the department.

SECTION 3.0090. The heading to Section 32.0211, Health and Safety Code, is amended to read as follows:

Sec. 32.0211. WOMEN, INFANTS, AND CHILDREN PROGRAM OUTREACH CAMPAIGN TO PROMOTE FATHERS' INVOLVEMENT.

SECTION 3.0091. Sections 32.0211(a), (c), and (d), Health and Safety Code, are amended to read as follows:

(a) The attorney general shall:

(1) subject to Subsections (b) and (c), develop and periodically update a publication that:

(A) describes the importance and long-term positive effects on children of a father's involvement during a mother's pregnancy; and

(B) provides guidance to prospective fathers on the positive actions that they can take to support the pregnant mother during pregnancy and the effect those actions have on pregnancy outcomes; and

(2) make the publication described by Subdivision (1) available to any agency, organization, or other entity that contracts with the Special Supplemental Nutrition Program for Women, Infants, and Children and on the attorney general's Internet website in a format that allows the public to download and print the publication.

(c) In developing the publication required by Subsection (a), the attorney general shall consult with:

(1) the department as the state agency responsible for administering the Special Supplemental Nutrition Program for Women, Infants, and Children and this state's program under the Maternal and Child Health Services Block Grant Act (42 U.S.C. Section 701 et seq.); and

(2) the Texas Council on Family Violence.

(d) An agency, organization, or other entity that contracts with the Special Supplemental Nutrition Program for Women, Infants, and Children shall make the publication described by Subsection (a) available to each client receiving clinical or nutritional services under the program.

SECTION 3.0092. The heading to Section 32.042, Health and Safety Code, is amended to read as follows:

Sec. 32.042. DUTIES OF EXECUTIVE COMMISSIONER [BOARD]; RULES.

SECTION 3.0093. Section 32.042(a), Health and Safety Code, is amended to read as follows:

(a) The executive commissioner [board] by rule shall adopt:

(1) minimum standards and objectives to implement voluntary perinatal health care systems; and

(2) policies for health promotion and education, risk assessment, access to care, and perinatal system structure, including the transfer and transportation of pregnant women and infants.

SECTION 3.0094. Section 32.044(a), Health and Safety Code, is amended to read as follows:

(a) Each voluntary perinatal health care system must have:

(1) a coordinating board responsible for ensuring, providing, or coordinating planning access to services, data collection, and provider education;

(2) access to appropriate emergency medical services;

(3) risk assessment, transport, and transfer protocols for perinatal patients;

(4) one or more health care facilities categorized according to perinatal care capabilities using standards adopted by department [board] rule; and

(5) documentation of broad-based participation in planning by providers of perinatal services and community representatives throughout the defined geographic region.

SECTION 3.0095. Sections 32.045(b) and (c), Health and Safety Code, are amended to read as follows:

(b) The executive commissioner [board] by rule shall establish eligibility criteria for awarding the grants. The rules must require the department to consider:

(1) the need of an area and the extent to which the grant would meet the identified need;

(2) the availability of personnel and training programs;

(3) the availability of other funding sources;

(4) the assurance of providing quality services;

(5) the need for emergency transportation of perinatal patients and the extent to which the system meets the identified needs; and

(6) the stage of development of a perinatal health care system.

(c) The department may approve grants according to rules adopted by the executive commissioner [board]. A grant awarded under this section is governed by Chapter 783, Government Code, and rules adopted under that chapter.

SECTION 3.0096. Section 32.062, Health and Safety Code, is amended to read as follows:

Sec. 32.062. ESTABLISHMENT; PRESIDING OFFICER. (a) The task force is composed of 25 members appointed by the executive commissioner [of the Health and Human Services Commission] as follows:

(1) four representatives of family violence centers, as defined by Section 51.002, Human Resources Code, from different geographic regions in this state, including both rural and urban areas;

(2) one representative of a statewide family violence advocacy organization;

(3) one representative of a statewide association of obstetricians and gynecologists;

(4) two representatives of the family and community health programs in the department [Department of State Health Services];

(5) one representative of a statewide sexual assault advocacy organization;

(6) one representative of the commission's [Health and Human Services Commission] Texas Home Visiting Program;

(7) one representative of a statewide association of midwifery;

(8) one representative of a statewide family physician's association;

(9) one representative of a statewide nursing association;

(10) one representative of a statewide hospital association;

(11) one representative of a statewide pediatric medical association;

(12) one representative of a statewide medical association;

(13) one representative of The University of Texas School of Social Work Institute on Domestic Violence and Sexual Assault;

(14) one representative of The University of Texas School of Law Domestic Violence Clinic;

(15) one representative of the governor's EMS and Trauma Advisory Council;

(16) one representative of a Department of Family and Protective Services prevention and early intervention program;

(17) one representative of a statewide osteopathic medical association;

(18) one representative of a statewide association of community health centers;

(19) one representative of the office of the attorney general;

(20) one representative from a medical school or a teaching hospital in the state who is either an attending physician of the hospital or a faculty member of the medical school; and

(21) one representative of the commission's [Health and Human Services Commission's] Family Violence Program.

(b) The executive commissioner [of the Health and Human Services Commission] shall appoint a task force member to serve as presiding officer of the task force.

SECTION 3.0097. Section 32.064, Health and Safety Code, is amended to read as follows:

Sec. 32.064. REPORT. Not later than September 1, 2015, the task force shall submit a report to the governor, the lieutenant governor, the speaker of the house of representatives, the presiding officers of the standing committees of the legislature having primary jurisdiction over health and human services, the executive commissioner [of the Health and Human Services Commission], and the commissioner [of state health services] containing:

(1) the findings and legislative, policy, and research recommendations of the task force; and

(2) a description of the activities of the task force.

SECTION 3.0098. Section 33.001(3), Health and Safety Code, is amended to read as follows:

(3) "Other benefit" means a benefit, other than a benefit under this chapter, to which an individual is entitled for the payment of the costs of services. The term includes:

(A) benefits available under:

(i) an insurance policy, group health plan, or prepaid medical care plan;

(ii) Title XVIII of the Social Security Act (42 U.S.C. Section 1395 et seq.);

(iii) Title XIX of the Social Security Act (42 U.S.C. Section 1396 et seq.);

(iv) the United States Department of Veterans Affairs [Veterans' Administration];

(v) the TRICARE program of the United States Department of Defense [Civilian Health and Medical Program of the Uniformed Services]; or

(vi) workers' compensation or any other compulsory employers insurance program;

(B) a public program created by federal or state law or by ordinance or rule of a municipality or political subdivision of the state, except those benefits created by the establishment of a municipal or county hospital, a joint municipal-county hospital, a county hospital authority, a hospital district, or by the facilities of a publicly supported medical school; and

(C) benefits resulting from a cause of action for health care expenses, or a settlement or judgment based on the cause of action, if the expenses are related to the need for services provided under this chapter.

SECTION 3.0099. Section 33.002(b), Health and Safety Code, is amended to read as follows:

(b) The executive commissioner [board] shall adopt rules necessary to carry out the program, including a rule specifying other heritable diseases covered by this chapter.

SECTION 3.0100. Section 33.004, Health and Safety Code, is amended to read as follows:

Sec. 33.004. [STUDY ON] NEWBORN SCREENING PROGRAM; FEES [METHODOLOGY AND EQUIPMENT]. [(a) Not later than March 1, 2006, the department shall:

[(1) conduct a study to determine the most cost-effective method of conducting newborn screening, including screening for disorders listed in the core uniform panel of newborn screening conditions recommended in the 2005 report by the American College of Medical Genetics entitled "Newborn Screening: Toward a Uniform Screening Panel and System" or another report determined by the department to provide more appropriate newborn screening guidelines, to protect the health and welfare of this state's newborns and to maximize the number of newborn screenings that may be conducted with the funding available for the screening;

[(2) determine the disorders to be studied under Subdivision (1) and ensure the study does not examine screening and services provided under Chapter 47; and

[(3) obtain proposals or information regarding the conduct of newborn screening and compare the costs of the department performing newborn screening services to the costs of outsourcing screening to a qualified laboratory with at least two years' experience performing newborn screening tests.]

(b) In accordance with rules adopted by the executive commissioner [of the Health and Human Services Commission], the department shall [may] implement a newborn screening program.

(c) In implementing the newborn screening program [If the department determines under Subsection (a) that the department's performance of newborn screening services is more cost-effective than outsourcing newborn screening], the department shall obtain the use of screening methodologies[, including tandem mass spectrometers,] and hire the employees necessary to administer newborn screening under this chapter.

[(d) If the department determines under Subsection (a) that outsourcing of newborn screening is more cost-effective, the department shall contract for the resources and services necessary to conduct newborn screening using a competitive procurement process.]

(e) The department shall periodically review the newborn screening program [as revised under this section] to determine the efficacy and cost-effectiveness of the program and determine whether adjustments to the program are necessary to protect the health and welfare of this state's newborns and to maximize the number of newborn screenings that may be conducted with the funding available for the screening.

(f) The executive commissioner by rule [department] may establish [adjust] the amounts charged for newborn screening fees, including fees assessed for follow-up services, tracking confirmatory testing, and diagnosis.

SECTION 3.0101. Section 33.011(a-1), Health and Safety Code, is amended to read as follows:

(a-1) Except as provided by this subsection and to the extent funding is available for the screening, the department shall require newborn screening tests to screen for disorders listed as core and secondary conditions in the [December 2011] Recommended Uniform Screening Panel of the Secretary's Advisory Committee on Heritable Disorders in Newborns and Children or another report determined by the department to provide more stringent newborn screening guidelines to protect the health and welfare of this state's newborns. The department, with the advice of the Newborn Screening Advisory Committee, may require additional newborn screening tests under this subsection to screen for other disorders or conditions. The department may exclude from the newborn screening tests required under this subsection screenings for galactose epimerase and galactokinase.

SECTION 3.0102. Section 33.0112, Health and Safety Code, is amended to read as follows:

Sec. 33.0112. DESTRUCTION OF GENETIC MATERIAL. (a) The department shall destroy any genetic material obtained from a child under this chapter not later than the second anniversary of the date the department receives the genetic material unless a parent, managing conservator, or guardian of the child consents to disclosure under Section 33.018(c-1) [33.017(c-1)].

(b) The department shall destroy any genetic material obtained from a child under this chapter not later than the second anniversary of the date the department receives the genetic material if:

(1) a parent, managing conservator, or guardian of the child consents to disclosure under Section 33.018(c-1) [33.017(c-1)];

(2) the parent, managing conservator, or guardian who consented to the disclosure revokes the consent under Section 33.018(i) [33.017(i)]; and

(3) the department receives the written revocation of consent under Section 33.018(i) [33.017(i)] not later than the second anniversary of the date the department received the genetic material.

(c) The department shall destroy any genetic material obtained from a child under this chapter not later than the 60th day after the date the department receives a written revocation of consent under Section 33.018(i) [33.017(i)] if:

(1) a parent, managing conservator, or guardian of the child consented to disclosure under Section 33.018(c-1) [33.017(c-1)];

(2) the parent, managing conservator, or guardian who consented to the disclosure or the child revokes the consent under Section 33.018(i) [33.017(i)]; and

(3) the department receives the written revocation of consent later than the second anniversary of the date the department received the genetic material.

[(d) A reference in this section to Section 33.017 means Section 33.017 as added by Chapter 179 (H.B. 1672), Acts of the 81st Legislature, Regular Session, 2009.]

SECTION 3.0103. Sections 33.016(a), (d), and (f), Health and Safety Code, are amended to read as follows:

(a) The department may develop a program to approve any laboratory that wishes to perform the tests required to be administered under this chapter. To the extent that they are not otherwise provided in this chapter, the executive commissioner [board] may adopt rules prescribing procedures and standards for the conduct of the program.

(d) The department may extend or renew any approval in accordance with reasonable procedures prescribed by the executive commissioner [board].

(f) Hearings under this section shall be conducted in accordance with the department's hearing rules [adopted by the board] and the applicable provisions of Chapter 2001, Government Code.

SECTION 3.0104. Sections 33.017(b) and (f), Health and Safety Code, are amended to read as follows:

(b) The advisory committee consists of members appointed by the commissioner [of state health services]. The advisory committee must include the following members:

(1) at least four physicians licensed to practice medicine in this state, including at least two physicians specializing in neonatal-perinatal medicine;

(2) at least two hospital representatives;

(3) at least two persons who have family members affected by a condition for which newborn screening is or may be required under this subchapter; and

(4) at least two health care providers who are involved in the delivery of newborn screening services, follow-up, or treatment in this state.

(f) The advisory committee shall meet at least three times each year and at other times at the call of the commissioner [of state health services].

SECTION 3.0105. Section 33.032, Health and Safety Code, is amended to read as follows:

Sec. 33.032. PROGRAM SERVICES. (a) Within the limits of funds available for this purpose and in cooperation with the individual's physician, the department may provide services directly or through approved providers to individuals of any age who meet the eligibility criteria specified by department [board] rules on the confirmation of a positive test for phenylketonuria, other heritable diseases, hypothyroidism, or another disorder for which the screening tests are required.

(b) The executive commissioner [board] may adopt:

(1) rules specifying the type, amount, and duration of program services to be offered;

(2) rules establishing the criteria for eligibility for services, including the medical and financial criteria;

(3) rules establishing the procedures necessary to determine the medical, financial, and other eligibility of the individual;

(4) substantive and procedural rules for applying for program services and processing those applications;

(5) rules for providing services according to a sliding scale of financial eligibility;

(6) substantive and procedural rules for the denial, modification, suspension, and revocation of an individual's approval to receive services; and

(7) substantive and procedural rules for the approval of providers to furnish program services.

(c) The department may select providers according to the criteria in the department's [board's] rules.

(d) The executive commissioner by rule [board] may establish [charge] fees to be collected by the department for the provision of services, except that services may not be denied to an individual because of the individual's inability to pay the fees.

SECTION 3.0106. Section 33.035(d), Health and Safety Code, is amended to read as follows:

(d) The executive commissioner [board] by rule shall provide criteria for actions taken under this section.

SECTION 3.0107. Section 33.036(c), Health and Safety Code, is amended to read as follows:

(c) Chapter 2001, Government Code, does [do] not apply to the notice and hearing required by this section.

SECTION 3.0108. Section 33.037(a), Health and Safety Code, is amended to read as follows:

(a) The department [board] may require an individual or, if the individual is a minor, the minor's parent, managing conservator, or guardian, or other person with a legal obligation to support the individual to pay or reimburse the department for all or part of the cost of the services provided.

SECTION 3.0109. Sections 33.038(b) and (d), Health and Safety Code, are amended to read as follows:

(b) This section creates a separate and distinct cause of action, and the department [commissioner] may request the attorney general to bring suit in the appropriate court of Travis County on behalf of the department.

(d) The executive commissioner [board] by rule shall provide criteria for actions taken under this section.

SECTION 3.0110. Sections 35.0021(6), (7), (10), (11), and (12), Health and Safety Code, are amended to read as follows:

(6) "Other benefit" means a benefit, other than a benefit provided under this chapter, to which a person is entitled for payment of the costs of services provided under the program, including benefits available from:

(A) an insurance policy, group health plan, health maintenance organization, or prepaid medical or dental care plan;

(B) Title XVIII, Title XIX, or Title XXI of the Social Security Act (42 U.S.C. Sec. 1395 et seq., 42 U.S.C. Sec. 1396 et seq., and 42 U.S.C. Sec. 1397aa et seq.), as amended;

(C) the United States Department of Veterans Affairs;

(D) the TRICARE program of the United States Department of Defense [Civilian Health and Medical Program of the Uniformed Services];

(E) workers' compensation or any other compulsory employers' insurance program;

(F) a public program created by federal or state law or the ordinances or rules of a municipality or other political subdivision of the state, excluding benefits created by the establishment of a municipal or county hospital, a joint municipal-county hospital, a county hospital authority, a hospital district, or the facilities of a publicly supported medical school; or

(G) a cause of action for the cost of care, including medical care, dental care, facility care, and medical supplies, required for a person applying for or receiving services from the department, or a settlement or judgment based on the cause of action, if the expenses are related to the need for services provided under this chapter.

(7) "Physician" means a person licensed by the Texas [State Board of] Medical Board [Examiners] to practice medicine in this state.

(10) "Rehabilitation services" means the process of the physical restoration, improvement, or maintenance of a body function destroyed or impaired by congenital defect, disease, or injury and includes:

(A) facility care, medical and dental care, and occupational, speech, and physical therapy;

(B) the provision of braces, artificial appliances, durable medical equipment, and other medical supplies; and

(C) other types of care specified by department [the board in the program] rules.

(11) "Services" means the care, activities, and supplies provided under this chapter or department [program] rules, including medical care, dental care, facility care, medical supplies, occupational, physical, and speech therapy, and other care specified by department [program] rules.

(12) "Specialty center" means a facility and staff that meet minimum standards established under the program and are designated by the department [board] for program use in the comprehensive diagnostic and treatment services for a specific medical condition.

SECTION 3.0111. Sections 35.003(b) and (c), Health and Safety Code, are amended to read as follows:

(b) The executive commissioner [board] by rule shall:

(1) specify the type, amount, and duration of services to be provided under this chapter; and

(2) permit the payment of insurance premiums for eligible children.

(c) If budgetary limitations exist, the executive commissioner [board] by rule shall establish a system of priorities relating to the types of services or the classes of persons eligible for the services. A waiting list of eligible persons may be established if necessary for the program to remain within the budgetary limitations. The department shall collect from each applicant for services who is placed on a waiting list appropriate information to facilitate contacting the applicant when services become available and to allow efficient enrollment of the applicant in those services. The information collected must include:

(1) the applicant's name, address, and phone number;

(2) the name, address, and phone number of a contact person other than the applicant;

(3) the date of the applicant's earliest application for services;

(4) the applicant's functional needs;

(5) the range of services needed by the applicant; and

(6) a date on which the applicant is scheduled for reassessment.

SECTION 3.0112. Section 35.0033(b), Health and Safety Code, is amended to read as follows:

(b) Except as required by [the] department rule, a health benefits plan provider under this chapter is not subject to a law that requires coverage or the offer of coverage of a health care service or benefit.

SECTION 3.0113. Sections 35.004(a), (b), (d), (e), (f), (h), and (i), Health and Safety Code, are amended to read as follows:

(a) The executive commissioner [board] shall adopt substantive and procedural rules for the selection of providers to participate in the program, including rules for the selection of specialty centers and rules requiring that providers accept program payments as payment in full for services provided.

(b) The department [board] shall approve physicians, dentists, licensed dietitians, facilities, specialty centers, and other providers to participate in the program according to the criteria and following the procedures prescribed by department rules [the board].

(d) Except as specified in the department [program] rules, a recipient of services may select any provider approved by the department [board]. If the recipient is a minor, the person legally authorized to consent to the treatment may select the provider.

(e) The executive commissioner [board] shall adopt substantive and procedural rules for the modification, suspension, or termination of the approval of a provider.

(f) The department [board] shall provide a due process hearing procedure in accordance with department rules for the resolution of conflicts between the department and a provider. Chapter 2001, Government Code, does [do] not apply to conflict resolution procedures adopted under this section.

(h) Subsection (f) does not apply if a contract:

(1) is canceled by the department because services are restricted to conform to budgetary limitations and service priorities are adopted by the executive commissioner [board] regarding types of services to be provided; or

(2) expires according to its terms.

(i) The Interagency Cooperation Act, Chapter 771, Government Code, [(Article 4413(32), Vernon's Texas Civil Statutes)] does not apply to a payment made by the department for services provided by a publicly supported medical school facility to an eligible child. A publicly supported medical school facility receiving payment under this chapter shall deposit the payment in local funds.

SECTION 3.0114. Sections 35.0041(a) and (c), Health and Safety Code, are amended to read as follows:

(a) The executive commissioner [department] by rule shall develop and the department shall implement policies permitting reimbursement of a provider for services under the program performed using telemedicine medical services.

(c) In developing and implementing the policies required by this section, the executive commissioner and the department shall consult with:

(1) The University of Texas Medical Branch at Galveston;

(2) Texas Tech University Health Sciences Center;

(3) the commission [Health and Human Services Commission], including the state Medicaid office;

(4) providers of telemedicine medical services and telehealth services hub sites in this state;

(5) providers of services to children with special health care needs; and

(6) representatives of consumer or disability groups affected by changes to services for children with special health care needs.

SECTION 3.0115. Section 35.005, Health and Safety Code, is amended to read as follows:

Sec. 35.005. ELIGIBILITY FOR SERVICES. (a) The executive commissioner [board] by rule shall:

(1) define medical, financial, and other criteria for eligibility to receive services; and

(2) establish a system for verifying eligibility information submitted by an applicant for or recipient of services.

(b) In defining medical and financial criteria for eligibility under Subsection (a), the executive commissioner [board] may not:

(1) establish an exclusive list of coverable medical conditions; or

(2) consider as a source of support to provide services assets legally owned or available to a child's household.

(c) A child is not eligible to receive rehabilitation services unless:

(1) the child is a resident of this state;

(2) at least one physician or dentist certifies to the department that the physician or dentist has examined the child and finds the child to be a child with special health care needs whose disability meets the medical criteria established by the executive commissioner [board];

(3) the department determines that the persons who have any legal obligation to provide services for the child are unable to pay for the entire cost of the services;

(4) the child has a family income that is less than or equal to 200 percent of the federal poverty level; and

(5) the child meets all other eligibility criteria established by department [board] rules.

(d) A child is not eligible to receive services, other than rehabilitation services, unless the child:

(1) is a resident of this state; and

(2) meets all other eligibility criteria established by department [board] rules.

(e) Notwithstanding Subsection (c)(4), a child with special health care needs who has a family income that is greater than 200 percent of the federal poverty level and who meets all other eligibility criteria established by this section and by department [board] rules is eligible for services if the department determines that the child's family is or will be responsible for medical expenses that are equal to or greater than the amount by which the family's income exceeds 200 percent of the federal poverty level.

SECTION 3.0116. Sections 35.006(a), (c), (d), and (e), Health and Safety Code, are amended to read as follows:

(a) The executive commissioner [board] shall adopt substantive and procedural rules for the denial of applications and the modification, suspension, or termination of services.

(c) The executive commissioner [board] by rule shall provide criteria for action by the department under this section.

(d) The department shall conduct hearings under this section in accordance with the department's [board's] due process hearing rules. Chapter 2001, Government Code, does [do] not apply to the granting, denial, modification, suspension, or termination of services.

(e) This section does not apply if the department restricts services to conform to budgetary limitations that require the executive commissioner [board] to adopt service priorities regarding types of services to be provided.

SECTION 3.0117. Sections 35.007(a) and (b), Health and Safety Code, are amended to read as follows:

(a) The department [board] shall require a child receiving services, or the person who has a legal obligation to support the child, to pay for or reimburse the department for that part of the cost of the services that the child or person is financially able to pay.

(b) A child is not eligible to receive services under this chapter to the extent that the child or a person with a legal obligation to support the child is eligible for some other benefit that would pay for all or part of the services. The executive commissioner [board] may waive this subsection if its enforcement will deny services to a class of children because of conflicting state and federal laws or rules and regulations.

SECTION 3.0118. Section 35.008(b), Health and Safety Code, is amended to read as follows:

(b) This section creates a separate cause of action, and the department [commissioner] may request the attorney general to bring suit in the appropriate court of Travis County on behalf of the department.

SECTION 3.0119. Section 35.009, Health and Safety Code, is amended to read as follows:

Sec. 35.009. FEES. The executive commissioner by rule [board] may adopt reasonable procedures and standards for the determination of fees and charges for program services.

SECTION 3.0120. Sections 36.004(a) and (c), Health and Safety Code, are amended to read as follows:

(a) The executive commissioner [board] by rule shall require screening of individuals who attend public or private preschools or schools to detect vision and hearing disorders and any other special senses or communication disorders specified by the executive commissioner [board]. In developing the rules, the executive commissioner [board] may consider the number of individuals to be screened and the availability of:

(1) personnel qualified to administer the required screening;

(2) appropriate screening equipment; and

(3) state and local funds for screening activities.

(c) The executive commissioner [board] shall adopt a schedule for implementing the screening requirements and shall give priority to the age groups that may derive the greatest educational and social benefits from early identification of special senses and communication disorders.

SECTION 3.0121. Sections 36.005(a) and (c), Health and Safety Code, are amended to read as follows:

(a) An individual required to be screened shall undergo approved screening for vision and hearing disorders and any other special senses and communication disorders specified by the executive commissioner [board]. The individual shall comply with the requirements as soon as possible after the individual's admission to a preschool or school and within the period set by the executive commissioner [board]. The individual or, if the individual is a minor, the minor's parent, managing conservator, or guardian, may substitute professional examinations for the screening.

(c) The chief administrator of each preschool or school shall ensure that each individual admitted to the preschool or school complies with the screening requirements set by the executive commissioner [board] or submits an affidavit of exemption.

SECTION 3.0122. Sections 36.006(a) and (d), Health and Safety Code, are amended to read as follows:

(a) The chief administrator of each preschool or school shall maintain, on a form prescribed by the department in accordance with department rules, screening records for each individual in attendance, and the records are open for inspection by the department or the local health department.

(d) Each preschool or school shall submit to the department an annual report on the screening status of the individuals in attendance during the reporting year and shall include in the report any other information required by the executive commissioner [board]. The report must be on a form prescribed by the department in accordance with department rules and must be submitted according to the [board's] rules.

SECTION 3.0123. Sections 36.007(b) and (c), Health and Safety Code, are amended to read as follows:

(b) The executive commissioner [board] by rule shall:

(1) describe the type, amount, and duration of remedial services that the department provides;

(2) establish medical, financial, and other criteria to be applied by the department in determining an individual's eligibility for the services;

(3) establish criteria for the selection by the department of providers of remedial services; and

(4) establish procedures necessary to provide remedial services.

(c) The executive commissioner [board] may establish a schedule to determine financial eligibility.

SECTION 3.0124. Sections 36.008(d) and (e), Health and Safety Code, are amended to read as follows:

(d) The department may modify, suspend, or terminate the eligibility of an applicant for or recipient of remedial services after notice to the affected individual and an opportunity for a fair hearing that is conducted in accordance with the department's informal hearing rules [adopted by the board].

(e) The executive commissioner [board] by rule shall provide criteria for actions taken under this section.

SECTION 3.0125. Section 36.009(a), Health and Safety Code, is amended to read as follows:

(a) The executive commissioner [board] may require an individual or, if the individual is a minor, the minor's parent, managing conservator, or guardian, to pay or reimburse the department for a part of the cost of the remedial services provided.

SECTION 3.0126. Section 36.010(d), Health and Safety Code, is amended to read as follows:

(d) The executive commissioner [board] by rule shall provide criteria for actions taken under this section.

SECTION 3.0127. Section 36.011(a), Health and Safety Code, is amended to read as follows:

(a) The department in accordance with department rules may require that persons who administer special senses and communication disorders screening complete an approved training program, and the department may train those persons and approve training programs.

SECTION 3.0128. Sections 37.001(b), (c), and (d), Health and Safety Code, are amended to read as follows:

(b) The executive commissioner [board], in cooperation with the Texas Education Agency, shall adopt rules for the mandatory spinal screening of children in grades 6 and 9 attending public or private schools. The department shall coordinate the spinal screening program with any other screening program conducted by the department on those children.

(c) The executive commissioner [board] shall adopt substantive and procedural rules necessary to administer screening activities.

(d) A rule adopted by the executive commissioner [board] under this chapter may not require any expenditure by a school, other than an incidental expense required for certification training for nonhealth practitioners and for notification requirements under Section 37.003.

SECTION 3.0129. Sections 37.002(a) and (c), Health and Safety Code, are amended to read as follows:

(a) Each individual required by a department [board] rule to be screened shall undergo approved screening for abnormal spinal curvature. The individual's parent, managing conservator, or guardian may substitute professional examinations for the screening.

(c) The chief administrator of each school shall ensure that each individual admitted to the school complies with the screening requirements set by the executive commissioner [board] or submits an affidavit of exemption.

SECTION 3.0130. Section 39.002, Health and Safety Code, is amended to read as follows:

Sec. 39.002. CHILDREN'S OUTREACH HEART PROGRAM. The department, with approval of the executive commissioner [board], may establish a children's outreach heart program to provide:

(1) prediagnostic cardiac screening and follow-up evaluation services to persons under 21 years of age who are from low-income families and who may have a heart disease or defect; and

(2) training to local physicians and public health nurses in screening and diagnostic procedures for heart disease or defect.

SECTION 3.0131. Section 39.003, Health and Safety Code, is amended to read as follows:

Sec. 39.003. RULES. The executive commissioner [board] shall adopt rules the executive commissioner [it] considers necessary to define the scope of the children's outreach heart program and the medical and financial standards for eligibility.

SECTION 3.0132. Section 39.004, Health and Safety Code, is amended to read as follows:

Sec. 39.004. FEES. Recipients of services or training provided by the program may be charged a fee for services or training according to rules adopted by the executive commissioner [board].

SECTION 3.0133. Section 40.002, Health and Safety Code, is amended to read as follows:

Sec. 40.002. EPILEPSY PROGRAM. [(a)] The department, with approval of the executive commissioner [board], may establish an epilepsy program to provide diagnostic services, treatment, and support services to eligible persons who have epilepsy.

[(b) The commissioner may appoint an epilepsy advisory board to assist the department in developing the epilepsy program.]

SECTION 3.0134. Section 40.003, Health and Safety Code, is amended to read as follows:

Sec. 40.003. RULES. The executive commissioner [board] may adopt rules the executive commissioner [it] considers necessary to define the scope of the epilepsy program and the medical and financial standards for eligibility.

SECTION 3.0135. Section 40.004(a), Health and Safety Code, is amended to read as follows:

(a) The commissioner, with the approval of the executive commissioner [board], may appoint an administrator to carry out the epilepsy program.

SECTION 3.0136. Section 40.005, Health and Safety Code, is amended to read as follows:

Sec. 40.005. FEES. Program patients may be charged a fee for services according to rules adopted by the executive commissioner [board].

SECTION 3.0137. Sections 41.001(1) and (2), Health and Safety Code, are amended to read as follows:

(1) "Hemophilia" means a human physical condition characterized by bleeding resulting from a genetically or hereditarily determined deficiency of a blood coagulation factor [or hereditarily] resulting in an abnormal or deficient plasma procoagulant.

(2) "Other benefit" means a benefit, other than a benefit under this chapter, to which a person is entitled for payment of the costs of blood factor replacement products[, blood derivatives and concentrates,] and other substances provided under this chapter, including benefits available from:

(A) an insurance policy, group health plan, or prepaid medical or dental care plan;

(B) Title XVIII or Title XIX of the Social Security Act (42 U.S.C. Sec. 1395 et seq. or 42 U.S.C. Sec. 1396 et seq.);

(C) the United States Department of Veterans Affairs [Administration];

(D) the TRICARE program of the United States Department of Defense [Civilian Health and Medical Program of the Uniformed Services];

(E) workers' compensation or any compulsory employers' insurance program;

(F) a public program created by federal law, state law, or the ordinances or rules of a municipality or political subdivision of the state, excluding benefits created by the establishment of a municipal or county hospital, a joint municipal-county hospital, a county hospital authority, a hospital district, or the facilities of a publicly supported medical school; or

(G) a cause of action for medical or dental expenses to a person applying for or receiving services from the department, or a settlement or judgment based on the cause of action, if the expenses are related to the need for services provided under this chapter.

SECTION 3.0138. Section 41.002, Health and Safety Code, is amended to read as follows:

Sec. 41.002. HEMOPHILIA ASSISTANCE PROGRAM. (a) The hemophilia assistance program is in the department to assist persons who have hemophilia and who require continuing treatment with blood factor replacement [, blood derivatives, or manufactured pharmaceutical] products, but who are unable to pay the entire cost of the treatment.

(b) The executive commissioner [department] shall establish standards of eligibility for assistance under this chapter in accordance with Section 41.004.

(c) The department shall provide, through approved providers, financial assistance for medically eligible persons in obtaining blood factor replacement products [, blood derivatives and concentrates,] and other substances for use in medical or dental facilities or in the home.

SECTION 3.0139. Section 41.007(b), Health and Safety Code, is amended to read as follows:

(b) The department shall identify [investigate] any potential sources of funding from federal grants or programs.

SECTION 3.0140. Sections 42.001(b) and (c), Health and Safety Code, are amended to read as follows:

(b) The state finds that one of the most serious and tragic problems facing the public health and welfare is the death each year from end stage renal [chronic kidney] disease of hundreds of persons in this state, when the present state of medical art and technology could return many of those individuals to a socially productive life. Patients may die for lack of personal financial resources to pay for the expensive equipment and care necessary for survival. The state therefore recognizes a responsibility to allow its citizens to remain healthy without being pauperized and a responsibility to use the resources and organization of the state to gather and disseminate information on the prevention and treatment of end stage renal [chronic kidney] disease.

(c) A comprehensive program to combat end stage renal [kidney] disease must be implemented through the combined and correlated efforts of individuals, state and local governments, persons in the field of medicine, universities, and nonprofit organizations. The program provided by this chapter is designed to direct the use of resources and to coordinate the efforts of the state in this vital matter of public health.

SECTION 3.0141. Section 42.002(2), Health and Safety Code, is amended to read as follows:

(2) "Other benefit" means a benefit, other than one provided under this chapter, to which a person is entitled for payment of the costs of medical care and treatment, services, pharmaceuticals, transportation, and supplies, including benefits available from:

(A) an insurance policy, group health plan, or prepaid medical care plan;

(B) Title XVIII or Title XIX of the Social Security Act (42 U.S.C. Sec. 1395 et seq. and 42 U.S.C. Sec. 1396 et seq.);

(C) the United States Department of Veterans Affairs [Administration];

(D) the TRICARE program of the United States Department of Defense [Civilian Health and Medical Program of the Uniformed Services];

(E) workers' compensation or other compulsory employers' insurance programs [program];

(F) a public program created by federal law, state law, or the ordinances or rules of a municipality or other political subdivision of the state, excluding benefits created by the establishment of a municipal or county hospital, a joint municipal-county hospital, a county hospital authority, or a hospital district; or

(G) a cause of action for medical expenses brought by an applicant for or recipient of services from the department, or a settlement or judgment based on the cause of action, if the expenses are related to the need for services provided under this chapter.

SECTION 3.0142. Section 42.003, Health and Safety Code, is amended to read as follows:

Sec. 42.003. KIDNEY HEALTH CARE PROGRAM [DIVISION]. (a) The kidney health care program [division] is in the department to carry out this chapter. [The board shall administer the division.]

(b) The department [division] may develop and expand [assist in the development and expansion of] programs for the care and treatment of persons with end stage renal [chronic kidney] disease, including dialysis and other lifesaving medical procedures and techniques.

(c) The executive commissioner [board] may adopt rules necessary to carry out this chapter and to provide adequate kidney care and treatment for citizens of this state.

SECTION 3.0143. Section 42.004, Health and Safety Code, is amended to read as follows:

Sec. 42.004. SERVICES. (a) The department [division] shall provide kidney care services directly or through public or private resources to persons the department determines [determined by the board] to be eligible for services authorized under this chapter.

(b) The department [division] may cooperate with other departments, agencies, political subdivisions, and public and private institutions to provide the services authorized by this chapter to eligible persons, to study the public health and welfare needs involved, and to plan, establish, develop, and provide programs or facilities and services that are necessary or desirable, including any that are jointly administered with state agencies.

(c) The department [division] may conduct research and compile statistics relating to the provision of kidney care services and the need for the services by [disabled or handicapped] persons with disabilities.

(d) The department [division] may contract with schools, hospitals, corporations, agencies, and individuals, including doctors, nurses, and technicians, for training, physical restoration, transportation, and other services necessary to treat and care for persons with end stage renal [kidney] disease.

SECTION 3.0144. Sections 42.0045(a), (b), and (c), Health and Safety Code, are amended to read as follows:

(a) Sections 483.041(a) and 483.042 of this code, Subtitle J, Title 3, Occupations Code, and other applicable laws establishing prohibitions do not apply to a dialysate, device, or drug exclusively used or necessary to perform dialysis that a physician prescribes or orders for administration or delivery to a person with end stage renal disease [chronic kidney failure] if:

(1) the dialysate, device, or drug is lawfully held by a manufacturer or wholesaler licensed by the department [registered with the board];

(2) the manufacturer or wholesaler delivers the dialysate, device, or drug to:

(A) a person with end stage renal disease [chronic kidney failure] for self-administration at the person's home or a specified address, as ordered by a physician; or

(B) a physician for administration or delivery to a person with end stage renal disease [chronic kidney failure]; and

(3) the manufacturer or wholesaler has sufficient and qualified supervision to adequately protect the public health.

(b) The executive commissioner [board] shall adopt rules necessary to ensure the safe distribution, without the interruption of supply, of a dialysate, device, or drug covered by Subsection (a). The rules must include provisions regarding manufacturer and wholesaler licensing, record keeping, evidence of a delivery to a patient or a patient's designee, patient training, specific product and quantity limitation, physician prescriptions or order forms, adequate facilities, and appropriate labeling to ensure that necessary information is affixed to or accompanies the dialysate, device, or drug.

(c) If the department [board] determines that a dialysate, device, or drug distributed under this chapter is ineffective or unsafe for its intended use, the department [board] may immediately recall the dialysate, device, or drug distributed to an individual patient.

SECTION 3.0145. Sections 42.005(a), (b), (c), and (d), Health and Safety Code, are amended to read as follows:

(a) The executive commissioner [board] may establish [and maintain] standards for the accreditation of all facilities designed or intended to deliver care or treatment for persons with end stage renal [chronic kidney] disease, and the department shall maintain all established standards.

(b) The department [division] may conduct surveys of existing facilities in this state that diagnose, evaluate, and treat patients with end stage renal [kidney] disease and may prepare and submit its findings and a specific program of action.

(c) The department [division] may evaluate the need to create local or regional facilities and to establish a major kidney research center.

(d) The department [division] may:

(1) establish or construct rehabilitation facilities and workshops;

(2) make grants to public agencies and make contracts or other arrangements with public and other nonprofit agencies, organizations, or institutions for the establishment of workshops and rehabilitation facilities; and

(3) operate facilities to carry out this chapter.

SECTION 3.0146. Sections 42.006(a), (b), and (d), Health and Safety Code, are amended to read as follows:

(a) The department shall select providers to furnish kidney health care services under the program according to the criteria and procedures adopted by the executive commissioner [board].

(b) The department [board] shall provide a hearing procedure in accordance with department rules for the resolution of conflicts between the department and a provider. Chapter 2001, Government Code, does [do] not apply to conflict resolution procedures adopted under this section.

(d) Subsections (b) and (c) do not apply if a contract:

(1) is canceled because program services are restricted to conform to budgetary limitations that require the executive commissioner [board] to adopt service priorities regarding types of services to be furnished or classes of eligible individuals; or

(2) expires according to its terms.

SECTION 3.0147. Section 42.007, Health and Safety Code, is amended to read as follows:

Sec. 42.007. ELIGIBILITY FOR SERVICES. The executive commissioner [board] may determine the terms, conditions, and standards, including medical and financial standards, for the eligibility of persons with end stage renal [chronic kidney] disease to receive the aid, care, or treatment provided under this chapter.

SECTION 3.0148. Sections 42.008(b), (c), and (d), Health and Safety Code, are amended to read as follows:

(b) The program rules adopted by the executive commissioner [board] must contain the criteria for the department's action under this section.

(c) Chapter 2001, Government Code, does [do] not apply to the granting, denial, modification, suspension, or termination of services provided under this chapter. Hearings under this section must be conducted in accordance with the department's [board's] hearing rules.

(d) This section does not apply if program services are restricted to conform to budgetary limitations that require the executive commissioner [board] to adopt service priorities regarding types of services to be furnished or classes of eligible persons.

SECTION 3.0149. Section 42.009(d), Health and Safety Code, is amended to read as follows:

(d) The executive commissioner [board] may waive the provisions of Subsection (a) in certain individually considered cases when the enforcement of that provision will deny services to a class of end stage renal disease patients because of conflicting state or federal laws or rules.

SECTION 3.0150. Sections 42.011(a) and (b), Health and Safety Code, are amended to read as follows:

(a) The department [division] may receive and use gifts to carry out this chapter.

(b) The department [board] may comply with any requirements necessary to obtain federal funds in the maximum amount and most advantageous proportions possible to carry out this chapter.

SECTION 3.0151. Section 42.012(a), Health and Safety Code, is amended to read as follows:

(a) The department [division] may enter into contracts and agreements with persons, colleges, universities, associations, corporations, municipalities, and other units of government as necessary to carry out this chapter.

SECTION 3.0152. Section 42.013, Health and Safety Code, is amended to read as follows:

Sec. 42.013. COOPERATION. (a) The department [division] may cooperate with private or public agencies to facilitate the availability of adequate care for all citizens with end stage renal [chronic kidney] disease.

(b) The department [board] shall make agreements, arrangements, or plans to cooperate with the federal government in carrying out the purposes of this chapter or of any federal statute or rule relating to the prevention, care, or treatment of end stage renal [kidney] disease or the care, treatment, or rehabilitation of persons with end stage renal [kidney] disease. The executive commissioner [board] may adopt rules and methods of administration found by the federal government to be necessary for the proper and efficient operation of the agreements, arrangements, or plans.

(c) The department [division] may enter into reciprocal agreements with other states.

SECTION 3.0153. Section 42.014, Health and Safety Code, is amended to read as follows:

Sec. 42.014. SCIENTIFIC INVESTIGATIONS. (a) The department [division] may develop and administer scientific investigations into the cause, prevention, methods of treatment, and cure of end stage renal [kidney] disease, including research into kidney transplantation.

(b) The department [division] may develop techniques for an effective method of mass testing to detect end stage renal [kidney] disease and urinary tract infections.

SECTION 3.0154. Section 42.015, Health and Safety Code, is amended to read as follows:

Sec. 42.015. EDUCATIONAL PROGRAMS. (a) The department [division] may develop, implement [institute, carry on], and supervise educational programs for the public and health providers, including physicians, hospitals, and public health departments, concerning end stage renal [chronic kidney] disease, including prevention and methods of care and treatment.

(b) The department [division] may use existing public or private programs or groups for the educational programs.

