87R12454 SCL-F

By: Oliverson H.B. No. 2981

A BILL TO BE ENTITLED

AN ACT

relating to establishment of the prescription drug savings program for certain uninsured individuals.

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

SECTION 1. This Act shall be known as the "Texas Cares Act."

SECTION 2. Subtitle C, Title 2, Health and Safety Code, is amended by adding Chapter 65 to read as follows:

CHAPTER 65. PRESCRIPTION DRUG SAVINGS PROGRAM FOR CERTAIN

UNINSURED INDIVIDUALS

SUBCHAPTER A. GENERAL PROVISIONS

Sec. 65.001. DEFINITIONS. In this chapter:

(1) "Account" means the Texas cares account established under Section 65.101.

(2) "Enrollee" means an individual enrolled in the program.

(3) "Pharmacy benefit manager" means a person, other than a pharmacy or pharmacist, who acts as an administrator in connection with prescription drug discounts provided under the program.

(4) "Program" means the prescription drug savings program established under this chapter.

(5) "Uninsured individual" means an individual without health benefit plan coverage for a prescription drug benefit.

Sec. 65.002. CONSTRUCTION OF CHAPTER; PURPOSE. (a) This chapter does not establish an entitlement to assistance in obtaining benefits for uninsured individuals.

(b) The purpose of this chapter is to make this state's risk pool whole by providing services to uninsured individuals without access to prescription drug benefits.

Sec. 65.003. CONFLICT WITH FEDERAL LAW; REPORT. (a) The executive commissioner shall monitor federal law affecting the administration or facilitation of a prescription drug savings program.

(b) If the executive commissioner determines that a federal law, rule, or regulation conflicts with this chapter, the executive commissioner shall provide a written report of the conflict to the governor, lieutenant governor, and speaker of the house of representatives. The report must include recommendations for legislation necessary to comply with federal law or recommendations for dissolution of a program established by this chapter that is duplicative of federal law.

Sec. 65.004. RULES. (a) Except as provided by Subsection (b), the executive commissioner shall adopt rules as necessary to implement this chapter.

(b) The executive commissioner may delegate rulemaking to another state agency with that agency's approval. If the executive commissioner delegates rulemaking under this subsection, the executive commissioner must approve the proposed rules of the delegated agency before the delegated agency adopts the rules.

SUBCHAPTER B. ESTABLISHMENT AND ADMINISTRATION OF PRESCRIPTION

DRUG SAVINGS PROGRAM

Sec. 65.051. ESTABLISHMENT OF PROGRAM. (a) The commission shall develop and design a prescription drug savings program that partners with a pharmacy benefit manager to make prescription drugs available at a discounted rate to uninsured individuals.

(b) In developing and implementing the program, the commission shall ensure that program benefits do not include prescription drugs to be used for the elective termination of a pregnancy.

(c) The executive commissioner shall ensure that the program is designed in a manner that provides the greatest possible value to the uninsured individuals it serves, with considerations given to the adequacy of the prescription drug formulary, costs of drugs, cost to the state, and other important factors.

Sec. 65.052. GENERAL DUTIES OF COMMISSION RELATED TO PROGRAM. (a) The commission shall oversee the implementation of the program and coordinate the activities of each state agency necessary for the implementation of the program, including the Texas Department of Insurance.

(b) The commission shall maximize the use of private resources in administering the program.

(c) The commission shall ensure that money spent administering the program does not exceed a limit on program expenditures imposed by the legislature.

(d) The commission shall develop a method to accept applications for participation in the program, including a process to:

(1) determine eligibility, screening, and enrollment procedures; and

(2) resolve disputes related to eligibility determinations.

Sec. 65.053. TEXAS DEPARTMENT OF INSURANCE DUTIES. At the request of the commission, the Texas Department of Insurance shall provide any necessary assistance with the development of the program. The Texas Department of Insurance shall monitor the quality of the services provided by a pharmacy benefit manager and resolve disputes relating to those services.

Sec. 65.054. PHARMACY BENEFIT MANAGER CONTRACT AND REQUIREMENTS. (a) The commission shall enter into a contract with a pharmacy benefit manager to provide enrollment and related services throughout this state under the program.

(b) The commission shall monitor, through reporting requirements or other means, the contracted pharmacy benefit manager to ensure performance under the contract and quality delivery of services.

(c) The commission shall provide payments under a contract entered into under this section to the contracted pharmacy benefit manager.

(d) A pharmacy benefit manager must hold a certificate of authority or other appropriate license issued by the Texas Department of Insurance that authorizes the pharmacy benefit manager to provide the type of coverage related to the services provided under the program.

