1-1 AN ACT
1-2 relating to the study and development of outreach and education
1-3 programs for promotoras or community health workers under which
1-4 community residents provide public health education services.
1-5 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-6 ARTICLE 1. PROMOTORA PROGRAM DEVELOPMENT COMMITTEE
1-7 SECTION 1.01. PURPOSE. The purpose of this article is to
1-8 establish a temporary committee that will study certain issues
1-9 related to the development of outreach and education programs for
1-10 promotoras or community health workers and that will advise the
1-11 Texas Department of Health, the governor, and the legislature
1-12 regarding its findings.
1-13 SECTION 1.02. DEFINITIONS. In this article:
1-14 (1) "CHIP" means the children's health insurance
1-15 program as created under Title XXI of the Social Security Act (42
1-16 U.S.C. Section 1397aa et seq.), as amended and as administered by
1-17 this state.
1-18 (2) "Commissioner" means the commissioner of public
1-19 health.
1-20 (3) "Committee" means the Promotora Program
1-21 Development Committee.
1-22 (4) "Department" means the Texas Department of Health.
1-23 (5) "Local pilot project" means a pilot project
1-24 operated in an area of this state under this article for the
2-1 purpose of demonstrating the feasibility and benefits of employing
2-2 promotoras to assist beneficiaries of the Medicaid managed care and
2-3 CHIP programs.
2-4 (6) "Medicaid managed care organization" means a
2-5 managed care organization, as that term is defined by Section
2-6 533.001, Government Code, that is operating a portion of the
2-7 Medicaid managed care program under Chapter 533, Government Code.
2-8 (7) "Promotora" or "community health worker" means a
2-9 person who promotes health within the community in which the person
2-10 resides, without regard to whether the person is compensated, by
2-11 engaging in activities such as providing health education, making
2-12 referrals to health and social services providers, coaching
2-13 families on effective ways to access health services, conducting
2-14 needs assessments, identifying barriers to health care delivery,
2-15 making home visits, providing language services, collecting
2-16 information regarding the outcome of health services provided to
2-17 families, and acting as a liaison between families and health care
2-18 providers.
2-19 SECTION 1.03. COMMITTEE. (a) The department shall
2-20 establish the committee to study the development of a framework for
2-21 a promotora development program and to advise the department, the
2-22 governor, and the legislature regarding its findings and
2-23 recommendations.
2-24 (b) The committee is composed of the following 15 members:
2-25 (1) two representatives designated by the department,
2-26 each of whom must be department employees, one of whom must be
2-27 assigned to the department's bureau of managed care and one of whom
3-1 must be assigned to the department's Texas Health Steps
3-2 Comprehensive Care Program;
3-3 (2) one representative of the Texas Higher Education
3-4 Coordinating Board designated by the board;
3-5 (3) one representative of the Texas Tech University
3-6 Health Science Center designated by the university;
3-7 (4) two representatives of The Texas A&M University
3-8 System designated by the system, one of whom must be from the
3-9 Center for Housing and Urban Development in the Texas A&M
3-10 University School of Architecture and one of whom must be from the
3-11 South Texas Center for Rural Public Health;
3-12 (5) two representatives of The University of Texas
3-13 System designated by the system, one of whom must be from the
3-14 system's Valley Border Health Coordination Office and one of whom
3-15 must be from the Health Education Training Centers Alliance of
3-16 Texas;
3-17 (6) one representative of the Texas Association of
3-18 Community Colleges designated by the association;
3-19 (7) two persons who are currently serving as
3-20 promotoras designated by the Texas Association of Community Health
3-21 Centers;
3-22 (8) one representative of the Texas Workforce
3-23 Commission, designated by the commission;
3-24 (9) one representative of the Texas-Mexico Border
3-25 Health Services Delivery Project, designated by The University of
3-26 Texas Health Science Center at Houston; and
3-27 (10) two representatives of the general public who are
4-1 not officers or employees of government designated by the State
4-2 Office of Rural Health of the Center for Rural Health Initiatives.
4-3 (c) Chapter 2110, Government Code, does not apply to the
4-4 committee, except Section 2110.005 does apply.
4-5 (d) A member of the committee is not entitled to
4-6 compensation for service on the committee. Reasonable and
4-7 necessary expenses incurred in performing duties as a member of the
4-8 committee by a member of the committee who is an officer or
4-9 employee of state government are reimbursed as expenses incurred in
4-10 the performance of the member's duties as a state officer or
4-11 employee. The two members of the committee who are currently
4-12 serving as promotoras and the two representatives of the general
4-13 public are entitled to reimbursement for reasonable travel expenses
4-14 incurred in performing duties as a member of the committee in the
4-15 manner provided by the General Appropriations Act and out of
4-16 appropriations to the department. Other members of the committee
4-17 are not entitled to reimbursement for expenses.