SECTION 3.0155. Section 42.016, Health and Safety Code, is amended to read as follows:

Sec. 42.016. REPORTS. The department [board] shall report to the governor and the legislature not later than February 1 of each year concerning its findings, progress, and activities under this chapter and the state's total need in the field of kidney health care.

SECTION 3.0156. Section 42.017, Health and Safety Code, is amended to read as follows:

Sec. 42.017. INSURANCE PREMIUMS. The department [board] may provide for payment of the premiums required to maintain coverage under Title XVIII of the Social Security Act (42 U.S.C. Section 1395 et seq.) for certain classes of persons with end stage renal disease, in individually considered instances according to criteria established by department [board] rules.

SECTION 3.0157. Section 42.018, Health and Safety Code, is amended to read as follows:

Sec. 42.018. FREEDOM OF SELECTION. The freedom of an eligible person to select a treating physician, a treatment facility, or a treatment modality is not limited by Section 42.009 if the physician, facility, or modality is approved by the department [board] as required by this chapter.

SECTION 3.0158. Section 43.003(a)(3), Health and Safety Code, is amended to read as follows:

(3) "Other benefit" means a benefit, other than a benefit provided under this chapter, to which an individual is entitled for the payment of the costs of oral health treatment services, including benefits available from:

(A) an insurance policy, group oral health plan, or prepaid oral care plan;

(B) Title XVIII or Title XIX of the Social Security Act, as amended (42 U.S.C. Sec. 1395 et seq. and 42 U.S.C. Sec. 1396 et seq.);

(C) the United States Department of Veterans Affairs [Administration];

(D) the TRICARE program of the United States Department of Defense [Civilian Health and Medical Program of the Uniformed Services];

(E) workers' compensation or any other compulsory employer's insurance program;

(F) a public program created by federal law, state law, or the ordinances or rules of a municipality or other political subdivision of the state; or

(G) a cause of action for the expenses of dental or oral health treatment services, or a settlement or judgment based on the cause of action, if the expenses are related to the need for treatment services provided under this chapter.

SECTION 3.0159. Section 43.003(b), Health and Safety Code, is amended to read as follows:

(b) The executive commissioner [board] by rule may define a word or term not defined by Subsection (a) as necessary to administer this chapter. The executive commissioner [board] may not define a word or term so that the word or term is inconsistent or in conflict with the purposes of this chapter.

SECTION 3.0160. Sections 43.004(b) and (e), Health and Safety Code, are amended to read as follows:

(b) The executive commissioner [board] shall adopt rules to govern the program, to prescribe the type, amount, and duration of oral health services to be provided, and, if necessary to conform to budgetary limitations, to prescribe a system of program priorities regarding the types of services to be furnished, the geographic areas to be covered, or the classes of individuals eligible for services.

(e) The department may provide services only as prescribed by department [board] rules.

SECTION 3.0161. Section 43.005(a), Health and Safety Code, is amended to read as follows:

(a) The department shall:

(1) administer the program of oral health services [established by the board]; and

(2) develop [adopt] the design and content of all forms necessary for the program.

SECTION 3.0162. Sections 43.006(a), (b), and (d), Health and Safety Code, are amended to read as follows:

(a) The executive commissioner [board] may adopt substantive and procedural rules relating to:

(1) the selection of dentists, physicians, facilities, and other providers to furnish program services, including criteria for the emergency selection of providers; and

(2) the denial, modification, suspension, or termination of a provider's program participation.

(b) The department shall approve providers to participate in the program according to the criteria, rules, and procedures adopted by the executive commissioner [board].

(d) The department [board] shall provide a due process hearing procedure in accordance with department rules for the resolution of conflicts between the department and a provider. Chapter 2001, Government Code, does [do] not apply to conflict resolution procedures adopted under this section.

SECTION 3.0163. Section 43.007, Health and Safety Code, is amended to read as follows:

Sec. 43.007. INDIVIDUAL REFERRAL AND APPLICATION FOR SERVICES. (a) The executive commissioner [board] may adopt substantive and procedural rules to govern the application for admission to the program and the receipt of treatment services, including the dental, financial, and other criteria for eligibility to receive treatment services.

(b) An applicant for treatment services must be referred to the program by a person who knows the individual's economic condition, such as a school administrator or school nurse, social worker, municipal or county official, dentist, physician, public health clinic, community health center, hospital, or any other source acceptable to the executive commissioner [board].

(c) An applicant for treatment services must complete or cause to be completed an application form prescribed under Section 43.005 [by the department].

(d) The application form must include or be accompanied by:

(1) a statement by the individual, or by the person with a legal obligation to support the individual, that the individual or the person is financially unable to pay for all or part of the cost of the necessary treatment services;

(2) a statement from the referring person that the treatment services are necessary to prevent or reduce the probability of pain, infection, or disease; and

(3) any other assurances from the applicant or any other documentary evidence required by the department [board] to support the applicant's eligibility.

SECTION 3.0164. Section 43.008, Health and Safety Code, is amended to read as follows:

Sec. 43.008. ELIGIBILITY FOR SERVICES. (a) The department shall determine an individual's eligibility for treatment services according to this chapter and department [the program] rules.

(b) An individual is not eligible to receive treatment services provided under this chapter unless:

(1) the individual is a resident of this state;

(2) the department has determined that neither the individual nor a person with a legal obligation to support the individual is financially able to pay for all or part of the treatment services provided by this chapter;

(3) the individual complies with any other requirements stated in the department [program] rules; and

(4) at least one licensed dentist or licensed physician has certified to the department that the dentist or physician has examined the individual and has found that:

(A) the individual meets the department's [board's] dental criteria; and

(B) the dentist or physician has reason to expect that the treatment services provided by or through the department will prevent or reduce the probability of the individual's experiencing pain, infection, or disease.

(c) Except as permitted by department [program] rules, the department may not provide treatment services before an individual's eligibility date assigned by the department or authorize payment for treatment services furnished by a provider before that date.

SECTION 3.0165. Sections 43.009(b) and (c), Health and Safety Code, are amended to read as follows:

(b) The executive commissioner [board] by rule shall provide criteria for action by the department under this section.

(c) Chapter 2001, Government Code, does [do] not apply to the granting, denial, modification, suspension, or termination of treatment services. The department shall conduct hearings in accordance with the department's [board's] due process hearing rules.

SECTION 3.0166. Section 43.010(e), Health and Safety Code, is amended to read as follows:

(e) The commissioner may waive the enforcement of Subsection (b) as prescribed by department [board] rules in certain individually considered cases in which enforcement will deny treatment services to a class of otherwise eligible individuals because of conflicting federal, state, or local laws or rules.

SECTION 3.0167. Section 43.012, Health and Safety Code, is amended to read as follows:

Sec. 43.012. FEES. The department, in accordance with department rules, [board] may charge fees for the oral health services provided directly by the department or through approved providers in accordance with Subchapter D, Chapter 12.

SECTION 3.0168. Section 43.013(a), Health and Safety Code, is amended to read as follows:

(a) The department [Subject to limitations or conditions prescribed by the legislature, the board] may seek, receive, and spend funds received from any public or private source for the purposes of this chapter, subject to:

(1) the limitations or conditions prescribed by the legislature; and

(2) any limitations or conditions prescribed by the executive commissioner.

SECTION 3.0169. Section 45.003, Health and Safety Code, is amended to read as follows:

Sec. 45.003. RULES. The executive commissioner [board] may adopt rules governing eligibility for a child passenger safety seat system from the program established under Section 45.002.

SECTION 3.0170. Sections 47.001(3), (4), (6), and (9), Health and Safety Code, are amended to read as follows:

(3) "Health care provider" means a registered nurse recognized as an advanced practice registered nurse by the Texas Board of Nursing or a physician assistant licensed by the Texas Physician Assistant Board.

(4) "Hearing loss" means a hearing loss of 30 dB HL or greater in the frequency region important for speech recognition and comprehension in one or both ears, approximately 500 through 4,000 Hz. As technological advances permit the detection of less severe hearing loss, the executive commissioner [department] may modify this definition by rule.

(6) "Intervention or follow-up care" means the early intervention services described in Part C, Individuals with Disabilities Education Act (20 U.S.C. Sections 1431-1443) [1431-1445), as amended by Pub. L. No. 105-17].

(9) "Physician" means a person licensed to practice medicine by the Texas [State Board of] Medical Board [Examiners].

SECTION 3.0171. Sections 47.004(a), (b), and (d), Health and Safety Code, are amended to read as follows:

(a) The executive commissioner [department or the department's designee] shall establish certification criteria for implementing a program.

(b) In order to be certified, the program must:

(1) provide hearing screening using equipment recommended by the department;

(2) use appropriate staff to provide the screening;

(3) maintain and report data electronically as required by [the] department rule;

(4) distribute family, health care provider, and physician educational materials standardized by the department;

(5) provide information, as recommended by the department, to the parents on follow-up services for newborns and infants who do not pass the screening; and

(6) be supervised by:

(A) a physician;

(B) an audiologist;

(C) a registered nurse; or

(D) a physician assistant.

(d) The department may renew the certification of a program on a periodic basis as established by department [board] rule in order to ensure quality services to newborns, infants, and families.

SECTION 3.0172. Section 47.007, Health and Safety Code, as amended by Chapters 1273 (H.B. 411) and 601 (S.B. 229), Acts of the 82nd Legislature, Regular Session, 2011, is reenacted and amended to read as follows:

Sec. 47.007. INFORMATION MANAGEMENT, REPORTING, AND TRACKING SYSTEM. (a) The department shall provide each birthing facility that provides newborn hearing screening under the state's medical assistance program provided under Chapter 32, Human Resources Code, with access to the appropriate information management, reporting, and tracking system for the program. The information management, reporting, and tracking system must be capable of providing the department with information and data necessary to plan, monitor, and evaluate the program, including the program's screening, follow-up, diagnostic, and intervention components.

(b) Subject to Section 47.008, a qualified hearing screening provider, hospital, health care provider, physician, audiologist, or intervention specialist shall access the information management, reporting, and tracking system to provide information to the department and may obtain information from the department relating to:

(1) the results of each hearing screening performed under Section 47.003(a) or 47.0031(a);

(2) the results of each diagnostic audiological evaluation required under Section 47.0031(b)(2);

(3) infants who receive follow-up care;

(4) infants identified with hearing loss;

(5) infants who are referred for intervention services; and

(6) case level information necessary to report required statistics to:

(A) the federal Maternal and Child Health Bureau on an annual basis; and

(B) the federal Centers for Disease Control and Prevention.

(c) A birthing facility described by Subsection (a) shall report the resulting information in the format and within the time frame specified by the department.

(d) [A birthing facility described by Subsection (a) shall report the resulting information in the format and within the time frame specified by the department.

[(d) A qualified hearing screening provider, audiologist, intervention specialist, educator, or other person who receives a referral from a program under this chapter shall:

[(1) provide the services needed by the child or refer the child to a person who provides the services needed by the child; and

[(2) provide, with the consent of the child's parent, the following information to the department or the department's designee:

[(A) results of follow-up care;

[(B) results of audiologic testing of infants identified with hearing loss; and

[(C) reports on the initiation of intervention services.

[(e)] A qualified hearing screening provider, audiologist, intervention specialist, educator, or other person who receives a referral from a program under this chapter shall:

(1) provide the services needed by the newborn or infant or refer the newborn or infant to a person who provides the services needed by the newborn or infant; and

(2) provide, with the consent of the newborn's or infant's parent, the following information to the department or the department's designee:

(A) results of follow-up care;

(B) results of audiologic testing of an infant identified with hearing loss; and

(C) reports on the initiation of intervention services.

(e) [A qualified hearing screening provider, audiologist, intervention specialist, educator, or other person who provides services to infants who are diagnosed with hearing loss shall provide, with the consent of the infant's parent, the following information to the department or the department's designee:

[(1) results of follow-up services;

[(2) results of audiologic testing of infants identified with hearing loss; and

[(3) reports on the initiation of intervention services.

[(f)] A qualified hearing screening provider, audiologist, intervention specialist, educator, or other person who provides services to an infant who is diagnosed with hearing loss shall provide, with the consent of the infant's parent, the following information to the department or the department's designee:

(1) results of follow-up care;

(2) results of audiologic testing; and

(3) reports on the initiation of intervention services.

(f) [A hospital that provides services under this chapter shall use the information management, reporting, and tracking system, which the department has provided the hospital with access to, to report, with the consent of the infant's parent, the following information to the department or the department's designee:

[(1) results of all follow-up services for infants who do not pass the birth admission screening if the hospital provides the follow-up services; or

[(2) the name of the provider or facility where the hospital refers an infant who does not pass the birth admission screening for follow-up services.

[(g)] A hospital that provides services under this chapter shall use the information management, reporting, and tracking system described by this section, access to which has been provided to the hospital by the department, to report, with the consent of the infant's parent, the following information to the department or the department's designee:

(1) results of all follow-up services for an infant who does not pass the screening described by Section 47.003(a) if the hospital provides the follow-up services; or

(2) the name of the provider or facility to which the hospital refers an infant who does not pass the screening described by Section 47.003(a) for follow-up services.

(g) The department shall ensure that the written consent of a parent is obtained before any information individually identifying the newborn or infant is released through the information management, reporting, and tracking system.

(h) Subject to Section 47.008, a qualified hearing screening provider, hospital, health care provider, physician, audiologist, or intervention specialist may obtain information from the department relating to:

(1) the results of each hearing screening performed under Section 47.003(a) or 47.0031(a);

(2) the results of each diagnostic audiological evaluation required under Section 47.0031(b)(2);

(3) infants who receive follow-up care;

(4) infants identified with hearing loss; and

(5) infants who are referred for intervention services.

SECTION 3.0173. Section 47.008(c), Health and Safety Code, is amended to read as follows:

(c) The executive commissioner [department] by rule shall develop guidelines to protect the confidentiality of patients in accordance with Chapter 159, Occupations Code, and require the written consent of a parent or guardian of a patient before any individually identifying information is provided to the department as set out in this chapter. The department shall permit a parent or guardian at any time to withdraw information provided to the department under this chapter.

SECTION 3.0174. Section 47.010(a), Health and Safety Code, is amended to read as follows:

(a) The executive commissioner [of the Health and Human Services Commission] may adopt rules for the department to implement this chapter.

SECTION 3.0175. Section 61.003(f), Health and Safety Code, is amended to read as follows:

(f) For purposes of this chapter, a person who is an inmate or resident of a state supported living center, as defined by Section 531.002, [school] or institution operated by the Texas Department of Criminal Justice, Department of Aging and Disability Services, Department of State Health Services, Texas Juvenile Justice Department [Youth Commission], Texas School for the Blind and Visually Impaired, Texas School for the Deaf, or any other state agency or who is an inmate, patient, or resident of a school or institution operated by a federal agency is not considered a resident of a hospital district or of any governmental entity except the state or federal government.

SECTION 3.0176. Section 61.004(b), Health and Safety Code, is amended to read as follows:

(b) The provider of assistance and the governmental entity or hospital district shall submit all relevant information to the department in accordance with the application, documentation, and verification procedures established by [the] department rule under Section 61.006.

SECTION 3.0177. Sections 61.006(c) and (e), Health and Safety Code, are amended to read as follows:

(c) The department shall also define the services and establish the payment standards for the categories of services listed in Sections 61.028(a) and 61.0285 in accordance with commission [Texas Department of Human Services] rules relating to the Temporary Assistance for Needy Families-Medicaid program.

(e) The department shall ensure that each person who meets the basic income and resources requirements for Temporary Assistance for Needy Families program payments but who is categorically ineligible for Temporary Assistance for Needy Families will be eligible for assistance under Subchapter B. Except as provided by Section 61.023(b), the executive commissioner [department] by rule shall also provide that a person who receives or is eligible to receive Temporary Assistance for Needy Families, Supplemental Security Income, or Medicaid benefits is not eligible for assistance under Subchapter B even if the person has exhausted a part or all of that person's benefits.

SECTION 3.0178. Section 61.007, Health and Safety Code, is amended to read as follows:

Sec. 61.007. INFORMATION PROVIDED BY APPLICANT. The executive commissioner [department] by rule shall require each applicant to provide at least the following information:

(1) the applicant's full name and address;

(2) the applicant's social security number, if available;

(3) the number of persons in the applicant's household, excluding persons receiving Temporary Assistance for Needy Families, Supplemental Security Income, or Medicaid benefits;

(4) the applicant's county of residence;

(5) the existence of insurance coverage or other hospital or health care benefits for which the applicant is eligible;

(6) any transfer of title to real property that the applicant has made in the preceding 24 months;

(7) the applicant's annual household income, excluding the income of any household member receiving Temporary Assistance for Needy Families, Supplemental Security Income, or Medicaid benefits; and

(8) the amount of the applicant's liquid assets and the equity value of the applicant's car and real property.

SECTION 3.0179. Section 61.008(a), Health and Safety Code, is amended to read as follows:

(a) The executive commissioner [department] by rule shall provide that in determining eligibility:

(1) a county may not consider the value of the applicant's homestead;

(2) a county must consider the equity value of a car that is in excess of the amount exempted under department guidelines as a resource;

(3) a county must subtract the work-related and child care expense allowance allowed under department guidelines;

(4) a county must consider as a resource real property other than a homestead and, except as provided by Subsection (b), must count that property in determining eligibility;

(5) if an applicant transferred title to real property for less than market value to become eligible for assistance under this chapter, the county may not credit toward eligibility for state assistance an expenditure for that applicant made during a two-year period beginning on the date on which the property is transferred; and

(6) if an applicant is a sponsored alien, a county may include in the income and resources of the applicant:

(A) the income and resources of a person who executed an affidavit of support on behalf of the applicant; and

(B) the income and resources of the spouse of a person who executed an affidavit of support on behalf of the applicant, if applicable.

SECTION 3.0180. Section 61.011, Health and Safety Code, is amended to read as follows:

Sec. 61.011. SERVICES BY STATE HOSPITAL OR CLINIC. A state hospital or clinic shall be entitled to payment for services rendered to an eligible resident under the provisions of this chapter applicable to other providers. The executive commissioner [department] may adopt rules as necessary to implement this section.

SECTION 3.0181. Section 61.0285(b), Health and Safety Code, is amended to read as follows:

(b) A county must notify the department of the county's intent to provide services specified by Subsection (a). If the services are approved in accordance with [by the department under] Section 61.006, or if the department fails to notify the county of the department's disapproval before the 31st day after the date the county notifies the department of its intent to provide the services, the county may credit the services toward eligibility for state assistance under this subchapter.

SECTION 3.0182. Section 61.034(b), Health and Safety Code, is amended to read as follows:

(b) A county may contract with a provider of assistance to provide a health care service at a rate below the payment standard set by [the] department rule.

SECTION 3.0183. Sections 61.036(c) and (d), Health and Safety Code, are amended to read as follows:

(c) Regardless of the application, documentation, and verification procedures or eligibility standards established [by the department] under Subchapter A, a county may credit an expenditure for an eligible resident toward eligibility for state assistance if the eligible resident received the health care services at:

(1) a hospital maintained or operated by a state agency that has a contract with the county to provide health care services;

(2) a federally qualified health center delivering federally qualified health center services, as those terms are defined in 42 U.S.C. Sections 1396d(l)(2)(A) and (B), that has a contract with the county to provide health care services; or

(3) a hospital or other health care provider if the eligible resident is an inmate of a county jail or another county correctional facility.

(d) Regardless of the application, documentation, and verification procedures or eligibility standards established [by the department] under Subchapter A, a county may credit an intergovernmental transfer to the state toward eligibility for state assistance if the transfer was made to provide health care services as part of the Texas Healthcare Transformation and Quality Improvement Program waiver issued under 42 U.S.C. Section 1315.

SECTION 3.0184. Section 61.037(h), Health and Safety Code, is amended to read as follows:

(h) The executive commissioner [department] shall adopt rules governing the circumstances under which a waiver may be granted under Subsection (g) and the procedures to be used by a county to apply for the waiver. The procedures must provide that the department shall make a determination with respect to an application for a waiver not later than the 90th day after the date the application is submitted to the department in accordance with the procedures established by [the] department rule. To be eligible for state assistance under Subsection (g), a county must submit monthly financial reports, in the form required by the department, covering the 12-month period preceding the date on which the assistance is sought.

SECTION 3.0185. Section 61.0395(b), Health and Safety Code, is amended to read as follows:

(b) The executive commissioner [department] may adopt rules governing the distribution of state assistance under this chapter that establish a maximum annual allocation for each county eligible for assistance under this chapter in compliance with Subsection (a).

SECTION 3.0186. Section 61.042(a), Health and Safety Code, is amended to read as follows:

(a) A county may establish procedures consistent with those used by the commission [Texas Department of Human Services] under Chapter 31, Human Resources Code, for administering an employment services program and requiring an applicant or eligible resident to register for work with the Texas Workforce [Employment] Commission.

SECTION 3.0187. Section 61.065(c), Health and Safety Code, is amended to read as follows:

(c) If the contract for the sale of the hospital provides for the provision by the hospital of health care services to county residents, the value of the health care services credited or paid in a state fiscal year under the contract is included as part of the computation of a county expenditure under Section 61.037 to the extent that the value of the services does not exceed the payment standard established by [the] department rule for allowed inpatient and outpatient services.

SECTION 3.0188. Section 61.067(g), Health and Safety Code, is amended to read as follows:

(g) The lien does not attach to a claim under the workers' compensation law of this state, the Federal Employers' [Employees] Liability Act, or the Federal Longshore and Harbor Workers' Compensation Act.

SECTION 3.0189. Section 61.068(a), Health and Safety Code, is amended to read as follows:

(a) A public hospital or hospital district may establish procedures consistent with those used by the commission [Health and Human Services Commission] under Chapter 31, Human Resources Code, for administering an employment services program and requiring an applicant or eligible resident to register for work with the Texas Workforce Commission.

SECTION 3.0190. Section 62.002(4), Health and Safety Code, is amended to read as follows:

(4) "Household [Net family] income" means the sum [amount] of the individual incomes of each individual in an applicant's or enrollee's household, minus the standard income disregard prescribed by federal law [income established for a family after reduction for offsets for child care expenses, in accordance with standards applicable under the Medicaid program].

SECTION 3.0191. Section 62.004, Health and Safety Code, is amended to read as follows:

Sec. 62.004. FEDERAL LAW AND REGULATIONS. The executive commissioner shall monitor federal legislation affecting Title XXI of the Social Security Act (42 U.S.C. Section 1397aa et seq.) and changes to the federal regulations implementing that law. If the executive commissioner determines that a change to Title XXI of the Social Security Act (42 U.S.C. Section 1397aa et seq.) or the federal regulations implementing that law conflicts with this chapter, the executive commissioner shall report the changes to the governor, lieutenant governor, and speaker of the house of representatives, with recommendations for legislation necessary to implement the federal law or regulations, seek a waiver, or withdraw from participation.

SECTION 3.0192. Sections 62.051 and 62.052, Health and Safety Code, are amended to read as follows:

Sec. 62.051. DUTIES OF EXECUTIVE COMMISSIONER AND COMMISSION IN GENERAL. (a) The executive commissioner [commission] shall administer [develop] a state-designed child health plan program to obtain health benefits coverage for children in low-income families. The executive commissioner [commission] shall ensure that the child health plan program is designed and administered in a manner that qualifies for federal funding under Title XXI of the Social Security Act (42 U.S.C. Section 1397aa et seq.), as amended, and any other applicable law or regulations.

(b) The executive commissioner [commission] is [the agency] responsible for making policy for the child health plan program, including policy related to covered benefits provided under the child health plan. The executive commissioner [commission] may not delegate this duty to another agency or entity.

(c) The executive commissioner [commission] shall oversee the implementation of the child health plan program and coordinate the activities of each agency necessary to the implementation of the program, including the [Texas Department of Health, Texas Department of Human Services, and] Texas Department of Insurance.

(d) The executive commissioner [commission] shall adopt rules as necessary to implement this chapter. [The commission may require the Texas Department of Health, the Texas Department of Human Services, or any other health and human services agency to adopt, with the approval of the commission, any rules that may be necessary to implement the program. With the consent of another agency, including the Texas Department of Insurance, the commission may delegate to that agency the authority to adopt, with the approval of the commission, any rules that may be necessary to implement the program.]

(e) The commission shall conduct a review of each entity that enters into a contract under Section 62.055 or [Section] 62.155[,] to ensure that the entity is available, prepared, and able to fulfill the entity's obligations under the contract in compliance with the contract, this chapter, and rules adopted under this chapter.

(f) The commission shall ensure that the amounts spent for administration of the child health plan program do not exceed any limit on those expenditures imposed by federal law.

Sec. 62.052. AUTHORITY OF COMMISSION RELATING TO HEALTH PLAN PROVIDER CONTRACTS [DUTIES OF TEXAS DEPARTMENT OF HEALTH]. [(a)] The commission may [direct the Texas Department of Health to]:

(1) implement contracts with health plan providers under Section 62.155;

(2) monitor the health plan providers, through reporting requirements and other means, to ensure performance under the contracts and quality delivery of services;

(3) monitor the quality of services delivered to enrollees through outcome measurements including:

(A) rate of hospitalization for ambulatory sensitive conditions, including asthma, diabetes, epilepsy, dehydration, gastroenteritis, pneumonia, and UTI/kidney infection;

(B) rate of hospitalization for injuries;

(C) percent of enrolled adolescents reporting risky health behavior such as injuries, tobacco use, alcohol/drug use, dietary behavior, physical activity, or other health related behaviors; and

(D) percent of adolescents reporting attempted suicide; and

(4) provide payment under the contracts to the health plan providers.

[(b) The commission, or the Texas Department of Health under the direction of and in consultation with the commission, shall adopt rules as necessary to implement this section.]

SECTION 3.0193. Subchapter B, Chapter 62, Health and Safety Code, is amended by amending Section 62.053 and adding Section 62.0531 to read as follows:

Sec. 62.053. AUTHORITY OF COMMISSION RELATING TO ELIGIBILITY AND MEDICAID COORDINATION [DUTIES OF TEXAS DEPARTMENT OF HUMAN SERVICES]. The commission [(a) Under the direction of the commission, the Texas Department of Human Services] may:

(1) accept applications for coverage under the child health plan and implement the child health plan program eligibility screening and enrollment procedures;

(2) resolve grievances relating to eligibility determinations; and

(3) coordinate the child health plan program with the Medicaid program.

Sec. 62.0531. AUTHORITY OF COMMISSION RELATING TO THIRD PARTY ADMINISTRATOR. [(b)] If the commission contracts with a third party administrator under Section 62.055, the commission may [direct the Texas Department of Human Services to]:

(1) implement the contract;

(2) monitor the third party administrator, through reporting requirements and other means, to ensure performance under the contract and quality delivery of services; and

(3) provide payment under the contract to the third party administrator.

[(c) The commission, or the Texas Department of Human Services under the direction of and in consultation with the commission, shall adopt rules as necessary to implement this section.]

SECTION 3.0194. Sections 62.054(a) and (b), Health and Safety Code, are amended to read as follows:

(a) At the request of the commission, the Texas Department of Insurance shall provide any necessary assistance with the [development of the] child health plan. The department shall monitor the quality of the services provided by health plan providers and resolve grievances relating to the health plan providers.

(b) The commission and the Texas Department of Insurance may adopt a memorandum of understanding that addresses the responsibilities of each agency with respect to [in developing] the plan.

SECTION 3.0195. Section 62.055, Health and Safety Code, is amended by amending Subsection (e) and adding Subsection (f) to read as follows:

(e) The executive commissioner [commission] shall[:

[(1)] retain all policymaking authority over the state child health plan.[;]

(f) The commission shall:

(1) [(2)] procure all contracts with a third party administrator through a competitive procurement process in compliance with all applicable federal and state laws or regulations; and

(2) [(3)] ensure that all contracts with child health plan providers under Section 62.155 are procured through a competitive procurement process in compliance with all applicable federal and state laws or regulations.

SECTION 3.0196. Sections 62.101(a), (b), and (c), Health and Safety Code, are amended to read as follows:

(a) A child is eligible for health benefits coverage under the child health plan if the child:

(1) is younger than 19 years of age;

(2) is not eligible for medical assistance under the Medicaid program;

(3) is not covered by a health benefits plan offering adequate benefits, as determined by the commission;

(4) has a household [family] income that is less than or equal to the income eligibility level established under Subsection (b); and

(5) satisfies any other eligibility standard imposed under the child health plan program in accordance with 42 U.S.C. Section 1397bb, as amended, and any other applicable law or regulations.

(b) The executive commissioner [commission] shall establish income eligibility levels consistent with Title XXI, Social Security Act (42 U.S.C. Section 1397aa et seq.), as amended, and any other applicable law or regulations, and subject to the availability of appropriated money, so that a child who is younger than 19 years of age and whose household [net family] income is at or below 200 percent of the federal poverty level is eligible for health benefits coverage under the program. [In addition, the commission may establish eligibility standards regarding the amount and types of allowable assets for a family whose net family income is above 150 percent of the federal poverty level.]

(c) The executive commissioner shall evaluate enrollment levels and program impact [every six months during the first 12 months of implementation and] at least annually [thereafter] and shall submit a finding of fact to the Legislative Budget Board and the Governor's Office of Budget, [and] Planning, and Policy as to the adequacy of funding and the ability of the program to sustain enrollment at the eligibility level established by Subsection (b). In the event that appropriated money is insufficient to sustain enrollment at the authorized eligibility level, the executive commissioner shall:

(1) suspend enrollment in the child health plan;

(2) establish a waiting list for applicants for coverage; and

(3) establish a process for periodic or continued enrollment of applicants in the child health plan program as the availability of money allows.

SECTION 3.0197. Section 62.1011, Health and Safety Code, is amended to read as follows:

Sec. 62.1011. VERIFICATION OF INCOME. The commission shall continue employing methods of verifying the individual incomes [net income] of the individuals considered in the calculation of an applicant's household [net family] income. The commission shall verify income under this section unless the applicant reports a household [net family] income that exceeds the income eligibility level established under Section 62.101(b).

SECTION 3.0198. Sections 62.1015(a) and (c), Health and Safety Code, are amended to read as follows:

(a) In this section:

(1) "Charter school"[, "charter school," "employee,"] and "regional education service center" have the meanings assigned by Section 1579.002 [2, Article 3.50-7], Insurance Code.

(2) "Employee" has the meaning assigned by Section 1579.003, Insurance Code.

(c) The cost of health benefits coverage for children enrolled in the child health plan under this section shall be paid as provided in the General Appropriations Act. Expenditures made to provide health benefits coverage under this section may not be included for the purpose of determining the state children's health insurance expenditures, as that term is defined by 42 U.S.C. Section 1397ee(d)(2)(B), as amended, unless the commission [Health and Human Services Commission], after consultation with the appropriate federal agencies, determines that the expenditures may be included without adversely affecting federal matching funding for the child health plan provided under this chapter.

SECTION 3.0199. Sections 62.102(b) and (c), Health and Safety Code, are amended to read as follows:

(b) During the sixth month following the date of initial enrollment or reenrollment of an individual whose household [net family] income exceeds 185 percent of the federal poverty level, the commission shall:

(1) review the individual's household [net family] income and may use electronic technology if available and appropriate; and

(2) continue to provide coverage if the individual's household [net family] income does not exceed the income eligibility limits prescribed by this chapter.

(c) If, during the review required under Subsection (b), the commission determines that the individual's household [net family] income exceeds the income eligibility limits prescribed by this chapter, the commission may not disenroll the individual until:

(1) the commission has provided the family an opportunity to demonstrate that the family's household [net family] income is within the income eligibility limits prescribed by this chapter; and

(2) the family fails to demonstrate such eligibility.

SECTION 3.0200. Sections 62.103(a) and (d), Health and Safety Code, are amended to read as follows:

(a) The executive commissioner [commission, or the Texas Department of Human Services at the direction of and in consultation with the commission,] shall adopt an application form and application procedures for requesting child health plan coverage under this chapter.

(d) The executive commissioner [commission] may permit application to be made by mail, over the telephone, or through the Internet.

SECTION 3.0201. Sections 62.104(a) and (g), Health and Safety Code, are amended to read as follows:

(a) The executive commissioner [commission, or the Texas Department of Human Services at the direction of and in consultation with the commission,] shall develop eligibility screening and enrollment procedures for children that comply with the requirements of 42 U.S.C. Section 1397bb, as amended, and any other applicable law or regulations. The procedures shall ensure that Medicaid-eligible children are identified and referred to the Medicaid program.

(g) The executive commissioner [In the first year of implementation of the child health plan, enrollment shall be open. Thereafter, the commission] may establish enrollment periods for the child health plan.

SECTION 3.0202. Sections 62.151(b), (c), (e), and (f), Health and Safety Code, are amended to read as follows:

(b) In modifying [developing] the covered benefits, the executive commissioner [commission] shall consider the health care needs of healthy children and children with special health care needs.

(c) In modifying [developing] the plan, the executive commissioner [commission] shall ensure that primary and preventive health benefits do not include reproductive services, other than prenatal care and care related to diseases, illnesses, or abnormalities related to the reproductive system.

(e) In modifying [developing] the covered benefits, the executive commissioner [commission] shall seek input from the Public Assistance Health Benefit Review and Design Committee established under Section 531.067, Government Code.

(f) If the executive commissioner [The commission, if it] determines the policy to be cost-effective, the executive commissioner may ensure that an enrolled child does not, unless authorized by the commission in consultation with the child's attending physician or advanced practice nurse, receive under the child health plan:

(1) more than four different outpatient brand-name prescription drugs during a month; or

(2) more than a 34-day supply of a brand-name prescription drug at any one time.

SECTION 3.0203. Sections 62.153(a) and (c), Health and Safety Code, are amended to read as follows:

(a) To the extent permitted under 42 U.S.C. Section 1397cc, as amended, and any other applicable law or regulations, the executive commissioner [commission] shall require enrollees to share the cost of the child health plan, including provisions requiring enrollees under the child health plan to pay:

(1) a copayment for services provided under the plan;

(2) an enrollment fee; or

(3) a portion of the plan premium.

(c) If cost-sharing provisions imposed under Subsection (a) include requirements that enrollees pay a portion of the plan premium, the executive commissioner [commission] shall specify the manner in which the premium is paid. The commission may require that the premium be paid to the [Texas Department of Health, the Texas Department of Human Services, or the] health plan provider.

SECTION 3.0204. Section 62.154(b), Health and Safety Code, is amended to read as follows:

(b) A child is not subject to a waiting period adopted under Subsection (a) if:

(1) the family lost coverage for the child as a result of:

(A) termination of employment because of a layoff or business closing;

(B) termination of continuation coverage under the Consolidated Omnibus Budget Reconciliation Act of 1985 (Pub. L. No. 99-272);

(C) change in marital status of a parent of the child;

(D) termination of the child's Medicaid eligibility because:

(i) the child's family's earnings or resources increased; or

(ii) the child reached an age at which Medicaid coverage is not available; or

(E) a similar circumstance resulting in the involuntary loss of coverage;

(2) the family terminated health benefits plan coverage for the child because the cost to the child's family for the coverage exceeded 9.5 [10] percent of the family's household [net] income;

(3) the child has access to group-based health benefits plan coverage and is required to participate in the health insurance premium payment reimbursement program administered by the commission; [or]

(4) the commission has determined that other grounds exist for a good cause exception; or

(5) federal law provides that the child is not subject to a waiting period adopted under Subsection (a).

SECTION 3.0205. Sections 62.155(a) and (d), Health and Safety Code, are amended to read as follows:

(a) The commission[, or the Texas Department of Health at the direction of and in consultation with the commission,] shall select the health plan providers under the program through a competitive procurement process. A health plan provider, other than a state administered primary care case management network, must hold a certificate of authority or other appropriate license issued by the Texas Department of Insurance that authorizes the health plan provider to provide the type of child health plan offered and must satisfy, except as provided by this chapter, any applicable requirement of the Insurance Code or another insurance law of this state.

(d) The executive commissioner may authorize an exception to Subsection (c)(2) if there is only one acceptable applicant to become a health plan provider in the service area.

SECTION 3.0206. Section 62.1551, Health and Safety Code, is amended to read as follows:

Sec. 62.1551. INCLUSION OF CERTAIN HEALTH CARE PROVIDERS IN PROVIDER NETWORKS. Notwithstanding any other law, including Sections 843.312 and 1301.052, Insurance Code, the executive commissioner [of the commission] shall adopt rules to require a managed care organization or other entity to ensure that advanced practice registered nurses and physician assistants are available as primary care providers in the organization's or entity's provider network. The rules must require advanced practice registered nurses and physician assistants to be treated in the same manner as primary care physicians with regard to:

(1) selection and assignment as primary care providers;

(2) inclusion as primary care providers in the provider network; and

(3) inclusion as primary care providers in any provider network directory maintained by the organization or entity.

SECTION 3.0207. Section 62.156, Health and Safety Code, is amended to read as follows:

Sec. 62.156. HEALTH CARE PROVIDERS. Health care providers who provide health care services under the child health plan must satisfy certification and licensure requirements, as required by [the] commission rules and[,] consistent with other law.

SECTION 3.0208. Section 62.1561, Health and Safety Code, is amended to read as follows:

Sec. 62.1561. PROHIBITION OF CERTAIN HEALTH CARE PROVIDERS. The executive commissioner [of the commission] shall adopt rules for prohibiting a person from participating in the child health plan program as a health care provider for a reasonable period, as determined by the executive commissioner, if the person:

(1) fails to repay overpayments under the program; or

(2) owns, controls, manages, or is otherwise affiliated with and has financial, managerial, or administrative influence over a provider who has been suspended or prohibited from participating in the program.

SECTION 3.0209. Sections 62.157(b) and (c), Health and Safety Code, as added by Chapter 959 (S.B. 1536), Acts of the 77th Legislature, Regular Session, 2001, are amended to read as follows:

(b) The policies must provide for:

(1) the availability of covered benefits appropriately provided through telemedicine medical services and telehealth services that are comparable to the same types of covered benefits provided without the use of telemedicine medical services and telehealth services; and

(2) the availability of covered benefits for different services performed by multiple health care providers during a single telemedicine medical services and telehealth services session, if the executive commissioner [commission] determines that delivery of the covered benefits in that manner is cost-effective in comparison to the costs that would be involved in obtaining the services from providers without the use of telemedicine medical services and telehealth services, including the costs of transportation and lodging and other direct costs.

(c) In developing the policies required by Subsection (a), the executive commissioner [commission] shall consult with:

(1) The University of Texas Medical Branch at Galveston;

(2) Texas Tech University Health Sciences Center;

(3) the [Texas] Department of State Health Services;

(4) providers of telemedicine hub sites in this state;

(5) providers of services to children with special health care needs; and

(6) representatives of consumer or disability groups affected by changes to services for children with special health care needs.

SECTION 3.0210. Section 62.157, Health and Safety Code, as added by Chapter 1255 (S.B. 789), Acts of the 77th Legislature, Regular Session, 2001, is redesignated as Section 62.1571, Health and Safety Code, and amended to read as follows:

Sec. 62.1571 [62.157]. TELEMEDICINE MEDICAL SERVICES. (a) In providing covered benefits to a child, a health plan provider must permit benefits to be provided through telemedicine medical services in accordance with policies developed by the commission.

(b) The policies must provide for:

(1) the availability of covered benefits appropriately provided through telemedicine medical services that are comparable to the same types of covered benefits provided without the use of telemedicine medical services; and

(2) the availability of covered benefits for different services performed by multiple health care providers during a single session of telemedicine medical services, if the executive commissioner [commission] determines that delivery of the covered benefits in that manner is cost-effective in comparison to the costs that would be involved in obtaining the services from providers without the use of telemedicine medical services, including the costs of transportation and lodging and other direct costs.

(c) In developing the policies required by Subsection (a), the executive commissioner [commission] shall consult with the telemedicine and telehealth advisory committee.

(d) In this section, "telemedicine medical service" has the meaning assigned by Section 531.001, Government [57.042, Utilities] Code.

SECTION 3.0211. Section 62.159, Health and Safety Code, is amended to read as follows:

Sec. 62.159. DISEASE MANAGEMENT SERVICES. (a) In this section, "disease management services" means services to assist a child manage a disease or other chronic health condition, such as heart disease, diabetes, respiratory illness, end-stage renal disease, HIV infection, or AIDS, and with respect to which the executive commissioner [commission] identifies populations for which disease management would be cost-effective.

(b) The child health plan must provide disease management services or coverage for disease management services in the manner required by the executive commissioner [commission], including:

(1) patient self-management education;

(2) provider education;

(3) evidence-based models and minimum standards of care;

(4) standardized protocols and participation criteria; and

(5) physician-directed or physician-supervised care.

SECTION 3.0212. Section 63.003, Health and Safety Code, is amended to read as follows:

Sec. 63.003. HEALTH BENEFITS PLAN COVERAGE FOR CERTAIN CHILDREN. The executive commissioner [commission] shall develop and implement a program to provide health benefits plan coverage for a child who:

(1) is a qualified alien, as that term is defined by 8 U.S.C. Section 1641(b);

(2) is younger than 19 years of age;

(3) entered the United States after August 22, 1996;

(4) has resided in the United States for less than five years; and

(5) meets the income eligibility requirement of, but is not eligible for assistance under:

(A) the child health plan program under Chapter 62; or

(B) the medical assistance program under Chapter 32, Human Resources Code.

SECTION 3.0213. Section 63.005(b), Health and Safety Code, is amended to read as follows:

(b) Except as required by the executive commissioner [commission], a health benefits plan provider under this chapter is not subject to a law that requires coverage or the offer of coverage of a health care service or benefit.

SECTION 3.0214. Section 63.006, Health and Safety Code, is amended to read as follows:

Sec. 63.006. COST-SHARING PAYMENTS. (a) Except as provided by Subsection (b), the executive commissioner [commission] may not require a child who is provided health benefits plan coverage under Section 63.003 and who meets the income eligibility requirement of the medical assistance program under Chapter 32, Human Resources Code, to pay a premium, deductible, coinsurance, or other cost-sharing payment as a condition of health benefits plan coverage under this chapter.

(b) The executive commissioner [commission] may require a child described by Subsection (a) to pay a copayment as a condition of health benefits plan coverage under this chapter that is equal to any copayment required under the child health plan program under Chapter 62.

(c) The executive commissioner [commission] may require a child who is provided health benefits plan coverage under Section 63.003 and who meets the income eligibility requirement of the child health plan program under Chapter 62 to pay a premium, deductible, coinsurance, or other cost-sharing payment as a condition of health benefits plan coverage under this chapter. The payment must be equal to any premium, deductible, coinsurance, or other cost-sharing payment required under the child health plan program under Chapter 62.