(e) A pharmacy benefit manager that provides health care services under the program must satisfy certification and licensure requirements prescribed by the commission and consistent with law.

Sec. 65.055. CONTRACT ADMINISTRATION. (a) The commission may contract with a third-party administrator or other entity to administer the program for the commission under this chapter.

(b) A third-party administrator or other entity may perform tasks under a contract entered into under Subsection (a) that would otherwise be performed by the commission.

(c) The commission may not delegate decisions about the policies of the program to a third party administrator or other entity.

Sec. 65.056. CONTRACT OVERSIGHT. (a) The commission shall conduct a review of each entity that enters into a contract under this subchapter to ensure 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.

(b) The commission's review of contractors under Subsection (a) must be based on the following criteria:

(1) adequate and appropriate staffing, including contracts with third parties;

(2) adequate and properly documented policies and procedures;

(3) fiscal soundness; and

(4) adequate information systems, electronic interfaces, and business practices.

(c) The commission shall ensure that each contract entered into under this subchapter is procured using a competitive procurement process in compliance with all applicable federal and state laws, rules, and regulations.

Sec. 65.057. COMMUNITY OUTREACH CAMPAIGN. The commission shall conduct a community outreach and education campaign in the form and manner determined by the commission to provide information relating to the availability of the program.

SUBCHAPTER C. TEXAS CARES ACCOUNT; PROGRAM TERMINATION

Sec. 65.101. ESTABLISHMENT OF TEXAS CARES ACCOUNT. (a) The Texas cares account is a dedicated account in the general revenue fund.

(b) The account consists of:

(1) gifts, grants, and donations received for the account;

(2) legislative appropriations;

(3) federal money available to be used for this purpose; and

(4) interest, dividends, and other income of the account.

(c) Section 403.0956, Government Code, does not apply to the account.

(d) Money in the account may be appropriated only for the administration of the program and the provision of program services.

(e) The commission may solicit and accept gifts, grants, and donations for the account.

Sec. 65.102. TERMINATION OF PROGRAM. The commission may terminate the program if the commission determines the account under Section 65.101 lacks sufficient funding to administer the program.

SUBCHAPTER D. PROGRAM ELIGIBILITY AND ENROLLEE REQUIREMENTS

Sec. 65.151. ELIGIBILITY CRITERIA. (a) Except as provided by Subsection (b), an individual is eligible for benefits under the program if the individual:

(1) is a resident of this state;

(2) is a citizen of the United States; and

(3) is uninsured, as determined by the commission.

(b) If the commission determines necessary, the commission may consider an applicant's financial vulnerability as an additional factor for determining program eligibility.

(c) The executive commissioner by rule shall establish eligibility levels consistent with any other applicable federal and state laws, rules, and regulations.

Sec. 65.152. COST SHARING. To the extent necessary, the commission shall require enrollees to share the cost of the program, including provisions requiring enrollees to pay a copayment at the point of service.

SUBCHAPTER E. OPERATION OF PROGRAM

Sec. 65.201. PROGRAM BENEFITS. (a) The commission may use money appropriated to the program in accordance with the General Appropriations Act and in the account to finance benefits for enrollees.

(b) The commission must approve program benefits offered under this chapter. The commission shall ensure that the benefits comply with all applicable federal and state laws, rules, and regulations.

Sec. 65.202. REPORTING. (a) A third-party administrator or other entity the commission contracts with under Section 65.055 shall report to the commission in the form and manner prescribed by the commission on the benefits and services provided under the program.

(b) The commission shall establish a procedure to monitor the provision of benefits and services under this chapter.

Sec. 65.203. FRAUD PREVENTION. The executive commissioner shall develop and implement rules for the prevention and detection of fraud in the program.

SECTION 3. (a) In this section, "commission" means the Health and Human Services Commission.

(b) The commission shall conduct a study on the development and implementation of the prescription drug savings program established by Chapter 65, Health and Safety Code, as added by this Act. The commission shall determine the effectiveness of the program in providing services to uninsured individuals in this state and any legislative recommendations for improvements to the program.

(c) Not later than October 16, 2022, the commission shall provide a written report of the results of the study conducted under Subsection (b) of this section to the governor, lieutenant governor, speaker of the house of representatives, and members of the standing committees of the legislature with primary jurisdiction over the commission.

SECTION 4. As soon as practicable after the effective date of this Act, the executive commissioner of the Health and Human Services Commission and any other state agency designated by the executive commissioner shall adopt rules necessary to implement Chapter 65, Health and Safety Code, as added by this Act.

SECTION 5. This Act takes effect September 1, 2021.