| |
|
|
A BILL TO BE ENTITLED
|
|
|
AN ACT
|
|
|
relating to the operation and financing of the federally qualified |
|
|
health center primary care access program to provide primary care |
|
|
access to persons in this state. |
|
|
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
|
|
SECTION 1. Subtitle C, Title 2, Health and Safety Code, is |
|
|
amended by adding Chapter 76 to read as follows: |
|
|
CHAPTER 76 FEDERALLY QUALIFIED HEALTH CENTER PRIMARY CARE ACCESS |
|
|
PROGRAM |
|
|
SUBCHAPTER A. GENERAL PROVISIONS |
|
|
Sec. 76.001. PURPOSE. The purpose of this chapter is to: |
|
|
(1) increase access to primary care services for |
|
|
low-income or at-risk Texans at federally qualified health centers; |
|
|
(2) improve the health of employees of participating |
|
|
employers and their dependents by improving the employees' and |
|
|
their dependents' access to health care; |
|
|
(3) contribute to economic development by helping |
|
|
small businesses remain competitive with a healthy workforce and |
|
|
health care benefits that will attract employees; and |
|
|
(4) encourage innovative solutions for providing and |
|
|
funding health care services and benefits. |
|
|
Sec. 76.002. DEFINITIONS. In this chapter: |
|
|
(1) "Employee" means an individual employed by an |
|
|
employer. The term includes a partner of a partnership and the |
|
|
proprietor of a sole proprietorship. |
|
|
(2) "Federally qualified health center" means an |
|
|
entity as defined by 42 U.S.C. Section 1396d(l)(2)(B). |
|
|
(3) "Federally qualified health center primary care |
|
|
access program" means a program established by a federally |
|
|
qualified health center offering primary care services for the |
|
|
benefit of the employees of participating employers and their |
|
|
dependents under Subchapter B. |
|
|
(4) "Participating employer" means an employer who |
|
|
meets the qualifications of the program and has agreed to |
|
|
participate in a federally qualified health center primary care |
|
|
access program. |
|
|
SUBCHAPTER B. FEDERALLY QUALIFIED HEALTH CENTER PRIMARY CARE |
|
|
ACCESS PROGRAM |
|
|
Sec. 76.051. ESTABLISHMENT OF PROGRAM. A federally |
|
|
qualified health center may establish or participate in a federally |
|
|
qualified health center primary care access program under this |
|
|
subchapter. |
|
|
Sec. 76.052. GOVERNANCE OF PROGRAM. A federally qualified |
|
|
health center primary care access program shall be operated subject |
|
|
to the direction of the governing board of the participating |
|
|
federally qualified health center. |
|
|
Sec. 76.053. OPERATION OF PROGRAM. (a) A federally |
|
|
qualified health center primary care access program provides |
|
|
primary health care services to: |
|
|
(1) the employees of participating employers who |
|
|
reside in or whose employer is located within the service area of a |
|
|
participating federally qualified health center. A federally |
|
|
qualified health center primary care access program may also |
|
|
provide services or benefits to the dependents of those employees. |
|
|
(2) other uninsured or underinsured groups as |
|
|
determined by the federally qualified health center. |
|
|
Sec. 76.054. PARTICIPATION BY EMPLOYERS; SHARE OF COST. |
|
|
(a) A federally qualified health center may establish criteria for |
|
|
participation in a federally qualified health center primary care |
|
|
access program by employers, the employees of the participating |
|
|
employers, and their dependents. The criteria may require that |
|
|
participating employers and employees who receive care through a |
|
|
federally qualified health center primary care access program pay a |
|
|
share of the premium or other cost of the program. |
|
|
(b) The federally qualified health center will ensure |
|
|
employees and their dependents are screened for eligibility for |
|
|
other state programs and federal subsidies in the Health Insurance |
|
|
Marketplace and assist in enrolling employees in programs that |
|
|
offer health insurance coverage. |
|
|
(c) The federally qualified health center may utilize a |
|
|
health foundation, non-profit, or other funding to support the |
|
|
employer and/or patient share of the program. |
|
|
Sec. 76.055. ADDITIONAL FUNDING. (a) A federally |
|
|
qualified health center may accept and use state money made |
|
|
available through an appropriation from the general revenue fund or |
|
|
a gift, grant, or donation from any source to operate the federally |
|
|
qualified health center primary care access program and to provide |
|
|
services or benefits under the program. |
|
|
(b) A federally qualified health center shall actively |
|
|