SECTION 3.0215. Section 64.001, Health and Safety Code, is amended to read as follows:

Sec. 64.001. TEACHING HOSPITAL ACCOUNT. The [Texas] Department of State Health Services state-owned multi-categorical teaching hospital account is an account in the general revenue fund. Money in the account may be appropriated only to the department to provide funding for indigent health care.

SECTION 3.0216. Section 81.003(5), Health and Safety Code, is amended to read as follows:

(5) "Physician" means a person licensed to practice medicine by the Texas [State Board of] Medical Board [Examiners].

SECTION 3.0217. Sections 81.004(b) and (c), Health and Safety Code, are amended to read as follows:

(b) The executive commissioner [board] may adopt rules necessary for the effective administration and implementation of this chapter.

(c) A designee of the executive commissioner [board] may exercise a power granted to or perform a duty imposed on the executive commissioner [board] under this chapter except as otherwise required by law.

SECTION 3.0218. Section 81.008, Health and Safety Code, is amended to read as follows:

Sec. 81.008. COMMUNICABLE DISEASE IN ANIMALS; EXCHANGE OF INFORMATION. The Texas Animal Health Commission and the Texas A&M University Veterinary Medical Diagnostic Laboratory shall each adopt by rule a memorandum of understanding, adopted also by rule by the executive commissioner, governing the [with the department to] exchange of information on communicable diseases in animals between the department and those entities.

SECTION 3.0219. Sections 81.010(c), (e), (h), (i), and (k), Health and Safety Code, are amended to read as follows:

(c) The council consists of one representative from each of the following agencies appointed by the executive director or commissioner of each agency:

(1) the Department of State Health Services;

(2) the Department of Aging and Disability Services;

(3) the Department of Assistive and Rehabilitative Services;

(4) the Department of Family and Protective Services;

(5) [the Texas Youth Commission;

[(6)] the Texas Department of Criminal Justice;

(6) [(7)] the Texas Juvenile Justice Department [Probation Commission];

(7) [(8)] the Texas Medical Board;

(8) [(9)] the Texas Board of Nursing;

(9) [(10)] the State Board of Dental Examiners;

(10) [(11)] the Health and Human Services Commission;

(11) [(12)] the Texas Workforce Commission; and

(12) [(13)] the Texas Higher Education Coordinating Board.

(e) The representative from the commission [Health and Human Services Commission] serves as chairperson of the council.

(h) The council shall:

(1) coordinate communication among the member agencies listed in Subsection (c) concerning each agency's programs in providing services related to AIDS, HIV, and hepatitis;

(2) develop a plan that facilitates coordination of agency programs based on statistical information regarding this state for:

(A) prevention of AIDS, HIV infection, and hepatitis; and

(B) provision of services to individuals who have hepatitis or are infected with HIV;

(3) identify all statewide plans related to AIDS, HIV, and hepatitis;

(4) compile a complete inventory of all federal, state, and local money spent in this state on HIV infection, AIDS, and hepatitis prevention and health care services, including services provided through or covered under Medicaid and Medicare;

(5) identify the areas with respect to which state agencies interact on HIV, AIDS, and hepatitis issues and the policy issues arising from that interaction;

(6) assess gaps in prevention and health care services for HIV infection, AIDS, and hepatitis in this state, including gaps in services that result from provision of services by different state agencies, and develop strategies to address these gaps through service coordination;

(7) identify barriers to prevention and health care services for HIV infection, AIDS, and hepatitis faced by marginalized populations;

(8) identify the unique health care service and other service needs of persons who are infected with HIV or who have AIDS or hepatitis;

(9) evaluate the level of service and quality of health care in this state for persons who are infected with HIV or who have AIDS or hepatitis as compared to national standards;

(10) identify issues that emerge related to HIV, AIDS, and hepatitis and the potential impact on delivery of prevention and health care services; and

(11) provide the information required under Subdivisions (1) through (10) to the department [Department of State Health Services].

(i) Not later than September 1 of each year, the department [Department of State Health Services] shall file a report with the legislature and the governor containing policy recommendations based on information reported to the council in Subsection (h) relating to:

(1) prevention of AIDS, HIV infection, and hepatitis; and

(2) delivery of health services to individuals who have AIDS or hepatitis or are infected with HIV.

(k) The commission [Health and Human Services Commission] shall provide administrative support to the council.

SECTION 3.0220. Section 81.021, Health and Safety Code, is amended to read as follows:

Sec. 81.021. PROTECTION OF PUBLIC HEALTH [BOARD'S DUTY]. The executive commissioner and department [board] shall exercise their powers [its power] in matters relating to protecting the public health to prevent the introduction of disease into the state.

SECTION 3.0221. Section 81.023, Health and Safety Code, is amended to read as follows:

Sec. 81.023. IMMUNIZATION. (a) The department [board] shall develop immunization requirements for children.

(b) The department [board] shall cooperate with the Department of Family and Protective [and Regulatory] Services in formulating and implementing the immunization requirements for children admitted to child-care facilities.

(c) The department [board] shall cooperate with the State Board of Education in formulating and implementing immunization requirements for students admitted to public or private primary or secondary schools.

SECTION 3.0222. Section 81.024, Health and Safety Code, is amended to read as follows:

Sec. 81.024. REPORTS BY DEPARTMENT [BOARD]. The department [board] shall provide regular reports of the incidence, prevalence, and medical and economic effects of each disease that the department [board] determines is a threatening risk to the public health. A disease may be a risk because of its indirect complications.

SECTION 3.0223. Section 81.041, Health and Safety Code, is amended to read as follows:

Sec. 81.041. REPORTABLE DISEASES. (a) The executive commissioner [board] shall identify each communicable disease or health condition that shall be reported under this chapter.

(b) The executive commissioner [board] shall classify each reportable disease according to its nature and the severity of its effect on the public health.

(c) The executive commissioner [board] shall maintain and revise as necessary the list of reportable diseases.

(d) The executive commissioner [board] may establish registries for reportable diseases and other communicable diseases and health conditions. The provision to the department of information relating to a communicable disease or health condition that is not classified as reportable is voluntary only.

(e) Acquired immune deficiency syndrome and human immunodeficiency virus infection are reportable diseases under this chapter for which the executive commissioner [board] shall require reports.

(f) In a public health disaster, the commissioner may require reports of communicable diseases or other health conditions from providers without the adoption of a [board] rule or other action by the executive commissioner. The commissioner shall issue appropriate instructions relating to complying with the reporting requirements of this section.

SECTION 3.0224. Sections 81.042(c) and (d), Health and Safety Code, are amended to read as follows:

(c) A local school authority shall report a child attending school who is suspected of having a reportable disease. The executive commissioner [board] by rule shall establish procedures to determine if a child should be suspected and reported and to exclude the child from school pending appropriate medical diagnosis or recovery.

(d) A person in charge of a clinical or hospital laboratory, blood bank, mobile unit, or other facility in which a laboratory examination of a specimen derived from a human body yields microscopical, cultural, serological, or other evidence of a reportable disease shall report the findings, in accordance with this section and procedures adopted by the executive commissioner [board], in the jurisdiction in which:

(1) the physician's office is located, if the laboratory examination was requested by a physician; or

(2) the laboratory is located, if the laboratory examination was not requested by a physician.

SECTION 3.0225. Section 81.043(b), Health and Safety Code, is amended to read as follows:

(b) A [Except as provided by Subsection (c), a] health authority shall report reportable diseases to the department's central office at least as frequently as the interval set by department [board] rule.

SECTION 3.0226. Sections 81.044(a), (b), and (d), Health and Safety Code, are amended to read as follows:

(a) The executive commissioner [board] shall prescribe the form and method of reporting under this chapter, which may be in writing, by telephone, by electronic data transmission, or by other means.

(b) The executive commissioner [board] may require the reports to contain any information relating to a case that is necessary for the purposes of this chapter, including:

(1) the patient's name, address, age, sex, race, and occupation;

(2) the date of onset of the disease or condition;

(3) the probable source of infection; and

(4) the name of the attending physician or dentist.

(d) For a case of acquired immune deficiency syndrome or human immunodeficiency virus infection, the executive commissioner [department] shall require the reports to contain:

(1) the information described by Subsection (b); and

(2) the patient's ethnicity, national origin, and city and county of residence.

SECTION 3.0227. Sections 81.048(a) and (g), Health and Safety Code, are amended to read as follows:

(a) The executive commissioner [board] shall:

(1) designate certain reportable diseases for notification under this section; and

(2) define the conditions that constitute possible exposure to those diseases.

(g) A hospital that gives notice of a possible exposure under Subsection (c) or a local health authority that receives notice of a possible exposure under Subsection (c) may give notice of the possible exposure to a person other than emergency medical personnel, a peace officer, a detention officer, a county jailer, or a fire fighter if the person demonstrates that the person was exposed to the reportable disease while providing emergency care. The executive commissioner [of the Health and Human Services Commission] shall adopt rules to implement this subsection.

SECTION 3.0228. Sections 81.050(a), (b), (c), (d), (e), (g), (j), (k), and (l), Health and Safety Code, are amended to read as follows:

(a) The executive commissioner [board] by rule shall prescribe the criteria that constitute exposure to reportable diseases[, including HIV infection]. The criteria must be based on activities that the United States Public Health Service determines pose a risk of infection.

(b) A person whose occupation or whose volunteer service is included in one or more of the following categories may request the department or a health authority to order testing of another person who may have exposed the person to a reportable disease[, including HIV infection]:

(1) a law enforcement officer;

(2) a fire fighter;

(3) an emergency medical service employee or paramedic;

(4) a correctional officer;

(5) an employee, contractor, or volunteer, other than a correctional officer, who performs a service in a correctional facility as defined by Section 1.07, Penal Code, or a secure correctional facility or secure detention facility as defined by Section 51.02, Family Code; or

(6) an employee of a juvenile probation department.

(c) A request under this section may be made only if the person:

(1) has experienced the exposure in the course of the person's employment or volunteer service;

(2) believes that the exposure places the person at risk of a reportable disease[, including HIV infection]; and

(3) presents to the department or health authority a sworn affidavit that delineates the reasons for the request.

(d) The department or the department's designee who meets the minimum training requirements prescribed by department [board] rule shall review the person's request and inform the person whether the request meets the criteria establishing risk of infection with a reportable disease[, including HIV infection].

(e) The department or the department's designee shall give the person who is subject to the order prompt and confidential written notice of the order. The order must:

(1) state the grounds and provisions of the order, including the factual basis for its issuance;

(2) refer the person to appropriate health care facilities where the person can be tested for reportable diseases[, including HIV infection]; and

(3) inform the person who is subject to the order of that person's right to refuse to be tested and the authority of the department or health authority to ask for a court order requiring the test.

(g) In reviewing the order, the court shall determine whether exposure occurred and whether that exposure presents a possible risk of infection as defined by department [board] rule. The attorney for the state and the attorney for the person subject to the order may introduce evidence at the hearing in support of or opposition to the testing of the person. On conclusion of the hearing, the court shall either issue an appropriate order requiring counseling and testing of the person for reportable diseases[, including HIV infection,] or refuse to issue the order if the court has determined that the counseling and testing of the person is unnecessary. The court may assess court costs against the person who requested the test if the court finds that there was not reasonable cause for the request.

(j) For the purpose of qualifying for workers' compensation or any other similar benefits for compensation, an employee who claims a possible work-related exposure to a reportable disease[, including HIV infection,] must provide the employer with a sworn affidavit of the date and circumstances of the exposure and document that, not later than the 10th day after the date of the exposure, the employee had a test result that indicated an absence of the reportable disease[, including HIV infection].

(k) A person listed in Subsection (b) who may have been exposed to a reportable disease[, including HIV infection,] may not be required to be tested.

(l) In this section, ["HIV" and] "test result" has [have] the meaning [meanings] assigned by Section 81.101.

SECTION 3.0229. Section 81.051(j), Health and Safety Code, is amended to read as follows:

(j) A partner notification program shall routinely evaluate the performance of counselors and other program personnel to ensure that high quality services are being delivered. A program shall adopt quality assurance and training guidelines according to recommendations of the Centers for Disease Control and Prevention of the United States Public Health Service for professionals participating in the program.

SECTION 3.0230. Section 81.062(b), Health and Safety Code, is amended to read as follows:

(b) A witness or deponent who is not a party and who is subpoenaed or otherwise compelled to appear at a hearing or proceeding under this section conducted outside the witness's or deponent's county of residence is entitled to a travel and per diem allowance. The executive commissioner [board] by rule shall set the allowance in an amount not to exceed the travel and per diem allowance authorized for state employees traveling in this state on official business.

SECTION 3.0231. Section 81.064(a), Health and Safety Code, is amended to read as follows:

(a) The department or a health authority may enter at reasonable times and inspect within reasonable limits a public place in the performance of that person's duty to prevent or control the entry into or spread in this state of communicable disease by enforcing this chapter or the rules [of the board] adopted under this chapter.

SECTION 3.0232. Section 81.081, Health and Safety Code, is amended to read as follows:

Sec. 81.081. DEPARTMENT'S [BOARD'S] DUTY. The department [board] shall impose control measures to prevent the spread of disease in the exercise of its power to protect the public health.

SECTION 3.0233. Sections 81.082(a) and (c-1), Health and Safety Code, are amended to read as follows:

(a) A health authority has supervisory authority and control over the administration of communicable disease control measures in the health authority's jurisdiction unless specifically preempted by the department. Control measures imposed by a health authority must be consistent with, and at least as stringent as, the control measure standards in rules adopted by the executive commissioner [board].

(c-1) A health authority may designate health care facilities within the health authority's jurisdiction that are capable of providing services for the examination, observation, quarantine, isolation, treatment, or imposition of control measures during a public health disaster or during an area quarantine under Section 81.085. A health authority may not designate a nursing facility [home] or other institution licensed under Chapter 242.

SECTION 3.0234. Section 81.084(d), Health and Safety Code, is amended to read as follows:

(d) The department or health authority shall remove the quarantine and return control of the property to the person who owns or controls it if the control measures are effective. If the control measures are ineffective or if there is not a technically feasible control measure available for use, the department or health authority may continue the quarantine and order the person who owns or controls the property:

(1) to destroy the property, other than land, in a manner that disinfects or decontaminates the property to prevent the spread of infection or contamination;

(2) if the property is land, to securely fence the perimeter of the land or any part of the land that is infected or contaminated; or

(3) to securely seal off an infected or contaminated structure or other property on land to prevent entry into the infected or contaminated area until the quarantine is removed by the department [board] or health authority.

SECTION 3.0235. Sections 81.086(d), (e), and (h), Health and Safety Code, are amended to read as follows:

(d) The owner or operator of a carrier or conveyance placed in quarantine by order of the department or health authority, or of a county or district court under Section 81.083 or 81.084, shall bear the expense of the control measures employed to disinfect or decontaminate the carrier or conveyance. The department or health authority, as appropriate, shall charge and be reimbursed for the cost of control measures performed by the department's or health authority's employees. The department [board] shall deposit the reimbursements to the credit of the general revenue fund to be used to administer this chapter. A health authority shall distribute the reimbursements to each county, municipality, or other governmental entity in an amount proportional to that entity's contribution to the quarantine and control expense.

(e) The owner or claimant of cargo or an object on board the carrier or conveyance shall pay the expense of the control measures employed in the manner provided by Section 81.084. The cost of services rendered or provided by the department [board] or health authority is subject to reimbursement as provided by Subsection (d).

(h) If the department or health authority has reasonable cause to believe that a carrier or conveyance is transporting cargo or an object that is or may be infected or contaminated with a communicable disease, the department or health authority may:

(1) require that the cargo or object be transported in secure confinement or sealed in a car, trailer, hold, or compartment, as appropriate, that is secured on the order and instruction of the department [board] or health authority, if the cargo or object is being transported through this state;

(2) require that the cargo or object be unloaded at an alternate location equipped with adequate investigative and disease control facilities if the cargo or object is being transported to an intermediate or ultimate destination in this state that cannot provide the necessary facilities; and

(3) investigate and, if necessary, quarantine the cargo or object and impose any required control measure as authorized by Section 81.084.

SECTION 3.0236. Sections 81.091(a), (c), and (d), Health and Safety Code, are amended to read as follows:

(a) A physician, nurse, midwife, or other person in attendance at childbirth shall use or cause to be used prophylaxis approved by the executive commissioner [board] to prevent ophthalmia neonatorum.

(c) Subject to the availability of funds, the department shall furnish prophylaxis approved by the executive commissioner [board] free of charge to:

(1) health care providers if the newborn's financially responsible adult is unable to pay; and

(2) a midwife identified under Chapter 203, Occupations Code, who requests prophylaxis for administration under standing delegation orders issued by a licensed physician under Subsection (b) and subject to the provisions of Subchapter A, Chapter 157, Occupations Code.

(d) If a physician is not available to issue a standing delegation order or if no physician will agree to issue a standing delegation order, a midwife shall administer or cause to be administered by an appropriately trained and licensed individual prophylaxis approved by the executive commissioner [Texas Board of Health] to prevent ophthalmia neonatorum to each infant that the midwife delivers.

SECTION 3.0237. Section 81.0955(b), Health and Safety Code, is amended to read as follows:

(b) A hospital, certified emergency medical services personnel, or a physician on behalf of the person exposed, following a report of the exposure incident, shall take reasonable steps to test the deceased person for communicable diseases. The hospital, certified emergency medical services personnel, or physician shall provide the test results to the department or to the local health authority responsible for following the procedures prescribed by Section 81.050(h) to inform the person exposed and, if applicable, the next of kin of the deceased person regarding the test results. The hospital, certified emergency medical services personnel, or physician shall follow applicable reporting requirements prescribed by Subchapter C. This subsection does not impose a duty on a hospital, certified emergency medical services personnel, or a physician to provide any further testing, treatment, or services or to perform further procedures. The executive commissioner [of the Health and Human Services Commission] shall adopt rules to implement this subsection.

SECTION 3.0238. Sections 81.101(1) and (4), Health and Safety Code, are amended to read as follows:

(1) "AIDS" means acquired immune deficiency syndrome as defined by the Centers for Disease Control and Prevention of the United States Public Health Service.

(4) "Blood bank" means a blood bank, blood center, regional collection center, tissue bank, transfusion service, or other similar facility licensed by the Center for [Bureau of] Biologics Evaluation and Research of the United States Food and Drug Administration, accredited for membership in the AABB (formerly known as the American Association of Blood Banks), or qualified for membership in the American Association of Tissue Banks.

SECTION 3.0239. Sections 81.102(a), (c), and (d), Health and Safety Code, are amended to read as follows:

(a) A person may not require another person to undergo a medical procedure or test designed to determine or help determine if a person has AIDS or HIV infection, antibodies to HIV, or infection with any other probable causative agent of AIDS unless:

(1) the medical procedure or test is required under Subsection (d), under Section 81.050, or under Article 21.31, Code of Criminal Procedure;

(2) the medical procedure or test is required under Section 81.090, and no objection has been made under Section 81.090(l);

(3) the medical procedure or test is authorized under Chapter 545, Insurance Code;

(4) a medical procedure is to be performed on the person that could expose health care personnel to AIDS or HIV infection, according to department rules [board guidelines] defining the conditions that constitute possible exposure to AIDS or HIV infection, and there is sufficient time to receive the test result before the procedure is conducted; or

(5) the medical procedure or test is necessary:

(A) as a bona fide occupational qualification and there is not a less discriminatory means of satisfying the occupational qualification;

(B) to screen blood, blood products, body fluids, organs, or tissues to determine suitability for donation;

(C) in relation to a particular person under this chapter;

(D) to manage accidental exposure to blood or other body fluids, but only if the test is conducted under written infectious disease control protocols adopted by the health care agency or facility;

(E) to test residents and clients of residential facilities of the department or the Department of Aging and Disability Services [Texas Department of Mental Health and Mental Retardation], but only if:

(i) the test result would change the medical or social management of the person tested or others who associated with that person; and

(ii) the test is conducted in accordance with guidelines adopted by the residential facility or rules of the appropriate department [Texas Department of Mental Health and Mental Retardation and approved by the department]; or

(F) to test residents and clients of residential facilities of the Texas Juvenile Justice Department [Youth Commission], but only if:

(i) the test result would change the medical or social management of the person tested or others who associate with that person; and

(ii) the test is conducted in accordance with guidelines adopted by the Texas Juvenile Justice Department [Youth Commission].

(c) Protocols adopted under Subsection (a)(5)(D) [(a)(4)(D)] must clearly establish procedural guidelines with criteria for testing that respect the rights of the person with the infection and the person who may be exposed to that infection. The protocols may not require the person who may have been exposed to be tested and must ensure the confidentiality of the person with the infection in accordance with this chapter.

(d) The executive commissioner [board] may adopt emergency rules for mandatory testing for HIV infection if the commissioner files a certificate of necessity with the executive commissioner [board] that contains supportive findings of medical and scientific fact and that declares a sudden and imminent threat to public health. The rules must provide for:

(1) the narrowest application of HIV testing necessary for the protection of the public health;

(2) procedures and guidelines to be followed by an affected entity or state agency that clearly specify the need and justification for the testing, specify methods to be used to assure confidentiality, and delineate responsibility and authority for carrying out the recommended actions;

(3) counseling of persons with seropositive test results; and

(4) confidentiality regarding persons tested and their test results.

SECTION 3.0240. Section 81.107(a), Health and Safety Code, is amended to read as follows:

(a) In a case of accidental exposure to blood or other body fluids under Section 81.102(a)(5)(D) [81.102(a)(4)(D)], the health care agency or facility may test a person who may have exposed the health care worker to HIV without the person's specific consent to the test.

SECTION 3.0241. Section 81.108, Health and Safety Code, is amended to read as follows:

Sec. 81.108. TESTING BY INSURERS. The Insurance Code and any rules adopted by the commissioner of insurance for the Texas Department [State Board] of Insurance exclusively govern all practices of insurers in testing applicants to show or help show whether a person has AIDS or HIV infection, antibodies to HIV, or infection with any other probable causative agent of AIDS.

SECTION 3.0242. Section 81.159(a), Health and Safety Code, is amended to read as follows:

(a) The commissioner shall designate health care facilities throughout the state that are capable of providing services for the examination, observation, isolation, or treatment of persons having or suspected of having a communicable disease. However, the commissioner may not designate:

(1) a nursing facility [home] or custodial care home required to be licensed under Chapter 242; or

(2) an ICF-IID [intermediate care facility for the mentally retarded] required to be licensed under Chapter 252.

SECTION 3.0243. Section 81.166(d), Health and Safety Code, is amended to read as follows:

(d) The notification of probable cause hearing shall read as follows:

(Style of Case)

NOTIFICATION OF PROBABLE CAUSE HEARING

On this the _____ day of _________________, 20__ [19__], the undersigned hearing officer heard evidence concerning the need for protective custody of ___________ (hereinafter referred to as proposed patient). The proposed patient was given the opportunity to challenge the allegations that the proposed patient [(s)he] presents a substantial risk of serious harm to self or others.

The proposed patient and the proposed patient's [his or her] attorney _________________________ have been given written notice that the proposed patient was placed under an order of protective custody and the reasons for such order on ___________ (date of notice).

I have examined the affidavit of medical evaluation and ________________ (other evidence considered). Based on this evidence, I find that there is probable cause to believe that the proposed patient presents a substantial risk of serious harm to self [himself or herself] (yes ____ or no ____) or others (yes ____ or no ____) such that the proposed patient [(s)he] cannot be at liberty pending final hearing because the proposed patient [(s)he] is infected with or is reasonably suspected of being infected with a communicable disease that presents an immediate threat to the public health and the proposed patient [(s)he] has failed or refused to comply with the orders of the health authority or the [Texas] Department of State Health Services delivered on __________ (date of service) ____________.

SECTION 3.0244. Section 81.178(d), Health and Safety Code, is amended to read as follows:

(d) The appropriate courts of this state retain jurisdiction to inquire at any time into the person's [mental] condition and the necessity of the person's continued commitment.

SECTION 3.0245. Sections 81.211(a) and (b), Health and Safety Code, are amended to read as follows:

(a) In the case of a person who is not a resident of this state and who may be admitted to a public health [state chest] hospital in accordance with Section 13.046, the attorney general, at the request of the department, shall file a copy of an order issued by a court of another state that authorizes the commitment of the person to a health care facility for inpatient care in the manner provided by Chapter 35, Civil Practice and Remedies Code, for enforcement of foreign judgments.

(b) The application must be filed with the district court in the county in which the public health [state chest] hospital to which the person will be admitted is located.

SECTION 3.0246. Section 81.304, Health and Safety Code, is amended to read as follows:

Sec. 81.304. MINIMUM STANDARDS. The executive commissioner [board] by rule shall adopt minimum standards to implement the exposure control plan and the other provisions of this subchapter. The rules shall be analogous to standards adopted by the federal Occupational Safety and Health Administration. Each governmental unit shall comply with the minimum standards adopted under this subchapter.

SECTION 3.0247. Section 81.305(a), Health and Safety Code, is amended to read as follows:

(a) The executive commissioner [board] by rule shall recommend that governmental units implement needleless systems and sharps with engineered sharps injury protection for employees.

SECTION 3.0248. Sections 81.306(a) and (c), Health and Safety Code, are amended to read as follows:

(a) The executive commissioner [board] by rule shall require that information concerning exposure incidents be recorded in a written or electronic sharps injury log to be maintained by a governmental unit. This information must be reported to the department and must include:

(1) the date and time of the exposure incident;

(2) the type and brand of sharp involved in the exposure incident; and

(3) a description of the exposure incident, including:

(A) the job classification or title of the exposed employee;

(B) the department or work area where the exposure incident occurred;

(C) the procedure that the exposed employee was performing at the time of the incident;

(D) how the incident occurred;

(E) the employee's body part that was involved in the exposure incident; and

(F) whether the sharp had engineered sharps injury protection and, if so, whether the protective mechanism was activated and whether the injury occurred before, during, or after the activation of the protective mechanism.

(c) All information and materials obtained or compiled by the department in connection with a report under this section are confidential and not subject to disclosure under Chapter 552, Government Code, and not subject to disclosure, discovery, subpoena, or other means of legal compulsion for their release by the department. The department shall make available, in aggregate form, the information described in Section 81.305(b) and this section, provided that the name and other information identifying the facility is deleted and the information is provided according to public health regions established by the executive commissioner [department].

SECTION 3.0249. Sections 81.307(a) and (c), Health and Safety Code, are amended to read as follows:

(a) The department, in accordance with rules adopted by the executive commissioner [board], shall implement a registration program for existing needleless systems and sharps with engineered sharps injury protection.

(c) The department shall collect [charge] a fee to register a device in an amount established by rule by the executive commissioner [board]. The fees collected under this section may be appropriated only to the department to implement this subchapter.

SECTION 3.0250. Section 81.352(b), Health and Safety Code, is amended to read as follows:

(b) The executive commissioner [department] shall adopt rules to govern:

(1) the form and content of the sign required by Subsection (a) and the manner and place of posting of the sign; and

(2) the form and content of the written warning required by Subsection (a).

SECTION 3.0251. Sections 81.353(a) and (d), Health and Safety Code, are amended to read as follows:

(a) The department may assess an administrative penalty if a person violates this subchapter [section] or a rule adopted under this subchapter [section].

(d) The enforcement of the penalty may be stayed during the time the order is under judicial review if the person pays the penalty to the clerk of the court or files a supersedeas bond with the court in the amount of the penalty. A person who cannot afford to pay the penalty or file the bond may stay the enforcement by filing an affidavit in the manner required by the Texas Rules of Civil Procedure for a party who cannot afford to file security for costs, subject to the right of the department [board] to contest the affidavit as provided by those rules.

SECTION 3.0252. Section 82.004, Health and Safety Code, is amended to read as follows:

Sec. 82.004. REGISTRY REQUIRED. The department [board] shall maintain a cancer registry for the state.

SECTION 3.0253. Section 82.005(b), Health and Safety Code, is amended to read as follows:

(b) The cancer registry must include:

(1) a record of the cases of cancer that occur in the state; and

(2) information concerning cancer cases as the executive commissioner [board] considers necessary and appropriate for the recognition, prevention, cure, or control of cancer.

SECTION 3.0254. Section 82.006, Health and Safety Code, is amended to read as follows:

Sec. 82.006. EXECUTIVE COMMISSIONER AND DEPARTMENT [BOARD] POWERS. (a) To implement this chapter, the executive commissioner [board] may [:

[(1)] adopt rules that the executive commissioner [board] considers necessary. [;]

(b) To implement this chapter, the department may:

(1) [(2)] execute contracts considered [that the board considers] necessary;

(2) [(3)] receive the data from medical records of cases of cancer that are in the custody or under the control of clinical laboratories, health care facilities, and health care practitioners to record and analyze the data directly related to those diseases;

(3) [(4)] compile and publish statistical and other studies derived from the patient data obtained under this chapter to provide, in an accessible form, information that is useful to physicians, other medical personnel, and the general public;

(4) [(5)] comply with requirements as necessary to obtain federal funds in the maximum amounts and most advantageous proportions possible;

(5) [(6)] receive and use gifts made for the purpose of this chapter; and

(6) [(7)] limit cancer reporting activities under this chapter to specified geographic areas of the state to ensure optimal use of funds available for obtaining the data.

SECTION 3.0255. Sections 82.008(a), (b), and (e), Health and Safety Code, are amended to read as follows:

(a) To ensure an accurate and continuing source of data concerning cancer, each health care facility, clinical laboratory, and health care practitioner shall furnish to the department [board or its representative], on request, data the executive commissioner [board] considers necessary and appropriate that is derived from each medical record pertaining to a case of cancer that is in the custody or under the control of the health care facility, clinical laboratory, or health care practitioner. The department may not request data that is more than three years old unless the department is investigating a possible cancer cluster.

(b) A health care facility, clinical laboratory, or health care practitioner shall furnish the data requested under Subsection (a) in a reasonable format prescribed by [the] department rule and within six months of the patient's admission, diagnosis, or treatment for cancer unless a different period is prescribed by the United States Department of Health and Human Services.

(e) The executive commissioner [board] shall adopt procedures that ensure adequate notice is given to the health care facility, clinical laboratory, or health care practitioner before the department accesses data under Subsection (d).

SECTION 3.0256. Section 82.009(b), Health and Safety Code, is amended to read as follows:

(b) Medical or epidemiological information may be released:

(1) for statistical purposes in a manner that prevents identification of individuals, health care facilities, clinical laboratories, or health care practitioners;

(2) with the consent of each person identified in the information; or

(3) to promote cancer research, including release of information to other cancer registries and appropriate state and federal agencies, under rules adopted by the executive commissioner [board] to ensure confidentiality as required by state and federal laws.

SECTION 3.0257. Section 82.011, Health and Safety Code, is amended to read as follows:

Sec. 82.011. EXAMINATION AND SUPERVISION NOT REQUIRED. This chapter does not require an individual to submit to any medical examination or supervision or to examination or supervision by the department [board or its representatives].

SECTION 3.0258. Sections 84.003(b), (c), (d), and (e), Health and Safety Code, are amended to read as follows:

(b) Blood lead levels in adults are laboratory findings that are reportable to the department as provided by department [board] rule.

(c) The executive commissioner [board] may adopt rules that require other occupational conditions to be reported under this chapter. Before the executive commissioner [board] requires another occupational condition to be reported, the executive commissioner [board] must find that the condition:

(1) has a well-understood etiology;

(2) results predominantly from occupational exposures; and

(3) is preventable.

(d) The executive commissioner [board] shall maintain a list of reportable conditions.

(e) The executive commissioner [board] shall adopt rules necessary to administer and implement this chapter.

SECTION 3.0259. Section 84.004(c), Health and Safety Code, is amended to read as follows:

(c) The executive commissioner [board] shall prescribe the form and method of reporting. The executive commissioner [board] may require the reports to contain any information necessary to achieve the purposes of this chapter, including the person's name, address, age, sex, race, occupation, employer, and attending physician.

SECTION 3.0260. Section 84.005(b), Health and Safety Code, is amended to read as follows:

(b) The department may seek, receive, and spend any funds received through appropriations, grants, or donations from public or private sources for the purpose of identifying, reporting, or preventing those occupational conditions that have been determined by the executive commissioner [board] to be injurious or to be a threat to the public health, subject to any limitations or conditions prescribed by the legislature.

SECTION 3.0261. Section 84.006(b), Health and Safety Code, is amended to read as follows:

(b) The executive commissioner [board] shall adopt rules establishing procedures to ensure that all information and records maintained by the department under this chapter are kept confidential and protected from release to unauthorized persons.

SECTION 3.0262. Section 84.007(b), Health and Safety Code, is amended to read as follows:

(b) In performing the department's [commissioner's] duty to prevent an occupational condition, the department's [commissioner or the commissioner's] designee may enter at reasonable times and inspect within reasonable limits all or any part of an area, structure, or conveyance, regardless of ownership, that is not used for private residential purposes.

SECTION 3.0263. Sections 85.002(1), (2), and (6), Health and Safety Code, are amended to read as follows:

(1) "AIDS" means acquired immune deficiency syndrome as defined by the Centers for Disease Control and Prevention of the United States Public Health Service.

(2) "Communicable disease" has the meaning assigned by Section 81.003 [(Communicable Disease Prevention and Control Act)].

(6) "Testing program" means a [medical] program using a diagnostic test approved by the United States Food and Drug Administration to indicate the presence of HIV [to test for AIDS, HIV infection, antibodies to HIV, or infection with any other probable causative agent of AIDS].

SECTION 3.0264. The heading to Subchapter A, Chapter 85, Health and Safety Code, is amended to read as follows:

SUBCHAPTER A. GENERAL PROVISIONS AND EDUCATIONAL MATERIALS

[EDUCATION PROGRAMS]

SECTION 3.0265. Sections 85.004 and 85.005, Health and Safety Code, are amended to read as follows:

Sec. 85.004. EDUCATIONAL MATERIALS [EDUCATION PROGRAMS]. (a) The department shall develop model educational materials [education programs] to be available on the department's Internet website to educate the public about AIDS and HIV infection.

(b) The [As part of the programs, the department shall develop a model] educational materials must:

(1) include information [pamphlet] about methods of transmission and prevention of HIV infection, [about] state laws relating to the transmission, and [to] conduct that may result in the transmission of HIV; and [.]

(2) [(c) The programs must] be scientifically accurate and factually correct and designed to:

(A) [(1)] communicate to the public knowledge about methods of transmission and prevention of HIV infection; and

(B) [(2)] educate the public about transmission risks in social, employment, and educational situations[;

[(3) educate health care workers and health facility employees about methods of transmission and prevention in their particular workplace environments; and

[(4) educate the public about state laws relating to the transmission and conduct that may result in the transmission of HIV].

Sec. 85.005. EDUCATIONAL MATERIALS DESIGNED FOR CERTAIN PERSONS; SPECIFIC INFORMATION [SPECIAL COMPONENTS OF EDUCATION PROGRAMS]. (a) The department shall include in the educational materials specific information [education programs special components] designed to reach:

(1) persons with behavior conducive to HIV transmission;

(2) persons younger than 18 years of age; and

(3) minority groups.

(b) In developing educational materials [designing education programs] for ethnic minorities and in assisting local community organizations in developing educational materials [education programs] for minority groups, the department shall ensure that the educational materials [programs] reflect the nature and spread of HIV infection in minorities in this state.

SECTION 3.0266. The heading to Section 85.006, Health and Safety Code, is amended to read as follows:

Sec. 85.006. EDUCATIONAL MATERIALS [EDUCATION PROGRAMS] FOR [DISABLED] PERSONS WITH DISABILITIES.

SECTION 3.0267. Sections 85.006(a) and (b), Health and Safety Code, are amended to read as follows:

(a) The department shall develop and promote the availability of educational materials concerning HIV [education] and prevention of HIV infection [programs] specifically designed to address the concerns of persons with physical or mental disabilities.

(b) In developing [designing] those educational materials [programs], the department shall consult persons with disabilities or consult experts in the appropriate professional disciplines.

SECTION 3.0268. The heading to Section 85.007, Health and Safety Code, is amended to read as follows:

Sec. 85.007. EDUCATIONAL MATERIALS [EDUCATION PROGRAMS] FOR MINORS.

SECTION 3.0269. Sections 85.007(a) and (c), Health and Safety Code, are amended to read as follows:

(a) The department shall give priority to developing model educational materials for education programs for persons younger than 18 years of age.

(c) In addition, the educational materials [in the education program] intended for persons younger than 18 years of age must:

(1) teach that sexual activity before marriage is likely to have harmful psychological and physical consequences;

(2) teach adolescents ways to recognize and respond to unwanted physical and verbal sexual advances;

(3) teach that the use of alcohol or drugs increases a person's vulnerability to unwanted sexual advances; and

(4) emphasize the importance of attaining self-sufficiency before engaging in sexual activity.

SECTION 3.0270. Sections 85.008, 85.009, 85.010, and 85.011, Health and Safety Code, are amended to read as follows:

Sec. 85.008. PROMOTION [DISTRIBUTION] OF AVAILABILITY OF EDUCATIONAL MATERIALS [EDUCATION PROGRAMS]. [(a)] The department shall determine where HIV education efforts are needed in this state and shall promote the availability of educational materials on the department's Internet website [initiate programs] in those areas [by identifying local resources].

[(b) The department shall assist communities, especially those in rural areas, in establishing self-sustaining education programs, using public and private resources.]

Sec. 85.009. AVAILABILITY OF EDUCATIONAL MATERIALS [EDUCATION PROGRAMS AVAILABLE ON REQUEST]. The department shall make the educational materials [the education programs] available on the department's Internet website for [to] local governments and private businesses [on request].

Sec. 85.010. EDUCATIONAL COURSE FOR EMPLOYEES AND CLIENTS OF HEALTH CARE FACILITIES. A health care facility licensed by the department or [,] the [Texas] Department of Aging and Disability Services [Mental Health and Mental Retardation, or the Texas Department of Human Services] shall require its employees to complete an educational course about HIV infection based on the model educational materials [education programs] developed by the department.

Sec. 85.011. CONTRACTS FOR EDUCATIONAL MATERIALS [EDUCATION PROGRAMS]. (a) The department may contract with any person, other than a person who advocates or promotes conduct that violates state law, for the design and[,] development[, and distribution] of educational materials [education programs].

(b) This section does not restrict the inclusion in educational materials of [an education program from providing] accurate information about different ways to reduce the risk of exposure to or the transmission of HIV.

SECTION 3.0271. Sections 85.012(b) and (e), Health and Safety Code, are amended to read as follows:

(b) The model workplace guidelines must include provisions stating that:

(1) all employees will receive some education about methods of transmission and prevention of HIV infection and related conditions;

(2) accommodations will be made to keep persons with HIV infection employed and productive for as long as possible;

(3) the confidentiality of employee medical records will be protected;

(4) HIV-related policies will be consistent with current information from public health authorities, such as the Centers for Disease Control and Prevention of the United States Public Health Service, and with state and federal law and regulations;

(5) persons with HIV infection are entitled to the same rights and opportunities as persons with other communicable diseases; and

(6) employers and employees should not engage in discrimination against persons with HIV infection unless based on accurate scientific information.

(e) Employers should be encouraged to adopt HIV-related workplace guidelines that incorporate, at a minimum, the guidelines established by the department [board] under this section.

SECTION 3.0272. Section 85.015(b), Health and Safety Code, is amended to read as follows:

(b) Subsection (a)(2) does not restrict the inclusion in educational materials of [an education program from providing] accurate information about ways to reduce the risk of exposure to or transmission of HIV.

SECTION 3.0273. Section 85.016, Health and Safety Code, is amended to read as follows:

Sec. 85.016. RULES. The executive commissioner [board] may adopt rules necessary to implement Subchapters A through F.

SECTION 3.0274. Sections 85.032 and 85.033, Health and Safety Code, are amended to read as follows:

Sec. 85.032. RULES; PROGRAM STRUCTURE. (a) The executive commissioner [board] may adopt rules relating to:

(1) the services that may be furnished under the program;

(2) a system of priorities regarding the types of services provided, geographic areas covered, or classes of individuals or communities targeted for services under the program; and

(3) a process for resolving conflicts between the department and a program receiving money under this subchapter.

(b) Executive commissioner [Board] or department actions relating to service, geographic, and other priorities shall be based on the set of priorities and guidelines established under this section.

(c) In structuring the program and adopting rules, the department and the executive commissioner, as appropriate, [board] shall attempt to:

(1) coordinate the use of federal, local, and private funds;

(2) encourage the provision of community-based services;

(3) address needs that are not met by other sources of funding;

(4) provide funding as extensively as possible across the regions of the state in amounts that reflect regional needs; and

(5) encourage cooperation among local service providers.

Sec. 85.033. COORDINATION OF SERVICES. (a) To prevent unnecessary duplication of services, the executive commissioner [board] and the department shall seek to coordinate the services provided by eligible programs under Subchapters A through G with existing federal, state, and local programs.

(b) The department shall consult with the [Texas] Department of Aging and Disability [Human] Services and the commission to ensure that programs funded under this subchapter complement and do not unnecessarily duplicate services provided through the [Texas] Department of Aging and Disability [Human] Services and the commission.

SECTION 3.0275. Section 85.041(b), Health and Safety Code, is amended to read as follows:

(b) The executive commissioner [board] may adopt rules relating to the information a program is required to report to the department and shall adopt procedures and forms for reporting the information to prevent unnecessary and duplicative reporting of data.

SECTION 3.0276. Section 85.044, Health and Safety Code, is amended to read as follows:

Sec. 85.044. ADVISORY COMMITTEE. The executive commissioner [board] may appoint an advisory committee to assist in the development of procedures and guidelines required by this subchapter.

SECTION 3.0277. Section 85.061(b), Health and Safety Code, is amended to read as follows:

(b) The program shall assist hospital districts, local health departments, public or nonprofit hospitals and clinics, nonprofit community organizations, and HIV-infected individuals in the purchase of medications approved by the commissioner [board] that have been shown to be effective in reducing hospitalizations due to HIV-related conditions.