4-18 (e) The department shall provide staff support to the
4-19 committee.
4-20 (f) The committee shall meet at the call of the presiding
4-21 officer of the committee, at the call of the commissioner, and as
4-22 provided by procedural rules or schedules adopted by the committee.
4-23 (g) The committee shall elect its presiding officer from
4-24 among its members.
4-25 SECTION 1.04. RESPONSIBILITIES OF COMMITTEE. (a) The
4-26 activities of the committee shall include the following:
4-27 (1) reviewing and assessing promotora programs
5-1 currently in operation around the state;
5-2 (2) studying the feasibility of establishing a
5-3 standardized curriculum for promotoras;
5-4 (3) studying the options for certification of
5-5 promotoras and the settings in which certification may be
5-6 appropriate;
5-7 (4) assessing available methods to evaluate the
5-8 success of promotora programs;
5-9 (5) creating, overseeing, and advising local pilot
5-10 projects established under this article, subject to the
5-11 availability of appropriations that may be used for this purpose;
5-12 and
5-13 (6) evaluating the feasibility of seeking a federal
5-14 waiver so that promotora services may be included as a reimbursable
5-15 service provided under the state Medicaid program.
5-16 (b) In conducting its activities, the committee shall
5-17 consult nationally recognized experts in the field of lay community
5-18 health outreach workers.
5-19 (c) Not later than December 31, 2000, the committee shall
5-20 submit a report to the department, the governor, and the presiding
5-21 officer of each house of the legislature that includes the
5-22 committee's findings to date and its recommendations for the
5-23 program.
5-24 (d) In addition to its other duties, the committee shall
5-25 identify, and develop a strategic plan to address, the barriers
5-26 encountered by recipients of benefits under the state Medicaid
5-27 program in accessing prenatal and neonatal health care services.
6-1 The committee shall submit a draft of its strategic plan to the
6-2 department, the governor, and the presiding officer of each house
6-3 of the legislature not later than December 31, 2000. In identifying
6-4 the barriers, the committee shall consider at least the cultural
6-5 and language differences that exist between health care providers
6-6 and their patients, the extent to which health care facilities'
6-7 days and hours of operation limit accessibility to health care, the
6-8 availability of transportation to and from health care facilities,
6-9 the extent to which health care facilities are inconveniently
6-10 located, the unfamiliarity of recipients with enrollment processes,
6-11 the unfamiliarity of health care providers with community needs and
6-12 cultural issues, and the unfamiliarity of recipients and health
6-13 care providers with available health care benefits.
6-14 SECTION 1.05. MEDICAID/CHIP PROMOTORA PILOT PROJECTS. (a)
6-15 The committee may establish a series of neighborhood-based peer
6-16 health outreach and education pilot projects to demonstrate the
6-17 feasibility and benefits of employing promotoras to assist
6-18 beneficiaries of the Medicaid managed care and CHIP programs.
6-19 (b) The activities of promotoras in any local pilot projects
6-20 shall include:
6-21 (1) educating beneficiaries of the programs on
6-22 appropriate use of health care resources, including the use of any
6-23 available Medicaid or CHIP managed care plan that provides coverage
6-24 to beneficiaries and the effective use of a beneficiary's primary
6-25 care provider;
6-26 (2) promoting regular use of preventive care services
6-27 by beneficiaries of the programs, particularly prenatal care
7-1 services and services available under the Early Periodic Screening,
7-2 Diagnosis, and Treatment Program;
7-3 (3) encouraging beneficiaries of the programs to
7-4 develop a basic family preventive health plan; and
7-5 (4) encouraging and supporting beneficiaries of the
7-6 programs in keeping appointments for health care, following up on
7-7 missed appointments, and complying with the instructions of health
7-8 care providers.
7-9 (c) Subject to the availability of appropriations that may
7-10 be used for this purpose, the commissioner with the advice of the
7-11 committee may provide grants to local pilot projects in not more
7-12 than five areas in the state to provide partial support for the
7-13 operation of the pilot program in that area.
7-14 (d) The commissioner with the advice of the committee may
7-15 adopt rules relating to an application for grants under this
7-16 section and to the use of funds granted to local pilot projects
7-17 under this section.
7-18 (e) Subject to the requirements of federal law or
7-19 regulations, the commissioner may authorize a local pilot project
7-20 to:
7-21 (1) obtain confidential information from:
7-22 (A) the department;
7-23 (B) the Texas Department of Human Services;
7-24 (C) the Health and Human Services Commission;
7-25 (D) any contractor implementing a part of the
7-26 state Medicaid program, including a Medicaid managed care
7-27 organization; or
8-1 (E) a health care provider providing services to
8-2 Medicaid recipients; and
8-3 (2) use the information obtained under Subdivision (1)
8-4 of this subsection to conduct the local pilot project in the area.
