87R13621 CJM-F
 
  By: Kolkhorst S.C.R. No. 31
 
 
 
CONCURRENT RESOLUTION
         WHEREAS, Plaintiffs Dorena Coleman, Curtis Jackson, and
  Federico Perez, individually, (collectively referred to as
  "Plaintiffs"), filed suit on August 13, 2020, against the Texas
  Health and Human Services Commission, including employees in their
  official capacities ("HHSC"), and sought relief both on Plaintiffs'
  own behalf and on behalf of a class of similarly situated
  individuals ("Medicaid HCV Class"), and filed a motion for class
  certification on August 14, 2020; and
         WHEREAS, Plaintiffs alleged HHSC's Prior Authorization
  Criteria and Policy's use of fibrosis score as criterion for direct
  action antiviral drug (DAA) coverage violated Title XIX of the
  Social Security Act:
         (a)  By discriminating among similarly situated Medicaid
  recipients on the basis of categorical restrictions that are not
  based upon prevailing clinical standards, as prohibited by 42
  U.S.C. § 1396a(a)(10)(B)(i) and (ii) and 42 C.F.R. § 440.240;
         (b)  By denying qualified Medicaid participants the
  provision of necessary medical assistance and treatment coverage
  with "reasonable promptness," as required by 42 U.S.C. §
   1396a(a)(8);
         (c)  By excluding qualified Medicaid recipients from
  medically necessary treatment coverage as required by 42 U.S.C. §
   1396a(a)(10)(A); and
         WHEREAS, Defendants denied the allegations of the Lawsuit,
  denied all allegations of wrongdoing and liability, and denied any
  causation of harm or damage to the Medicaid HCV Class; and
         WHEREAS, The parties mediated this matter on December 1,
  2020, with the Honorable Patrick Keel as mediator, and thereafter
  successfully reached an agreement in principle on December 17,
  2020; and
         WHEREAS, The Parties have now agreed to a full settlement on
  the following terms:
         (a)  HHSC will modify its Medicaid prior authorization (PA)
  criteria to treat chronic Hepatitis C clients who have METAVIR
  fibrosis scores of F2-F4 with Direct Acting Antiviral (DAA)
  treatment by March 1, 2021;
         (b)  Between March 1, 2021, and September 1, 2021, Medicaid
  enrollees with severe extrahepatic effects of chronic Hepatitis C
  who have fibrosis scores other than F2-F4 will be approved for DAA
  treatment on a case-by-case basis by the HHSC Chief Medical
  Director or an MCO Medical Director, if they are assigned to an MCO;
         (c)  As of September 1, 2021, HHSC will remove all METAVIR
  fibrosis score, drug screening, and specialist prescription PA
  criteria requirements for DAA treatment for chronic Hepatitis C
  clients, if the legislature approves the funding for HHSC's
  Exceptional Item (EI); HHSC agrees that, for the period September
  1, 2021, through August 31, 2023, HHSC will not reinstate these
  criteria; and
         WHEREAS, This Agreement is expressly conditioned upon
  approval by the Office of the Attorney General of Texas, the
  Governor of Texas, and the Texas Legislature; and
         WHEREAS, This Agreement is expressly conditioned upon
  enactment by the Texas Legislature of the EI requested by HHSC; and
         WHEREAS, Section 111.003(b), Texas Civil Practice and
  Remedies Code, requires a state agency to obtain legislative
  approval of a settlement agreement that "commits this state to a
  course of action that in reasonable probability will entail a
  continuing increased expenditure of state funds over subsequent
  state fiscal bienniums"; therefore, the Settlement Agreement is
  expressly conditioned upon the legislature approving and
  appropriating the agreed upon settlement amount; now, therefore, be
  it
         RESOLVED, That the 87th Legislature of the State of Texas
  hereby approve the proposed Settlement Agreement.