SECTION 3.0278. Section 85.062(a), Health and Safety Code, is amended to read as follows:

(a) To be eligible for the program, an individual:

(1) must not be eligible for Medicaid benefits;

(2) must meet financial eligibility criteria set by department [board] rule;

(3) must not qualify for any other state or federal program available for financing the purchase of the prescribed medication; and

(4) must be diagnosed by a licensed physician as having AIDS or an HIV-related condition or illness of at least the minimal severity set by the executive commissioner [board].

SECTION 3.0279. Section 85.063, Health and Safety Code, is amended to read as follows:

Sec. 85.063. PROCEDURES AND ELIGIBILITY GUIDELINES. The executive commissioner [board] by rule shall establish:

(1) application and distribution procedures;

(2) eligibility guidelines to ensure the most appropriate distribution of funds available each year; and

(3) appellate procedures to resolve any eligibility or funding conflicts.

SECTION 3.0280. Section 85.064(d), Health and Safety Code, is amended to read as follows:

(d) The department shall deposit money received under this section in the state treasury to the credit of the general revenue fund [HIV medication fund and to the credit of a special account in that fund that shall be established for each entity sending funds under this section].

SECTION 3.0281. Section 85.081(a), Health and Safety Code, is amended to read as follows:

(a) The department shall develop, and the executive commissioner shall adopt, model protocols for counseling and testing related to HIV infection. The protocols shall be made available to health care providers on request.

SECTION 3.0282. Section 85.087(d), Health and Safety Code, is amended to read as follows:

(d) The executive commissioner by rule [board] shall set the fee in an amount that is reasonable and necessary to cover the costs of providing the course.

SECTION 3.0283. Section 85.088(a), Health and Safety Code, is amended to read as follows:

(a) State-funded primary health, women's reproductive health, and sexually transmitted disease clinics shall:

(1) make available to patients and clients information and educational materials concerning the prevention of HIV infection; and

(2) provide or refer patients and clients to voluntary[, anonymous,] and affordable counseling and HIV testing services, including the patient's or client's choice of anonymous or confidential HIV testing or counseling [programs concerning HIV infection or provide referrals to those programs].

SECTION 3.0284. Sections 85.111(a), (b), and (c), Health and Safety Code, are amended to read as follows:

(a) Each state agency annually shall provide to each state employee [an] educational information [pamphlet] about:

(1) methods of transmission and prevention of HIV infection;

(2) state laws relating to the transmission of HIV infection; and

(3) conduct that may result in the transmission of HIV infection.

(b) The educational information [pamphlet] shall be provided to a newly hired state employee on the first day of employment.

(c) The educational information [pamphlet] shall be based on the model developed by the department and shall include the workplace guidelines adopted by the state agency.

SECTION 3.0285. Section 85.113, Health and Safety Code, is amended to read as follows:

Sec. 85.113. WORKPLACE GUIDELINES FOR STATE CONTRACTORS. An entity that contracts with or is funded by any of the following state agencies to operate a program involving direct client contact shall adopt and implement workplace guidelines similar to the guidelines adopted by the agency that funds or contracts with the entity:

(1) the Department of Assistive and Rehabilitative Services [Texas Commission on Alcohol and Drug Abuse;

[(2) the Texas Commission for the Blind;

[(3) the Texas Commission for the Deaf and Hard of Hearing];

(2) [(4)] the Texas Juvenile Justice Department [Probation Commission];

(3) [(5)] the Texas Department of Criminal Justice;

(4) [(6) the Texas Youth Commission;

[(7)] the department;

(5) [(8)] the [Texas] Department of Aging and Disability [Human] Services; and

(6) [(9)] the commission [Texas Department of Mental Health and Mental Retardation; and

[(10) the Texas Rehabilitation Commission].

SECTION 3.0286. Section 85.114(b), Health and Safety Code, is amended to read as follows:

(b) Education available under this section shall be based on the model educational materials [education program] developed by the department and tailored to the cultural, educational, language, and developmental needs of the clients, inmates, patients, or residents, including the use of Braille or telecommunication devices for the deaf.

SECTION 3.0287. Sections 85.116(b) and (d), Health and Safety Code, are amended to read as follows:

(b) The executive commissioner [board] by rule shall prescribe the criteria that constitute possible exposure to HIV under this section. The criteria must be based on activities the United States Public Health Service determines pose a risk of HIV infection.

(d) The cost of a state employee's testing and counseling shall be paid from funds appropriated for payment of workers' compensation benefits to state employees. The State Office of Risk Management [director of the workers' compensation division of the attorney general's office] shall adopt rules necessary to administer this subsection.

SECTION 3.0288. Section 85.201(a), Health and Safety Code, is amended to read as follows:

(a) The legislature finds that:

(1) the Centers for Disease Control and Prevention of the United States Public Health Service have made recommendations for preventing transmission of human immunodeficiency virus (HIV) and hepatitis B virus (HBV) to patients in the health care setting;

(2) the Centers for Disease Control and Prevention of the United States Public Health Service have found that when health care workers adhere to recommended infection-control procedures, the risk of transmitting HBV from an infected health care worker to a patient is small, and the risk of transmitting HIV is likely to be even smaller;

(3) the risk of transmission of HIV and HBV in health care settings will be minimized if health care workers adhere to the Centers for Disease Control and Prevention of the United States Public Health Service recommendations; and

(4) health care workers who perform exposure-prone procedures should know their HIV antibody status; health care workers who perform exposure-prone procedures and who do not have serologic evidence of immunity to HBV from vaccination or from previous infection should know their HBsAg status and, if that is positive, should also know their HBeAg status.

SECTION 3.0289. Section 85.202(4), Health and Safety Code, is amended to read as follows:

(4) "Universal precautions" means procedures for disinfection and sterilization of reusable medical devices and the appropriate use of infection control, including hand washing, the use of protective barriers, and the use and disposal of needles and other sharp instruments as those procedures are defined by the Centers for Disease Control and Prevention of the United States Public Health Service.

SECTION 3.0290. Sections 85.257(c) and (d), Health and Safety Code, are amended to read as follows:

(c) Counseling provided by a service provider, including written information provided under Subsection (a) and referrals, must conform with counseling protocols adopted by the executive commissioner [board]. Except as provided by Section 85.256, the counseling protocols must be consistent with the requirements of Section 81.109 and the protocols adopted under Section 85.081.

(d) Counseling provided by a service provider under this section must be provided in English and in Spanish. The department [board] may require a service provider to provide counseling in another language if the department [board] finds that the service provider is marketing home collection kits in a community in which a significant portion of the population speaks a language other than English or Spanish.

SECTION 3.0291. Section 85.258(c), Health and Safety Code, is amended to read as follows:

(c) In addition to the labeling requirements in Subsections (a) and (b), a home collection kit labeled in Spanish must also be available. The department [board] may require a service provider to label a home collection kit in another language if the department [board] finds that the service provider is marketing home collection kits in a community in which a significant portion of the population speaks a language other than English or Spanish.

SECTION 3.0292. Section 85.275(f), Health and Safety Code, is amended to read as follows:

(f) The assistant presiding officer shall:

(1) perform the duties of the presiding officer if the presiding officer is absent or is not able to perform those duties because of disability [becomes disabled]; and

(2) complete the unexpired portion of the presiding officer's term if the office of the presiding officer becomes vacant.

SECTION 3.0293. Section 87.001(7), Health and Safety Code, is amended to read as follows:

(7) "Health facility" includes:

(A) a general or special hospital licensed by the department under Chapter 241;

(B) a physician-owned or physician-operated clinic;

(C) a publicly or privately funded medical school;

(D) a state hospital operated by the department or a state supported living center operated [school maintained and managed] by the [Texas] Department of Aging and Disability Services [Mental Health and Mental Retardation];

(E) a genetic evaluation and counseling center;

(F) a public health clinic conducted by a local health unit, health department, or public health district organized and recognized under Chapter 121;

(G) a physician peer review organization; and

(H) another facility specified by department [board] rule.

SECTION 3.0294. Sections 87.002(c) and (d), Health and Safety Code, are amended to read as follows:

(c) The department may release medical, epidemiological, or toxicological information:

(1) for statistical purposes, if released in a manner that prevents the identification of any person;

(2) with the consent of each person identified in the information or, if the person is a minor, the minor's parents, managing conservator, guardian, or other person who is legally authorized to consent;

(3) to medical personnel, appropriate state agencies, health authorities, regional directors, and public officers of counties and municipalities as necessary to comply with this chapter and department [board] rules relating to the identification, monitoring, and referral of children with birth defects;

(4) to appropriate federal agencies, such as the Centers for Disease Control and Prevention of the United States Public Health Service; or

(5) to medical personnel to the extent necessary to protect the health or life of the child identified in the information.

(d) The executive commissioner [A board member], the commissioner, another employee of the department, or an authorized agent may not be examined in a civil, criminal, special, or other proceeding as to the existence or contents of pertinent records of or reports or information about a child identified or monitored for a birth defect by the department without the consent of the child's parents, managing conservator, guardian, or other person authorized by law of this state or another state or by a court order to give consent.

SECTION 3.0295. Section 87.021, Health and Safety Code, is amended to read as follows:

Sec. 87.021. SURVEILLANCE PROGRAM; REGISTRY ESTABLISHED. (a) The executive commissioner [board] shall establish in the department a program to:

(1) identify and investigate certain birth defects in children; and

(2) maintain a central registry of cases of birth defects.

(b) The executive commissioner [board] may authorize the department to implement a statewide program or to limit the program to a part or all of one or more public health regions, depending on the funding available to the department. In establishing the program, the executive commissioner [board] shall consider:

(1) the number and geographic distribution of births in the state;

(2) the trained personnel and other departmental resources that may be assigned to the program activities; and

(3) the occurrence or probable occurrence of an urgent situation that requires or will require an unusual commitment of the department's personnel and other resources.

(c) The [board and the] department shall design the program so that the program will:

(1) provide information to identify risk factors and causes of birth defects;

(2) provide information on other possible causes of birth defects;

(3) provide for the development of strategies to prevent birth defects;

(4) provide for interview studies about the causes of birth defects;

(5) together with other departmental programs, contribute birth defects data to a central registry;

(6) provide for the appointment of authorized agents to collect birth defects information; and

(7) provide for the active collection of birth defects information.

(d) The executive commissioner [board] shall adopt rules to govern the operation of the program and carry out the intent of this chapter. At a minimum, the rules shall:

(1) use a medically recognized system to specify the birth defects to be identified and investigated;

(2) select a system for classifying the birth defects according to the public health significance of each defect to prioritize the use of resources;

(3) develop a system to select and specify the cases to be investigated;

(4) specify a system for selecting the demographic areas in which the department may undertake investigations; and

(5) prescribe the training and experience a person must have for appointment as an authorized agent of the department.

(e) In adopting the rules required by Subsection (d), the executive commissioner [board] shall consider at least:

(1) the known incidence and prevalence rates of a birth defect in the state or portions of the state;

(2) the known incidence and prevalence rates of a particular birth defect in specific population groups who live in the state or portions of the state;

(3) the morbidity and mortality resulting from the birth defect; and

(4) the existence, cost, and availability of a strategy to prevent and treat the birth defect.

(f) In addition to providing for the active collection of birth defects information under Subsection (c)(7), the [board and the] department may design the program to also provide for the passive collection of that information.

SECTION 3.0296. Section 87.022, Health and Safety Code, is amended to read as follows:

Sec. 87.022. DATA COLLECTION. (a) To ensure an accurate source of data necessary to investigate the incidence, prevalence, and trends of birth defects, the executive commissioner [board] may require a health facility, health professional, or midwife to make available for review by the department or by an authorized agent medical records or other information that is in the facility's, professional's, or midwife's custody or control and that relates to the occurrence of a birth defect specified by the executive commissioner [board].

(b) The executive commissioner [board] by rule shall prescribe the manner in which records and other information are made available to the department.

(c) The executive commissioner [board] shall adopt procedural rules to facilitate cooperation between the health care facility, health professional, or midwife and a department employee or authorized agent, including rules for notice, requests for medical records, times for record reviews, and record management during review.

SECTION 3.0297. Section 87.023, Health and Safety Code, is amended to read as follows:

Sec. 87.023. REFERRAL FOR SERVICES. A child who meets the medical criteria prescribed by department [board] rule, and the child's family, shall be referred to the department's case management program for guidance in applying for financial or medical assistance available through existing state and federal programs.

SECTION 3.0298. Sections 87.061(b) and (c), Health and Safety Code, are amended to read as follows:

(b) The department shall use the registry to:

(1) investigate the causes of birth defects and other health conditions as authorized by Texas statutes;

(2) design and evaluate measures to prevent the occurrence of birth defects and other health conditions; and

(3) conduct other investigations and activities necessary for the executive commissioner [board] and department to fulfill their obligation to protect the health of the public.

(c) The department may store in the central registry information that is obtained from the section of the birth certificate entitled "For Medical and Health Use Only." This information may be used only as provided by Section 192.002(b), [191.002(b),] relating to the form and contents of the birth certificate.

SECTION 3.0299. Section 87.063(a), Health and Safety Code, is amended to read as follows:

(a) The commissioner and the department's committee for the protection of human subjects shall review each research proposal that requests the use of information in the central registry. The executive commissioner [board] shall adopt rules establishing criteria to be used in deciding if the research design should be approved. A proposal that meets the approval criteria is considered to establish a valid interest as required by Section 87.062(a), and the commissioner and the committee shall authorize the researcher to review the records relevant to the research proposal and to contact cases and controls.

SECTION 3.0300. Sections 88.001(6), (7), (9), and (11), Health and Safety Code, are amended to read as follows:

(6) "Reference level" ["Blood lead levels of concern"] means the presence of blood lead concentrations suspected to be associated with mental and physical disorders due to absorption, ingestion, or inhalation of lead as specified in the most recent reference value [criteria] issued by the [United States Department of Health and Human Services, United States Public Health Service,] Centers for Disease Control and Prevention of the United States Public Health Service.

(7) "Lead poisoning" means the presence of a confirmed venous blood level established by department [board] rule in the range specified for medical evaluation and possible pharmacologic treatment in the most recent criteria issued by the [United States Department of Health and Human Services, United States Public Health Service,] Centers for Disease Control and Prevention of the United States Public Health Service.

(9) "Physician" means a person licensed to practice medicine by the Texas [State Board of] Medical Board [Examiners].

(11) "Regional director" means a physician appointed under Section 121.007 [by the board] as the chief administrative officer of a public health region as designated under Chapter 121.

SECTION 3.0301. Sections 88.002(a), (b), and (d), Health and Safety Code, are amended to read as follows:

(a) Except as specifically authorized by this chapter, reports, records, and information furnished to a health authority, a regional director, or the department that relate to cases or suspected cases of children with reportable blood lead levels [of concern or lead poisoning] are confidential and may be used only for the purposes of this chapter.

(b) Reports, records, and information relating to cases or suspected cases of childhood lead poisoning and children with reportable blood lead levels [of concern] are not public information under the open records law, Chapter 552, Government Code, and may not be released or made public on subpoena or otherwise except as provided by this chapter.

(d) The commissioner, a regional director or other department employee, a health authority or employee of a public health district, a health authority or employee of a county or municipal health department, or a public official of a county or municipality may not be examined in a civil, criminal, special, or other proceeding as to the existence or contents of pertinent records of or reports or information about a child identified, examined, or treated for lead poisoning or about a child possessing reportable blood lead levels [of concern] by the department, a public health district, a local health department, or a health authority without the consent of the child's parents, managing conservator, guardian, or other person authorized by law to give consent.

SECTION 3.0302. Section 88.0025, Health and Safety Code, is amended to read as follows:

Sec. 88.0025. CHILDHOOD LEAD POISONING PREVENTION. The executive commissioner may adopt [board may implement] policies and procedures to promote the elimination of childhood lead poisoning within the state, and the department shall implement all adopted policies and procedures. The executive commissioner [board] may adopt measures to:

(1) significantly reduce the incidence of childhood lead poisoning throughout the state;

(2) improve public awareness of lead safety issues and educate both property owners and tenants about practices that can reduce the incidence of lead poisoning; and

(3) encourage the testing of children likely to suffer the consequences of lead poisoning so that prompt diagnosis and treatment and the prevention of harm are possible.

SECTION 3.0303. Section 88.003, Health and Safety Code, is amended to read as follows:

Sec. 88.003. REPORTABLE HEALTH CONDITION. (a) Childhood blood lead levels that exceed the reference level [of concern] are reportable.

(b) The executive commissioner [board] by rule may designate:

(1) blood lead concentrations in children that must be reported; and

(2) the ages of children for whom the reporting requirements apply.

(c) The executive commissioner [board] may adopt rules that establish a registry of children with blood lead levels that exceed the reference level [of concern] and lead poisoning.

SECTION 3.0304. Section 88.004, Health and Safety Code, is amended to read as follows:

Sec. 88.004. PERSONS REQUIRED TO REPORT. (a) A person required to report childhood blood lead levels [of concern] shall report to the department in the manner specified by department [board] rule. Except as provided by this section, a person required by this section to report must make the report immediately after the person gains knowledge of [the case or suspected case of] a child with a reportable blood lead level [of concern].

(b) A physician shall report a case or suspected case of childhood lead poisoning or of a child with a reportable blood lead level [of concern] after the physician's first examination of a child for whom reporting is required by this chapter or department [board] rule.

(c) A person in charge of an independent clinical laboratory, a hospital or clinic laboratory, or other facility in which a laboratory examination of a specimen derived from the human body yields evidence of a child with a reportable blood lead level [of concern] shall report the findings to the department as required by department [board] rule.

(d) If a report is not made as required by Subsection (b) or (c), the following persons shall report [a case or suspected case of a child with lead poisoning or] a child's reportable blood lead level [of concern] and all information known concerning the child:

(1) the administrator of a hospital licensed under Chapter 241;

(2) a [professional] registered nurse;

(3) an administrator or director of a public or private child care facility;

(4) an administrator of a home and community support services [health] agency;

(5) an administrator or health official of a public or private institution of higher education;

(6) a superintendent, manager, or health official of a public or private camp, home, or institution;

(7) a parent, managing conservator, or guardian; and

(8) a health professional.

SECTION 3.0305. Sections 88.005(a) and (b), Health and Safety Code, are amended to read as follows:

(a) The executive commissioner [board] shall prescribe the form and method of reporting under this chapter, including a report in writing, by telephone, or by electronic data transmission.

(b) The executive commissioner by rule [Board rules] may require the reports to contain any information relating to a case that is necessary for the purposes of this chapter, including:

(1) the child's name, address, age, sex, and race;

(2) the child's blood lead concentration;

(3) the procedure used to determine the child's blood lead concentration; and

(4) the name of the attending physician.

SECTION 3.0306. Section 88.006(a), Health and Safety Code, is amended to read as follows:

(a) A physician who attends a child during the child's hospitalization shall immediately notify the department if the physician knows or suspects that the child has lead poisoning or a blood lead level that exceeds the reference level [of concern] and the physician believes the lead poisoning or blood lead level [of concern] resulted from the child's exposure to a dangerous level of lead that may be a threat to the public health.

SECTION 3.0307. Section 88.007, Health and Safety Code, is amended to read as follows:

Sec. 88.007. DEPARTMENT RULES FOR FOLLOW-UP CARE; COORDINATION OF CARE. (a) The executive commissioner [department] may adopt rules establishing standards for follow-up care provided to children with a confirmed blood lead level that exceeds the reference level [of concern].

(b) Rules adopted under this section must meet any federal requirements for coordinated follow-up care for children with confirmed blood lead levels that exceed the reference level [of concern] and may include, in a manner consistent with current federal guidelines:

(1) an environmental lead investigation of all or parts of a child's home environment, child-care facility, or child-occupied facility that may be a source of a lead hazard causing or contributing to the child's lead exposure; and

(2) guidance to parents, guardians, and consulting physicians on how to eliminate or control lead exposures that may be contributing to the child's blood lead level.

SECTION 3.0308. Section 88.009, Health and Safety Code, is amended to read as follows:

Sec. 88.009. ENVIRONMENTAL LEAD INVESTIGATION PROCEDURES. The executive commissioner [department] may adopt rules establishing procedures for environmental lead investigations of dwellings and other premises subject to this chapter. The rules must meet, but may not exceed, any requirements established under regulations adopted by the federal Environmental Protection Agency under Subchapter IV, Toxic Substances Control Act (15 U.S.C. Section 2681 et seq.).

SECTION 3.0309. Section 89.001(5), Health and Safety Code, is amended to read as follows:

(5) "Jail" means:

(A) a county jail; or

(B) a facility for the confinement of persons accused of an offense that is:

(i) operated by a municipality or a vendor under contract with a municipality under Subchapter F [E], Chapter 351, Local Government Code; or

(ii) operated by a vendor under contract with a community supervision and corrections department under Chapter 76, Government Code.

SECTION 3.0310. Section 89.011(a), Health and Safety Code, is amended to read as follows:

(a) The governing body of a jail or community corrections facility, through the community supervision and corrections department, shall require that each employee or volunteer working or providing services in a jail or a community corrections facility, who meets the screening guidelines prescribed by department [board] rule, present to the governing body a certificate signed by a physician that states that:

(1) the employee or volunteer has been tested for tuberculosis infection in accordance with department [board] rules; and

(2) the results of the test indicate that the person does not have tuberculosis.

SECTION 3.0311. Section 89.051(a), Health and Safety Code, is amended to read as follows:

(a) Each inmate in a jail or community corrections facility shall undergo a screening test for tuberculosis infection approved by the executive commissioner [board] if:

(1) the inmate will probably be confined in jail or a community corrections facility for more than seven days; and

(2) the inmate meets the screening guidelines prescribed by department [board] rules.

SECTION 3.0312. Section 89.073, Health and Safety Code, is amended to read as follows:

Sec. 89.073. ADOPTION OF LOCAL STANDARDS. (a) The standards prescribed by this chapter and the rules adopted by the executive commissioner [board] relating to screening tests or examinations for tuberculosis required for certain employees and volunteers are minimum standards.

(b) With the prior approval of the department:

(1) a governing body may adopt and enforce standards for carrying out this chapter if the standards are compatible with and equal to or more stringent than the standards prescribed by this chapter and department [the board's] rules; and

(2) a private facility may adopt and enforce standards for carrying out this chapter if the standards are compatible with and equal to or more stringent than the standards prescribed by this chapter and department [the board's] rules.

(c) The executive commissioner [board] shall adopt substantive and procedural rules to govern the submission of standards adopted under Subsection (b). At a minimum these rules must contain:

(1) a procedure for the submission of standards for departmental review; and

(2) an internal departmental appeal process by which a governing body or private entity may seek a review of the department's decision to reject proposed standards.

SECTION 3.0313. Section 89.101(1), Health and Safety Code, is amended to read as follows:

(1) "Corrections facility" means:

(A) a jail or community corrections facility, without regard to whether the jail or facility satisfies the requirements of Section 89.002;

(B) any correctional facility operated by or under contract with a division of the Texas Department of Criminal Justice; or

(C) a detention facility operated by the Texas Juvenile Justice Department [Youth Commission].

SECTION 3.0314. Section 92.002, Health and Safety Code, is amended to read as follows:

Sec. 92.002. REPORTABLE INJURY; RULES. (a) Spinal cord injuries, traumatic brain injuries, and submersion injuries are reportable to the department. The executive commissioner [board] by rule shall define those terms for reporting purposes.

(b) The executive commissioner [board] may adopt rules that require other injuries to be reported under this subchapter.

(c) The executive commissioner [board] shall maintain and revise, as necessary, the list of reportable injuries.

(d) The executive commissioner [board] shall adopt rules necessary to administer this subchapter.

SECTION 3.0315. Section 92.003(c), Health and Safety Code, is amended to read as follows:

(c) The department [board] shall prescribe the form and method of reporting. The department [board] may require the reports to contain any information, including the person's name, address, age, sex, race, occupation, employer, and attending physician, necessary to achieve the purposes of this subchapter.

SECTION 3.0316. Section 92.004(b), Health and Safety Code, is amended to read as follows:

(b) The department may seek, receive, and spend any funds received through appropriations, grants, donations, or contributions from public or private sources for the purpose of identifying, reporting, or preventing those injuries [that have been] determined by the executive commissioner [board] to be harmful or to be a threat to the public health.

SECTION 3.0317. Sections 92.006(b) and (c), Health and Safety Code, are amended to read as follows:

(b) The executive commissioner [board] shall adopt rules establishing procedures to ensure that all information and records maintained by the department under this subchapter are kept confidential and protected from release to unauthorized persons.

(c) The commissioner [director], the commissioner's [director's] designee, the executive commissioner, or an employee of the department or commission may not be examined in a judicial or other proceeding about the existence or contents of pertinent records of, investigation reports of, or reports or information about a person examined or treated for an injury without that person's consent.

SECTION 3.0318. Sections 92.007(b) and (c), Health and Safety Code, are amended to read as follows:

(b) The department [director or the director's designee] may enter at reasonable times and inspect within reasonable limits a public place or building, including a public conveyance, in the department's [director's] duty to prevent an injury.

(c) The department [director or the director's designee] may not enter a private residence to conduct an investigation about the causes of injuries without first receiving permission from a lawful adult occupant of the residence.

SECTION 3.0319. Section 92.010, Health and Safety Code, is amended to read as follows:

Sec. 92.010. COORDINATION WITH DEPARTMENT OF ASSISTIVE AND REHABILITATIVE SERVICES [TEXAS REHABILITATION COMMISSION]. The department and the Department of Assistive and Rehabilitative Services [Texas Rehabilitation Commission] shall enter into a memorandum of understanding to:

(1) exchange relevant injury data on an ongoing basis notwithstanding Section 92.006;

(2) maintain the confidentiality of injury data provided to the department by the Department of Assistive and Rehabilitative Services [commission] in accordance with Section 92.006 and Section 111.057, Human Resources Code; and

(3) cooperate in conducting investigations of spinal cord and traumatic brain injuries.

SECTION 3.0320. Section 92.011(a), Health and Safety Code, is amended to read as follows:

(a) The department and the Texas Traumatic Brain Injury Advisory Council established [within the department] under Subchapter B shall:

(1) exchange relevant injury data on an ongoing basis to the extent allowed by Section 92.006;

(2) maintain the confidentiality of injury data provided to the council by the department in accordance with Section 92.006;

(3) permit the council to review and comment on the department's [board's] rules under Section 92.002(b) before the rules are proposed; and

(4) cooperate in conducting investigations of traumatic brain injuries.

SECTION 3.0321. Section 92.052, Health and Safety Code, is amended to read as follows:

Sec. 92.052. ADVISORY COUNCIL[; ASSOCIATED AGENCY]. [(a)] The Texas Traumatic Brain Injury Advisory Council is an advisory council within the commission [department].

[(b) Notwithstanding Subsection (a), if, as a result of legislation enacted in the 78th Legislature, Regular Session, 2003, a state agency other than the department is designated to serve as the agency with primary responsibility in relation to persons with physical disabilities, the council is an advisory council within that state agency and a reference in this chapter to the department means that agency.]

SECTION 3.0322. Section 92.053(b), Health and Safety Code, is amended to read as follows:

(b) The council is composed of 21 [22] members appointed as follows:

(1) eight public consumer members appointed by the executive commissioner [of health and human services], at least three of whom must be individuals related to persons with a traumatic brain injury and at least three of whom must be persons with a brain injury;

(2) six professional members appointed by the executive commissioner [of health and human services], each of whom must have special training and interest in the care, treatment, or rehabilitation of persons with a traumatic brain injury, with one representative each from:

(A) acute hospital trauma units;

(B) the National Institute on [for] Disability and Rehabilitation Research Traumatic Brain Injury Model System in this state;

(C) acute or post-acute rehabilitation facilities;

(D) community-based services;

(E) faculties of institutions of higher education; and

(F) providers in the areas of physical therapy, occupational therapy, or cognitive rehabilitation; and

(3) seven [eight] state agency members, with one representative from each of the following agencies appointed by the chief executive officer of the agency:

(A) [Texas] Department of State Health Services;

(B) [Texas] Department of Aging and Disability [Human] Services;

(C) Department of Assistive and Rehabilitative Services [Texas Department of Mental Health and Mental Retardation;

[(D) Texas Rehabilitation Commission];

(D) [(E)] Health and Human Services Commission;

(E) [(F)] Texas Education Agency;

(F) [(G)] Texas [Planning] Council for Developmental Disabilities; and

(G) [(H)] Texas Department of Insurance.

SECTION 3.0323. Section 92.057, Health and Safety Code, is amended by amending Subsections (b) and (c) and adding Subsection (b-1) to read as follows:

(b) Except as provided by Subsection (b-1), a [A] member who is a representative of a state agency shall be reimbursed for travel expenses incurred while conducting council business from the funds of the agency the person represents in accordance with the General Appropriations Act.

(b-1) A member who is a representative of a health and human services agency listed by Section 531.001(4), Government Code, shall be reimbursed for travel expenses incurred while conducting council business from the funds of the commission in accordance with the General Appropriations Act.

(c) If money is available for this purpose in the account established under Section 92.062(b), the commission [department] shall reimburse a public consumer member for the member's actual and necessary expenses incurred in performing council duties, including travel, meals, lodging, respite care for a dependent with a disability, and telephone long-distance charges.

SECTION 3.0324. Section 92.060, Health and Safety Code, is amended to read as follows:

Sec. 92.060. COMMISSION DUTIES [OF THE DEPARTMENT]. (a) The commission [department] shall:

(1) provide administrative support services to the council;

(2) accept gifts and grants on behalf of the council from any public or private entity;

(3) receive, deposit, and disburse gifts and grants for the council in accordance with this subchapter and provide other administrative services in support of the council as requested by and negotiated with the council; and

(4) enter into a memorandum of understanding with the council that delineates the responsibilities of the commission [department] and the council under this subchapter and amend the memorandum as necessary to reflect changes in those responsibilities.

(b) The executive commissioner [board] may adopt rules as necessary to implement the commission's [department's] duties under this subchapter and federal developmental disability laws.

SECTION 3.0325. Section 92.062(b), Health and Safety Code, is amended to read as follows:

(b) The [health and human services] commission shall deposit any money received under Subsection (a) to the credit of the Texas Traumatic Brain Injury Advisory Council account. The Texas Traumatic Brain Injury Advisory Council account is an account in the general revenue fund that may be appropriated only for the purpose of carrying out this subchapter.

SECTION 3.0326. Section 93.013(a), Health and Safety Code, is amended to read as follows:

(a) The council may receive gifts and grants from any public or private source to perform its duties under this chapter. The department shall accept the gifts on behalf of the council [and shall deposit any funds accepted under this section to the credit of a special account in the general revenue fund as required by Section 93.014].

SECTION 3.0327. Section 93.014, Health and Safety Code, is amended to read as follows:

Sec. 93.014. FUNDS FOR CLINICAL RESEARCH [HEART DISEASE AND STROKE RESOURCE FUND. (a) The heart disease and stroke resource fund is an account of the general revenue fund].

[(b) The legislature may appropriate money deposited to the credit of the heart disease and stroke resource fund only to the council for:

[(1) heart disease and stroke prevention, research, and medical care for heart attack and stroke victims; and

[(2) grants to nonprofit heart disease and stroke organizations.

[(c)] The council shall develop a policy governing the award of funds for clinical research that follows scientific peer review guidelines for primary and secondary prevention of heart disease or stroke or that follows other review procedures that are designed to distribute those funds on the basis of scientific merit.

[(d) Interest earned from the investment of the heart disease and stroke resource fund shall be deposited to the credit of the fund.]

SECTION 3.0328. Section 94.004(c), Health and Safety Code, is amended to read as follows:

(c) The department may charge a fee for the course to persons other than employees of entities receiving state or federal funds for hepatitis C counseling and testing programs through a contract with the department. The executive commissioner by rule [board] shall set the fee in an amount necessary to cover the costs of providing the course.

SECTION 3.0329. Section 95.002(f), Health and Safety Code, is amended to read as follows:

(f) The office shall:

(1) provide educational and other material to assist local risk assessment activities;

(2) monitor the quality of risk assessment activities provided under this chapter; and

(3) consult with the Texas Board of Nursing [Nurse Examiners] to determine the training requirements necessary for a nurse or other person to conduct risk assessment activities under this chapter.

SECTION 3.0330. Section 95.051, Health and Safety Code, is amended to read as follows:

Sec. 95.051. DEFINITION [DEFINITIONS]. In this subchapter, "public[:

[(1) "Department" means the Department of State Health Services.

[(2) "Executive commissioner" means the executive commissioner of the Health and Human Services Commission.

[(3) "Public] health district" means a district created under Chapter 121.

SECTION 3.0331. Section 95A.001, Health and Safety Code, is amended to read as follows:

Sec. 95A.001. DEFINITION [DEFINITIONS]. In this chapter, "council"[:

[(1) "Commission" means the Health and Human Services Commission.

[(2) "Council"] means the Texas Diabetes Council.

SECTION 3.0332. Section 96.001(3), Health and Safety Code, is amended to read as follows:

(3) "Health facility" includes:

(A) a general or special hospital licensed by the department under Chapter 241;

(B) a physician-owned or physician-operated clinic;

(C) a publicly or privately funded medical school;

(D) a state hospital operated [or state school maintained and managed] by the department or a state supported living center operated by [Department of State Health Services or] the Department of Aging and Disability Services;

(E) a public health clinic conducted by a local health unit, health department, or public health district organized and recognized under Chapter 121; and

(F) another facility specified by a rule adopted by the executive commissioner.

SECTION 3.0333. Section 98.110(a), Health and Safety Code, is amended to read as follows:

(a) Notwithstanding any other law, the department may disclose information reported by health care facilities under Section 98.103 or 98.1045 to other programs within the department, to the commission [Health and Human Services Commission], to other health and human services agencies, as defined by Section 531.001, Government Code, and to the federal Centers for Disease Control and Prevention, or any other agency of the United States Department of Health and Human Services, for public health research or analysis purposes only, provided that the research or analysis relates to health care-associated infections or preventable adverse events. The privilege and confidentiality provisions contained in this chapter apply to such disclosures.

SECTION 3.0334. Sections 101.001(1) and (3), Health and Safety Code, are amended to read as follows:

(1) "Alzheimer's disease and related disorders support group" means a local, state, or national organization that:

(A) is established to provide support services to aid persons with [victims of] Alzheimer's disease and related disorders and their caregivers;

(B) encourages research into the cause, prevention, treatment, and care of persons with [victims of] Alzheimer's disease and related disorders; and

(C) is dedicated to the development of essential services for persons with [victims of] Alzheimer's disease and related disorders and their caregivers.

(3) "Primary family caregiver" means an individual who is a relative of a person with [victim of] Alzheimer's disease or related disorders, who has or has had a major responsibility for care and supervision of the person [victim], and who is not a professional health care provider paid to care for the person [victim].

SECTION 3.0335. Section 101.002(a), Health and Safety Code, is amended to read as follows:

(a) The Texas Council on Alzheimer's Disease and Related Disorders is composed of:

(1) five public members, one of whom is an individual related to a person with [victim of] Alzheimer's disease or related disorders but who is not a primary family caregiver, one of whom is a primary family caregiver, two of whom are members of an Alzheimer's disease and related disorders support group, and one of whom is an interested citizen;

(2) seven professional members with special training and interest in Alzheimer's disease and related disorders, with one representative each from nursing facilities [homes], physicians, nurses, public hospitals, private hospitals, home health agencies, and faculty of institutions of higher education; and

(3) the [chief executive officer or the officer's designated] representative from the commission, department, and [Texas] Department of [on] Aging and Disability Services designated by the executive commissioner or commissioner of each agency, as applicable[, Texas Department of Human Services, Texas Department of Mental Health and Mental Retardation, and Long-Term Care Coordinating Council for the Elderly].

SECTION 3.0336. Section 101.007(a), Health and Safety Code, is amended to read as follows:

(a) The council shall:

(1) advise the department [board] and recommend needed action for the benefit of persons with [victims of] Alzheimer's disease and related disorders and for their caregivers;

(2) coordinate public and private family support networking systems for primary family caregivers;

(3) disseminate information on services and related activities for persons with [victims of] Alzheimer's disease and related disorders to the medical and health care community, the academic community, primary family caregivers, advocacy associations, and the public;

(4) coordinate a volunteer assistance program primarily for in-home and respite care services;

(5) encourage research to benefit persons with [victims of] Alzheimer's disease and related disorders;

(6) recommend to the department [board] disbursement of grants and funds available for the council; and

(7) facilitate coordination of state agency services and activities relating to persons with [victims of] Alzheimer's disease and related disorders.

SECTION 3.0337. Section 101.008, Health and Safety Code, is amended to read as follows:

Sec. 101.008. DUTIES OF DEPARTMENT. The department shall:

(1) provide administrative assistance, services, and materials to the council;

(2) accept, deposit, and disburse funds made available to the council at the direction of the executive commissioner [board];

(3) accept gifts and grants on behalf of the council from any public or private entity;

(4) maintain a population data base of persons with [victims of] Alzheimer's disease and related disorders in this state; and

(5) apply for and receive on behalf of the council any appropriations, gifts, or other funds from the state or federal government or any other public or private entity, subject to limitations and conditions prescribed by legislative appropriation.

SECTION 3.0338. Section 101.009(b), Health and Safety Code, is amended to read as follows:

(b) The department [board] shall deposit any money received under Subsection (a) in the state treasury [to the credit of the Alzheimer's disease and related disorders council fund] to be used for the purposes of this chapter.

SECTION 3.0339. Section 101.010, Health and Safety Code, is amended to read as follows:

Sec. 101.010. REPORT. Before September 1 of each even-numbered year, the council shall submit a biennial report of the council's activities and recommendations to the governor, lieutenant governor, speaker of the house of representatives, and members of the legislature[, Long-Term Care Coordinating Council for the Elderly, and board].

SECTION 3.0340. Sections 103.002(a), (b), and (c), Health and Safety Code, are amended to read as follows:

(a) The Texas Diabetes Council is composed of 11 citizen members appointed from the public and one representative each from the department, the commission [Health and Human Services Commission], and the Department of Assistive and Rehabilitative Services.

(b) The governor, with the advice and consent of the senate, shall appoint the following citizen members:

(1) a licensed physician with a specialization in treating diabetes;

(2) a registered nurse with a specialization in diabetes education and training;

(3) a registered and licensed dietitian with a specialization in the diabetes education field;

(4) a person with experience and training in public health policy;

(5) three consumer members, with special consideration given to persons active in the Texas affiliates of the Juvenile Diabetes Research Foundation (JDRF) or the American Diabetes Association; and

(6) four members from the general public with expertise or demonstrated commitment to diabetes issues.

(c) The commissioner, executive commissioner, and commissioner of assistive and rehabilitative services [chairman of the board of each agency listed in Subsection (a)] shall appoint that agency's representative to the council. Agency representatives shall be nonvoting members of the council.

SECTION 3.0341. Section 103.008(b), Health and Safety Code, is amended to read as follows:

(b) If the office of a member who is an agency representative becomes vacant, the commissioner or executive commissioner, as appropriate, [chairman of the board] of that agency shall appoint an agency representative to serve for the remainder of that member's term.

SECTION 3.0342. Section 103.009, Health and Safety Code, is amended to read as follows:

Sec. 103.009. REIMBURSEMENT. [(a)] The department shall reimburse council and advisory committee members for travel and other necessary expenses incurred in performing official duties as provided by Section 2110.004, Government Code [at the same rate provided for state employees in the General Appropriations Act].

[(b) Funds for travel reimbursement shall be appropriated to the department.]

SECTION 3.0343. Section 103.013(c), Health and Safety Code, is amended to read as follows:

(c) The council shall make written recommendations for performing its duties under this chapter to the executive commissioner [board] and the legislature. If the council considers a recommendation that will affect an agency not represented on the council, the council shall seek the advice and assistance of the agency before taking action on the recommendation. The council's recommendations shall be implemented by the agencies affected by the recommendations.

SECTION 3.0344. Section 103.0131(a), Health and Safety Code, is amended to read as follows:

(a) In conjunction with developing each state plan described in Section 103.013, the council shall conduct a statewide assessment of existing programs for the prevention of diabetes and treatment of individuals with diabetes that are administered by the commission [Health and Human Services Commission] or a health and human services agency, as defined by Section 531.001, Government Code. As part of the assessment, the council shall collect data regarding:

(1) the number of individuals served by the programs;

(2) the areas where services to prevent diabetes and treat individuals with diabetes are unavailable; and

(3) the number of health care providers treating individuals with diabetes under the programs.

SECTION 3.0345. Section 103.015(a), Health and Safety Code, is amended to read as follows:

(a) The council may receive gifts and grants from any public or private source to perform its duties under this chapter. The department shall accept the gifts on behalf of the council and shall deposit any funds accepted under this section to the credit of [a special account in] the general revenue fund.

SECTION 3.0346. Sections 103.017(a) and (c), Health and Safety Code, are amended to read as follows:

(a) The department, commission, and [the] Department of Assistive and Rehabilitative Services[, and the Health and Human Services Commission] shall work with the council to jointly develop, produce, and implement a general public awareness strategy focusing on diabetes, its complications, and techniques for achieving good management. Each agency shall pay for the costs of producing and disseminating information on diabetes to clients served by that agency.

(c) The department, commission, and [the] Department of Assistive and Rehabilitative Services[, and the Health and Human Services Commission] may jointly develop and implement a statewide plan for conducting regional training sessions for public and private service providers, including institutional health care providers, who have routine contact with persons with diabetes.

SECTION 3.0347. Section 103A.007, Health and Safety Code, is amended to read as follows:

Sec. 103A.007. DUTIES OF COUNCIL. The council using existing resources may conduct studies and advise the department, the commission [Health and Human Services Commission], and the Texas Department of Insurance on:

(1) public use data, outcome data, and other information submitted to or collected by the department under Chapter 108 or other law related to hemophilia or other bleeding or clotting disorders and the department's disclosure and dissemination of that information within and outside the department; and

(2) other issues that affect the health and wellness of persons living with hemophilia or other bleeding or clotting disorders.

SECTION 3.0348. Section 104.011(a), Health and Safety Code, is amended to read as follows:

(a) The statewide health coordinating council is composed of 17 members determined as follows:

(1) the executive commissioner or a representative designated by the executive commissioner;

(2) the chair of the Texas Higher Education Coordinating Board or a representative designated by the presiding officer;

(3) the commissioner or a representative designated by the commissioner;

(4) the commissioner [presiding officer] of aging [the Department of Aging] and disability services [Disability Services] or a representative designated by the commissioner of aging and disability services [presiding officer]; and

(5) the following members appointed by the governor:

(A) three health care professionals from the allied health, dental, medical, mental health, and pharmacy professions, no two of whom may be from the same profession;

(B) one registered nurse;

(C) two representatives of a university or health-related institution of higher education;

(D) one representative of a junior or community college with a nursing program;

(E) one hospital administrator;

(F) one managed care administrator; and

(G) four public members.