8-5 (f) Information that may be obtained by a local pilot
8-6 project under Subsection (e) of this section is limited to the
8-7 information that the commissioner with the advice of the committee
8-8 determines is necessary to achieve the purposes of the local pilot
8-9 project. The information obtained may include a Medicaid
8-10 recipient's:
8-11 (1) name, address, and telephone number;
8-12 (2) date of birth;
8-13 (3) Medicaid managed care plan and primary care
8-14 provider; and
8-15 (4) appointment scheduling information.
8-16 (g) Confidential information obtained by a local pilot
8-17 project may be used by the local pilot project and by persons
8-18 connected with the local pilot project only for the purposes for
8-19 which it was obtained and may not be released by the local pilot
8-20 project or by persons connected with the local pilot project to any
8-21 person other than the person who is the subject of the information.
8-22 The commissioner shall adopt rules as necessary that impose
8-23 additional restrictions on the use of the information.
8-24 SECTION 1.06. FUNDING. The department shall pay for the
8-25 costs of all activities authorized or required under this article
8-26 out of money appropriated to the department that may be used for
8-27 that purpose.
9-1 SECTION 1.07. EXPIRATION. The committee is abolished and
9-2 this article expires September 1, 2001.
9-3 ARTICLE 2. VOLUNTARY TRAINING AND REGULATION PROGRAM
9-4 SECTION 2.01. AMENDMENT. Subtitle B, Title 2, Health and
9-5 Safety Code, is amended by adding Chapter 46 to read as follows:
9-6 CHAPTER 46. TRAINING AND REGULATION OF PROMOTORAS
9-7 Sec. 46.001. DEFINITION. In this chapter, "promotora" means
9-8 a person who, with or without compensation, provides a bilingual
9-9 liaison between health care providers and patients through
9-10 activities that include assisting in case conferences, providing
9-11 patient education, making referrals to health and social services,
9-12 conducting needs assessments, distributing surveys to identify
9-13 barriers to health care delivery, making home visits, and providing
9-14 language services.
9-15 Sec. 46.002. PROMOTORA TRAINING PROGRAM. (a) The
9-16 department shall establish and operate a program designed to train
9-17 and educate persons who act as promotoras. In establishing the
9-18 training program, the department, to the extent possible, shall use
9-19 as a resource the uniform curriculum for training and educating
9-20 promotoras developed by the Health Education Training Centers
9-21 Alliance of Texas.
9-22 (b) Participation in a training and education program
9-23 established under this section is voluntary.
9-24 Sec. 46.003. CERTIFICATION PROGRAM FOR PROMOTORAS. (a) The
9-25 department shall establish and operate a certification program for
9-26 persons who act as promotoras. In establishing the program, the
9-27 board shall adopt rules that provide minimum standards and
10-1 guidelines, including participation in the training and education
10-2 program under Section 46.002, for issuance of a certificate to a
10-3 person under this section.
10-4 (b) Receipt of a certificate issued under this section may
10-5 not be a requirement for a person to act as a promotora.
10-6 SECTION 2.02. PROGRAM ESTABLISHMENT; ADOPTION OF RULES. The
10-7 Texas Department of Health shall establish the promotora training
10-8 and certification program required by Chapter 46, Health and Safety
10-9 Code, as added by this article, not later than January 1, 2000.
10-10 The Texas Board of Health shall adopt rules as necessary under
10-11 Chapter 46, Health and Safety Code, as added by this article, not
10-12 later than December 1, 1999.
10-13 ARTICLE 3. EFFECTIVE DATE; EMERGENCY
10-14 SECTION 3.01. EFFECTIVE DATE. This Act takes effect
10-15 September 1, 1999.
10-16 SECTION 3.02. EMERGENCY. The importance of this legislation
10-17 and the crowded condition of the calendars in both houses create an
10-18 emergency and an imperative public necessity that the
10-19 constitutional rule requiring bills to be read on three several
10-20 days in each house be suspended, and this rule is hereby suspended.
_______________________________ _______________________________
President of the Senate Speaker of the House
I certify that H.B. No. 1864 was passed by the House on May
8, 1999, by a non-record vote; and that the House concurred in
Senate amendments to H.B. No. 1864 on May 21, 1999, by a non-record
vote.
_______________________________
Chief Clerk of the House
I certify that H.B. No. 1864 was passed by the Senate, with
amendments, on May 19, 1999, by a viva-voce vote.
_______________________________
Secretary of the Senate
APPROVED: _____________________
Date
_____________________
Governor