solicit gifts, grants, and donations to: |
|
|
(1) fund services and benefits provided under the |
|
|
federally qualified health center primary care access program; and |
|
|
(2) reduce the cost of participation in the program |
|
|
for participating employers and their employees. |
|
|
SUBCHAPTER C. HEALTH CARE SERVICES AND BENEFITS |
|
|
Sec. 76.101. PROGRAM OBJECTIVES. (a) Federally qualified |
|
|
health center primary care access programs must be developed, to |
|
|
the extent practicable, to: |
|
|
(1) reduce the number of individuals without primary |
|
|
care access who reside in or whose employer is located within the |
|
|
service area of the federally qualified health center; |
|
|
(2) address rising health care costs and reduce the |
|
|
cost of health care services for small employers and their |
|
|
employees who reside in or whose employer is located within the |
|
|
service area of the federally qualified health center; |
|
|
(3) promote preventive care and reduce the incidence |
|
|
of preventable health conditions, such as heart disease, cancer, |
|
|
and diabetes and low birth weight in infants; |
|
|
(4) promote efficient and collaborative delivery of |
|
|
health care services; |
|
|
(5) serve as a model for the innovative use of health |
|
|
information technology to promote efficient delivery of health care |
|
|
services, reduce health care costs, and improve the health of the |
|
|
community; and |
|
|
(6) provide fair payment rates for health care |
|
|
providers. |
|
|
Sec. 76.102. HEALTH CARE SERVICES. (a) A federally |
|
|
qualified health center primary care access program shall provide |
|
|
primary health care services directly to the employees of |
|
|
participating employers and the dependents of those employees. |
|
|
(b) A federally qualified health center may require that |
|
|
participating employees and dependents obtain primary health care |
|
|
services provided under a federally qualified health center primary |
|
|
care access program only from health care providers at the |
|
|
federally qualified health center. |
|
|
(c) A federally qualified health center that operates a |
|
|
federally qualified health center primary care access program under |
|
|
this section is not an insurer or health maintenance organization |
|
|
and the program is not subject to regulation by the Texas Department |
|
|
of Insurance. |
|
|
SUBCHAPTER E. GRANTS FOR DEMONSTRATION PROJECTS |
|
|
Sec. 76.201. GRANT PROGRAM. (a) The Texas Department of |
|
|
Insurance, in collaboration with the Texas Health and Human |
|
|
Services, shall develop a grant program to support the initial |
|
|
establishment and operation of federally qualified health center |
|
|
primary care access programs as demonstration projects, subject to |
|
|
the appropriation of money for this purpose. |
|
|
(b) In selecting grant recipients, the Texas Department of |
|
|
Insurance shall consider the extent to which the federally |
|
|
qualified health center primary care access program proposed by the |
|
|
applicant accomplishes the purposes of this chapter and meets the |
|
|
objectives established under Section 76.101. |
|
|
(c) The Texas Department of Insurance shall establish |
|
|
performance objectives for a grant recipient and shall monitor the |
|
|
performance of the grant recipient. |
|
|
(d) In addition to money appropriated by the legislature, |
|
|
the Texas Department of Insurance may accept gifts, grants, or |
|
|
donations from any source to administer and finance the federally |
|
|
qualified health center primary care access program. |
|
|
Sec. 76.202. REVIEW OF DEMONSTRATION PROJECT; REPORT. Not |
|
|
later than December 1, 2026, the Texas Department of Insurance |
|
|
shall complete a review of each federally qualified health center |
|
|
primary care access program that receives a grant under this |
|
|
subchapter and shall submit to the governor, the lieutenant |
|
|
governor, and the speaker of the house of representatives a report |
|
|
that includes: |
|
|
(1) an evaluation of the success of the federally |
|
|
qualified health center primary care access program in |
|
|
accomplishing the purposes of this chapter; and |
|
|
(2) the Texas Department of Insurance's |
|
|
recommendations for any legislation needed to facilitate or improve |
|
|
the federally qualified health center primary care access program. |
|
|
SECTION 2. This Act takes effect immediately if it receives |
|
|
a vote of two-thirds of all the members elected to each house, as |
|
|
provided by Section 39, Article III, Texas Constitution. If this |
|
|
Act does not receive the vote necessary for immediate effect, this |
|
|
Act takes effect September 1, 2023. |