SECTION 3.0349. Section 104.0112(c), Health and Safety Code, is amended to read as follows:

(c) If the executive commissioner has knowledge that a potential ground for removal exists, the executive commissioner shall notify the presiding officer of the council of the potential ground. The presiding officer shall then notify the governor and the attorney general that a potential ground for removal exists. If the potential ground for removal involves the presiding officer, the executive commissioner shall notify the next highest ranking officer of the council, who shall then notify the governor and the attorney general that a potential ground for removal exists.

SECTION 3.0350. Section 104.023, Health and Safety Code, is amended to read as follows:

Sec. 104.023. REVIEW OF STATE HEALTH PLAN. The statewide health coordinating council shall submit the state health plan to the commission [Health and Human Services Commission] for review and comment before the plan is sent to the governor.

SECTION 3.0351. Section 104.043(a), Health and Safety Code, is amended to read as follows:

(a) If the department does not receive necessary data from an entity as required by department [the executive commissioner's] rules, the department shall send to the entity a notice requiring the entity to submit the data not later than the 30th day after the date on which the entity receives the notice.

SECTION 3.0352. Section 105.005, Health and Safety Code, is amended to read as follows:

Sec. 105.005. RULES. The executive commissioner [of the Health and Human Services Commission] may adopt rules to govern the reporting and collection of data.

SECTION 3.0353. Section 107A.001, Health and Safety Code, is amended to read as follows:

Sec. 107A.001. CENTER FOR ELIMINATION OF DISPROPORTIONALITY AND DISPARITIES. The executive commissioner [of the Health and Human Services Commission] shall maintain a center for elimination of disproportionality and disparities in the commission [Health and Human Services Commission] to:

(1) assume a leadership role in working or contracting with state and federal agencies, universities, private interest groups, communities, foundations, and offices of minority health to develop health initiatives to decrease or eliminate health and health access disparities among racial, multicultural, disadvantaged, ethnic, and regional populations, including appropriate language services; and

(2) maximize use of existing resources without duplicating existing efforts.

SECTION 3.0354. Section 107A.003, Health and Safety Code, is amended to read as follows:

Sec. 107A.003. FUNDING. The commission [Health and Human Services Commission] may distribute to the center unobligated and unexpended appropriations to be used to carry out its powers.

SECTION 3.0355. Chapter 108, Health and Safety Code, is amended to read as follows:

CHAPTER 108. [TEXAS] HEALTH CARE DATA COLLECTION [INFORMATION

COUNCIL]

Sec. 108.001. DEPARTMENT DUTIES [CREATION OF COUNCIL]. The department [Texas Health Care Information Council] shall administer this chapter and report to the governor, the legislature, and the public.

Sec. 108.002. DEFINITIONS. In this chapter:

(1) "Accurate and consistent data" means data that has been edited by the department [council] and subject to provider validation and certification.

[(2) "Board" means the Texas Board of Health.]

(3) "Certification" means the process by which a provider confirms the accuracy and completeness of the data set required to produce the public use data file in accordance with department [council] rule.

(4) "Charge" or "rate" means the amount billed by a provider for specific procedures or services provided to a patient before any adjustment for contractual allowances. The term does not include copayment charges to enrollees in health benefit plans charged by providers paid by capitation or salary.

(4-a) "Commission" means the Health and Human Services Commission.

(6) "Data" means information collected under Section 108.0065 or 108.009 in the form initially received.

[(7) "Department" means the Department of State Health Services.]

(8) "Edit" means to use an electronic standardized process developed and implemented by department [council] rule to identify potential errors and mistakes in data elements by reviewing data fields for the presence or absence of data and the accuracy and appropriateness of data.

[(8-a) "Executive commissioner" means the executive commissioner of the Health and Human Services Commission.]

(9) "Health benefit plan" means a plan provided by:

(A) a health maintenance organization; or

(B) an approved nonprofit health corporation that is certified under Section 162.001, Occupations Code, and that holds a certificate of authority issued by the commissioner of insurance under Chapter 844, Insurance Code.

(10) "Health care facility" means:

(A) a hospital;

(B) an ambulatory surgical center licensed under Chapter 243;

(C) a chemical dependency treatment facility licensed under Chapter 464;

(D) a renal dialysis facility;

(E) a birthing center;

(F) a rural health clinic;

(G) a federally qualified health center as defined by 42 U.S.C. Section 1396d(l)(2)(B); or

(H) a free-standing imaging center.

(11) "Health maintenance organization" means an organization as defined in Section 843.002, Insurance Code.

(12) "Hospital" means a public, for-profit, or nonprofit institution licensed or owned by this state that is a general or special hospital, private mental hospital, chronic disease hospital, or other type of hospital.

(13) "Outcome data" means measures related to the provision of care, including:

(A) patient demographic information;

(B) patient length of stay;

(C) mortality;

(D) co-morbidity;

(E) complications; and

(F) charges.

(14) "Physician" means an individual licensed under the laws of this state to practice medicine under Subtitle B, Title 3, Occupations Code.

(15) "Provider" means a physician or health care facility.

(16) "Provider quality" means the extent to which a provider renders care that, within the capabilities of modern medicine, obtains for patients medically acceptable health outcomes and prognoses, after severity adjustment.

(17) "Public use data" means patient level data relating to individual hospitalizations that has not been summarized or analyzed, that has had patient identifying information removed, that identifies physicians only by use of uniform physician identifiers, and that is severity and risk adjusted, edited, and verified for accuracy and consistency. Public use data may exclude some data elements submitted to the department [council].

(19) "Severity adjustment" means a method to stratify patient groups by degrees of illness and mortality.

(20) "Uniform patient identifier" means a number assigned by the department [council] to an individual patient and composed of numeric, alpha, or alphanumeric characters.

(21) "Uniform physician identifier" means a number assigned by the department [council] to an individual physician and composed of numeric, alpha, or alphanumeric characters.

(22) "Validation" means the process by which a provider verifies the accuracy and completeness of data and corrects any errors identified before certification in accordance with department [council] rule.

[Sec. 108.0026. TRANSFER OF DUTIES; REFERENCE TO COUNCIL. (a) The powers and duties of the Texas Health Care Information Council under this chapter were transferred to the Department of State Health Services in accordance with Section 1.19, Chapter 198 (H.B. 2292), Acts of the 78th Legislature, Regular Session, 2003.

[(b) In this chapter or other law, a reference to the Texas Health Care Information Council means the Department of State Health Services.

[Sec. 108.003. COUNCIL COMPOSITION; EXPENSES. (a) The council is composed of four ex officio state agency members and 15 members appointed by the governor in accordance with this section.

[(b) The ex officio members of the council are:

[(1) the commissioner of public health or the commissioner's designee;

[(2) the commissioner of health and human services or the commissioner's designee;

[(3) the commissioner of insurance or the commissioner's designee; and

[(4) the public insurance counsel or the counsel's designee.

[(c) The governor shall appoint the following members of the council:

[(1) three representatives of the business community, with at least one representing small businesses, who are purchasers of health care but who are not involved in the provision of health care or health insurance;

[(2) two representatives from labor, one of whom is not directly involved with management of health care benefits;

[(3) two representatives of consumers who are not professionally involved in the purchase, provision, administration, or review of health care or health care insurance;

[(4) two representatives of hospitals;

[(5) one representative of health maintenance organizations;

[(6) three representatives of physicians who are involved in direct patient care; and

[(7) two members who are not professionally involved in the purchase, provision, administration, or utilization review of health care or health care insurance and who have expertise in:

[(A) health planning;

[(B) health economics;

[(C) provider quality assurance;

[(D) information systems; or

[(E) the reimbursement of medical education and research costs.

[(d) The chairman is appointed by and serves at the pleasure of the governor. Members annually shall elect a vice chairman.

[(e) A majority of voting members constitutes a quorum for the transaction of any business. An act by the majority of the voting members present at any meeting at which there is a quorum is considered to be an act of the council.

[(f) The council may appoint committees and may elect any officers subordinate to those provided for in Subsection (d).

[(g) The council shall appoint technical advisory committees and shall consult with the appropriate technical advisory committee with respect to a rule before the rule is finally adopted by the council. The council is not required to consult with a technical advisory committee before adopting an emergency rule in accordance with Section 2001.034, Government Code. The council shall submit an emergency rule adopted by the council to the appropriate advisory committee for review not later than the first advisory committee meeting that occurs after the rule is adopted. The council may consult with the appropriate technical advisory committee with respect to other formal action of the council. A technical advisory committee may consult with other professionals as necessary. Chapter 2110, Government Code, does not apply to an advisory committee appointed under this subsection. The technical advisory committees shall include:

[(1) a technical advisory committee that includes, among other individuals, at least five practicing physicians licensed in this state to provide advice and recommendations to the council on the development and implementation of the methodology and the interpretation of a provider quality report and data under Section 108.010;

[(2) a technical advisory committee composed of at least five practicing physicians licensed in this state who have been actively engaged in organized peer review at a hospital in this state to provide advice, recommendations, and peer review expertise to the council on:

[(A) the use of peer review in the determination of quality inpatient care;

[(B) the development and interpretation of data elements necessary to the determination of quality inpatient care; and

[(C) the development and format of reports and information relating to provider quality;

[(3) a technical advisory committee that includes providers and consumers to provide advice and recommendations to the council relating to education about the development and dissemination of provider reports and data;

[(4) a technical advisory committee that includes representatives of consumers and each type of issuer of health benefit plans to assist the council in complying with Section 108.009(o); and

[(5) a technical advisory committee composed of providers, consumers, and individuals who have expertise in hospital information systems, health information management, quality management, and security of confidential data.

[(h) A member of the council may not receive compensation for service on the council. However, the member shall be reimbursed for the member's actual and necessary meals, lodging, transportation, and incidental expenses if incurred while performing council business.

[(i) A member of an advisory committee appointed by the council may not receive compensation or reimbursement of any expense incurred while serving on the committee.

[(j) Appointments to the council shall be made without regard to the race, color, disability, sex, religion, age, or national origin of appointees. Additionally, in making the appointments to the council, the governor shall consider geographical representation.

[(k) A person may not serve as a member of the council if the person is required to register as a lobbyist under Chapter 305, Government Code, because of the person's activities for compensation on behalf of a profession related to the operation of the council.

[Sec. 108.004. MEETINGS. (a) The council, council committees, and technical advisory committees are subject to the open meetings law, Chapter 551, Government Code.

[(b) The council shall meet as often as necessary, but not less often than quarterly, to perform its duties under this chapter.

[(c) The council shall publish a notice of its meetings in the Texas Register.

[Sec. 108.0045. OPEN RECORDS. Subject to the restrictions of this chapter, the council is subject to the open records law, Chapter 552, Government Code.

[Sec. 108.005. TERMS. (a) The terms of the agency members are concurrent with their terms of office. The appointed council members serve six-year staggered terms, with the terms of five members expiring September 1 of each odd-numbered year.

[(b) An appointed member may not serve more than two full consecutive terms.

[(c) It is a ground for removal from the council if a member of the council:

[(1) does not have at the time of appointment the qualifications required by Section 108.003;

[(2) does not maintain during service the qualifications required by Section 108.003;

[(3) cannot discharge the member's duties for a substantial part of the term for which the member is appointed because of illness or disability; or

[(4) fails to attend at least one-half of the regularly scheduled meetings that the member is eligible to attend during a calendar year.]

Sec. 108.006. POWERS AND DUTIES OF EXECUTIVE COMMISSIONER AND DEPARTMENT [COUNCIL]. (a) The department [council] shall develop a statewide health care data collection system to collect health care charges, utilization data, provider quality data, and outcome data to facilitate the promotion and accessibility of cost-effective, good quality health care. The executive commissioner or department, as applicable, [council] shall perform the following duties:

(1) the department shall direct the collection, dissemination, and analysis of data under this chapter;

(2) [contract with] the department shall [to] collect the data under this chapter;

(3) the executive commissioner shall adopt policies and rules necessary to carry out this chapter, including rules concerning data collection requirements;

(4) the department shall build on and not duplicate other data collection required by state or federal law, by an accreditation organization, or by department [board] rule;

(5) working with appropriate agencies, the department, with the approval of the executive commissioner, shall review public health data collection programs in this state and recommend, where appropriate, consolidation of the programs and any legislation necessary to effect the consolidation;

(6) the department shall assure that public use data is made available and accessible to interested persons;

(7) the executive commissioner shall prescribe by rule the process for providers to submit data consistent with Section 108.009;

(8) the executive commissioner shall adopt by rule and the department shall implement a methodology to collect and disseminate data reflecting provider quality in accordance with Section 108.010;

(9) the department shall make reports to the legislature, the governor, and the public on:

(A) the charges and rate of change in the charges for health care services in this state;

(B) the effectiveness of the department [council] in carrying out the legislative intent of this chapter;

(C) if applicable, any recommendations on the need for further legislation; and

(D) the quality and effectiveness of health care and access to health care for all citizens of this state;

(10) the department shall develop an annual work plan and establish priorities to accomplish its duties;

(11) the department shall provide consumer education on the interpretation and understanding of the public use or provider quality data before the data is disseminated to the public;

(12) the department shall work with the commission [Health and Human Services Commission] and each health and human services agency that administers a part of the state Medicaid program to avoid duplication of expenditures of state funds for computer systems, staff, or services in the collection and analysis of data relating to the state Medicaid program;

(13) the department shall work with the Department of Information Resources in developing and implementing the statewide health care data collection system and maintain consistency with Department of Information Resources standards; and

(14) the department shall develop and implement a health care information plan [to be used by the department] to:

(A) support public health and preventative health initiatives;

(B) assist in the delivery of primary and preventive health care services;

(C) facilitate the establishment of appropriate benchmark data to measure performance improvements;

(D) establish and maintain a systematic approach to the collection, storage, and analysis of health care data for longitudinal, epidemiological, and policy impact studies; and

(E) develop and use system-based protocols to identify individuals and populations at risk.

(b) The department [council] may:

(1) employ a [or contract with the department to employ an executive] director and other staff, including administrative personnel, necessary to comply with this chapter and rules adopted under this chapter;

(2) engage professional consultants as it considers necessary to the performance of its duties; and

(3) [adopt rules clarifying which health care facilities must provide data under this chapter; and

[(4)] apply for and receive any appropriation, donation, or other funds from the state or federal government or any other public or private source, subject to Section 108.015 and limitations and conditions provided by legislative appropriation.

(b-1) The executive commissioner may adopt rules clarifying which health care facilities must provide data under this chapter.

(c) The department [council] may not establish or recommend rates of payment for health care services.

(d) The department [council] may not take an action that affects or relates to the validity, status, or terms of an interagency agreement [or a contract with the department] without the executive commissioner's [board's] approval.

(e) In the collection of data, the department [council] shall consider the research and initiatives being pursued by the United States Department of Health and Human Services, the National Committee for Quality Assurance, and The [the] Joint Commission [on Accreditation of Healthcare Organizations] to reduce potential duplication or inconsistencies. The executive commissioner [council] may not adopt rules that conflict with or duplicate any federally mandated data collection programs or requirements of comparable scope.

(f) The executive commissioner [council] shall prescribe by rule a public use data file minimum data set that maintains patient confidentiality and establishes data accuracy and consistency.

(g) The public use data file minimum data set as defined by department [council] rule is subject to annual review by the department [council with the assistance of the advisory committee under Section 108.003(g)(5)]. The purpose of the review is to evaluate requests to modify the existing minimum data set and editing process. A decision to modify the minimum data set by the addition or deletion of data elements shall include consideration of the value of the specific data to be added or deleted and the technical feasibility of establishing data accuracy and consistency. The department [council] may also consider the costs to the department [council] and providers associated with modifying the minimum data set.

(h) In accordance with Section 108.0135, the department [council] may release data collected under Section 108.009 that is not included in the public use data file minimum data set established under Subsection (f).

[Sec. 108.0062. DRUG PURCHASING COOPERATIVES. (a) The council shall develop criteria for evaluating drug purchasing cooperatives that purchase drugs on behalf of consumers and create an evaluation form for consumers to evaluate drug purchasing cooperatives.

[(b) The council shall distribute the evaluation forms to the department, local health departments, the Texas Department of Insurance, and the consumer protection division of the office of the attorney general.

[(c) The council shall compile the information from completed evaluation forms and make the information available to the public.]

Sec. 108.0065. POWERS AND DUTIES OF COMMISSION AND DEPARTMENT [COUNCIL] RELATING TO MEDICAID MANAGED CARE. (a) In this section,[:

[(1) "Commission" means the Health and Human Services Commission.

[(2)] "Medicaid managed care organization" means a managed care organization, as defined by Section 533.001, Government Code, that is contracting with the commission to implement the Medicaid managed care program under Chapter 533, Government Code.

(b) The commission may direct the department [council] to collect data under this chapter with respect to Medicaid managed care organizations. The department [council] shall coordinate the collection of the data with the collection of data for health benefit plan providers, but with the approval of the commission may collect data in addition to the data otherwise required of health benefit plan providers.

(c) Each Medicaid managed care organization shall provide to the department the data required by the executive commissioner [council] in the form required by the executive commissioner [council] or, if the data is also being submitted to the commission [or Medicaid operating agency], in the form required by the commission [or Medicaid operating agency].

(d) Dissemination of data collected under this section is subject to Sections 108.010, 108.011, 108.012, 108.013, 108.014, and 108.0141.

(e) The commission shall analyze the data collected in accordance with this section and shall use the data to:

(1) evaluate the effectiveness and efficiency of the Medicaid managed care system;

(2) determine the extent to which Medicaid managed care does or does not serve the needs of Medicaid recipients in this state; and

(3) assess the cost-effectiveness of the Medicaid managed care system in comparison to the fee-for-service system, considering any improvement in the quality of care provided.

(h) The commission, using existing funds, may contract with an entity to comply with the requirements under Subsection (e).

Sec. 108.007. REVIEW POWERS. (a) The [council, through the] department, [and] subject to reasonable rules and guidelines, may:

(1) inspect documents and records used by data sources that are required to compile data and reports; and

(2) compel providers to produce accurate documents and records.

(b) The department [council] may enter into a memorandum of understanding with a state agency, including the division of the commission [Health and Human Services Commission] responsible for the state Medicaid program, or with a school of public health or another institution of higher education, to share data and expertise, to obtain data for the department [council], or to make data available to the department [council]. An agreement entered into under this subsection must protect patient confidentiality.

[Sec. 108.008. DUTIES OF DEPARTMENT. (a) The department, as the state health planning and development agency under Chapter 104, is responsible for the collection of data under Chapter 311.

[(b) The department shall:

[(1) contract with the council to collect data under this chapter;

[(2) provide administrative assistance to the council;

[(3) coordinate administrative responsibilities with the council to avoid unnecessary duplication of the collection of data and other duties;

[(4) on request of the council, give the council access to data collected by the department;

[(5) submit or assist in the council's budget request to the legislature; and

[(6) work with the Department of Information Resources in developing and implementing the statewide health care data collection system and maintain consistency with Department of Information Resources standards.

[(c) The department may not take an action that affects or relates to the validity, status, or terms of an interagency agreement or a contract with the council without the council's approval.

[Sec. 108.0081. MEMORANDUM OF UNDERSTANDING. The council and the department shall enter into a memorandum of understanding to implement the department's duties under Section 108.008(b). The memorandum of understanding must address:

[(1) payroll and travel reimbursement services;

[(2) purchasing services;

[(3) personnel services;

[(4) budget management services;

[(5) computer support and maintenance services;

[(6) meeting coordination services;

[(7) any other administrative support or other services to be provided by the department for the council; and

[(8) the manner in which the council will reimburse the department for the cost of services provided by the department for the council.]

Sec. 108.0085. DUTIES OF ATTORNEY GENERAL. The attorney general shall furnish the department [council] with advice and legal assistance that may be required to implement this chapter.

Sec. 108.009. DATA SUBMISSION AND COLLECTION. (a) The department [council] may collect, and, except as provided by Subsection [Subsections (c) and] (d), providers shall submit to the department [council] or another entity as determined by the department [council], all data required by this section. The data shall be collected according to uniform submission formats, coding systems, and other technical specifications necessary to make the incoming data substantially valid, consistent, compatible, and manageable using electronic data processing, if available.

(b) The executive commissioner [council] shall adopt rules to implement the data submission requirements imposed by Subsection (a) in appropriate stages to allow for the development of efficient systems for the collection and submission of the data. A rule adopted by the executive commissioner [council] that requires submission of a data element that, before adoption of the rule, was not required to be submitted may not take effect before the 90th day after the date the rule is adopted and must take effect not later than the first anniversary after the date the rule is adopted.

(d) The department [council] may not collect data from individual physicians or from an entity that is composed entirely of physicians and that is a professional association organized under the former Texas Professional Association Act (Article 1528f, Vernon's Texas Civil Statutes) or formed under the Texas Professional Association Law, as described by Section 1.008(l), Business Organizations Code, a limited liability partnership organized under former Section 3.08, Texas Revised Partnership Act (Article 6132b-3.08, Vernon's Texas Civil Statutes), or formed as described by Subchapter J, Chapter 152, Business Organizations Code, or a limited liability company organized under the former Texas Limited Liability Company Act (Article 1528n, Vernon's Texas Civil Statutes) or formed under the Texas Limited Liability Company Law, as described by Section 1.008(e), Business Organizations Code, except to the extent the entity owns and operates a health care facility in this state. This subsection does not prohibit the release of data about physicians using uniform physician identifiers that has been collected from a health care facility under this chapter.

(e) The department [council] shall establish [the department as] the single collection point for receipt of data from providers. With the approval of the executive commissioner [council and the board], the department may transfer collection of any data required to be collected by the department under any other law to the statewide health care data collection system.

(f) The executive commissioner [council] may not require providers to submit data more frequently than quarterly, but providers may submit data on a more frequent basis.

(g) The department [council] shall coordinate data collection with the data collection formats used by federally qualified health centers. To satisfy the requirements of this chapter:

(1) a federally qualified health center shall submit annually to the department [council] a copy of the Medicaid cost report of federally qualified health centers; and

(2) a provider receiving federal funds under 42 U.S.C. Section 254b or[,] 254c[, or 256] shall submit annually to the department [council] a copy of the Uniform Data System [Bureau of Common Reporting Requirements] data report developed by the United States Department of [Public] Health and Human Services [Service].

(h) The department shall coordinate data collection with the data submission formats used by hospitals and other providers. The department shall accept data in the format developed by the American National Standards Institute or its successor or other nationally accepted standardized forms that hospitals and other providers use for other complementary purposes.

(i) The executive commissioner [council] shall develop by rule reasonable alternate data submission procedures for providers that do not possess electronic data processing capacity.

(k) The department [council] shall collect health care data elements relating to payer type, the racial and ethnic background of patients, and the use of health care services by consumers. The department [council] shall prioritize data collection efforts on inpatient and outpatient surgical and radiological procedures from hospitals, ambulatory surgical centers, and free-standing imaging [radiology] centers.

(m) To the extent feasible, the department [council] shall obtain from public records the information that is available from those records.

(o) A provider of a health benefit plan shall annually submit to the department [council] aggregate data by service area required by the Healthcare Effectiveness [Health Plan Employer] Data and Information Set (HEDIS) as operated by the National Committee for Quality Assurance. The department [council] may approve the submission of data in accordance with other methods generally used by the health benefit plan industry. If the Healthcare Effectiveness [Health Plan Employer] Data and Information Set does not generally apply to a health benefit plan, the department [council] shall require submission of data in accordance with other methods. This subsection does not relieve a health care facility that provides services under a health benefit plan from the requirements of this chapter. Information submitted under this section is subject to Section 108.011 but is not subject to Section 108.010.

Sec. 108.010. COLLECTION AND DISSEMINATION OF PROVIDER QUALITY DATA. (a) Subject to Section 108.009, the department [council] shall collect data reflecting provider quality based on a methodology and review process established through the executive commissioner's [council's] rulemaking process. The methodology shall identify and measure quality standards and adhere to any federal mandates.

(b) The department [council] shall study and analyze initial methodologies for obtaining provider quality data, including outcome data.

(c) The department [council] shall test the methodology by collecting provider quality data for one year, subject to Section 108.009. The department [council] may test using pilot methodologies. After collecting provider quality data for one year, the department [council] shall report findings applicable to a provider to that provider and allow the provider to review and comment on the initial provider quality data applicable to that provider. The department [council] shall verify the accuracy of the data during this review and revision process. After the review and revision process, provider quality data for subsequent reports shall be published and made available to the public, on a time schedule the department [council] considers appropriate.

(d) If the department [council] determines that provider quality data to be published under Subsection (c) does not provide the intended result or is inaccurate or inappropriate for dissemination, the department [council] is not required to publish the data or reports based in whole or in part on the data. This subsection does not affect the release of public use data in accordance with Section 108.011 or the release of information submitted under Section 108.009(o).

(e) The executive commissioner [council] shall adopt rules allowing a provider to submit concise written comments regarding any specific provider quality data to be released concerning the provider. The department [council] shall make the comments available to the public at the office of the department [council] and in an electronic form accessible through the Internet. The comments shall be attached to any public release of provider quality data. Providers shall submit the comments to the department [council] to be attached to the public release of provider quality data in the same format as the provider quality data that is to be released.

(f) The methodology adopted [by the council] for measuring quality shall include case-mix qualifiers, severity adjustment factors, adjustments for medical education and research, and any other factors necessary to accurately reflect provider quality.

(g) In addition to the requirements of this section, any release of provider quality data shall comply with Sections 108.011(e) and (f).

(h) A provider quality data report may not identify an individual physician by name, but must identify the physician by the uniform physician identifier designated by the department [council] under Section 108.011(c).

(i) The department [council] shall release provider quality data in an aggregate form without uniform physician identifiers when[:

[(1) the data relates to providers described by Section 108.0025(1); or

[(2)] the cell size of the data is below the minimum size established by department [council] rule that would enable identification of an individual patient or physician.

Sec. 108.011. DISSEMINATION OF PUBLIC USE DATA AND DEPARTMENT [COUNCIL] PUBLICATIONS. (a) The department [council] shall promptly provide public use data and data collected in accordance with Section 108.009(o) to those requesting it. The public use data does not include provider quality data prescribed by Section 108.010 or confidential data prescribed by Section 108.013.

(b) Subject to the restrictions on access to department [council] data prescribed by Sections 108.010 and 108.013, and using the public use data and other data, records, and matters of record available to it, the department [council] shall prepare and issue reports to the governor, the legislature, and the public as provided by this section and Section 108.006(a). The department [council] must issue the reports at least annually.

(c) Subject to the restrictions on access to department [council] data prescribed by Sections 108.010 and 108.013, the department [council] shall use public use data to prepare and issue reports that provide information relating to providers, such as the incidence rate of selected medical or surgical procedures. The reports must provide the data in a manner that identifies individual providers, including individual physicians, and that identifies and compares data elements for all providers. Individual physicians may not be identified by name, but shall be identified by uniform physician identifiers. The executive commissioner [council] by rule shall designate the characters to be used as uniform physician identifiers.

(c-1) The department [council] shall use public use data to prepare and issue reports that provide information for review and analysis by the commission [Health and Human Services Commission] relating to services that are provided in a niche hospital, as defined by Section 105.002, Occupations Code, and that are provided by a physician with an ownership interest in the niche hospital.

(c-2) Subsection (c-1) does not apply to an ownership interest in publicly available shares of a registered investment company, such as a mutual fund, that owns publicly traded equity securities or debt obligations issued by a niche hospital or an entity that owns the niche hospital.

(d) The executive commissioner [council] shall adopt procedures to establish the accuracy and consistency of the public use data before releasing the public use data to the public. The department may adopt additional procedures as the department determines necessary.

(e) If public use data is requested from the department [council] about a specific provider, the department [council] shall notify the provider about the release of the data. This subsection does not authorize the provider to interfere with the release of that data.

(f) A report issued by the department [council] shall include a reasonable review and comment period for the affected providers before public release of the report.

(g) The executive commissioner [council] shall adopt rules allowing a provider to submit concise written comments regarding any specific public use data to be released concerning the provider. The department [council] shall make the comments available to the public at [and] the office of the department [council] and in an electronic form accessible through the Internet. The comments shall be attached to any public release of the public use data. Providers shall submit the comments to the department [council] to be attached to the public release of public use data in the same format as the public use data that is to be released.

(h) Tapes containing public use data and provider quality reports that are released to the public must include general consumer education material, including an explanation of the benefits and limitations of the information provided in the public use data and provider quality reports.

(i) The department [council] shall release public use data in an aggregate form without uniform physician identifiers when[:

[(1) the data relates to providers described by Section 108.0025(1); or

[(2)] the cell size of the data is below the minimum size established by department [council] rule that would enable identification of an individual patient or physician.

Sec. 108.012. COMPUTER ACCESS TO DATA. (a) The department [council] shall provide a means for computer-to-computer access to the public use data. All reports shall maintain patient confidentiality as provided by Section 108.013.

(b) The department [council] may charge a person requesting public use or provider quality data a fee for the data. The fees may reflect the quantity of information provided and the expense incurred by the department [council] in collecting and providing the data. The executive commissioner by rule [and] shall [be] set the fees at a level that will raise revenue sufficient for the operation of the department [council]. The department [council] may not charge a fee for providing public use data to another state agency.

Sec. 108.013. CONFIDENTIALITY AND GENERAL ACCESS TO DATA. (a) The data received by the department under this chapter shall be used by the department and commission for the benefit of the public. Subject to specific limitations established by this chapter and department [executive commissioner] rule, the department shall make determinations on requests for information in favor of access.

(b) The executive commissioner by rule shall designate the characters to be used as uniform patient identifiers. The basis for assignment of the characters and the manner in which the characters are assigned are confidential.

(c) Unless specifically authorized by this chapter, the department may not release and a person or entity may not gain access to any data obtained under this chapter:

(1) that could reasonably be expected to reveal the identity of a patient;

(2) that could reasonably be expected to reveal the identity of a physician;

(3) disclosing provider discounts or differentials between payments and billed charges;

(4) relating to actual payments to an identified provider made by a payer; or

(5) submitted to the department in a uniform submission format that is not included in the public use data set established under Sections 108.006(f) and (g), except in accordance with Section 108.0135.

(d) Except as provided by this section, all data collected and used by the department under this chapter is subject to the confidentiality provisions and criminal penalties of:

(1) Section 311.037;

(2) Section 81.103; and

(3) Section 159.002, Occupations Code.

(e) Data on patients and compilations produced from the data collected that identify patients are not:

(1) subject to discovery, subpoena, or other means of legal compulsion for release to any person or entity except as provided by this section; or

(2) admissible in any civil, administrative, or criminal proceeding.

(f) Data on physicians and compilations produced from the data collected that identify physicians are not:

(1) subject to discovery, subpoena, or other means of legal compulsion for release to any person or entity except as provided by this section; or

(2) admissible in any civil, administrative, or criminal proceeding.

(g) Unless specifically authorized by this chapter, the department may not release data elements in a manner that will reveal the identity of a patient. The department may not release data elements in a manner that will reveal the identity of a physician.

(h) Subsections (c) and (g) do not prohibit the release of a uniform physician identifier in conjunction with associated public use data in accordance with Section 108.011 or a provider quality report in accordance with Section 108.010.

(i) Notwithstanding any other law and except as provided by this section, the department may not provide information made confidential by this section to any other agency of this state.

(j) The executive commissioner shall by rule develop and implement a mechanism to comply with Subsections (c)(1) and (2).

(k) The department may disclose data collected under this chapter that is not included in public use data to any department or commission program if the disclosure is reviewed and approved by the institutional review board under Section 108.0135.

(l) Confidential data collected under this chapter that is disclosed to a department or commission program remains subject to the confidentiality provisions of this chapter and other applicable law. The department shall identify the confidential data that is disclosed to a program under Subsection (k). The program shall maintain the confidentiality of the disclosed confidential data.

(m) The following provisions do not apply to the disclosure of data to a department or commission program:

(1) Section 81.103;

(2) Sections 108.010(g) and (h);

(3) Sections 108.011(e) and (f);

(4) Section 311.037; and

(5) Section 159.002, Occupations Code.

(n) Nothing in this section authorizes the disclosure of physician identifying data.

Sec. 108.0131. LIST OF PURCHASERS OR RECIPIENTS OF DATA. The department shall post on the department's Internet website a list of each entity that purchases or receives data collected under this chapter.

Sec. 108.0135. INSTITUTIONAL REVIEW BOARD. (a) The department shall establish an institutional review board to review and approve requests for access to data not contained in public use data. The members of the institutional review board must have experience and expertise in ethics, patient confidentiality, and health care data.

(b) To assist the institutional review board in determining whether to approve a request for information, the executive commissioner shall adopt rules similar to the federal Centers for Medicare and Medicaid Services' guidelines on releasing data.

(c) A request for information other than public use data must be made on the form prescribed by the department.

(d) Any approval to release information under this section must require that the confidentiality provisions of this chapter be maintained and that any subsequent use of the information conform to the confidentiality provisions of this chapter.

Sec. 108.014. CIVIL PENALTY. (a) A person who knowingly or negligently releases data in violation of this chapter is liable for a civil penalty of not more than $10,000.

(b) A person who fails to supply available data under Sections 108.009 and 108.010 is liable for a civil penalty of not less than $1,000 or more than $10,000 for each act of violation.

(c) The attorney general, at the request of the department [council], shall enforce this chapter. The venue of an action brought under this section is in Travis County.

(d) A civil penalty recovered in a suit instituted by the attorney general under this chapter shall be deposited in the general revenue fund to the credit of the health care information account.

Sec. 108.0141. CRIMINAL PENALTY. (a) A person who knowingly accesses data in violation of this chapter or who with criminal negligence releases data in violation of this chapter commits an offense.

(b) An offense under this section is a state jail felony.

Sec. 108.015. CONFLICT OF INTEREST. The department [council] may not accept a donation from a person required to provide data under this chapter or from a person or business entity who provides goods or services to the department [council] for compensation.

Sec. 108.016. SUNSET REVIEW. Unless continued in existence in accordance with Chapter 325, Government Code (Texas Sunset Act), after the review required by Section 11.003(b), this chapter expires September 1, 2015.

SECTION 3.0356. Section 114.002, Health and Safety Code, is amended to read as follows:

Sec. 114.002. INTERAGENCY OBESITY COUNCIL. The council is composed of the commissioner, the commissioner of agriculture, [the commissioner of state health services,] and the commissioner of education, or a staff member designated by each of those commissioners.

SECTION 3.0357. Section 114.005, Health and Safety Code, is amended to read as follows:

Sec. 114.005. REVIEW OF AGENCY PROGRAMS. The council shall review the status of the programs of the department, the Department of Agriculture, [the Department of State Health Services,] and the Texas Education Agency that promote better health and nutrition and prevent obesity among children and adults in this state.

SECTION 3.0358. Section 114.006(d), Health and Safety Code, is amended to read as follows:

(d) The council shall provide to the department [Department of State Health Services] information on effective strategies for employers to use to promote workplace wellness, including information on the projected costs and benefits. The department [Department of State Health Services] shall post the information on its Internet website.

SECTION 3.0359. Section 114.007(c), Health and Safety Code, is amended to read as follows:

(c) A report submitted by the council under Subsection (a) must include the following information regarding the evidence-based public health awareness plan under Section 114.006:

(1) a cost estimate for an ongoing program to implement the plan;

(2) projected benefits of the program;

(3) a summary of the information provided to the department [Department of State Health Services] for its Internet website; and

(4) recommendations for goals and future legislation.

SECTION 3.0360. Section 115.007(a), Health and Safety Code, is amended to read as follows:

(a) The task force consists of:

(1) the commissioner, the executive director or director, or a deputy or assistant commissioner of:

(A) the commission, designated by the executive commissioner;

(B) the Department of Aging and Disability Services, designated by the commissioner of aging and disability services [that agency];

(C) the Department of Assistive and Rehabilitative Services, designated by the commissioner of assistive and rehabilitative services [that agency];

(D) the division of early childhood intervention services, designated by the commissioner of assistive and rehabilitative services [the Department of Assistive and Rehabilitative Services];

(E) the Department of Family and Protective Services, designated by the commissioner of family and protective services [that agency];

(F) the department [Department of State Health Services], designated by the commissioner [of that agency];

(G) the Texas Education Agency, designated by the commissioner of education [that agency];

(H) the Texas Juvenile Justice Department [Youth Commission], designated by the executive director [commissioner] of that agency; and

(I) [the Texas Juvenile Probation Commission, designated by the executive director of that agency; and

[(J)] the Texas Correctional Office on Offenders with Medical or Mental Impairments, designated by the director of that office; and

(2) eight nonvoting members who are:

(A) a representative of a local mental health authority or a local intellectual and developmental disability [mental retardation] authority, appointed by the governor;

(B) two members of the house of representatives, appointed by the speaker of the house of representatives;

(C) two senators, appointed by the lieutenant governor; and

(D) three parents or consumer advocates, one each appointed by the commission, the Texas Education Agency, and the Texas Juvenile Justice Department [Youth Commission].

SECTION 3.0361. Section 121.002(2), Health and Safety Code, is amended to read as follows:

(2) "Physician" means a person licensed to practice medicine by the Texas Medical [State] Board [of Medical Examiners].

SECTION 3.0362. Section 121.003(b), Health and Safety Code, is amended to read as follows:

(b) The governing bodies of municipalities and the commissioners courts of counties may cooperate with one another in making necessary improvements and providing services to promote the public health in accordance with Chapter 791, Government Code [The Interlocal Cooperation Act (Article 4413(32c), Vernon's Texas Civil Statutes)].

SECTION 3.0363. Section 121.004, Health and Safety Code, is amended to read as follows:

Sec. 121.004. LOCAL HEALTH UNITS. A local health unit is a division of municipal or county government that provides public health services but does not provide each service listed [required of a local health department] under Section 121.006(d) [121.032(a)] or required of a public health district under Section 121.043(a).

SECTION 3.0364. Section 121.005(d), Health and Safety Code, is amended to read as follows:

(d) The executive commissioner [board] may adopt rules necessary to implement this section.

SECTION 3.0365. Section 121.006(c), Health and Safety Code, is amended to read as follows:

(c) Chapter 783, Government Code, [The Uniform Grant and Contract Management Act of 1981 (Article 4413(32g), Vernon's Texas Civil Statutes)] and standards adopted under that chapter [Act] control, if applicable, if the local health unit, local health department, or public health district receives state support for the provision of public health services.

SECTION 3.0366. Section 121.0065(c), Health and Safety Code, is amended to read as follows:

(c) The executive commissioner [board] shall adopt rules governing:

(1) the allocation formula for grants awarded under this section;

(2) the manner in which a municipality, county, public health district, or other political subdivision applies for a grant;

(3) the procedures for awarding grants; and

(4) the minimum essential public health services to be provided under the grant and other standards applicable to the services to be provided under the grant.

SECTION 3.0367. Section 121.007, Health and Safety Code, is amended to read as follows:

Sec. 121.007. PUBLIC HEALTH REGIONS. (a) The department [board] may designate geographic areas of the state as public health regions to provide public health services.

(b) The department [board] shall appoint a physician to serve as regional director for each public health region. The regional director is the chief administrative officer of the region. The department [board] shall establish the qualifications and terms of employment of a regional director.

(c) The department [board or its designee] may require a regional director to perform the duties of a health authority. The regional director may perform those duties, as authorized by the department [board or commissioner], in a jurisdiction in the region in which the health authority fails to perform duties prescribed [by the board] under Section 121.024. The regional director shall perform the duties of a health authority in a jurisdiction in the region in which there is not a health authority.

SECTION 3.0368. Section 121.008(a), Health and Safety Code, is amended to read as follows:

(a) The department [board] shall hold an annual conference for health authorities and for directors of local health departments and public health districts. The commissioner or the commissioner's designee shall preside over the conference.

SECTION 3.0369. Section 121.022(b), Health and Safety Code, is amended to read as follows:

(b) To be qualified to serve as a health authority, the appointee must:

(1) take and subscribe to the official oath; and

(2) file a copy of the oath and appointment with the department [board].

SECTION 3.0370. Sections 121.024(b) and (c), Health and Safety Code, are amended to read as follows:

(b) A health authority shall perform each duty that is:

(1) necessary to implement and enforce a law to protect the public health; or

(2) prescribed by the department [board].

(c) The duties of a health authority include:

(1) establishing, maintaining, and enforcing quarantine in the health authority's jurisdiction;

(2) aiding the department [board] in relation to local quarantine, inspection, disease prevention and suppression, birth and death statistics, and general sanitation in the health authority's jurisdiction;

(3) reporting the presence of contagious, infectious, and dangerous epidemic diseases in the health authority's jurisdiction to the department [board] in the manner and at the times prescribed by the department [board];

(4) reporting to the department [board] on any subject on which it is proper for the department [board] to direct that a report be made; and

(5) aiding the department [board] in the enforcement of the following in the health authority's jurisdiction:

(A) proper rules, requirements, and ordinances;

(B) sanitation laws;

(C) quarantine rules; and

(D) vital statistics collections.

SECTION 3.0371. Sections 121.029(a) and (b), Health and Safety Code, are amended to read as follows:

(a) A health authority, unless otherwise restricted by law, may delegate a power or duty imposed on the health authority by the department [board], or by this or any other law, to a properly qualified physician to act while the health authority is absent or incapacitated.

(b) The physician designated by the health authority must:

(1) meet the qualifications set out in Section 121.022(a);

(2) be appointed as a designee in the same manner as the appointment of the health authority;

(3) take, subscribe, and file the official oath and appointment with the department [board] as required by Section 121.022(b); and

(4) file a certified copy of the written delegation with the department [board].

SECTION 3.0372. Section 121.033(d), Health and Safety Code, is amended to read as follows:

(d) A director of a local health department who is not a physician shall appoint a physician as the health authority in the local health department's jurisdiction, subject to the approval of the governing body or the commissioners court, as appropriate, and the department [board].

SECTION 3.0373. Sections 121.0331(a) and (b), Health and Safety Code, are amended to read as follows:

(a) A health authority, unless otherwise restricted by law, may delegate a power or duty imposed on the health authority by the department [board], or by this or any other law, to a properly qualified physician who is employed by the municipality's or county's local health department to act while the health authority is absent or incapacitated.

(b) The physician designated by the health authority must:

(1) meet the qualifications set out in Section 121.022(a);

(2) be appointed as a designee in the same manner as the appointment of the health authority;

(3) take, subscribe, and file the official oath and appointment with the department [board] as required by Section 121.022(b); and

(4) file a certified copy of the written delegation with the department [board].

SECTION 3.0374. Section 121.043(b), Health and Safety Code, is amended to read as follows:

(b) For purposes of Section 121.005, a public health district shall be identified by its program of public health services and shall, at a minimum, provide the services listed [for a local health department] under Section 121.006(d) [121.032(b)].

SECTION 3.0375. Section 121.045(d), Health and Safety Code, is amended to read as follows:

(d) A director of a public health district who is not a physician shall appoint a physician as the health authority for the district, subject to the approval of the members and the department [board].

SECTION 3.0376. Sections 121.0451(a) and (b), Health and Safety Code, are amended to read as follows:

(a) A health authority, unless otherwise restricted by law, may delegate a power or duty imposed on the health authority by the department [board], or by this or any other law, to a properly qualified physician who is employed by the public health district to act while the health authority is absent or incapacitated.

(b) The physician designated by the health authority must:

(1) meet the qualifications set out in Section 121.022(a);

(2) be appointed as a designee in the same manner as the appointment of the health authority;

(3) take, subscribe, and file the official oath and appointment with the department [board] as required by Section 121.022(b); and

(4) file a certified copy of the written delegation with the department [board].

SECTION 3.0377. Section 122.008(b), Health and Safety Code, is amended to read as follows:

(b) A nurse employed under Subsection (a) shall:

(1) investigate the health conditions and sanitary surroundings of the schools and the personal, physical, and health condition of students in the schools;

(2) cooperate with the department [Texas Department of Health] and local health authorities; and

(3) perform other duties required by the commissioners court.

SECTION 3.0378. Sections 141.002(2) and (5), Health and Safety Code, are amended to read as follows:

(2) "Day camp" includes any camp that primarily operates during any portion of the day between 7 a.m. and 10 p.m. for a period of four or more consecutive days but may incidentally offer not more than two overnight stays each camp session. The term does not include a facility required to be licensed with the Department of Family and Protective [and Regulatory] Services.

(5) "Youth camp" means a facility or property, other than a facility required to be licensed by the Department of Family and Protective [and Regulatory] Services, that:

(A) has the general characteristics of a day camp, resident camp, or travel camp;

(B) is used primarily or partially for recreational, athletic, religious, or educational activities; and

(C) accommodates at least five minors who attend or temporarily reside at the camp for all or part of at least four days.

SECTION 3.0379. Section 141.0035, Health and Safety Code, is amended to read as follows:

Sec. 141.0035. LICENSE FEES. (a) The executive commissioner [board] by rule shall establish the amount of the fee for obtaining or renewing a license under this chapter. The executive commissioner [board] shall set the fee in a reasonable amount designed to recover the direct and indirect costs to the department of administering and enforcing this chapter. The executive commissioner [board] may set fees in a different amount for resident youth camps and day youth camps to reflect differences in the costs of administering and enforcing this chapter for resident and day camps.

(b) Before the executive commissioner adopts or amends [adopting or amending] a rule under Subsection (a), the department [board] shall solicit comments and information from the operators of affected youth camps and allow affected youth camp operators the opportunity to meet with appropriate department staff who are involved with the rulemaking process.

SECTION 3.0380. Section 141.004(a), Health and Safety Code, is amended to read as follows:

(a) To obtain a license, a person must submit a license application accompanied by a license fee in an amount set by the executive commissioner by rule [board].

SECTION 3.0381. Section 141.005, Health and Safety Code, is amended to read as follows:

Sec. 141.005. LICENSE RENEWAL. (a) A person holding a license issued under this chapter must renew the license annually by submitting a renewal application on a date determined by department [board] rule on a form provided by the department.

(b) The application must be accompanied by a renewal fee in an amount set by the executive commissioner by rule [board].

(c) The department may not renew the license of a youth camp which has not corrected deficiencies before the application for renewal is submitted. The executive commissioner [board] shall adopt substantive and procedural rules for the submission by a youth camp operator of evidence that a deficiency or deficiencies have been corrected.

SECTION 3.0382. Sections 141.007(b) and (c), Health and Safety Code, are amended to read as follows:

(b) An employee or agent who enters a youth camp to investigate and inspect conditions shall notify the person in charge of the camp of the inspector's presence and shall present proper credentials. The department may exercise the remedies authorized by Section 141.015(b) [141.014(b)] if the employee or agent is not allowed to enter.

(c) The executive commissioner [department] may prescribe reasonable record-keeping requirements for licensed youth camps, including a requirement that the youth camp keep records relating to matters involving the health and safety of campers. An employee or agent of the department may examine, during regular business hours, any records relating to the health and safety of campers.

SECTION 3.0383. Section 141.008(a), Health and Safety Code, is amended to read as follows:

(a) The executive commissioner [board] may adopt rules to implement this chapter. In adopting the rules the executive commissioner [board] shall comply with Subchapter B, Chapter 2001, Government Code, including Sections 2001.032(b) and 2001.033, Government Code. In developing the rules to be adopted by the executive commissioner, the department [board] shall consult parents, youth camp operators, and appropriate public and private officials and organizations.

SECTION 3.0384. Section 141.009, Health and Safety Code, is amended to read as follows:

Sec. 141.009. STANDARDS. The executive commissioner [board] by rule shall establish health and safety standards for youth camps. The standards may relate to:

(1) adequate and proper supervision at all times of camp activities;

(2) qualifications for directors, supervisors, and staff and sufficient numbers of those persons;

(3) proper safeguards for sanitation and public health;

(4) adequate medical services for personal health and first aid;

(5) proper procedures for food preparation, handling, and mass feeding;

(6) healthful and sufficient water supply;

(7) proper waste disposal;

(8) proper water safety procedures for swimming pools, lakes, and waterways;

(9) safe boating equipment;

(10) proper maintenance and safe use of motor vehicles;

(11) safe buildings and physical facilities;

(12) proper fire precautions;

(13) safe and proper recreational and other equipment;

(14) proper regard for density and use of the premises; and

(15) records of criminal convictions of camp personnel.

SECTION 3.0385. Sections 141.0095(d) and (f), Health and Safety Code, are amended to read as follows:

(d) In accordance with this section and the criteria and guidelines developed by the training advisory committee established under Section 141.0096, the executive commissioner [of the Health and Human Services Commission] by rule shall establish criteria and guidelines for training and examination programs on sexual abuse and child molestation. The department may approve training and examination programs offered by trainers under contract with youth camps or by online training organizations or may approve programs offered in another format authorized by the department.

(f) The department may assess a fee in the amount set by the executive commissioner by rule as necessary to cover the costs of administering this section to each person that applies for the department's approval of a training and examination program on sexual abuse and child molestation under this section.

SECTION 3.0386. Sections 141.0096(a), (b), and (c), Health and Safety Code, are amended to read as follows:

(a) The department shall appoint a training advisory committee to advise the department and the executive commissioner [of the Health and Human Services Commission] in the development of criteria and guidelines for the training and examination program on sexual abuse and child molestation required under Section 141.0095 and to perform any other functions requested by the department.

(b) The training advisory committee consists of not more than nine members selected by the commissioner [of state health services] as follows:

(1) at least two members who represent the general public; and

(2) other members, who include experienced camping professionals representing the camping communities of this state, representatives of youth camps selected by the department, and representatives of the Council on Sex Offender Treatment established under Chapter 110, Occupations Code.

(c) The training advisory committee shall meet at the call of the commissioner [of state health services].

SECTION 3.0387. Sections 141.010(a), (b), and (d), Health and Safety Code, are amended to read as follows:

(a) The executive commissioner [board] shall appoint a committee to advise the executive commissioner [board] in the development of standards and procedures, make recommendations to the executive commissioner [board] regarding the content of the rules adopted to implement this chapter [Act], and perform any other functions requested by the executive commissioner [board] in the implementation and administration of the chapter [Act].

(b) The advisory committee may not exceed nine members, at least two of whom shall be members of the general public. The other members should be experienced camping professionals who represent the camping communities of the state. In making the appointments, the executive commissioner [board] shall attempt to reflect the geographic diversity of the state in proportion to the number of camps licensed by the department in each geographic area of the state.

(d) A vacancy on the advisory committee is filled by the executive commissioner [board] in the same manner as other appointments to the advisory committee.

SECTION 3.0388. The heading to Section 141.013, Health and Safety Code, is amended to read as follows:

Sec. 141.013. [BOARD] HEARINGS.

SECTION 3.0389. Section 141.013(a), Health and Safety Code, is amended to read as follows:

(a) The department [board] may:

(1) call and conduct hearings;

(2) administer oaths;

(3) receive evidence;

(4) issue subpoenas for witnesses, papers, and documents related to the hearing; and

(5) make findings of fact and decisions concerning the administration of this chapter and rules adopted under this chapter.

SECTION 3.0390. Sections 141.016(a) and (b), Health and Safety Code, are amended to read as follows:

(a) The department [commissioner] may assess an administrative penalty if a person violates this chapter [Act] or a rule or order adopted or license issued under this chapter [Act].

(b) In determining the amount of the penalty, the department [commissioner] shall consider:

(1) the person's previous violations;

(2) the seriousness of the violation;

(3) any hazard to the health and safety of the public;

(4) the person's demonstrated good faith; and

(5) such other matters as justice may require.

SECTION 3.0391. Sections 141.017(b), (c), and (d), Health and Safety Code, are amended to read as follows:

(b) If a hearing is held, the administrative law judge [commissioner] shall make findings of fact and shall issue a written proposal for decision regarding the occurrence of the violation and the amount of the penalty that may be warranted.

(c) If the person charged with the violation does not request a hearing, the department [commissioner] may assess a penalty after determining that a violation has occurred and the amount of the penalty that may be warranted.

(d) After making a determination under this section that a penalty is to be assessed against a person, the department [commissioner] shall issue an order requiring that the person pay the penalty.

SECTION 3.0392. Section 141.018, Health and Safety Code, is amended to read as follows:

Sec. 141.018. PAYMENT OF ADMINISTRATIVE PENALTY. (a) Not later than the 30th day after the date an order finding that a violation has occurred is issued, the department [commissioner] shall inform the person against whom the order is issued of the amount of the penalty for the violation.

(b) Not later than the 30th day after the date on which a decision or order charging a person with a penalty is final, the person shall:

(1) pay the penalty in full; or

(2) file a petition for [if the person seeks] judicial review of the department's order contesting the amount of the penalty, the fact of the violation, or both.

(b-1) Within the period prescribed by Subsection (b), a person who files a petition for judicial review may:

(1) stay enforcement of the penalty by:

(A) paying [send the amount of] the penalty to the court [commissioner] for placement in an escrow account; or

(B) posting [post] with the court [commissioner] a supersedeas bond for the amount of the penalty; or

(2) request that the department stay enforcement of the penalty by:

(A) filing with the court a sworn affidavit of the person stating that the person is financially unable to pay the penalty and is financially unable to give the supersedeas bond; and

(B) sending a copy of the affidavit to the department.

(b-2) If the department receives a copy of an affidavit under Subsection (b-1)(2), the department may file with the court, within five days after the date the copy is received, a contest to the affidavit. The court shall hold a hearing on the facts alleged in the affidavit as soon as practicable and shall stay the enforcement of the penalty on finding that the alleged facts are true. The person who files an affidavit has the burden of proving that the person is financially unable to pay the penalty or to give a supersedeas bond.

(c) A bond posted under this section must be in a form approved by the court [commissioner] and be effective until all judicial review of the order or decision is final.

(d) A person who does not send money to, [the commissioner or] post the bond with, or file the affidavit with the court within the period prescribed by Subsection (b) waives all rights to contest the violation or the amount of the penalty.

SECTION 3.0393. Section 141.019, Health and Safety Code, is amended to read as follows:

Sec. 141.019. REFUND OF ADMINISTRATIVE PENALTY. On [Not later than the 30th day after] the date the court's judgment [of a judicial determination] that an administrative penalty against a person should be reduced or not assessed becomes final, the court [commissioner] shall order that:

(1) [remit to the person] the appropriate amount of any penalty payment plus accrued interest be remitted to the person not later than the 30th day after that date; or

(2) [execute a release of] the bond be released, if the person has posted a bond.

SECTION 3.0394. Section 141.020, Health and Safety Code, is amended to read as follows:

Sec. 141.020. RECOVERY OF ADMINISTRATIVE PENALTY BY ATTORNEY GENERAL. The attorney general at the request of the department [commissioner] may bring a civil action to recover an administrative penalty under this chapter.

SECTION 3.0395. Sections 142.001(6) and (22), Health and Safety Code, are amended to read as follows:

(6) "Certified agency" means a home and community support services agency, or a portion of the agency, that:

(A) provides a home health service; and

(B) is certified by an official of the United States Department of Health and Human Services as in compliance with conditions of participation in Title XVIII, Social Security Act (42 U.S.C. Section 1395 et seq.).

(22) "Personal assistance service" means routine ongoing care or services required by an individual in a residence or independent living environment that enable the individual to engage in the activities of daily living or to perform the physical functions required for independent living, including respite services. The term includes:

(A) personal care;

(B) health-related services performed under circumstances that are defined as not constituting the practice of professional nursing by the Texas Board of Nursing under the terms of [through] a memorandum of understanding executed by [with] the board and the department [in accordance with Section 142.016]; and

(C) health-related tasks provided by unlicensed personnel under the delegation of a registered nurse or that a registered nurse determines do not require delegation.

SECTION 3.0396. Section 142.0011, Health and Safety Code, is amended by amending Subsection (b) and adding Subsection (c) to read as follows:

(b) The executive commissioner [department] shall protect clients of home and community support services agencies by [regulating those agencies and:

[(1)] adopting rules relating to quality of care and quality of life.

(c) The department shall protect clients of home and community support services agencies by:

(1) regulating those agencies;

(2) strictly monitoring factors relating to the health, safety, welfare, and dignity of each client;

(3) imposing prompt and effective remedies for violations of this chapter and rules and standards adopted under this chapter;

(4) enabling agencies to provide services that allow clients to maintain the highest possible degree of independence and self-determination; and

(5) providing the public with helpful and understandable information relating to agencies in this state.

SECTION 3.0397. Section 142.0012(d), Health and Safety Code, is amended to read as follows:

(d) The executive commissioner [department] may adopt rules that specify the ownership interests and other relationships that qualify a person as a controlling person.

SECTION 3.0398. Section 142.004(c), Health and Safety Code, is amended to read as follows:

(c) The executive commissioner [board] by rule shall require that, at a minimum, before the department may approve a license application, the applicant must provide to the department:

(1) documentation establishing that, at a minimum, the applicant has sufficient financial resources to provide the services required by this chapter and by the department during the term of the license;

(2) a list of the management personnel for the proposed home and community support services agency, a description of personnel qualifications, and a plan for providing continuing training and education for the personnel during the term of the license;

(3) documentation establishing that the applicant is capable of meeting the minimum standards established by the executive commissioner [board] relating to the quality of care;

(4) a plan that provides for the orderly transfer of care of the applicant's clients if the applicant cannot maintain or deliver home health, hospice, or personal assistance services under the license;

(5) identifying information on the home and community support services agency owner, administrator, and chief financial officer to enable the department to conduct criminal background checks on those persons;

(6) identification of any controlling person with respect to the applicant; and

(7) documentation relating to any controlling person identified under Subdivision (6), if requested by the department and relevant to the controlling person's compliance with any applicable licensing standard required or adopted [by the board] under this chapter.

SECTION 3.0399. Sections 142.006(a), (b), and (c), Health and Safety Code, are amended to read as follows:

(a) The department shall issue a home and community support services agency license to provide home health, hospice, or personal assistance services for each place of business to an applicant if:

(1) the applicant:

(A) qualifies for the license to provide the type of service that is to be offered by the applicant;

(B) submits an application and license fee as required by this chapter; and

(C) complies with all applicable licensing standards required or adopted [by the board] under this chapter; and

(2) any controlling person with respect to the applicant complies with all applicable licensing standards required or adopted [by the board] under this chapter.

(b) A license issued under this chapter expires two years after the date of issuance. The executive commissioner [of the Health and Human Services Commission] by rule may adopt a system under which licenses expire on various dates during the two-year period. For the year in which a license expiration date is changed, the department shall prorate the license fee on a monthly basis. Each license holder shall pay only that portion of the license fee allocable to the number of months for which the license is valid. A license holder shall pay the total license renewal fee at the time of renewal. The department may issue an initial license for a shorter term to conform expiration dates for a locality or an applicant. The department may issue a temporary license to an applicant for an initial license.

(c) The department may find that a home and community support services agency has satisfied the requirements for licensing if the agency is accredited by an accreditation organization, such as The [the] Joint Commission [on Accreditation of Healthcare Organizations] or the Community Health Accreditation Program, and the department finds that the accreditation organization has standards that meet or exceed the requirements for licensing under this chapter. A license fee is required of the home and community support services agency at the time of a license application.

SECTION 3.0400. Section 142.008(b), Health and Safety Code, is amended to read as follows:

(b) The executive commissioner [board] by rule shall establish eligibility requirements for a branch office license.

SECTION 3.0401. Section 142.0085(b), Health and Safety Code, is amended to read as follows:

(b) The executive commissioner [board] by rule shall establish standards required for the issuance of an alternate delivery site license.

SECTION 3.0402. Sections 142.009(h) and (l), Health and Safety Code, are amended to read as follows:

(h) Except for the investigation of complaints, a home and community support services agency licensed by the department under this chapter is not subject to additional surveys relating to home health, hospice, or personal assistance services while the agency maintains accreditation for the applicable service from The [the] Joint Commission [for Accreditation of Healthcare Organizations], the Community Health Accreditation Program, or other accreditation organizations that meet or exceed the regulations adopted under this chapter. Each provider must submit to the department documentation from the accrediting body indicating that the provider is accredited when the provider is applying for the initial license and annually when the license is renewed.

(l) The department and other state agencies that are under the commission [Health and Human Services Commission] and that contract with home and community support services agencies to deliver services for which a license is required under this chapter shall execute a memorandum of understanding that establishes procedures to eliminate or reduce duplication of standards or conflicts between standards and of functions in license, certification, or compliance surveys and complaint investigations. [The Health and Human Services Commission shall review the recommendation of the council relating to the memorandum of understanding before considering approval.] The memorandum of understanding must be approved by the commission.

SECTION 3.0403. Sections 142.010(a) and (b), Health and Safety Code, are amended to read as follows:

(a) The executive commissioner by rule [department] shall set license fees for home and community support services agencies in amounts that are reasonable to meet the costs of administering this chapter, except that the fees may not be less than $600 or more than $2,000 for a license to provide home health, hospice, or personal assistance services.

(b) The executive commissioner [board] shall consider the size of the home and community support services agency, the number of clients served, the number of services provided, and the necessity for review of other accreditation documentation in determining the amount collected by the department for [of] initial and renewal license fees.

SECTION 3.0404. Section 142.0104(a), Health and Safety Code, is amended to read as follows:

(a) If certain application information as specified by department [executive commissioner] rule changes after the applicant submits an application to the department for a license under this chapter or after the department issues the license, the license holder shall report the change to the department and pay a fee not to exceed $50 not later than the time specified by department [executive commissioner] rule.

SECTION 3.0405. Section 142.011(d), Health and Safety Code, is amended to read as follows:

(d) A person whose application is denied or whose license is suspended or revoked is entitled to a hearing [before the department] if the person submits a written request to the commission [department]. Chapter 2001, Government Code, and the department's rules for contested case hearings apply to hearings conducted under this section and to appeals from department decisions.

SECTION 3.0406. Sections 142.017(c), (d), (e), and (g), Health and Safety Code, are amended to read as follows:

(c) The executive commissioner [department] by rule shall specify each violation for which the department may assess an administrative penalty [may be assessed]. In determining which violations warrant penalties, the department shall consider:

(1) the seriousness of the violation, including the nature, circumstances, extent, and gravity of the violation and the hazard of the violation to the health or safety of clients; and

(2) whether the affected home and community support services agency had identified the violation as a part of its internal quality assurance process and had made appropriate progress on correction.

(d) The executive commissioner [department] by rule shall establish a schedule of appropriate and graduated penalties for each violation based on:

(1) the seriousness of the violation, including the nature, circumstances, extent, and gravity of the violation and the hazard or safety of clients;

(2) the history of previous violations by the person or a controlling person with respect to that person;

(3) whether the affected home and community support services agency had identified the violation as a part of its internal quality assurance process and had made appropriate progress on correction;

(4) the amount necessary to deter future violations;

(5) efforts made to correct the violation; and

(6) any other matters that justice may require.

(e) Except as provided by Subsection (j), the executive commissioner [department] by rule shall provide the home and community support services agency with a reasonable period of time following the first day of a violation to correct the violation before the department assesses [assessing] an administrative penalty if a plan of correction has been implemented.

(g) The executive commissioner [department] shall establish a system to ensure standard and consistent application of penalties regardless of the home and community support services agency location.

SECTION 3.0407. Section 142.0171(c), Health and Safety Code, is amended to read as follows:

(c) If the person notified of the violation accepts the determination of the department or if the person fails to respond in a timely manner to the notice, the department [commissioner or the commissioner's designee] shall [issue an] order [approving the determination and ordering that] the person to pay the proposed penalty.

SECTION 3.0408. Section 142.0172, Health and Safety Code, is amended to read as follows:

Sec. 142.0172. HEARING; ORDER. (a) If the person notified requests a hearing, the department shall refer the case to the State Office of Administrative Hearings and an administrative law judge of that office shall conduct the hearing.

(a-1) The department shall[:

[(1) set a hearing;

[(2)] give written notice of the hearing to the person[; and

[(3) designate a hearings examiner to conduct the hearing].

(b) The administrative law judge [hearings examiner] shall make findings of fact and conclusions of law and shall promptly issue to the department [commissioner or the commissioner's designee] a proposal for decision as to the occurrence of the violation and a recommendation as to the amount of the proposed penalty if a penalty is determined to be warranted.

(c) Based on the findings of fact and conclusions of law and the recommendations of the administrative law judge [hearings examiner], the department [commissioner or the commissioner's designee] by order may find that a violation has occurred and may assess a penalty or may find that no violation has occurred.

SECTION 3.0409. Sections 142.018(a) and (b), Health and Safety Code, are amended to read as follows:

(a) In this section, "abuse," "exploitation," and "neglect" have the meanings applicable through a rule adopted by the executive commissioner [of the Health and Human Services Commission] under Section 48.002(c), Human Resources Code, except that if the executive commissioner has not adopted applicable rules under that section, the statutory definitions of those terms under Section 48.002(a), Human Resources Code, shall be used.

(b) A home and community support services agency that has cause to believe that a person receiving services from the agency has been abused, exploited, or neglected by an employee of the agency shall report the information to:

(1) the department; and

(2) the Department of Family and Protective [and Regulatory] Services or other appropriate state agency as required by Section 48.051, Human Resources Code.

SECTION 3.0410. Section 142.021, Health and Safety Code, is amended to read as follows:

Sec. 142.021. ADMINISTRATION OF MEDICATION. A person may not administer medication to a client of a home and community support services agency unless the person:

(1) holds a license under state law that authorizes the person to administer medication;

(2) holds a permit issued under Section 142.025 and acts under the delegated authority of a person who holds a license under state law that authorizes the person to administer medication;

(3) administers a medication to a client of a home and community support service agency in accordance with rules of the Texas Board of Nursing that permit delegation of the administration of medication to a person not holding a permit under Section 142.025; or

(4) administers noninjectable medication under circumstances authorized by the memorandum of understanding executed by the department and the Texas Board of Nursing [adopted under Section 142.016].

SECTION 3.0411. Section 142.023, Health and Safety Code, is amended to read as follows:

Sec. 142.023. RULES FOR ADMINISTRATION OF MEDICATION. The executive commissioner [board] by rule shall establish:

(1) minimum requirements for the issuance, denial, renewal, suspension, emergency suspension, and revocation of a permit to a home health medication aide;

(2) curricula to train a home health medication aide;

(3) minimum standards for the approval of home health medication aide training programs and for rescinding approval;

(4) the acts and practices that are allowed or prohibited to a permit holder; and

(5) minimum standards for on-site supervision of a permit holder by a registered nurse.

SECTION 3.0412. Section 142.024(a), Health and Safety Code, is amended to read as follows:

(a) An application for the approval of a home health medication aide training program must be made to the department on a form prescribed by the department and under department rules [prescribed by the board].

SECTION 3.0413. Sections 142.025(a) and (d), Health and Safety Code, are amended to read as follows:

(a) To be issued or to have renewed a home health medication aide permit, a person shall apply to the department on a form prescribed by the department and under department rules [adopted by the board].

(d) The department shall issue a permit or renew a permit to an applicant who:

(1) meets the minimum requirements adopted under Section 142.023;

(2) successfully completes the examination or the continuing education requirements; and

(3) pays a nonrefundable application fee specified in department rules [determined by the board].

SECTION 3.0414. Section 142.026(a), Health and Safety Code, is amended to read as follows:

(a) The executive commissioner by rule [board] shall set the fees in amounts reasonable and necessary to recover the amount projected by the department as required to administer its functions under this subchapter. The fees may not exceed:

(1) $25 for a combined permit application and examination fee; and

(2) $15 for a renewal permit application fee.

SECTION 3.0415. Section 144.013(f), Health and Safety Code, is amended to read as follows:

(f) If the department denies an application twice, the application is canceled. The applicant is entitled to a hearing [before the commissioner] on the denial if the applicant requests the hearing not later than the 30th day after the date of the second denial.

SECTION 3.0416. Section 144.021(b), Health and Safety Code, is amended to read as follows:

(b) As a condition of licensure, the department, in accordance with department rules, may prescribe other reasonable and appropriate construction, operational, maintenance, and inspection requirements to ensure compliance with this chapter and other applicable rules [of the department].

SECTION 3.0417. Section 144.022(a), Health and Safety Code, is amended to read as follows:

(a) Each licensed rendering establishment, related station, or dead animal hauler shall have a dead animal log that meets the requirements prescribed by [the] department rule. The name of the licensed rendering establishment, related station, or dead animal hauler must be on the front of the log.

SECTION 3.0418. Section 144.026(b), Health and Safety Code, is amended to read as follows:

(b) Liquid waste shall be treated in the manner required by the department and disposed of in a manner approved by [the] department rule.

SECTION 3.0419. Section 144.043(e), Health and Safety Code, is amended to read as follows:

(e) If the department denies an application twice, the application is canceled. The applicant is entitled to a hearing [before the commissioner] on the denial if the applicant requests the hearing not later than the 30th day after the date of the second denial.

SECTION 3.0420. Sections 144.063(b) and (c), Health and Safety Code, are amended to read as follows:

(b) The term of a [An operating] license issued under this chapter is two years [is valid for one year and may be renewed annually by the license holder]. The executive commissioner by rule [department] shall set a [an annual] renewal fee.

(c) A license holder may renew a license by paying the renewal fee to the department on or before the expiration date of the license [January 1 of each year]. On receipt of the fee, the license is automatically renewed [for the next calendar year].

SECTION 3.0421. Section 144.064, Health and Safety Code, is amended to read as follows:

Sec. 144.064. DENIAL, SUSPENSION, OR REVOCATION OF LICENSE OR PERMIT; REINSTATEMENT. (a) The department [commissioner] may deny, suspend, or revoke an operating license, construction permit, or renewal of an operating license or construction permit if the department [commissioner] finds that:

(1) the license holder or permit holder has violated this chapter or a rule or order adopted under this chapter or did not exercise due care to prevent the violation; or

(2) a fact or condition exists that would have justified the denial of the license or permit application if the fact or condition was known at the time the original application was filed.

(b) On the discovery of such a violation, the department [commissioner] shall notify the license holder or permit holder of the violation. If the license holder or permit holder fails to make the necessary corrections, the department shall notify the license holder or permit holder of a hearing to suspend or revoke the license or permit.

(c) The department [commissioner] may reinstate a suspended license or permit, or may issue a new license or permit to a person whose license or permit has been revoked, if a ground to deny the original license or permit application does not exist.

SECTION 3.0422. Section 144.072(e), Health and Safety Code, is amended to read as follows:

(e) The executive commissioner [department] by rule shall set the fees authorized by this chapter in amounts that allow the department to recover the annual expenditures of state funds by the department in:

(1) reviewing and acting on a license renewal or registration;

(2) amending a license, renewal license, or registration;

(3) inspecting a licensed facility or vehicles and equipment regulated under this chapter; and

(4) implementing and enforcing this chapter, including a rule or order adopted or a license issued under this chapter.

SECTION 3.0423. Section 144.073, Health and Safety Code, is amended to read as follows:

Sec. 144.073. FEES [ACCOUNT]. All fees collected under this chapter are payable to the department and shall be deposited to the credit of the [rendering fee account in the] general revenue fund[. Money in the account may be appropriated only to the department] to be used to process and investigate applications filed under this chapter and to administer this chapter.

SECTION 3.0424. Section 144.074, Health and Safety Code, is amended to read as follows:

Sec. 144.074. ADOPTION OF RULES. The executive commissioner [board] may adopt rules consistent with this chapter as necessary for the enforcement of this chapter.

SECTION 3.0425. Section 144.076, Health and Safety Code, is amended to read as follows:

Sec. 144.076. PUBLIC RECORDS. The transcript of any hearing held by the State Office of Administrative Hearings [commissioner] and findings made by the administrative law judge [commissioner] or the department under this chapter are public records open to inspection at all reasonable times.

SECTION 3.0426. Sections 144.081(a) and (b), Health and Safety Code, are amended to read as follows:

(a) The department [commissioner] may assess an administrative penalty against a person who violates this chapter, a rule adopted [by the board] under the authority of this chapter, or an order or license issued under this chapter.

(b) In determining the amount of the penalty, the department [commissioner] shall consider:

(1) the person's previous violations;

(2) the seriousness of the violation;

(3) any hazard to the health and safety of the public;

(4) the person's demonstrated good faith; and

(5) such other matters as justice may require.

SECTION 3.0427. Sections 144.082(b), (c), and (d), Health and Safety Code, are amended to read as follows:

(b) If a hearing is held, the administrative law judge [commissioner] shall make findings of fact and shall issue a written proposal for decision regarding the occurrence of the violation and the amount of the penalty that may be warranted.

(c) If the person notified of the violation does not request a hearing, the department [commissioner] may assess a penalty after determining that a violation has occurred and the amount of the penalty that may be warranted.

(d) After making a determination under this section that a penalty is to be assessed against a person, the department [commissioner] shall issue an order requiring that the person pay the penalty.

SECTION 3.0428. Section 144.083, Health and Safety Code, is amended to read as follows:

Sec. 144.083. PAYMENT OF ADMINISTRATIVE PENALTY. (a) Not later than the 30th day after the date an order finding that a violation has occurred is issued, the department [commissioner] shall inform the person against whom the order is issued of the amount of the penalty for the violation.

(b) Not later than the 30th day after the date on which a decision or order charging a person with a penalty is final, the person shall:

(1) pay the penalty in full; or

(2) file a petition for [if the person seeks] judicial review of the department's order contesting the amount of the penalty, the fact of the violation, or both.

(b-1) Within the period prescribed by Subsection (b), a person who files a petition for judicial review may:

(1) stay enforcement of the penalty by:

(A) paying [send the amount of] the penalty to the court [commissioner] for placement in an escrow account; or

(B) posting [post] with the court [commissioner] a supersedeas bond for the amount of the penalty; or

(2) request that the department stay enforcement of the penalty by:

(A) filing with the court a sworn affidavit of the person stating that the person is financially unable to pay the penalty and is financially unable to give the supersedeas bond; and

(B) sending a copy of the affidavit to the department.

(b-2) If the department receives a copy of an affidavit under Subsection (b-1)(2), the department may file with the court, within five days after the date the copy is received, a contest to the affidavit. The court shall hold a hearing on the facts alleged in the affidavit as soon as practicable and shall stay the enforcement of the penalty on finding that the alleged facts are true. The person who files an affidavit has the burden of proving that the person is financially unable to pay the penalty or to give a supersedeas bond.

(c) A bond posted under this section must be in a form approved by the court [commissioner] and be effective until all judicial review of the order or decision is final.

(d) A person who does not send money to, [the commissioner or] post the bond with, or file the affidavit with the court within the period prescribed by Subsection (b) waives all rights to contest the violation or the amount of the penalty.

SECTION 3.0429. Section 144.084, Health and Safety Code, is amended to read as follows:

Sec. 144.084. REFUND OF ADMINISTRATIVE PENALTY. On [Not later than the 30th day after] the date the court's judgment [of a judicial determination] that an administrative penalty against a person should be reduced or not assessed becomes final, the court [commissioner] shall order that:

(1) [remit to the person] the appropriate amount of any penalty payment plus accrued interest be remitted to the person not later than the 30th day after that date; or

(2) [execute a release of] the bond be released, if the person has posted a bond.

SECTION 3.0430. Section 144.085, Health and Safety Code, is amended to read as follows:

Sec. 144.085. RECOVERY OF ADMINISTRATIVE PENALTY BY ATTORNEY GENERAL. The attorney general at the request of the department [commissioner] may bring a civil action to recover an administrative penalty under this subchapter.

SECTION 3.0431. Section 145.004(b), Health and Safety Code, is amended to read as follows:

(b) The department [Texas Department of Health] may enforce Chapter 431 against a person who adulterates or misbrands a tanning device. The department may investigate a person accused of adulterating or misbranding a tanning device. For the purposes of this subsection, a tanning device is adulterated or misbranded if the tanning device would be an adulterated or misbranded device under Section 431.111 or 431.112[, Health and Safety Code].

SECTION 3.0432. Section 145.006, Health and Safety Code, is amended to read as follows:

Sec. 145.006. WARNING SIGNS. (a) A tanning facility shall post a warning sign in a conspicuous location where it is readily visible by persons entering the establishment. The executive commissioner [board] by rule shall specify the size, design, and graphic design of the sign. The sign must have dimensions of at least 11 inches by 17 inches and must contain the following wording:

Repeated exposure to ultraviolet radiation may cause chronic sun damage characterized by wrinkling, dryness, fragility, bruising of the skin, and skin cancer.

DANGER: ULTRAVIOLET RADIATION

Failure to use protective eyewear may result in severe burns or permanent injury to the eyes.

Medications or cosmetics may increase your sensitivity to ultraviolet radiation. Consult a physician before using a sunlamp if you are using medications, have a history of skin problems, or believe you are especially sensitive to sunlight. Pregnant women or women taking oral contraceptives who use this product may develop discolored skin.

A customer may call the [Texas] Department of State Health Services at (insert toll-free telephone number) to report an alleged injury regarding this tanning facility.

IF YOU DO NOT TAN IN THE SUN, YOU ARE UNLIKELY TO TAN FROM USE OF AN

ULTRAVIOLET LAMP OR SUNLAMP.

(b) A tanning facility operator shall also post a warning sign at each tanning device in a conspicuous location that is readily visible to a person about to use the device. The executive commissioner [board] by rule shall specify the size, design, and graphic design of the sign. The sign must have dimensions of at least 11 inches by 17 inches and must contain the following wording:

DANGER: ULTRAVIOLET RADIATION

1. Follow the manufacturer's instructions for use of this device.

2. Avoid too frequent or lengthy exposure. As with natural sunlight, exposure can cause serious eye and skin injuries and allergic reactions. Repeated exposure may cause skin cancer.

3. Wear protective eyewear. Failure to use protective eyewear may result in severe burns or permanent damage to the eyes.

4. Do not sunbathe before or after exposure to ultraviolet radiation from sunlamps.

5. Medications or cosmetics may increase your sensitivity to ultraviolet radiation. Consult a physician before using a sunlamp if you are using medication, have a history of skin problems, or believe you are especially sensitive to sunlight. Pregnant women or women using oral contraceptives who use this product may develop discolored skin.

A customer may call the [Texas] Department of State Health Services at (insert toll-free telephone number) to report an alleged injury regarding this tanning device.

IF YOU DO NOT TAN IN THE SUN, YOU ARE UNLIKELY TO TAN FROM USE OF

THIS DEVICE.

(c) The department [Texas Department of Health] shall include with a license application and an application for renewal of a license a description of the design standards required for signs under this section.

SECTION 3.0433. Sections 145.008(i), (j), and (k), Health and Safety Code, are amended to read as follows:

(i) A record of each customer using a tanning device shall be maintained at the tanning facility at least until the third anniversary of the date of the customer's last use of a tanning device. The executive commissioner [of the Health and Human Services Commission] by rule shall prescribe the form and content of the records. The record shall include:

(1) the date and time of the customer's use of a tanning device;

(2) the length of time the tanning device was used;

(3) any injury or illness resulting from the use of a tanning device;

(4) any written informed consent statement required to be signed under Subsection (e);

(5) the customer's skin type, as determined by the customer by using the Fitzpatrick scale for classifying a skin type;

(6) whether the customer has a family history of skin cancer; and

(7) whether the customer has a past medical history of skin cancer.

(j) An operator shall keep an incident log at each tanning facility. The log shall be maintained at the tanning facility at least until the third anniversary of the date of an incident. The executive commissioner [board] by rule shall prescribe the form and content of the log. The log shall include each:

(1) alleged injury;

(2) use of a tanning device by a customer not wearing protective eyewear;

(3) mechanical problem with a tanning device; and

(4) customer complaint.

(k) The department [Texas Department of Health] shall provide to each applicant for an original or renewal license a written copy of the Fitzpatrick scale.

SECTION 3.0434. Sections 145.009(a), (c), (d), and (e), Health and Safety Code, are amended to read as follows:

(a) A person may not operate a tanning facility unless the person holds a license issued by the department to operate the facility. Unless revoked or suspended, a license is valid until the second [first] anniversary of the date the license was issued. A separate license is required for each tanning facility.

(c) The department [board annually] shall renew licenses after application for renewal is made on forms provided by the department for this purpose and after receipt of renewal fees.

(d) The executive commissioner [department] by rule may adopt a system under which licenses expire on various dates during the year. As part of this system the license fees and [the annual] renewal fees may be prorated on a monthly basis to reflect the actual number of months the license is valid.

(e) The department may revoke, suspend, suspend on an emergency basis, or probate by an emergency order of the commissioner, or the commissioner's designee, a license to operate a tanning facility for:

(1) a failure to pay a license fee or [an annual] renewal fee for a license;

(2) an applicant's acquisition or attempted acquisition of a license by fraud or deception;

(3) a violation of this chapter;

(4) a violation of a rule of the department adopted under this chapter; or

(5) a violation of an order issued under this chapter.

SECTION 3.0435. Sections 145.010(a), (b), (c), and (e), Health and Safety Code, are amended to read as follows:

(a) The department [board] shall collect a fee for:

(1) a license issued or renewed; or

(2) a license that is modified.

(b) The department [board] may charge prorated [or annual] fees.

(c) The executive commissioner [board] by rule shall set the fees for issuance or renewal of a license in the amounts prescribed by Section 12.0111 and for modification of a license in an amount [in amounts] that allows [allow] the department to recover not less than 50 percent of the costs to the department in:

(1) reviewing and acting on a license application;

(2) modifying [or renewing] a license;

(3) inspecting a licensed facility; and

(4) implementing and enforcing this chapter or rules relating to this chapter.

(e) A license fee received by the department shall be deposited in the state treasury to the credit of the food and drug registration account in the general revenue fund. The fees are dedicated to the department for the administration and enforcement of this chapter.

SECTION 3.0436. Section 145.011(a), Health and Safety Code, is amended to read as follows:

(a) The executive commissioner [board] may adopt rules as necessary to implement this chapter.

SECTION 3.0437. Section 145.012(c), Health and Safety Code, is amended to read as follows:

(c) If an emergency order is issued without a hearing, the department shall refer the matter to the State Office of Administrative Hearings. An administrative law judge of that office shall determine a time and place for a hearing and hold the hearing [at which the emergency order is affirmed, modified, or set aside]. The hearing shall be held under rules of the department.

SECTION 3.0438. Sections 145.0121(a) and (f), Health and Safety Code, are amended to read as follows:

(a) If it appears that a person has violated or is violating this chapter or an order issued or a rule adopted under this chapter, the department [commissioner] may request the attorney general or the district or county attorney or the municipal attorney of a municipality in the jurisdiction where the violation is alleged to have occurred or may occur to institute a civil suit for:

(1) an order enjoining the violation;

(2) a permanent or temporary injunction, a temporary restraining order, or other appropriate remedy if the department shows that the person has engaged in or is engaging in a violation;

(3) the assessment and recovery of a civil penalty; or

(4) both injunctive relief and a civil penalty.

(f) The department [commissioner] or the attorney general may each recover reasonable expenses incurred in obtaining injunctive relief or a civil penalty under this section, including investigation and court costs, reasonable attorney's fees, witness fees, and other expenses. The expenses recovered by the department [commissioner] under this section shall be used for the administration and enforcement of this chapter. The expenses recovered by the attorney general shall be used by the attorney general.

SECTION 3.0439. Sections 145.0122(a), (d), (e), (f), (g), (h), (i), (j), (k), (l), (m), and (n), Health and Safety Code, are amended to read as follows:

(a) The department [board or the board's designee] may impose an administrative penalty against a person licensed or regulated under this chapter who violates this chapter or a rule or order adopted under this chapter.

(d) If the department [commissioner or the commissioner's designee] determines a violation has occurred, the department shall give to the person written notice [commissioner or the commissioner's designee may issue to the board or the board's designee a report] that states the facts on which the determination is based and the department's [commissioner's or the designee's] recommendation on the imposition of a penalty[, including a recommendation on the amount of the penalty].

[(e) Within 14 days after the date the report is issued, the commissioner or the commissioner's designee shall give written notice of the report to the person.] The notice may be given by certified mail. The notice must include a brief summary of the alleged violation and a statement of the amount of the recommended penalty and must inform the person that the person has a right to a hearing on the occurrence of the violation, the amount of the penalty, or both the occurrence of the violation and the amount of the penalty.

(f) Within 20 days after the date the person receives the notice, the person in writing may accept the determination and recommended penalty of the department [commissioner or the commissioner's designee] or may make a written request for a hearing on the occurrence of the violation, the amount of the penalty, or both the occurrence of the violation and the amount of the penalty.

(g) If the person accepts the determination and recommended penalty of the department [commissioner or the commissioner's designee], the department [board] by order shall [approve the determination and] impose the recommended penalty.

(h) If the person requests a hearing or fails to respond timely to the notice, the department shall refer the matter to the State Office of Administrative Hearings [commissioner or the commissioner's designee shall set a hearing] and shall give notice of the hearing to the person. The hearing shall be held by an administrative law judge of that office [the department]. The administrative law judge shall make findings of fact and conclusions of law and promptly issue to the department [board] a written proposal for a decision about the occurrence of the violation and the amount of a proposed penalty. Based on the findings of fact, conclusions of law, and proposal for a decision, the department [board] by order may find that a violation has occurred and impose a penalty or may find that no violation occurred.

(i) The notice of the department's [board's] order given to the person under Chapter 2001, Government Code, must include a statement of the right of the person to judicial review of the order.

(j) Within 30 days after the date the department's [board's] order becomes final as provided by Section 2001.144, Government Code, the person shall:

(1) pay the amount of the penalty;

(2) pay the amount of the penalty and file a petition for judicial review contesting the occurrence of the violation, the amount of the penalty, or both the occurrence of the violation and the amount of the penalty; or

(3) without paying the amount of the penalty, file a petition for judicial review in a district court in Travis County contesting the occurrence of the violation, the amount of the penalty, or both the occurrence of the violation and the amount of the penalty.

(k) Within the 30-day period, a person who acts under Subsection (j)(3) may:

(1) stay enforcement of the penalty by:

(A) paying the amount of the penalty to the court for placement in an escrow account; or

(B) giving to the court a supersedeas bond that is approved by the court for the amount of the penalty and that is effective until all judicial review of the department's [board's] order is final; or

(2) request the court to stay enforcement of the penalty by:

(A) filing with the court a sworn affidavit of the person stating that the person is financially unable to pay the amount of the penalty and is financially unable to give the supersedeas bond; and

(B) giving a copy of the affidavit to the department [commissioner] by certified mail.

(l) If the department [commissioner] receives a copy of an affidavit under Subsection (k)(2), the department [commissioner] may file with the court, not later than the fifth day after the date the copy is received, a contest to the affidavit. The court shall hold a hearing on the facts alleged in the affidavit as soon as practicable and shall stay the enforcement of the penalty on finding that the alleged facts are true. The person who files an affidavit has the burden of proving that the person is financially unable to pay the amount of the penalty and give a supersedeas bond.

(m) If the person does not pay the amount of the penalty and the enforcement of the penalty is not stayed, the department [commissioner] may refer the matter to the attorney general for collection of the amount of the penalty.

(n) Judicial review of the department's order [of the board]:

(1) is instituted by filing a petition as provided by Subchapter G, Chapter 2001, Government Code; and

(2) is under the substantial evidence rule.

SECTION 3.0440. Section 146.0025(a), Health and Safety Code, is amended to read as follows:

(a) This chapter does not apply to:

(1) a medical facility licensed under other law;

(2) an office or clinic of a person licensed by the Texas [State Board of] Medical Board [Examiners];

(3) a person who performs only ear piercing; or

(4) a facility in which only ear piercing is performed.

SECTION 3.0441. Section 146.003(b), Health and Safety Code, as amended by Chapters 516 (S.B. 61) and 1528 (S.B. 932), Acts of the 76th Legislature, Regular Session, 1999, is reenacted to read as follows:

(b) The department may issue a license or temporary location license for a tattoo or body piercing studio after determining that the studio is in compliance with applicable statutes, rules, and zoning codes.

SECTION 3.0442. Section 146.004, Health and Safety Code, is amended to read as follows:

Sec. 146.004. LICENSE TERM; RENEWAL. (a) A tattoo studio or body piercing studio license is valid for two years [one year] from the date of issuance. A temporary tattooing or body piercing location license is valid for a specified period not to exceed seven days.

(b) A tattoo studio or body piercing studio license may be renewed [annually] on payment of the required renewal fee.

SECTION 3.0443. Section 146.0041(a), Health and Safety Code, is amended to read as follows:

(a) The department may refuse to issue an original or renewal tattoo studio or body piercing studio license if it has reasonable grounds to believe and finds that any of the following circumstances exist:

(1) the applicant has been convicted of a violation of this chapter during the two years immediately preceding the filing of the application;

(2) three years have not elapsed since the termination, by pardon or otherwise, of a sentence imposed on the applicant for a conviction associated with tattooing or body piercing;

(3) the applicant violated or caused to be violated a provision of this chapter or a rule [of the department] adopted under this chapter involving moral turpitude during the six months immediately preceding the filing of the application;

(4) the applicant failed to answer or falsely or incorrectly answered a question in an original or renewal application;

(5) the applicant is indebted to the state for a fee or penalty imposed by this chapter or by rule [of the department] adopted under this chapter;

(6) the applicant is a minor; or

(7) the applicant does not provide an adequate building available at the address for which the license is sought before conducting any activity authorized by the license.

SECTION 3.0444. Section 146.0042(b), Health and Safety Code, is amended to read as follows:

(b) The department may suspend for not more than 60 days or revoke an original or renewal tattoo studio or body piercing studio license if it is found, after notice and hearing, that any of the following is true:

(1) the license holder has been finally convicted of a violation of this chapter;

(2) the license holder violated a provision of this chapter or a rule [of the department] adopted under this chapter;

(3) the license holder made a false or misleading statement in connection with the original or renewal application, either in the formal application itself or in any other written instrument relating to the application submitted to the department;

(4) the license holder is indebted to the state for fees or payment of penalties imposed by this chapter or by a rule [of the department] adopted under this chapter;

(5) the license holder knowingly misrepresented to a customer or the public any tattoo or body piercing jewelry sold by the license holder; or

(6) the license holder was intoxicated on the licensed premises.

SECTION 3.0445. Section 146.005, Health and Safety Code, is amended to read as follows:

Sec. 146.005. FEES. [(a)] The executive commissioner by rule [board] shall set license and registration fees and license and registration renewal fees in amounts necessary for the department to administer this chapter.

[(b) Fees collected under this section may only be appropriated to the department to administer and enforce this chapter.]

SECTION 3.0446. Section 146.007(b), Health and Safety Code, is amended to read as follows:

(b) The [board, commissioner, and] department may enforce Chapter 431 in relation to a drug, cosmetic, or device that is used in tattooing and that is not otherwise subject to that chapter as if the drug, cosmetic, or device satisfied the definitions assigned those terms under Section 431.002.

SECTION 3.0447. Section 146.010(a), Health and Safety Code, is amended to read as follows:

(a) The executive commissioner [board] by rule shall establish sanitation requirements for tattoo and body piercing studios and any other necessary requirements relating to the building or part of the building in which a tattoo or body piercing studio is located.

SECTION 3.0448. Section 146.013(a), Health and Safety Code, is amended to read as follows:

(a) A tattooist shall maintain a permanent record of each person tattooed by the tattooist for a period established by department rule [the board]. A person who performs body piercing shall maintain a permanent record of each individual whose body is pierced by the person for a period established by department rule [the board].

SECTION 3.0449. Section 146.015(a), Health and Safety Code, is amended to read as follows:

(a) The executive commissioner [board] shall adopt rules to implement this chapter.

SECTION 3.0450. Section 146.017(b), Health and Safety Code, is amended to read as follows:

(b) The refusal to issue a license, the suspension or revocation of a license, and any appeals are governed by the department's [board's] formal hearing procedures and the procedures for a contested case hearing under Chapter 2001, Government Code. A person may appeal a final decision of the department as provided by that chapter.

SECTION 3.0451. Sections 146.019(a), (d), (e), (f), (g), (h), (i), (j), (k), (l), (m), and (n), Health and Safety Code, are amended to read as follows:

(a) The department [commissioner] may impose an administrative penalty against a person who violates a rule adopted under Section 146.007 or an order adopted or license issued under this chapter.

(d) The department [commissioner who determines that a violation has occurred] shall issue an order that states the facts on which a [the] determination that a violation occurred is based, including an assessment of the penalty.

(e) The department [Within 14 days after the date the report is issued, the commissioner] shall give written notice of the order [report] to the person. The notice may be given by certified mail. The notice must include a brief summary of the alleged violation and a statement of the amount of the recommended penalty and must inform the person that the person has a right to a hearing on the occurrence of the violation, the amount of the penalty, or both the occurrence of the violation and the amount of the penalty.

(f) Within 20 days after the date the person receives the notice, the person in writing may accept the determination and recommended penalty of the department [commissioner] or may make written request for a hearing on the occurrence of the violation, the amount of the penalty, or both the occurrence of the violation and the amount of the penalty.

(g) If the person accepts the determination and recommended penalty of the department [commissioner], the department [commissioner] by order shall [approve the determination and] impose the recommended penalty.

(h) If the person requests a hearing or fails to respond timely to the notice, the department [commissioner] shall refer the case to the State Office of Administrative Hearings and [set a hearing and give notice of the hearing to the person. The hearing shall be held by] an administrative law judge of that office shall hold the hearing. The department shall give written notice of the hearing to the person [the State Office of Administrative Hearings]. The administrative law judge shall make findings of fact and conclusions of law and promptly issue to the department [commissioner] a proposal for a decision about the occurrence of the violation and the amount of a proposed penalty. Based on the findings of fact, conclusions of law, and proposal for a decision, the department [commissioner] by order may find that a violation has occurred and impose a penalty or may find that no violation occurred.

(i) The notice of the department's [commissioner's] order given to the person under Chapter 2001, Government Code, must include a statement of the right of the person to judicial review of the order.

(j) Within 30 days after the date the department's [commissioner's] order is final as provided by Subchapter F, Chapter 2001, Government Code, the person shall:

(1) pay the amount of the penalty;

(2) pay the amount of the penalty and file a petition for judicial review contesting the occurrence of the violation, the amount of the penalty, or both the occurrence of the violation and the amount of the penalty; 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 the occurrence of the violation and the amount of the penalty.

(k) Within the 30-day period, a person who acts under Subsection (j)(3) [of this section] may:

(1) stay enforcement of the penalty by:

(A) paying the amount of the penalty to the court for placement in an escrow account; or

(B) giving to the court a supersedeas bond approved by the court for the amount of the penalty and that is effective until all judicial review of the department's [commissioner's] order is final; or

(2) request the court to stay enforcement of the penalty by:

(A) filing with the court a sworn affidavit of the person stating that the person is financially unable to pay the amount of the penalty and is financially unable to give the supersedeas bond; and

(B) giving a copy of the affidavit to the department [commissioner] by certified mail.

(l) The department on receipt of [commissioner who receives] a copy of an affidavit under Subsection (k)(2) [of this section] may file, with the court within five days after the date the copy is received, a contest to the affidavit. The court shall hold a hearing on the facts alleged in the affidavit as soon as practicable and shall stay the enforcement of the penalty on finding that the alleged facts are true. The person who files an affidavit has the burden of proving that the person is financially unable to pay the amount of the penalty and to give a supersedeas bond.

(m) If the person does not pay the amount of the penalty and the enforcement of the penalty is not stayed, the department [commissioner] may refer the matter to the attorney general for collection of the amount of the penalty.

(n) Judicial review of the order of the department [commissioner]:

(1) is instituted by filing a petition as provided by Subchapter G, Chapter 2001, Government Code [and its subsequent amendments]; and

(2) is under the substantial evidence rule.

SECTION 3.0452. Section 146.024, Health and Safety Code, is amended to read as follows:

Sec. 146.024. REGISTRATION TERM; RENEWAL. (a) A tattooist or body piercer registration is valid for two years [one year] from the date of issuance.

(b) A tattooist or body piercer registration may be renewed [annually] on:

(1) payment of the required renewal fee; and

(2) submission of proof of completion of a training course approved by the department that includes not less than four hours related to bloodborne pathogens, infection control, and aseptic technique.

SECTION 3.0453. Sections 146.025(b) and (d), Health and Safety Code, are amended to read as follows:

(b) The department may approve a course of instruction based on any standards set by the executive commissioner [department] to reasonably ensure that a tattooist or body piercer develops the job skills and knowledge necessary to protect public health and safety.

(d) The executive commissioner [department] by rule shall set a fee in an amount reasonable and necessary to cover the cost to the department of reviewing the course content and issuing the approval.

SECTION 3.0454. Section 161.001(a), Health and Safety Code, is amended to read as follows:

(a) A person who administers or authorizes the administration of a vaccine or immunizing agent is not liable for an injury caused by the vaccine or immunizing agent if the immunization is required by department rule [the board] or is otherwise required by law or other rules [rule].

SECTION 3.0455. Sections 161.004(a) and (f), Health and Safety Code, are amended to read as follows:

(a) Every child in the state shall be immunized against vaccine preventable diseases caused by infectious agents in accordance with the immunization schedule adopted in department rules [by the board].

(f) The executive commissioner [board] shall adopt rules that are necessary to administer this section.

SECTION 3.0456. Sections 161.005(a) and (b), Health and Safety Code, are amended to read as follows:

(a) On admission of a child to a mental health facility of the department, a state supported living center of the [Texas] Department of Aging and Disability Services, or a facility of [Mental Health and Mental Retardation,] the Texas Department of Criminal Justice[,] or the Texas Juvenile Justice Department [Youth Commission], the facility physician shall review the immunization history of the child and administer any needed vaccinations or refer the child for immunization.

(b) The department and the executive commissioner [board] have the same powers and duties under this section as the department and the executive commissioner [those entities] have under Sections 38.001 and 51.933, Education Code. In addition, the provisions of those sections relating to provisional admissions and exceptions apply to this section.

SECTION 3.0457. Sections 161.0051(b) and (c), Health and Safety Code, are amended to read as follows:

(b) The executive commissioner [board] by rule may require nursing facilities [homes] to offer, in accordance with an immunization schedule adopted in department rules [by the board], immunizations to elderly residents or to staff who are in contact with elderly residents against diseases that the executive commissioner [board] determines to be:

(1) caused by infectious agents;

(2) potentially deadly; and

(3) preventable by vaccine.

(c) The executive commissioner [board] by rule shall require nursing homes to offer, in accordance with an immunization schedule adopted in department rules [by the board]:

(1) pneumococcal vaccine to elderly residents; and

(2) influenza vaccine to elderly residents and to staff who are in contact with elderly residents.

SECTION 3.0458. Sections 161.0052(b), (c), (d), (f), and (h), Health and Safety Code, are amended to read as follows:

(b) The executive commissioner [of the Health and Human Services Commission] by rule shall require a hospital to inform each elderly person admitted to the hospital for a period of 24 hours or more that the pneumococcal and influenza vaccines are available. If the elderly person requests a vaccine, and if a physician, or an advanced nurse practitioner or physician assistant on behalf of a physician, determines that the vaccine is in the person's best interest, the hospital must make the vaccination available to the person before the person is discharged from the hospital.

(c) The executive commissioner [of the Health and Human Services Commission] by rule shall require an end stage renal disease facility to offer, to the extent possible as determined by the facility, the opportunity to receive the pneumococcal and influenza vaccines to each elderly person who receives ongoing care at the facility if a physician, or an advanced nurse practitioner or physician assistant on behalf of a physician, determines that the vaccine is in the person's best interest. If the facility decides it is not feasible to offer the vaccine, the facility must provide the person with information on other options for obtaining the vaccine.

(d) The Texas [State Board of] Medical Board [Examiners] by rule shall require a physician responsible for the management of a physician's office that provides ongoing medical care to elderly persons to offer, to the extent possible as determined by the physician, the opportunity to receive the pneumococcal and influenza vaccines to each elderly person who receives ongoing care at the office. If the physician decides it is not feasible to offer the vaccine, the physician must provide the person with information on other options for obtaining the vaccine.

(f) In adopting rules under this section, the executive commissioner [of the Health and Human Services Commission] and the Texas [State Board of] Medical Board [Examiners] shall consider the recommendations of the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention.

(h) The department shall make available to hospitals and end stage renal disease facilities, and the Texas [State Board of] Medical Board [Examiners] shall make available to physicians' offices, educational and informational materials concerning vaccination against influenza virus and pneumococcal disease.

SECTION 3.0459. Sections 161.007(a), (a-3), and (k), Health and Safety Code, are amended to read as follows:

(a) The department, for the primary purpose of establishing and maintaining a single repository of accurate, complete, and current immunization records to be used in aiding, coordinating, and promoting efficient and cost-effective communicable disease prevention and control efforts, shall establish and maintain an immunization registry. The executive commissioner [of the Health and Human Services Commission] by rule shall develop guidelines to:

(1) protect the confidentiality of patients in accordance with Section 159.002, Occupations Code;

(2) inform the individual or the individual's legally authorized representative about the registry and that registry information may be released under Section 161.00735;

(3) require the written or electronic consent of the individual or the individual's legally authorized representative before any information relating to the individual is included in the registry;

(4) permit the individual or the individual's legally authorized representative to withdraw consent for the individual to be included in the registry; and

(5) determine the process by which consent is verified, including affirmation by a health care provider, birth registrar, regional health information exchange, or local immunization registry that consent has been obtained.

(a-3) The executive commissioner [of the Health and Human Services Commission] by rule shall develop guidelines and procedures for obtaining consent from an individual after the individual's 18th birthday, including procedures for retaining immunization information in a separate database that is inaccessible by any person other than the department during the one-year period during which an 18-year-old may consent to inclusion in the registry under Subsection (a-2).

(k) The executive commissioner [of the Health and Human Services Commission] shall adopt rules to implement this section.

SECTION 3.0460. Sections 161.00705(e) and (i), Health and Safety Code, are amended to read as follows:

(e) The executive commissioner [of the Health and Human Services Commission] by rule shall determine the period during which the information collected under this section must remain in the immunization registry following the end of the disaster, public health emergency, terrorist attack, hostile military or paramilitary action, or extraordinary law enforcement emergency.

(i) The executive commissioner [of the Health and Human Services Commission] shall adopt rules necessary to implement this section.

SECTION 3.0461. Section 161.00706(c), Health and Safety Code, is amended to read as follows:

(c) The executive commissioner [of the Health and Human Services Commission] shall:

(1) develop rules to ensure that immunization history submitted under Subsection (a)(2) is medically verified immunization information;

(2) develop guidelines for use by the department in informing first responders about the registry and that registry information may be released under Section 161.00735; and

(3) adopt rules necessary for the implementation of this section.

SECTION 3.0462. Section 161.0072(c), Health and Safety Code, is amended to read as follows:

(c) The executive commissioner [board] shall develop rules to ensure that the immunization history submitted by an individual or the individual's legally authorized representative is medically verified immunization information.

SECTION 3.0463. Sections 161.00735(e) and (h), Health and Safety Code, are amended to read as follows:

(e) The executive commissioner [of the Health and Human Services Commission,] by rule[,] shall determine the period during which the information collected under Subsection (c) must remain in the immunization registry following the end of the disaster.

(h) The executive commissioner [of the Health and Human Services Commission] shall make every effort to enter into a memorandum of agreement with each state to which residents of this state are likely to evacuate in a disaster on:

(1) the release and use of registry information under this section to the appropriate health authority or local health authority of that state, including the length of time the information may be retained by that state; and

(2) the receipt and use of information submitted by the health authority or local health authority of that state for inclusion in the registry under this section.

SECTION 3.0464. Section 161.008(h), Health and Safety Code, is amended to read as follows:

(h) The executive commissioner [of the Health and Human Services Commission] shall adopt rules to implement this section.

SECTION 3.0465. Section 161.0105(c), Health and Safety Code, is amended to read as follows:

(c) The immunity created by this section is in addition to any immunity created by Sections 161.001 and 161.007(i) [161.007(g)].

SECTION 3.0466. Section 161.0107(c), Health and Safety Code, is amended to read as follows:

(c) The executive commissioner [of the Health and Human Services Commission] by rule shall specify:

(1) the fields necessary to populate the immunization registry, including a field that indicates the patient's consent to be listed in the immunization registry has been obtained; and

(2) the data standards that must be used for electronic submission of immunization information.

SECTION 3.0467. Section 161.0109(b), Health and Safety Code, is amended to read as follows:

(b) The department shall collaborate with the Cancer Prevention and Research Institute of Texas [Cancer Council] or its successor entity to develop educational programs for parents regarding human papillomavirus and promoting awareness of a minor's need for preventive services for cervical cancer and its precursors.

SECTION 3.0468. Section 161.021(a), Health and Safety Code, is amended to read as follows:

(a) Unless prohibited by other law, a person, including a hospital, sanatorium, nursing facility [home], rest home, medical society, cancer registry, or other organization, may provide interviews, reports, statements, memoranda, or other information relating to the condition and treatment of any person, to be used in a study to reduce morbidity or mortality or to identify persons who may need immunization, to:

(1) the department;

(2) a person that makes inquiries under immunization surveys conducted for the department;

(3) a medical organization;

(4) a hospital;

(5) a hospital committee; or

(6) a cancer registry, including a cancer registry of a cancer treatment center [as defined by Section 82.002].

SECTION 3.0469. Section 161.0213, Health and Safety Code, is amended to read as follows:

Sec. 161.0213. CONFIDENTIALITY. Reports, records, and information furnished to the commissioner or the commissioner's designee or the Texas [Natural Resource Conservation] Commission on Environmental Quality that relate to an epidemiologic or toxicologic investigation of human illnesses or conditions and of environmental exposures that are harmful or believed to be harmful to the public health are not public information under Chapter 552, Government Code, and are subject to the same confidentiality requirements as described by Section 81.046.

SECTION 3.0470. Sections 161.0315(c) and (e), Health and Safety Code, are amended to read as follows:

(c) A hospital district may require in a contract with a health care facility described by Subsection (b) a provision that allows the governing body of the district to appoint a specified number of members to the facility's medical peer review committee or medical committee to evaluate medical and health care services for which the district contracts with the facility to provide. The governing body of a hospital district may receive a report from the facility's medical peer review committee or medical committee under this section in a closed meeting. A report, information, or a record that the district receives from the facility related to a review action conducted under the terms of the contract is:

(1) confidential;

(2) not subject to disclosure under Chapter 552, Government Code; and

(3) subject to the same confidentiality and disclosure requirements to which a report, information, or record of a medical peer review committee under Section 160.007 [160.006], Occupations Code, is subject.

(e) The governing body of a hospital district may receive a report under Subsection (d)(3) in a closed meeting. A report, information, or a record that the hospital district receives under Subsection (d)(3) is:

(1) confidential;

(2) not subject to disclosure under Chapter 552, Government Code; and

(3) subject to the same confidentiality and disclosure requirements to which a report, information, or record of a medical peer review committee under Section 160.007 [160.006], Occupations Code, is subject.

SECTION 3.0471. Section 161.083(a), Health and Safety Code, is amended to read as follows:

(a) Pursuant to federal regulation under 21 C.F.R. Section 1140.14(b) [897.14(b)], a person may not sell, give, or cause to be sold or given a cigarette or tobacco product to someone who is younger than 27 years of age unless the person to whom the cigarette or tobacco product was sold or given presents an apparently valid proof of identification.

SECTION 3.0472. Section 161.101(c), Health and Safety Code, is amended to read as follows:

(c) The executive commissioner [board] shall adopt rules to implement this section.

SECTION 3.0473. Sections 161.131(1) and (8), Health and Safety Code, are amended to read as follows:

(1) "Abuse" has the meaning assigned by the federal Protection and Advocacy for [Mentally Ill] Individuals with Mental Illness Act [of 1986] (42 U.S.C. Section 10801 et seq.).

(8) "Neglect" has the meaning assigned by the federal Protection and Advocacy for [Mentally Ill] Individuals with Mental Illness Act [of 1986] (42 U.S.C. Section 10801 et seq.).

SECTION 3.0474. Sections 161.132(d) and (f), Health and Safety Code, are amended to read as follows:

(d) The executive commissioner by rule for the department and the Department of Aging and Disability Services, and [Texas Board of Mental Health and Mental Retardation, Texas Board of Health, Texas Commission on Alcohol and Drug Abuse, and] each state health care regulatory agency by rule, shall:

(1) prescribe procedures for the investigation of reports received under Subsection (a) or (b) and for coordination with and referral of reports to law enforcement agencies or other appropriate agencies; and

(2) prescribe follow-up procedures to ensure that a report referred to another agency receives appropriate action.

(f) The executive commissioner by rule and each [Each] state health care regulatory agency by rule shall provide for appropriate disciplinary action against a health care professional licensed by the agency who fails to report as required by this section.

SECTION 3.0475. Section 161.133, Health and Safety Code, is amended to read as follows:

Sec. 161.133. [MEMORANDUM OF UNDERSTANDING ON] INSERVICE TRAINING. (a) The executive commissioner [Texas Board of Mental Health and Mental Retardation, Texas Board of Health, and Texas Commission on Alcohol and Drug Abuse] by rule shall require [adopt a joint memorandum of understanding that requires] each inpatient mental health facility, treatment facility, or hospital that provides comprehensive medical rehabilitation services to annually provide as a condition of continued licensure a minimum of eight hours of inservice training designed to assist employees and health care professionals associated with the facility in identifying patient abuse or neglect and illegal, unprofessional, or unethical conduct by or in the facility.

(b) The rules [memorandum] must prescribe:

(1) minimum standards for the training program; and

(2) a means for monitoring compliance with the requirement.

(c) The department [Each agency] shall review and the executive commissioner shall modify the rules [memorandum] as necessary not later than the last month of each state fiscal year.

SECTION 3.0476. Section 161.134(a), Health and Safety Code, is amended to read as follows:

(a) A hospital, mental health facility, or treatment facility may not suspend or terminate the employment of or discipline or otherwise discriminate against an employee for reporting to the employee's supervisor, an administrator of the facility, a state regulatory agency, or a law enforcement agency a violation of law, including a violation of this chapter, a rule adopted under this chapter, or a rule of another agency [adopted by the Texas Board of Mental Health and Mental Retardation, the Texas Board of Health, or the Texas Commission on Alcohol and Drug Abuse].

SECTION 3.0477. Sections 161.135(a) and (c), Health and Safety Code, are amended to read as follows:

(a) A hospital, mental health facility, or treatment facility may not retaliate against a person who is not an employee for reporting a violation of law, including a violation of this chapter, a rule adopted under this chapter, or a rule of another agency [adopted by the Texas Board of Mental Health and Mental Retardation, the Texas Board of Health, or the Texas Commission on Alcohol and Drug Abuse].

(c) A person suing under this section has the burden of proof, except that it is a rebuttable presumption that the plaintiff was retaliated against if:

(1) before the 60th day after the date on which the plaintiff made a report in good faith, the hospital, mental health facility, or treatment facility:

(A) discriminates in violation of Section 161.134 against a relative who is an employee of the facility;

(B) transfers, disciplines, suspends, terminates, or otherwise discriminates against the person or a relative who is a volunteer in the facility or who is employed under the patient work program administered by the department [Texas Department of Mental Health and Mental Retardation];

(C) commits or threatens to commit, without justification, the person or a relative of the person; or

(D) transfers, discharges, punishes, or restricts the privileges of the person or a relative of the person who is receiving inpatient or outpatient services in the facility; or

(2) a person expected to testify on behalf of the plaintiff is intentionally made unavailable through an action of the facility, including a discharge, resignation, or transfer.

SECTION 3.0478. Sections 161.301(a), (b), and (d), Health and Safety Code, are amended to read as follows:

(a) The department [commissioner] shall develop and implement a public awareness campaign designed to reduce tobacco use by minors in this state. The campaign may use advertisements or similar media to provide educational information about tobacco use.

(b) The department [commissioner] may contract with another person to develop and implement the public awareness campaign. The contract shall be awarded on the basis of competitive bids.

(d) The department [commissioner] may not award a contract under Subsection (b) to:

(1) a person or entity that is required to register with the Texas Ethics Commission under Chapter 305, Government Code, except as provided by Subsection (f);

(2) any partner, employee, employer, relative, contractor, consultant, or related entity of a person or entity described by Subdivision (1) and not described by Subsection (f); or

(3) a person or entity who has been hired to represent associations or other entities for the purpose of affecting the outcome of legislation, agency rules, or other government policies through grassroots or media campaigns.

SECTION 3.0479. Section 161.352(c), Health and Safety Code, is amended to read as follows:

(c) The executive commissioner [department] by rule shall establish the time for filing an annual report under this section and shall prescribe the form for the report.

SECTION 3.0480. Section 161.353(a), Health and Safety Code, is amended to read as follows:

(a) Each manufacturer shall assign a nicotine yield rating to each cigarette or tobacco product distributed in this state. The rating shall be assigned in accordance with department standards [adopted by the department].

SECTION 3.0481. Section 161.402, Health and Safety Code, is amended to read as follows:

Sec. 161.402. MATERIAL SAFETY DATA SHEET REQUIRED; ASBESTOS INSTALLATION OR REINSTALLATION PROHIBITED. The executive commissioner [board] shall adopt rules designating the materials or replacement parts for which a person must obtain a material safety data sheet before installing the materials or parts in a public building. A person may not install materials or replacement parts in a public building if:

(1) the person does not obtain a required material safety data sheet; or

(2) the materials or parts, according to the material safety data sheet, contain more than one percent asbestos and there is an alternative material or part.

SECTION 3.0482. Section 161.501(a), Health and Safety Code, is amended to read as follows:

(a) A hospital, birthing center, physician, nurse midwife, or midwife who provides prenatal care to a pregnant woman during gestation or at delivery of an infant shall:

(1) provide the woman and the father of the infant, if possible, or another adult caregiver for the infant, with a resource pamphlet that includes:

(A) a list of the names, addresses, and phone numbers of professional organizations that provide postpartum counseling and assistance to parents relating to postpartum depression and other emotional trauma associated with pregnancy and parenting;

(B) information regarding the prevention of shaken baby syndrome including:

(i) techniques for coping with anger caused by a crying baby;

(ii) different methods for preventing a person from shaking a newborn, infant, or other young child;

(iii) the dangerous effects of shaking a newborn, infant, or other young child; and

(iv) the symptoms of shaken baby syndrome and who to contact, as recommended by the American Academy of Pediatrics, if a parent suspects or knows that a baby has been shaken in order to receive prompt medical treatment;

(C) a list of diseases for which a child is required by state law to be immunized and the appropriate schedule for the administration of those immunizations;

(D) the appropriate schedule for follow-up procedures for newborn screening;

(E) information regarding sudden infant death syndrome, including current recommendations for infant sleeping conditions to lower the risk of sudden infant death syndrome; and

(F) educational information in both English and Spanish on pertussis disease and the availability of a vaccine to protect against pertussis, including information on the Centers for Disease Control and Prevention recommendation that parents receive Tdap during the postpartum period to protect newborns from the transmission of pertussis;

(2) if the woman is a recipient of medical assistance under Chapter 32, Human Resources Code, provide the woman and the father of the infant, if possible, or another adult caregiver with a resource guide that includes information in both English and Spanish relating to the development, health, and safety of a child from birth until age five, including information relating to:

(A) selecting and interacting with a primary health care practitioner and establishing a "medical home" for the child;

(B) dental care;

(C) effective parenting;

(D) child safety;

(E) the importance of reading to a child;

(F) expected developmental milestones;

(G) health care resources available in the state;

(H) selecting appropriate child care; and

(I) other resources available in the state;

(3) document in the woman's record that the woman received the resource pamphlet described in Subdivision (1) and the resource guide described in Subdivision (2), if applicable; and

(4) retain the documentation for at least five years in the hospital's, birthing center's, physician's, nurse midwife's, or midwife's records.

SECTION 3.0483. The heading to Section 161.502, Health and Safety Code, is amended to read as follows:

Sec. 161.502. DUTIES OF DEPARTMENT, EXECUTIVE COMMISSIONER, AND COMMISSION.

SECTION 3.0484. Sections 161.502(c) and (d), Health and Safety Code, are amended to read as follows:

(c) The executive commissioner [Health and Human Services Commission] shall develop specific performance measures by which the commission may evaluate the effectiveness of the resource guide under Section 161.501(a)(2) in:

(1) reducing costs to the state; and

(2) improving outcomes for children.

(d) Not later than December 1 of each even-numbered year, the commission [Health and Human Services Commission] shall submit a report to the legislature on the effectiveness of the resource guide under Section 161.501(a)(2), including legislative recommendations concerning the guide.

SECTION 3.0485. Section 161.551, Health and Safety Code, is amended to read as follows:

Sec. 161.551. DEFINITIONS. (a) In this subchapter, "servicemember" [:

[(1) "Commission" means the Health and Human Services Commission.

[(2) "Department" means the Department of State Health Services.

[(3) "Servicemember"] means a member or former member of the state military forces or a component of the United States armed forces, including a reserve component.

(b) In this section, "state military forces" has the meaning assigned by Section 437.001, Government Code.

SECTION 3.0486. Sections 162.001(1) and (2), Health and Safety Code, are amended to read as follows:

(1) "Blood bank" means a facility that obtains blood from voluntary donors, as that term is defined by the United States Food and Drug Administration, the AABB (formerly known as the American Association of Blood Banks), and the American Red Cross Blood Services and that is registered or licensed by the Center for [Office of] Biologics Evaluation and Research of the United States Food and Drug Administration and accredited by the AABB [American Association of Blood Banks] or the American Red Cross Blood Services, or is qualified for membership in the American Association of Tissue Banks. The term includes a blood center, regional collection center, tissue bank, and transfusion service.

(2) "AIDS" means acquired immune deficiency syndrome as defined by the Centers for Disease Control and Prevention of the United States Public Health Service.

SECTION 3.0487. Section 162.002(a), Health and Safety Code, is amended to read as follows:

(a) For each donation of blood, a blood bank shall require the donor to submit to tests for communicable [infectious] diseases, including tests for AIDS, HIV, or hepatitis, and serological tests for contagious venereal diseases.

SECTION 3.0488. Section 162.004, Health and Safety Code, is amended to read as follows:

Sec. 162.004. DISCLOSURE REQUIRED BY LAW. A blood bank shall disclose all information required by law, including HIV test results, to:

(1) the department and a local health authority as required under Chapter 81 (Communicable Disease Prevention and Control Act);

(2) the Centers for Disease Control and Prevention of the United States Public Health Service, as required by federal law or regulation; or

(3) any other local, state, or federal entity, as required by law, rule, or regulation.

SECTION 3.0489. Sections 162.006(a) and (b), Health and Safety Code, are amended to read as follows:

(a) A blood bank may report to other blood banks the name of a donor with a possible communicable [infectious] disease according to positive blood test results.

(b) A blood bank that reports a donor's name to other blood banks under this section may not disclose the communicable [infectious] disease that the donor has or is suspected of having.

SECTION 3.0490. Section 162.007(a), Health and Safety Code, is amended to read as follows:

(a) A blood bank shall report blood test results for blood confirmed as HIV positive by the normal procedures blood banks presently use or found to be contaminated by any other communicable [infectious] disease to:

(1) the hospital or other facility in which the blood was transfused or provided;

(2) the physician who transfused the infected blood; or

(3) the recipient of the blood.

SECTION 3.0491. Section 162.016, Health and Safety Code, is amended to read as follows:

Sec. 162.016. BE A BLOOD DONOR ACCOUNT; DEDICATION. (a) The be a blood donor account is a separate account in the general revenue fund. The account is composed of:

(1) money deposited to the credit of the account under Section 504.641, Transportation Code; and

(2) gifts, grants, donations, and legislative appropriations.

(b) The department administers the account.

(b-1) The department [and] may spend money credited to the account or money deposited to the associated trust fund account created under Section 504.6012, Transportation Code, only to:

(1) make grants to nonprofit blood centers in this state for programs to recruit and retain volunteer blood donors; and

(2) defray the cost of administering the account.

(c) The department [board:

[(1)] may accept gifts, grants, and donations from any source for the benefit of the account. The executive commissioner of the Health and Human Services Commission [; and

[(2)] by rule shall establish guidelines for spending money described by Subsection (b-1) [credited to the account].

SECTION 3.0492. Section 162.018, Health and Safety Code, is amended to read as follows:

Sec. 162.018. BROCHURE ON UMBILICAL CORD BLOOD OPTIONS. (a) The executive commissioner [of the Health and Human Services Commission] shall prepare and update as necessary a brochure based on nationally accepted, peer reviewed, scientific research information regarding stem cells contained in the umbilical cord blood after delivery of an infant. The information in the brochure must include:

(1) the current and potential uses, risks, and benefits of stem cells contained in umbilical cord blood to a potential recipient of donated stem cells, including a biological family member, extended family member, or nonrelated individual;

(2) the options available for future use or storage of umbilical cord blood after delivery of an infant, including:

(A) discarding the stem cells;

(B) donating the stem cells to a public umbilical cord blood bank;

(C) storing the stem cells in a private family umbilical cord blood bank for use by immediate and extended family members; and

(D) storing the stem cells for immediate and extended family use through a family or sibling donor banking program that provides free collection, processing, and storage when a medical need exists;

(3) the medical process used to collect umbilical cord blood after delivery of an infant;

(4) any risk associated with umbilical cord blood collection to the mother and the infant;

(5) any costs that may be incurred by a pregnant woman who chooses to donate or store umbilical cord blood after delivery of the woman's infant; and

(6) the average cost of public and private umbilical cord blood banking.

(b) The department [Department of State Health Services] shall make the brochure available on the department's website and shall distribute the brochure on request to physicians or other persons permitted by law to attend a pregnant woman during gestation or at delivery of an infant.

SECTION 3.0493. Section 164.003(5), Health and Safety Code, is amended to read as follows:

(5) "Mental health facility" means:

(A) a "mental health facility" as defined by Section 571.003;

(B) a residential treatment facility, other than a mental health facility, in which persons are treated for emotional problems or disorders in a 24-hour supervised living environment; and

(C) an adult day-care facility [or adult day health care facility] as defined by Section 103.003, Human Resources Code.

SECTION 3.0494. Section 164.004, Health and Safety Code, is amended to read as follows:

Sec. 164.004. EXEMPTIONS. This chapter does not apply to:

(1) a treatment facility:

(A) operated by the department [Texas Department of Mental Health and Mental Retardation], a federal agency, or a political subdivision; or

(B) funded by the department [Texas Commission on Alcohol and Drug Abuse];

(2) a community center established under Subchapter A, Chapter 534, or a facility operated by a community center; or

(3) a facility owned and operated by a nonprofit or not-for-profit organization offering counseling concerning family violence, help for runaway children, or rape.

SECTION 3.0495. Section 164.006, Health and Safety Code, is amended to read as follows:

Sec. 164.006. SOLICITING AND CONTRACTING WITH CERTAIN REFERRAL SOURCES. A treatment facility or a person employed or under contract with a treatment facility, if acting on behalf of the treatment facility, may not:

(1) contact a referral source or potential client for the purpose of soliciting, directly or indirectly, a referral of a patient to the treatment facility without disclosing its soliciting agent's, employee's, or contractor's affiliation with the treatment facility;

(2) offer to provide or provide mental health or chemical dependency services to a public or private school in this state, on a part-time or full-time basis, the services of any of its employees or agents who make, or are in a position to make, a referral, if the services are provided on an individual basis to individual students or their families. Nothing herein prohibits a treatment facility from:

(A) offering or providing educational programs in group settings to public schools in this state if the affiliation between the educational program and the treatment facility is disclosed;

(B) providing counseling services to a public school in this state in an emergency or crisis situation if the services are provided in response to a specific request by a school; provided that, under no circumstances may a student be referred to the treatment facility offering the services; or

(C) entering into a contract under Section 464.020 with the board of trustees of a school district with a disciplinary alternative education program, or with the board's designee, for the provision of chemical dependency treatment services;

(3) provide to an entity of state or local government, on a part-time or full-time basis, the mental health or chemical dependency services of any of its employees, agents, or contractors who make or are in a position to make referrals unless:

(A) the treatment facility discloses to the governing authority of the entity:

(i) the employee's, agent's, or contractor's relationship to the facility; and

(ii) the fact that the employee, agent, or contractor might make a referral, if permitted, to the facility; and

(B) the employee, agent, or contractor makes a referral only if:

(i) the treatment facility obtains the governing authority's authorization in writing for the employee, agent, or contractor to make the referrals; and

(ii) the employee, agent, or contractor discloses to the prospective patient the employee's, agent's, or contractor's relationship to the facility at initial contact; or

(4) in relation to intervention and assessment services, contract with, offer to remunerate, or remunerate a person who operates an intervention and assessment service that makes referrals to a treatment facility for inpatient treatment of mental illness or chemical dependency unless the intervention and assessment service is:

(A) operated by a community mental health and intellectual disability [mental retardation] center funded by the department and the Department of Aging and Disability Services [Texas Department of Mental Health and Mental Retardation];

(B) operated by a county or regional medical society;

(C) a qualified mental health referral service as defined by Section 164.007; or

(D) owned and operated by a nonprofit or not-for-profit organization offering counseling concerning family violence, help for runaway children, or rape.

SECTION 3.0496. Section 164.007(a), Health and Safety Code, is amended to read as follows:

(a) A qualified mental health referral service means a service that conforms to all of the following standards:

(1) the referral service does not exclude as a participant in the referral service an individual who meets the qualifications for participation and qualifications for participation cannot be based in whole or in part on an individual's or entity's affiliation or nonaffiliation with other participants in the referral service;

(2) a payment the participant makes to the referral service is assessed equally against and collected equally from all participants, and is only based on the cost of operating the referral service and not on the volume or value of any referrals to or business otherwise generated by the participants of the referral service;

(3) the referral service imposes no requirements on the manner in which the participant provides services to a referred person, except that the referral service may require that the participant charge the person referred at the same rate as it charges other persons not referred by the referral service, or that these services be furnished free of charge or at a reduced charge;

(4) a referral made to a mental health professional or chemical dependency treatment facility is made only in accordance with Subdivision (1) and the referral service does not make referrals to mental health facilities other than facilities maintained or operated by the department [Texas Department of Mental Health and Mental Retardation], community mental health [and mental retardation] centers, or other political subdivisions, provided that a physician may make a referral directly to any mental health facility;

(5) the referral service is staffed by appropriately licensed and trained mental health professionals and a person who makes assessments for the need for treatment of mental illness or chemical dependency is a mental health professional as defined by this chapter;

(6) in response to each inquiry or after personal assessment, the referral service makes referrals, on a clinically appropriate, rotational basis, to at least three mental health professionals or chemical dependency treatment facilities whose practice addresses or facilities are located in the county of residence of the person seeking the referral or assessment, but if there are not three providers in the inquirer's county of residence, the referral service may include additional providers from other counties nearest the inquirer's county of residence;

(7) no information that identifies the person seeking a referral, such as name, address, or telephone number, is used, maintained, distributed, or provided for a purpose other than making the requested referral or for administrative functions necessary to operating the referral service;

(8) the referral service makes the following disclosures to each person seeking a referral:

(A) the manner in which the referral service selects the group of providers participating in the referral service;

(B) whether the provider participant has paid a fee to the referral service;

(C) the manner in which the referral service selects a particular provider from its list of provider participants to which to make a referral;

(D) the nature of the relationship or any affiliation between the referral service and the group of provider participants to whom it could make a referral; and

(E) the nature of any restriction that would exclude a provider from continuing as a provider participant;

(9) the referral service maintains each disclosure in a written record certifying that the disclosure has been made and the record certifying that the disclosure has been made is signed by either the person seeking a referral or by the person making the disclosure on behalf of the referral service; and

(10) if the referral service refers callers to a 1-900 telephone number or another telephone number that requires the payment of a toll or fee payable to or collected by the referral service, the referral service discloses the per minute charge.

SECTION 3.0497. Section 164.009(a), Health and Safety Code, is amended to read as follows:

(a) A treatment facility may not admit a patient to its facilities without fully disclosing to the patient or, if the patient is a minor, the patient's parent, managing conservator, or guardian, in, if possible, the primary language of the patient, managing conservator, or guardian, as the case may be, the following information in writing before admission:

(1) the treatment facility's estimated average daily charge for inpatient treatment with an explanation that the patient may be billed separately for services provided by mental health professionals;

(2) the name of the attending physician, if the treatment facility is a mental health facility, or the name of the attending mental health professional, if the facility is a chemical dependency facility; and

(3) the current "patient's bill of rights" as adopted by the executive commissioner [Texas Department of Mental Health and Mental Retardation, the Texas Commission on Alcohol and Drug Abuse, or the Texas Department of Health] that sets out restrictions to the patient's freedom that may be imposed on the patient during the patient's stay in a treatment facility.

SECTION 3.0498. Section 164.014, Health and Safety Code, is amended to read as follows:

Sec. 164.014. RULE-MAKING AUTHORITY. The executive commissioner [Texas Commission on Alcohol and Drug Abuse and Texas Board of Mental Health and Mental Retardation] may adopt rules interpreting the provisions of this chapter relating to the activities of a chemical dependency facility or mental health facility under the department's [its] jurisdiction.

SECTION 3.0499. Section 166.002(12), Health and Safety Code, is amended to read as follows:

(12) "Physician" means:

(A) a physician licensed by the Texas Medical [State] Board [of Medical Examiners]; or

(B) a properly credentialed physician who holds a commission in the uniformed services of the United States and who is serving on active duty in this state.

SECTION 3.0500. Section 166.004(a), Health and Safety Code, is amended to read as follows:

(a) In this section, "health care provider" means:

(1) a hospital;

(2) an institution licensed under Chapter 242, including a skilled nursing facility;

(3) a home and community support services agency;

(4) an assisted living [a personal care] facility; and

(5) a special care facility.

SECTION 3.0501. Section 166.011(c), Health and Safety Code, is amended to read as follows:

(c) The executive commissioner [of the Health and Human Services Commission] by rule shall modify the advance directive forms required under this chapter as necessary to provide for the use of a digital or electronic signature that complies with the requirements of this section.

SECTION 3.0502. Section 166.039(g), Health and Safety Code, is amended to read as follows:

(g) A person listed in Subsection (b) who wishes to challenge a treatment decision made under this section must apply for temporary guardianship under Chapter 1251, Estates [Section 875, Texas Probate] Code. The court may waive applicable fees in that proceeding.

SECTION 3.0503. Sections 166.046(b) and (c), Health and Safety Code, are amended to read as follows:

(b) The patient or the person responsible for the health care decisions of the individual who has made the decision regarding the directive or treatment decision:

(1) may be given a written description of the ethics or medical committee review process and any other policies and procedures related to this section adopted by the health care facility;

(2) shall be informed of the committee review process not less than 48 hours before the meeting called to discuss the patient's directive, unless the time period is waived by mutual agreement;

(3) at the time of being so informed, shall be provided:

(A) a copy of the appropriate statement set forth in Section 166.052; and

(B) a copy of the registry list of health care providers and referral groups that have volunteered their readiness to consider accepting transfer or to assist in locating a provider willing to accept transfer that is posted on the website maintained by the department [Texas Health Care Information Council] under Section 166.053; and

(4) is entitled to:

(A) attend the meeting; and

(B) receive a written explanation of the decision reached during the review process.

(c) The written explanation required by Subsection (b)(4)(B) [(b)(2)(B)] must be included in the patient's medical record.

SECTION 3.0504. Sections 166.052(a) and (b), Health and Safety Code, are amended to read as follows:

(a) In cases in which the attending physician refuses to honor an advance directive or treatment decision requesting the provision of life-sustaining treatment, the statement required by Section 166.046(b)(3)(A) [166.046(b)(2)(A)] shall be in substantially the following form:

When There Is A Disagreement About Medical Treatment: The

Physician Recommends Against Life-Sustaining Treatment That You

Wish To Continue

You have been given this information because you have requested life-sustaining treatment,* which the attending physician believes is not appropriate. This information is being provided to help you understand state law, your rights, and the resources available to you in such circumstances. It outlines the process for resolving disagreements about treatment among patients, families, and physicians. It is based upon Section 166.046 of the Texas Advance Directives Act, codified in Chapter 166 of the Texas Health and Safety Code.

When an attending physician refuses to comply with an advance directive or other request for life-sustaining treatment because of the physician's judgment that the treatment would be inappropriate, the case will be reviewed by an ethics or medical committee. Life-sustaining treatment will be provided through the review.

You will receive notification of this review at least 48 hours before a meeting of the committee related to your case. You are entitled to attend the meeting. With your agreement, the meeting may be held sooner than 48 hours, if possible.

You are entitled to receive a written explanation of the decision reached during the review process.

If after this review process both the attending physician and the ethics or medical committee conclude that life-sustaining treatment is inappropriate and yet you continue to request such treatment, then the following procedure will occur:

1. The physician, with the help of the health care facility, will assist you in trying to find a physician and facility willing to provide the requested treatment.

2. You are being given a list of health care providers and referral groups that have volunteered their readiness to consider accepting transfer, or to assist in locating a provider willing to accept transfer, maintained by the Department of State Health Services [Texas Health Care Information Council]. You may wish to contact providers or referral groups on the list or others of your choice to get help in arranging a transfer.

3. The patient will continue to be given life-sustaining treatment until he or she can be transferred to a willing provider for up to 10 days from the time you were given the committee's written decision that life-sustaining treatment is not appropriate.

4. If a transfer can be arranged, the patient will be responsible for the costs of the transfer.

5. If a provider cannot be found willing to give the requested treatment within 10 days, life-sustaining treatment may be withdrawn unless a court of law has granted an extension.

6. You may ask the appropriate district or county court to extend the 10-day period if the court finds that there is a reasonable expectation that a physician or health care facility willing to provide life-sustaining treatment will be found if the extension is granted. *"Life-sustaining treatment" means treatment that, based on reasonable medical judgment, sustains the life of a patient and without which the patient will die. The term includes both life-sustaining medications and artificial life support, such as mechanical breathing machines, kidney dialysis treatment, and artificial nutrition and hydration. The term does not include the administration of pain management medication or the performance of a medical procedure considered to be necessary to provide comfort care, or any other medical care provided to alleviate a patient's pain.

(b) In cases in which the attending physician refuses to comply with an advance directive or treatment decision requesting the withholding or withdrawal of life-sustaining treatment, the statement required by Section 166.046(b)(3)(A) shall be in substantially the following form:

When There Is A Disagreement About Medical Treatment: The

Physician Recommends Life-Sustaining Treatment That You Wish To

Stop

You have been given this information because you have requested the withdrawal or withholding of life-sustaining treatment* and the attending physician refuses to comply with that request. The information is being provided to help you understand state law, your rights, and the resources available to you in such circumstances. It outlines the process for resolving disagreements about treatment among patients, families, and physicians. It is based upon Section 166.046 of the Texas Advance Directives Act, codified in Chapter 166 of the Texas Health and Safety Code.

When an attending physician refuses to comply with an advance directive or other request for withdrawal or withholding of life-sustaining treatment for any reason, the case will be reviewed by an ethics or medical committee. Life-sustaining treatment will be provided through the review.

You will receive notification of this review at least 48 hours before a meeting of the committee related to your case. You are entitled to attend the meeting. With your agreement, the meeting may be held sooner than 48 hours, if possible.

You are entitled to receive a written explanation of the decision reached during the review process.

If you or the attending physician do not agree with the decision reached during the review process, and the attending physician still refuses to comply with your request to withhold or withdraw life-sustaining treatment, then the following procedure will occur:

1. The physician, with the help of the health care facility, will assist you in trying to find a physician and facility willing to withdraw or withhold the life-sustaining treatment.

2. You are being given a list of health care providers and referral groups that have volunteered their readiness to consider accepting transfer, or to assist in locating a provider willing to accept transfer, maintained by the Department of State Health Services [Texas Health Care Information Council]. You may wish to contact providers or referral groups on the list or others of your choice to get help in arranging a transfer. *"Life-sustaining treatment" means treatment that, based on reasonable medical judgment, sustains the life of a patient and without which the patient will die. The term includes both life-sustaining medications and artificial life support, such as mechanical breathing machines, kidney dialysis treatment, and artificial nutrition and hydration. The term does not include the administration of pain management medication or the performance of a medical procedure considered to be necessary to provide comfort care, or any other medical care provided to alleviate a patient's pain.

SECTION 3.0505. Sections 166.053(a), (c), and (d), Health and Safety Code, are amended to read as follows:

(a) The department [Texas Health Care Information Council] shall maintain a registry listing the identity of and contact information for health care providers and referral groups, situated inside and outside this state, that have voluntarily notified the department [council] they may consider accepting or may assist in locating a provider willing to accept transfer of a patient under Section 166.045 or 166.046.

(c) The department [Texas Health Care Information Council] shall post the current registry list on its website in a form appropriate for easy comprehension by patients and persons responsible for the health care decisions of patients [and shall provide a clearly identifiable link from its home page to the registry page]. The list shall separately indicate those providers and groups that have indicated their interest in assisting the transfer of:

(1) those patients on whose behalf life-sustaining treatment is being sought;

(2) those patients on whose behalf the withholding or withdrawal of life-sustaining treatment is being sought; and

(3) patients described in both Subdivisions (1) and (2).

(d) The registry list described in this section shall include the following disclaimer:

"This registry lists providers and groups that have indicated to the Department of State Health Services [Texas Health Care Information Council] their interest in assisting the transfer of patients in the circumstances described, and is provided for information purposes only. Neither the Department of State Health Services [Texas Health Care Information Council] nor the State of Texas endorses or assumes any responsibility for any representation, claim, or act of the listed providers or groups."

SECTION 3.0506. Sections 166.081(2), (6), and (10), Health and Safety Code, are amended to read as follows:

(2) "DNR identification device" means an identification device specified by department rule [the board] under Section 166.101 that is worn for the purpose of identifying a person who has executed or issued an out-of-hospital DNR order or on whose behalf an out-of-hospital DNR order has been executed or issued under this subchapter.

(6) "Out-of-hospital DNR order":

(A) means a legally binding out-of-hospital do-not-resuscitate order, in the form specified by department rule [the board] under Section 166.083, prepared and signed by the attending physician of a person, that documents the instructions of a person or the person's legally authorized representative and directs health care professionals acting in an out-of-hospital setting not to initiate or continue the following life-sustaining treatment:

(i) cardiopulmonary resuscitation;

(ii) advanced airway management;

(iii) artificial ventilation;

(iv) defibrillation;

(v) transcutaneous cardiac pacing; and

(vi) other life-sustaining treatment specified by department rule [the board] under Section 166.101(a); and

(B) does not include authorization to withhold medical interventions or therapies considered necessary to provide comfort care or to alleviate pain or to provide water or nutrition.

(10) "Statewide out-of-hospital DNR protocol" means a set of statewide standardized procedures adopted by the executive commissioner [board] under Section 166.101(a) for withholding cardiopulmonary resuscitation and certain other life-sustaining treatment by health care professionals acting in out-of-hospital settings.

SECTION 3.0507. Sections 166.082(a) and (f), Health and Safety Code, are amended to read as follows:

(a) A competent person may at any time execute a written out-of-hospital DNR order directing health care professionals acting in an out-of-hospital setting to withhold cardiopulmonary resuscitation and certain other life-sustaining treatment designated by department rule [the board].

(f) The executive commissioner [board], on the recommendation of the department, shall by rule adopt procedures for the disposition and maintenance of records of an original out-of-hospital DNR order and any copies of the order.

SECTION 3.0508. Sections 166.083(a), (b), and (c), Health and Safety Code, are amended to read as follows:

(a) A written out-of-hospital DNR order shall be in the standard form specified by department [board] rule as recommended by the department.

(b) The standard form of an out-of-hospital DNR order specified by department rule [the board] must, at a minimum, contain the following:

(1) a distinctive single-page format that readily identifies the document as an out-of-hospital DNR order;

(2) a title that readily identifies the document as an out-of-hospital DNR order;

(3) the printed or typed name of the person;

(4) a statement that the physician signing the document is the attending physician of the person and that the physician is directing health care professionals acting in out-of-hospital settings, including a hospital emergency department, not to initiate or continue certain life-sustaining treatment on behalf of the person, and a listing of those procedures not to be initiated or continued;

(5) a statement that the person understands that the person may revoke the out-of-hospital DNR order at any time by destroying the order and removing the DNR identification device, if any, or by communicating to health care professionals at the scene the person's desire to revoke the out-of-hospital DNR order;

(6) places for the printed names and signatures of the witnesses or the notary public's acknowledgment and for the printed name and signature of the attending physician of the person and the medical license number of the attending physician;

(7) a separate section for execution of the document by the legal guardian of the person, the person's proxy, an agent of the person having a medical power of attorney, or the attending physician attesting to the issuance of an out-of-hospital DNR order by nonwritten means of communication or acting in accordance with a previously executed or previously issued directive to physicians under Section 166.082(c) that includes the following:

(A) a statement that the legal guardian, the proxy, the agent, the person by nonwritten means of communication, or the physician directs that each listed life-sustaining treatment should not be initiated or continued in behalf of the person; and

(B) places for the printed names and signatures of the witnesses and, as applicable, the legal guardian, proxy, agent, or physician;

(8) a separate section for execution of the document by at least one qualified relative of the person when the person does not have a legal guardian, proxy, or agent having a medical power of attorney and is incompetent or otherwise mentally or physically incapable of communication, including:

(A) a statement that the relative of the person is qualified to make a treatment decision to withhold cardiopulmonary resuscitation and certain other designated life-sustaining treatment under Section 166.088 and, based on the known desires of the person or a determination of the best interest of the person, directs that each listed life-sustaining treatment should not be initiated or continued in behalf of the person; and

(B) places for the printed names and signatures of the witnesses and qualified relative of the person;

(9) a place for entry of the date of execution of the document;

(10) a statement that the document is in effect on the date of its execution and remains in effect until the death of the person or until the document is revoked;

(11) a statement that the document must accompany the person during transport;

(12) a statement regarding the proper disposition of the document or copies of the document, as the executive commissioner [board] determines appropriate; and

(13) a statement at the bottom of the document, with places for the signature of each person executing the document, that the document has been properly completed.

(c) The executive commissioner [board] may, by rule and as recommended by the department, modify the standard form of the out-of-hospital DNR order described by Subsection (b) in order to accomplish the purposes of this subchapter.

SECTION 3.0509. Sections 166.088(e) and (g), Health and Safety Code, are amended to read as follows:

(e) The fact that an adult person has not executed or issued an out-of-hospital DNR order does not create a presumption that the person does not want a treatment decision made to withhold cardiopulmonary resuscitation and certain other designated life-sustaining treatment designated by department rule [the board].

(g) A person listed in Section 166.039(b) who wishes to challenge a decision made under this section must apply for temporary guardianship under Chapter 1251, Estates [Section 875, Texas Probate] Code. The court may waive applicable fees in that proceeding.

SECTION 3.0510. Section 166.089(h), Health and Safety Code, is amended to read as follows:

(h) An out-of-hospital DNR order executed or issued and documented or evidenced in the manner prescribed by this subchapter is valid and shall be honored by responding health care professionals unless the person or persons found at the scene:

(1) identify themselves as the declarant or as the attending physician, legal guardian, qualified relative, or agent of the person having a medical power of attorney who executed or issued the out-of-hospital DNR order on behalf of the person; and

(2) request that cardiopulmonary resuscitation or certain other life-sustaining treatment designated by department rule [the board] be initiated or continued.

SECTION 3.0511. Section 166.090(a), Health and Safety Code, is amended to read as follows:

(a) A person who has a valid out-of-hospital DNR order under this subchapter may wear a DNR identification device around the neck or on the wrist as prescribed by department [board] rule adopted under Section 166.101.

SECTION 3.0512. Section 166.092(b), Health and Safety Code, is amended to read as follows:

(b) An oral revocation under Subsection (a)(3) or (a)(4) takes effect only when the declarant or a person who identifies himself or herself as the legal guardian, a qualified relative, or the agent of the declarant having a medical power of attorney who executed the out-of-hospital DNR order communicates the intent to revoke the order to the responding health care professionals or the attending physician at the scene. The responding health care professionals shall record the time, date, and place of the revocation in accordance with the statewide out-of-hospital DNR protocol and rules adopted by the executive commissioner [board] and any applicable local out-of-hospital DNR protocol. The attending physician or the physician's designee shall record in the person's medical record the time, date, and place of the revocation and, if different, the time, date, and place that the physician received notice of the revocation. The attending physician or the physician's designee shall also enter the word "VOID" on each page of the copy of the order in the person's medical record.

SECTION 3.0513. Section 166.094, Health and Safety Code, is amended to read as follows:

Sec. 166.094. LIMITATION ON LIABILITY FOR WITHHOLDING CARDIOPULMONARY RESUSCITATION AND CERTAIN OTHER LIFE-SUSTAINING PROCEDURES. (a) A health care professional or health care facility or entity that in good faith causes cardiopulmonary resuscitation or certain other life-sustaining treatment designated by department rule [the board] to be withheld from a person in accordance with this subchapter is not civilly liable for that action.

(b) A health care professional or health care facility or entity that in good faith participates in withholding cardiopulmonary resuscitation or certain other life-sustaining treatment designated by department rule [the board] from a person in accordance with this subchapter is not civilly liable for that action.

(c) A health care professional or health care facility or entity that in good faith participates in withholding cardiopulmonary resuscitation or certain other life-sustaining treatment designated by department rule [the board] from a person in accordance with this subchapter is not criminally liable or guilty of unprofessional conduct as a result of that action.

(d) A health care professional or health care facility or entity that in good faith causes or participates in withholding cardiopulmonary resuscitation or certain other life-sustaining treatment designated by department rule [the board] from a person in accordance with this subchapter and rules adopted under this subchapter is not in violation of any other licensing or regulatory laws or rules of this state and is not subject to any disciplinary action or sanction by any licensing or regulatory agency of this state as a result of that action.

SECTION 3.0514. Section 166.096, Health and Safety Code, is amended to read as follows:

Sec. 166.096. HONORING OUT-OF-HOSPITAL DNR ORDER DOES NOT CONSTITUTE OFFENSE OF AIDING SUICIDE. A person does not commit an offense under Section 22.08, Penal Code, by withholding cardiopulmonary resuscitation or certain other life-sustaining treatment designated by department rule [the board] from a person in accordance with this subchapter.

SECTION 3.0515. Section 166.097(b), Health and Safety Code, is amended to read as follows:

(b) A person is subject to prosecution for criminal homicide under Chapter 19, Penal Code, if the person, with the intent to cause cardiopulmonary resuscitation or certain other life-sustaining treatment designated by department rule [the board] to be withheld from another person contrary to the other person's desires, falsifies or forges an out-of-hospital DNR order or intentionally conceals or withholds personal knowledge of a revocation and thereby directly causes cardiopulmonary resuscitation and certain other life-sustaining treatment designated by department rule [the board] to be withheld from the other person with the result that the other person's death is hastened.

SECTION 3.0516. Section 166.098, Health and Safety Code, is amended to read as follows:

Sec. 166.098. PREGNANT PERSONS. A person may not withhold cardiopulmonary resuscitation or certain other life-sustaining treatment designated by department rule [the board] under this subchapter from a person known by the responding health care professionals to be pregnant.

SECTION 3.0517. Sections 166.100 and 166.101, Health and Safety Code, are amended to read as follows:

Sec. 166.100. LEGAL RIGHT OR RESPONSIBILITY NOT AFFECTED. This subchapter does not impair or supersede any legal right or responsibility a person may have under a constitution, other statute, regulation, or court decision to effect the withholding of cardiopulmonary resuscitation or certain other life-sustaining treatment designated by department rule [the board].

Sec. 166.101. DUTIES OF DEPARTMENT AND EXECUTIVE COMMISSIONER [BOARD]. (a) The executive commissioner [board] shall, on the recommendation of the department, adopt all reasonable and necessary rules to carry out the purposes of this subchapter, including rules:

(1) adopting a statewide out-of-hospital DNR order protocol that sets out standard procedures for the withholding of cardiopulmonary resuscitation and certain other life-sustaining treatment by health care professionals acting in out-of-hospital settings;

(2) designating life-sustaining treatment that may be included in an out-of-hospital DNR order, including all procedures listed in Sections 166.081(6)(A)(i) through (v); and

(3) governing recordkeeping in circumstances in which an out-of-hospital DNR order or DNR identification device is encountered by responding health care professionals.

(b) The rules adopted [by the board] under Subsection (a) are not effective until approved by the Texas Medical [State] Board [of Medical Examiners].

(c) Local emergency medical services authorities may adopt local out-of-hospital DNR order protocols if the local protocols do not conflict with the statewide out-of-hospital DNR order protocol adopted by the executive commissioner [board].

(d) The executive commissioner [board] by rule shall specify a distinctive standard design for a necklace and a bracelet DNR identification device that signifies, when worn by a person, that the possessor has executed or issued a valid out-of-hospital DNR order under this subchapter or is a person for whom a valid out-of-hospital DNR order has been executed or issued.

(e) The department shall report to the executive commissioner [board] from time to time regarding issues identified in emergency medical services responses in which an out-of-hospital DNR order or DNR identification device is encountered. The report may contain recommendations to the executive commissioner [board] for necessary modifications to the form of the standard out-of-hospital DNR order or the designated life-sustaining procedures listed in the standard out-of-hospital DNR order, the statewide out-of-hospital DNR order protocol, or the DNR identification devices.

SECTION 3.0518. Section 171.012(a-1), Health and Safety Code, is amended to read as follows:

(a-1) During a visit made to a facility to fulfill the requirements of Subsection (a), the facility and any person at the facility may not accept any form of payment, deposit, or exchange or make any financial agreement for an abortion or abortion-related services other than for payment of a service required by Subsection (a). The amount charged for a service required by Subsection (a) may not exceed the reimbursement rate established for the service by the executive commissioner [Health and Human Services Commission] for statewide medical reimbursement programs.

SECTION 3.0519. Section 171.0124, Health and Safety Code, is amended to read as follows:

Sec. 171.0124. EXCEPTION FOR MEDICAL EMERGENCY. A physician may perform an abortion without obtaining informed consent under this subchapter in a medical emergency. A physician who performs an abortion in a medical emergency shall:

(1) include in the patient's medical records a statement signed by the physician certifying the nature of the medical emergency; and

(2) not later than the 30th day after the date the abortion is performed, certify to the department [Department of State Health Services] the specific medical condition that constituted the emergency.

SECTION 3.0520. Section 171.014(d), Health and Safety Code, is amended to read as follows:

(d) The department shall annually review the materials to determine if changes to the contents of the materials are necessary. The executive commissioner [department] shall adopt rules necessary for considering and making changes to the materials.

SECTION 3.0521. Section 181.053, Health and Safety Code, is amended to read as follows:

Sec. 181.053. NONPROFIT AGENCIES. The executive commissioner [department] shall by rule exempt from this chapter a nonprofit agency that pays for health care services or prescription drugs for an indigent person only if the agency's primary business is not the provision of health care or reimbursement for health care services.

SECTION 3.0522. Section 181.102(c), Health and Safety Code, is amended to read as follows:

(c) For purposes of Subsection (a), the executive commissioner, in consultation with the department [Department of State Health Services], the Texas Medical Board, and the Texas Department of Insurance, by rule may recommend a standard electronic format for the release of requested health records. The standard electronic format recommended under this section must be consistent, if feasible, with federal law regarding the release of electronic health records.

SECTION 3.0523. Section 181.103, Health and Safety Code, is amended to read as follows:

Sec. 181.103. CONSUMER INFORMATION WEBSITE. The attorney general shall maintain an Internet website that provides:

(1) information concerning a consumer's privacy rights regarding protected health information under federal and state law;

(2) a list of the state agencies, including the department [Department of State Health Services], the Texas Medical Board, and the Texas Department of Insurance, that regulate covered entities in this state and the types of entities each agency regulates;

(3) detailed information regarding each agency's complaint enforcement process; and

(4) contact information, including the address of the agency's Internet website, for each agency listed under Subdivision (2) for reporting a violation of this chapter.

SECTION 3.0524. Section 182.053(b), Health and Safety Code, is amended to read as follows:

(b) The governor shall also appoint at least two ex officio, nonvoting members representing the department [Department of State Health Services].

SECTION 3.0525. Section 182.103(b), Health and Safety Code, is amended to read as follows:

(b) The corporation shall comply with all state and federal laws and rules relating to the transmission of health information, including Chapter 181, and rules adopted under that chapter, and the Health Insurance Portability and Accountability Act of 1996 (Pub. L. No. 104-191) and rules adopted under that Act.

SECTION 3.0526. Section 182.108(b), Health and Safety Code, is amended to read as follows:

(b) The commission shall review and the executive commissioner by rule shall adopt acceptable standards submitted for ratification under Subsection (a).

SECTION 3.0527. Section 191.001, Health and Safety Code, is amended to read as follows:

Sec. 191.001. DEFINITIONS. In this title:

(1) ["Board" means the Texas Board of Health.

[(2)] "Department" means the [Texas] Department of State Health Services.

(2) "Executive commissioner" means the executive commissioner of the Health and Human Services Commission.

(3) "Vital statistics unit" means the vital statistics unit established in the Department of State Health Services.

SECTION 3.0528. Subchapter A, Chapter 191, Health and Safety Code, is amended by adding Section 191.0011 to read as follows:

Sec. 191.0011. REFERENCE IN OTHER LAW. A reference in other law to the bureau of vital statistics of the department or of the former Texas Department of Health means the vital statistics unit established in the department.

SECTION 3.0529. Section 191.002(b), Health and Safety Code, is amended to read as follows:

(b) The department shall:

(1) establish a [bureau of] vital statistics unit in the department with suitable offices that are properly equipped for the preservation of its official records;

(2) establish a statewide system of vital statistics;

(3) provide instructions and prescribe forms for collecting, recording, transcribing, compiling, and preserving vital statistics;

(4) require the enforcement of this title and rules adopted under this title;

(5) prepare, print, and supply to local registrars forms for registering, recording, and preserving returns or otherwise carrying out the purposes of this title; and

(6) propose legislation necessary for the purposes of this title.

SECTION 3.0530. Section 191.003, Health and Safety Code, is amended to read as follows:

Sec. 191.003. POWERS AND DUTIES OF EXECUTIVE COMMISSIONER AND DEPARTMENT [BOARD]. (a) The executive commissioner [board] shall[:

[(1)] adopt necessary rules for collecting, recording, transcribing, compiling, and preserving vital statistics.

(a-1) The department shall:

(1) [; (2)] supervise the [bureau of] vital statistics unit; and

(2) [(3)] appoint the director of the [bureau of] vital statistics unit.

(b) In an emergency, the executive commissioner [board] may suspend any part of this title that hinders the uniform and efficient registration of vital events and may substitute emergency rules designed to expedite that registration under disaster conditions.

SECTION 3.0531. Section 191.004(a), Health and Safety Code, is amended to read as follows:

(a) The director of the [bureau of] vital statistics unit is the state registrar of vital statistics. The director must be a competent vital statistician.

SECTION 3.0532. Sections 191.0045(a), (b), (c), (d), (e), and (g), Health and Safety Code, are amended to read as follows:

(a) The department [bureau of vital statistics] may collect [charge] fees for providing services to the public and performing other activities in connection with maintenance of the vital statistics system, including:

(1) performing searches of birth, death, fetal death, marriage, divorce, annulment, and other records;

(2) preparing and issuing copies and certified copies of birth, death, fetal death, marriage, divorce, annulment, and other records; and

(3) filing a record, amendment, or affidavit under this title.

(b) The executive commissioner [board] by rule may prescribe a schedule of fees for vital statistics services. The aggregate of the amounts of the fees may not exceed the cost of administering the vital statistics system.

(c) The department [bureau of vital statistics] shall refund to an applicant any fee received for services that the department [bureau] cannot perform. If the money has been deposited to the credit of the vital statistics account in the general revenue fund, the comptroller shall issue a warrant against the fund for refund of the payment on presentation of a claim signed by the state registrar.

(d) A local registrar or county clerk who issues a certified copy of a birth or death certificate shall collect [charge] the same fees as collected [charged] by the department [bureau of vital statistics], including the additional fee required under Subsection (e), except as provided by Subsections (g) and (h).

(e) In addition to fees charged [collected] by the department [bureau of vital statistics] under Subsection (b), the department [bureau] shall collect an additional $2 fee for each of the following:

(1) issuing a certified copy of a certificate of birth;

(2) issuing a wallet-sized certification of birth; and

(3) conducting a search for a certificate of birth.

(g) A local registrar or county clerk that on March 31, 1995, was collecting [charging] a fee for the issuance of a certified copy of a birth certificate that exceeded the fee collected [charged] by the department [bureau of vital statistics] for the same type of certificate may continue to do so but shall not raise this fee until the fee collected [charged] by the department [bureau] exceeds the fee collected [charged] by the local registrar or county clerk. A local registrar or county clerk to which this subsection applies shall collect [charge] the additional fee as required under Subsection (e).

SECTION 3.0533. Section 191.0047, Health and Safety Code, is amended to read as follows:

Sec. 191.0047. BIRTH INFORMATION FOR DEPARTMENT OF FAMILY AND PROTECTIVE SERVICES. (a) The department [Department of State Health Services] shall implement an efficient and effective method to verify birth information or provide a certified copy of a birth record necessary to provide services for the benefit of a minor being served by the Department of Family and Protective Services.

(b) The department [Department of State Health Services] shall enter into a memorandum of understanding with the Department of Family and Protective Services to implement this section. Subject to Subsection (c), the terms of the memorandum of understanding must include methods for reimbursing the department [Department of State Health Services] in an amount that is not more than the actual costs the department incurs in verifying the birth information or providing the birth record to the Department of Family and Protective Services.

(c) The department [Department of State Health Services] may not collect a fee or other amount for verification of birth information or provision of a certified copy of the birth record under Subsection (a) for a child in the managing conservatorship of the Department of Family and Protective Services if parental rights to the child have been terminated and the child is eligible for adoption.

SECTION 3.0534. Section 191.0048(b), Health and Safety Code, is amended to read as follows:

(b) On each paper or electronic application form for a copy or certified copy of a birth, marriage, or divorce record, the department [bureau of vital statistics] shall include a printed box for the applicant to check indicating that the applicant wishes to make a voluntary contribution of $5 to promote healthy early childhood by supporting the Texas Home Visiting Program administered by the Office of Early Childhood Coordination of the Health and Human Services Commission.

SECTION 3.0535. Section 191.005, Health and Safety Code, is amended to read as follows:

Sec. 191.005. VITAL STATISTICS ACCOUNT [FUND]. (a) The vital statistics account [fund] is an account in the general revenue fund in the state treasury.

(b) The legislature shall make appropriations to the department from the vital statistics account [fund] to be used to defray expenses incurred in the administration and enforcement of the system of vital statistics.

(c) All fees collected by the department under this chapter [bureau of vital statistics] shall be deposited to the credit of the vital statistics account [fund].

SECTION 3.0536. Section 191.021(b), Health and Safety Code, is amended to read as follows:

(b) To facilitate registration, the department [board] may combine or divide registration districts.

SECTION 3.0537. Section 191.022(d), Health and Safety Code, is amended to read as follows:

(d) The local registrar shall sign each report made to the department [bureau of vital statistics].

SECTION 3.0538. Section 191.025(c), Health and Safety Code, is amended to read as follows:

(c) A local registrar shall supply forms of certificates to persons who need them. The executive commissioner [board] shall establish and promulgate rules for strict accountability of birth certificates to prevent birth certificate fraud.

SECTION 3.0539. Sections 191.026(c) and (e), Health and Safety Code, are amended to read as follows:

(c) The local registrar shall copy in the record book required under Section 191.025 each certificate that the local registrar registers, unless the local registrar keeps duplicates under Subsection (d) or makes photographic duplications as authorized by Chapter [181 or] 201, Local Government Code, or the provisions of Chapter 204, Local Government Code, derived from former Chapter 181, Local Government Code. Except as provided by Subsection (e), the copies shall be permanently preserved in the local registrar's office as the local record, in the manner directed by the state registrar.

(e) The local registrar may, after the first anniversary of the date of registration of a birth, death, or fetal death, destroy the permanent record of the birth, death, or fetal death maintained by the local registrar if:

(1) the local registrar has access to electronic records of births, deaths, and fetal deaths maintained by the [bureau of] vital statistics unit; and

(2) before destroying the records, the local registrar certifies to the state registrar that each record maintained by the local office that is to be destroyed has been verified against the records contained in the unit's [bureau's] database and that each record is included in the database or otherwise accounted for.

SECTION 3.0540. Section 191.032(b), Health and Safety Code, is amended to read as follows:

(b) The executive commissioner [board] shall adopt rules necessary to implement this section.

SECTION 3.0541. Section 191.033(a), Health and Safety Code, is amended to read as follows:

(a) The state registrar may attach to the original record an addendum that sets out any information received by the state registrar that may contradict the information in a birth, death, or fetal death record required to be maintained in the [bureau of] vital statistics unit.

SECTION 3.0542. Section 191.051(a), Health and Safety Code, is amended to read as follows:

(a) Subject to department [board] rules controlling the accessibility of vital records, the state registrar shall supply to a properly qualified applicant, on request, a certified copy of a record, or part of a record, of a birth, death, or fetal death registered under this title.

SECTION 3.0543. Section 191.056(b), Health and Safety Code, is amended to read as follows:

(b) The department [bureau of vital statistics] may contract with the national agency to have copies of vital records that are filed with the vital statistics unit [bureau] transcribed for that agency.

SECTION 3.0544. Section 191.057(b), Health and Safety Code, is amended to read as follows:

(b) If the [bureau of] vital statistics unit or any local registration official receives an application for a certified copy of a birth, death, or fetal death record to which an addendum has been attached under Section 191.033, the application shall be sent immediately to the state registrar. After examining the application, the original record, and the addendum, the state registrar may refuse to issue a certified copy of the record or part of the record to the applicant.

SECTION 3.0545. Sections 192.002(b) and (d), Health and Safety Code, are amended to read as follows:

(b) The section of the birth certificate entitled "For Medical and Health Use Only" is not part of the legal birth certificate. Information held by the department under that section of the certificate is confidential. That information may not be released or made public on subpoena or otherwise, except that release may be made for statistical purposes only so that no person, patient, or facility is identified, or to medical personnel of a health care entity, as that term is defined in Subtitle B, Title 3, Occupations Code, or to a faculty member at a medical school, as that term is defined in Section 61.501, Education Code, for statistical or medical research, or to appropriate state or federal agencies for statistical research. The executive commissioner [board] may adopt rules to implement this subsection.

(d) The social security numbers of the mother and father recorded on the form shall be made available to the United States [federal] Social Security Administration.

SECTION 3.0546. Sections 192.0021(a) and (b), Health and Safety Code, are amended to read as follows:

(a) The department shall promote and sell copies of an heirloom birth certificate. The department shall solicit donated designs for the certificate from Texas artists and select the best donated designs for the form of the certificate. An heirloom birth certificate must contain the same information as, and have the same effect of, a certified copy of another birth record. The executive commissioner by rule [department] shall prescribe a fee for the issuance of an heirloom birth certificate in an amount that does not exceed $50. The heirloom birth certificate must be printed on high-quality paper with the appearance of parchment not smaller than 11 inches by 14 inches.

(b) The department shall deposit 50 percent of the proceeds from the sale of heirloom birth certificates to the credit of the childhood immunization account and the other 50 percent to the credit of the undedicated portion of the general revenue fund. The childhood immunization account is an account in the general revenue fund. Money in the account may be used only by the department [Department of State Health Services] for:

(1) making grants to fund childhood immunizations and related education programs; and

(2) administering this section.

SECTION 3.0547. Sections 192.0022(b), (c), (f), (g), (h), and (i), Health and Safety Code, are amended to read as follows:

(b) The person who is required to file a fetal death certificate under Section 193.002 shall advise the parent or parents of a stillborn child:

(1) that a parent may, but is not required to, request the preparation of a certificate of birth resulting in stillbirth;

(2) that a parent may obtain a certificate of birth resulting in stillbirth by contacting the [bureau of] vital statistics unit to request the certificate and paying the required fee; and

(3) regarding the way or ways in which a parent may contact the [bureau of] vital statistics unit to request the certificate.

(c) A parent may provide a name for a stillborn child on the request for a certificate of birth resulting in stillbirth. If the requesting parent does not wish to provide a name, the [bureau of] vital statistics unit shall fill in the certificate with the name "baby boy" or "baby girl" and the last name of the parent. The name of the stillborn child provided on or later added by amendment to the certificate of birth resulting in stillbirth shall be the same name as placed on the original or amended fetal death certificate.

(f) The department [bureau of vital statistics] may not use a certificate of birth resulting in stillbirth to calculate live birth statistics.

(g) On issuance of a certificate of birth resulting in stillbirth to a parent who has requested the certificate as provided by this section, the [bureau of] vital statistics unit shall file an exact copy of the certificate with the local registrar of the registration district in which the stillbirth occurred. The local registrar shall file the certificate of birth resulting in stillbirth with the fetal death certificate.

(h) A parent may request the [bureau of] vital statistics unit to issue a certificate of birth resulting in stillbirth without regard to the date on which the fetal death certificate was issued.

(i) The executive commissioner [of the Health and Human Services Commission] may adopt rules necessary to administer this section.

SECTION 3.0548. Section 192.005(a), Health and Safety Code, is amended to read as follows:

(a) The items on a birth certificate relating to the child's father shall be completed only if:

(1) the child's mother was married to the father:

(A) at the time of the child's conception;

(B) at the time of the child's birth; or

(C) after the child's birth;

(2) paternity is established by order of a court of competent jurisdiction; or

(3) a valid acknowledgment of paternity executed by the father has been filed with the [bureau of] vital statistics unit as provided by Subchapter D, Chapter 160, Family Code.

SECTION 3.0549. Sections 192.006(c), (d), and (e), Health and Safety Code, are amended to read as follows:

(c) The state registrar shall require proof of the change in status that the executive commissioner [board] by rule may prescribe.

(d) Supplementary birth certificates and applications for supplementary birth certificates shall be prepared and filed in accordance with department [board] rules.

(e) In accordance with department [board] rules, a supplementary birth certificate may be filed for a person whose parentage has been determined by an acknowledgment of paternity.

SECTION 3.0550. Section 192.008(c), Health and Safety Code, is amended to read as follows:

(c) The executive commissioner [board] shall adopt rules and procedures to ensure that birth records and indexes under the control of the department or local registrars and accessible to the public do not contain information or cross-references through which the confidentiality of adoption placements may be directly or indirectly violated. The rules and procedures may not interfere with the registries established under Subchapter E, Chapter 162, Family Code, or with a court order under this section.

SECTION 3.0551. Section 192.009(d), Health and Safety Code, is amended to read as follows:

(d) If the department [bureau of vital statistics] determines that a certificate filed with the state registrar under this section requires correction, the department [bureau] shall mail the certificate directly to an attorney of record with respect to the petition of adoption, annulment of adoption, or revocation of adoption. The attorney shall return the corrected certificate to the department [bureau]. If there is no attorney of record, the department [bureau] shall mail the certificate to the clerk of the court for correction.

SECTION 3.0552. Section 192.010, Health and Safety Code, is amended to read as follows:

Sec. 192.010. CHANGE OF NAME. (a) Subject to department [board] rules, an adult whose name is changed by court order, or the legal representative of any person whose name is changed by court order, may request that the state registrar attach an amendment showing the change to the person's original birth record.

(b) The state registrar shall require proof of the change of name that the executive commissioner [board] by rule may prescribe.

SECTION 3.0553. Section 192.012(a), Health and Safety Code, is amended to read as follows:

(a) If the mother of a child is not married to the father of the child, a person listed in Section 192.003 who is responsible for filing the birth certificate shall:

(1) provide an opportunity for the child's mother and putative father to sign an acknowledgment of paternity as provided by Subchapter D [C], Chapter 160, Family Code; and

(2) provide oral and written information to the child's mother and putative father about:

(A) establishing paternity, including an explanation of the rights and responsibilities that result from acknowledging paternity; and

(B) the availability of child support services.

SECTION 3.0554. Section 192.021(c), Health and Safety Code, is amended to read as follows:

(c) Registration under this section is subject to department [board] rules.

SECTION 3.0555. Section 192.022, Health and Safety Code, is amended to read as follows:

Sec. 192.022. DELAY OF ONE YEAR OR MORE: APPLICATION FILED WITH STATE REGISTRAR. Subject to department [board] rules, an application to file a delayed birth certificate for a birth in this state not registered before the one-year anniversary of the date of birth shall be made to the state registrar.

SECTION 3.0556. Section 193.001(d), Health and Safety Code, is amended to read as follows:

(d) The department [bureau of vital statistics] and each local registrar shall make the information provided under Subsection (c) available to the public and may collect [charge] a fee in an amount prescribed under Section 191.0045 for providing